Transgender in Latin America:

“I’m a survivor,” says Yuliana Oviedo, who lives in Avellaneda, a southern province in Buenos Aires, Argentina.

She is 55 years old and 1.70 m (5 ft 7in) tall. She makes ends meet by cleaning houses, cutting, and styling hair. She suffers from chronic obstructive pulmonary disease (COPD) and she has encountered several barriers to accessing healthcare. In the 80’s, she got pumped—she got silicone injected into her breasts, hips, buttocks, and crotch. After a while, she ended up in the hospital. Doctors initially thought she had pneumonia, yet the black spots in Yuliana’s lungs were the silicone that had migrated through her body. “When I meet a transgender girl or boy, I urge them to get medical advice prior to any invasive procedure and to do some research,” she says. 

Yuliana, like other transgender people, has a gender identity that does not conform to what is associated with the sex she was assigned at birth. Yuliana was assigned male at birth based on the appearance of her external genitalia, but she identifies and lives as female. Also, there are cases in which a person who was assigned female at birth, identifies and lives as male.

Transgender people, just like every human being, have the fundamental right to live fulfilled and dignified lives, to education, to health, and to employment. Trans people are part of the great human diversity. However, they still have to contend with stigma and discrimination in Latin America as they are frequently exposed to violence and harassment, living on the margin of their school, family, job, and health services.

Yuliana is finishing elementary school today. She hopes to start junior high next year. “If my health allows, I hope to major in Political Science.” She got off marijuana and cocaine, and left prostitution behind, but—as many other transgender women—she has been exposed to specific social determinants leading to a series of problems that result in an average life expectancy that ranges from 35 to 41 years old in contrast with the 75-year life expectancy of the region according to the project REDLACTRANS (Trans Women Without Borders Against Transphobia and HIV/AIDS) based on partial regional reports.

“It is unacceptable that trans people, as any other vulnerable population group, have a shorter life expectancy. In 2014, Pan American Health Organization (PAHO) member states approved the Strategy for Universal Access to Health and Universal Health Coverage. ‘Universal health’ is the foundation of a system based on the values of the right to health, equity, and solidarity. ‘Universal’ means that everyone has access and coverage to comprehensive, quality care, plus it calls to for strengthening intersectoral approaches to the social determinants of health without financial difficulties. This strategy requires both the commitment to transform the region’s health systems and a concerted effort to eliminate barriers and improve access,” PAHO’s Health Services and Access Chief Amalia del Riego said.

Historically, it had been determined that transgender people suffered from a mental health condition as there is a mismatch between their gender identity and the sex they were assigned at birth. In June, 2018, the World Health Organization (WHO) removed categories related to transgender identity from the classification of mental disorders, opting to use the term “gender dysphoria” instead. The United Nations (UN) has emphasized that “pathologization is one of the root causes of human rights violations faced by trans people.”

A reclassification made by an institution, however influential, does not guarantee a woke society. Stigmatization has a huge impact on transgender people. According to the REDLACTRANS network—a trans advocacy NGO fighting discrimination in the region since 2004— up to 77% of trans people were kicked out of their house in their childhood. One in four transgender people dropped out of junior high due to harassment by teachers and classmates. Moreover, 52% of trans people faced discrimination in health centers and hospitals. In many countries, administrative personnel, security guards, and even health professionals have not received adequate training to provide appropriate care to trans people which in turn leads to mistreatment and stigmatization. Not long ago, Yuliana remembers when a receptionist in a hospital insisted on calling her by her birth name, but a doctor allowed to change that name to “Yuliana” in her medical record.

Unfortunately, such a touching display of empathy is the exception to the rule. Most of the time, transgender people are not called by the name that matches the gender with which they self-identify. In other cases, health-care providers link being transgender with living with HIV (Human Immunodeficiency Virus) which in turn leads to greater stigmatization.

Trans people avoid early medical intervention as they have felt stigma from the initial seeking of treatment. They experience fear and most of the time they return to seek medical care too late in the course of their disease, which leads to poorer prognoses. For decades, denial of medical care has led trans people to turn to either licensed treatment in private clinics or illegal treatment as Yuliana did when she modified her body through procedures that lacked both scientific evidence and proof of safety.