Q&A: Speaking out on transgender recognition
Trans activists Marcela Romero and Mitch Yusof discuss the importance of gender recognition in HIV services for transgender people
AVERT spoke to activists Marcela Romero from Argentina and Mitch Yusof from Malaysia about their cumulative 32 years championing the health, legal and social rights of transgender people. What’s changed? What needs to change? And what lessons have been learned?
How have rights and realities for transgender people in Argentina and Malaysia changed in the last couple of decades?
MR: “Before the gender recognition law was passed in Argentina in 2012 our identities were not recognized. It’s now a law that doesn’t require a diagnosis from a doctor or another state professional.
It’s really important to understand that gender identity is a universal right – because a person without an identity does not exist. As trans people in the world we just didn’t exist before this law.
Going forward, REDLACTRANS are working to have trans people included in political decision making process from the very beginning to ensure our needs – gender identity, comprehensive and integral healthcare and social inclusion – are respected.”
MY: “Unfortunately there has been little progress for the freedom of trans people in Malaysia. Unlike Argentina, we don’t have a law that protects our gender identity and there are even issues when we need to access general healthcare. For example, if you are a trans woman you have to be prepared to be admitted into a men’s ward or to be called by your assigned birth name rather than your preferred name.
Right now there doesn’t seem to be much separation between religious and civil law, and this allows persecutions from religious practitioners to go unchecked. One of our states recently brought back public caning for people caught having sex outside of marriage. This is worrying for a lot of us, especially when civil unions aren’t even recognised.”
What do you think is needed to effectively promote and provide access to HIV services for trans men and trans women?
MY: “At the moment in Malaysia, most HIV services are promoted for the benefit of trans women and not for trans men. The question I want to ask is why are we still invisible? There is a lack of data which makes it seem like trans men don’t exist in Malaysia, where we are still being categorised as ‘women’ when we go for an HIV test.
It would be great if there were more community-based HIV services so that, when we go for a test or advice on prevention methods, we are with someone who speaks our language.”
“The question I want to ask is why are we still invisible?”
MR: “I agree. I think it’s really important for healthcare workers to respect your gender identity, so that when you go for an HIV test they call you by your chosen name – this helps break down the walls between professionals and patients.
Transgender women too are currently being lost in a system which still believes they are men. Too often we are labelled under the same category as men who have sex with men. I think we need to work with the healthcare professionals at breaking down their patriarchal viewpoint where they only see us as a penis or vagina.
Outside of HIV healthcare, for example, I could go into the hospital to get toothache checked and I might be asked to undress – what sort of trust does this establish between the professional and the patient?”
In your respective countries, how do stigma, violence and marginalisation affect access to HIV services for the trans community? What can be done?
MR: “We can't talk about HIV without talking about gender violence. Rapes, poor treatment, imprisonment – HIV is part of all of this.
For trans people living with HIV, they also face double discrimination and extra risks. In some countries, even where ART is available, a trans woman living with HIV might be put into prison for trying to access medication and then further being denied treatment in prison.
It’s the state’s responsibility to improve the quality of life for trans people. There needs to be a political decision made to hold professionals accountable when they do not meet the World Health Organization’s protocols for health and care.”
MY: “There’s many things that can be done, but for me what is most important is legal gender recognition. With this, other things fall into place, and we can hold the marginalization that trans people face to account.
By being legally recognised, we will be less afraid to report incidences of violence and not fear that they will be misreported. At the moment if a trans woman wants to report an incidence of violence or sexual assault, the media may instead say that ‘a man, dressed up a woman’ was attacked. We just want to be included.”
“We can't talk about HIV without talking about gender violence.”
What do you think would improve the lives of people living with HIV in your country now?
MR: “I think the most important thing is for HIV donors to understand what the reality of life is for many trans people. We can’t just keep giving workshops on how to use a condom because sometimes this isn’t the main priority. I don’t want more condoms, I want inclusion.
Social inclusion will reduce the risks of HIV exposure in the first place. But for this, we need to work together with other organisations to discuss key issues like drug and alcohol dependency and poverty. As it stands, 90% of trans women live below the poverty line and 99% rely on survival-based sex work as a result. Sex work shouldn’t be the only option - we want more options than this.
We’ve also got to talk on about treatment adherence. For trans women living with HIV right now in Latin America, their life expectancy is only 35 years old - this is half that of other citizens . And why are transgender women dying? If the state does not support the access to hormonal treatment, then of course the risk of generating co-infections like hepatitis will occur from self-medicating.”
MY: “Legal recognition would help to improve everyone’s lives. Right now if we approached the minister of health about comprehensive access to healthcare services they will say ‘But how many of you are there? Why should we provide comprehensive HIV services to people who do not exist?’
With data, we will be able to argue to our position in society, to provide the evidence that we are part of the wider community – hopefully this recognition will both help to educate the public and empower trans people.”
“We can’t just keep giving workshops on how to use a condom because sometimes this isn’t the main priority. I don’t want more condoms, I want inclusion.”
What lessons have been learnt from the foundations which you work for? And do you have any key success stories to share?
MR: “I’m still learning every day because, as an activist, there is always more to be done to support the needs of our community.
Our REDLACTRANS report shows that the gender identity law has measurably improved the lives of trans people. Before the law only one in 10 transgender people could go to study and only four in 10 had access to healthcare services – these numbers have now more than doubled as a result having access to our human rights .
But it’s difficult to enjoy these good practices. I know that in other countries there are many who do not have these same gender recognition rights. The global trans community cannot allow groups of doctors and psychologists to control our lives. That someone has to wait just to be able to live how they want to – that’s torture for a trans person.”
MY: “When SEED started, we started with nothing. But we have survived the past three years on the support of people, and not just from those in the trans community.
However, what makes me sad is that those same people who support us with donations do not speak up for us. They might give us two packets of rice, vegetables, meat, but when it comes to speaking up they will not shout with us.
So what I’ve learnt is that we need to make the conversation about trans rights a more open one so that other people can understand that we are humans too, that we are part of their society. We have every right to everything that they do – we pay income tax just like everyone else. People need to know that when we speak about a country being democratic, even if one group of people do not have full access to their human rights then this is not a democracy. All I can say is that, in my full 50 years, I have not experienced democracy.”
Marcela Romero is an Argentinean activist and human rights defender and has been regional coordinator of the Latin American and Caribbean network of transgender people (REDLACTRANS) since 2006. She succeeded in being legally recognised as a woman in 2009, after a decade long battle with Argentina’s court, and in the same year was also named ‘Outstanding Woman’.
Mitch Yusof is the co-founder of SEED Malaysia, the first trans-led community based non-profit organization in the country, and also champions trans rights as Co-chair for the Asia and Pacific Transgender Network (APTN). His foundation has most recently directed their efforts into creating the first shelter for trans people over the age of 50, in response to discrimination that many elderly trans men and women face in care settings.
Thanks to the International HIV/AIDS Alliance for facilitating access for this interview.
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