Stigma-Related Access Barriers and Violence Against Trans Women in the Colombian Healthcare System

Background:

This paper presents the participatory action research published in Global Public Health that mapped stigma-related barriers to healthcare experienced by trans women and their experiences of multi-level violence within the Colombian Healthcare System (CHS). In comparison to international standards of care, the CHS lacks specific guidelines regarding body transformation surgeries and assessment, sexual and reproductive care, risks associated with hormone therapy in conjunction with HIV treatment, or mental health concerns associated with discrimination. The authors discuss how advocacy work was conducted as part of the research/action process and how trans community leaders were involved throughout the project in order to promote policy-relevance and community-based implementation of findings. 

Methods:

The method followed a two-year participatory research process with 28 trans women. Participant recruitment was led by community leaders in the city center and in La Modelo prison. Participants' ages ranged from 19– 56 years old and they were all part of the lowest socioeconomic status. The inclusion criteria limited participation to trans women who had initiated or already undergone a range of body transformation interventions. We made an empirical decision to limit the study to trans women in order to create targeted public health policy recommendations, sexual and reproductive rights and healthcare recommendations and to inform the specific protocols for trans women. The study received IRB approval. 

Results:

The interviews revealed four major health consequences of the generalized rejection of trans women within the CHS and their lack of healthcare alternatives resulting in the use of informal body transformation practices: i) 60% of participants experienced life-threatening consequences associated with peer-led injection of liquid silicon or other liquids used for body transformation; ii) 82% of participants reported informal use of hormone therapy without medical guidance starting this practice during early adolescence, the youngest being 10 years old; iii) 71% of participants reported having lost a peer to informal body transformations; iv) 96% of participants have experienced violations of their right to healthcare and 71% of participants have experienced torture or other grave human rights violations within the CHS. Also, participants identified inadequacies within the CHS like: gender-biased misapplication of hormones, verbal abuse, profiling, discriminatory language from health professionals and economic barriers. All 28 participants described symptoms of anxiety, depression and drug use as a means of self-medicating to cope with extreme situations of adversity and stress related to their experiences of stigma, medical and psychological violence and discrimination within the CHS.

Conclusions:

There is no healthcare protocol tailored to the needs of the trans population in general, and to those transgender individuals who suffer from intersectional multi-level violence. Part of the advocacy work of this project involved the design and community-based implementation of a trans health rights treatment protocol, which was co-designed and disseminated with trans community leaders. We contend that the different forms of violence, stigma and discrimination against trans women in the healthcare system are a manifestation of broader societal dilemmas including structural stigma within government institutions that are deeply penetrated by homophobia, transphobia and heteronormative belief systems.