Making rights a reality: A compilation of case studies on the experiences of transgender people by International HIV/AIDS Alliance

Making rights a reality

A compilation of case studies: The experiences of organizations of transgender people

Making rights a reality A compilation of case studies: The experiences of organizations of transgender people The case studies were developed in collaboration by UNAIDS (with the contribution of Victoria Bendaud, Hege Wagan and Michela Polesana), REDLACTRANS (Marcela Romero and transgender national focal points mentioned below) and the International HIV/AIDS Alliance (Javier Hourcade Bellocq and Cecilia Dávila). Regional coordinator of the study and compiler: Lídice López Tocón Our special thanks to local researchers who collected and analyzed the information, and wrote the case studies: Argentina: Liliana Vignau and Claudia Pía Baudracco Bolivia: María Natusky Zapata Mercado and Rayza Torriani Uruguay: Pablo Nalerio Reyes and Gloria Alves Mariños Ecuador: Sandra Álvarez Monsalve and Rashell Erazo Honduras: Lenín Martínez and Claudia Spellmant El Salvador: Edwin Paty Hernández and Mónica Hernández Editing and proofreading: Cecilia Dávila and Emily Spence Translation into English: Silvia and Miriam Strauss Design and layout: Cintia Di Cónsoli The images used in the case studies were taken by and provided by the consultants or the organizations. All were licensed for use herein. Cover photo: Meybelin Rivas (Photographer: Marvin Recinos). April 2012 This publication is dedicated to the memory of Claudia Pia Baudracco, a well-known Argentine transgender leader and co-author of the case study about ATTTA, who passed away on the 18th of March, 2012.

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rights and gender equality for the HIV response.

Index Acronyms

Glossary

Overview

Introduction

Human Rights, HIV and transgender people in Latin America HIV and transgender people Getting to Zero Discrimination: the Latin American response to the situation of transgender people and HIV The response from transgender people organizations

8 9

Methodology for compiling case studies

Case studies In Argentina, Gender Identity Law Now! The transgender people movement in Bolivia Promoting heathy transitions in young transgender people Transforming health access in El Salvador The conquest of the Country Coordinating Mechanism The formalization of sex work by transgender people in Uruguay

15 16 20 24 28 32 36

Conclusions

Recommendations

References

10 12

Acronyms AIDS

Acquired Immune Deficiency Syndrome

CCM

Country Coordination Mechanism

HIV

Human Immunodeficiency Virus

IACHR

Inter-American Commission on Human Rights

LGBTI

Lesbians, Gays, Bisexuals, Transgender, Intersex

MSM

Men who have Sex with Men

OAS

Organization of American States

PAHO

Pan American Health Organization

REDLACTRANS

Latin American and the Caribbean Network of Transgender People

STI

Sexually Transmitted Infections

UNAIDS

Joint United Nations Program on HIV/AIDS

UNDP

United Nations Development Program

WHO

World Health Organization

Glossary Advocacy

The English term is widely used in Latin America to refer to processes to defend the rights of a group of people, whether seeking to influence public policies or ensuring that policies are followed.

Transgender person

A transgender person has a gender identity other than the sex by birth. The term is used generically to refer to transvestites, transsexuals and transgenders. While there are transgender people with a male gender identity, in this study we refer specifically to transgender people as those with a feminine gender identity.

Transgender people organizations

Transgender people organizations are those groups of people who meet and perform activities aimed at responding to a need in the transgender population. These organizations may or may not have legal status.

Overview Transgender people: a vibrant force for getting to zero In Latin America transgender people face serious situations every day regarding stigma and discrimination that limit their access to health services, the education system and job opportunities. This condition of marginalization and social exclusion in which they are forced to live increases their vulnerability to HIV. However, the dynamism and mobilization of the transgender community and organizations led by transgender people have unleashed forces for important political and social changes to achieve a more pluralistic and democratic society based on respect for diversity. As clearly shown by the content of this publication, progress has been made in Argentina and Uruguay in the legal recognition of human rights of transgender people. In the first case, the adoption of the law of gender identity confirmed transgender people as full citizens in the eyes of the law. In Uruguay, through a government decree, sex work has been formalized and legalized. Now transgender sex workers are entitled to health insurance, retirement and other benefits the same as any employee. In Honduras and Bolivia we have borne witness to the achievement of transgender peopleâ&#x20AC;&#x2122;s participation in decision-making spaces within key structures of the HIV response such as the Country Coordinator Mechanism. In addition, in El Salvador and Ecuador initiatives in the field of comprehensive health resulted in meeting the specific needs of transgender people in a friendly manner. All these achievements have one thing in common: the leadership of transgender people to demand and defend their rights. At this decisive moment, the leadership and participation of transgender people are essential to achieving social justice and strengthening the rule of law. This is crucial to achieve the goals of the 2011 Political Declaration and our vision of getting to zero (zero new HIV infections, zero discrimination and zero AIDS-related deaths).

Dr Cesar NuĂąez UNAIDS Regional Director for Latin America

Introduction Some recent studies have shown that among transgender people there is a proportion of HIV infection over 30% in various Latin American citiesi,ii. These high HIV prevalence rates in this population and new cases of HIV among transgender people each year have served to highlight their vulnerability, not only to infection, but also to violations of their human rights. In addition to vulnerability and HIV infection, transgender people face serious stigmatization and discrimination that limit their access to education, health and workiii, excluding them from society and pushing them into a situation of poverty and marginalization. Faced with this situation, and with the support of various actors, transgender people have launched several initiatives that aim to achieve respect and the full exercise of their human rights, whether civil, political, economic, social or cultural. All this under the premise that full exercise of their right to information and education, to political participation, to a life free of violence, to work, to identity and to health, free of stigmatization and discrimination, will contribute to reducing the HIV infection rates in this population. Therefore, transgender people organizations in Latin America have constructed agendas in recent years that respond to their needs, gaining ground in political decision-making spaces, broadening their social bases and providing training for the people, so that society will acknowledge their existence, as well as demanding respect and the protection of their rights. There have been diverse experiences. Some transgender people organizations have focused their actions on eliminating mistreatment, stigmatization and discrimination in health services, whether by creating alternative services, training the population on diverse aspects of health or raising the awareness of healthcare staff working at public healthcare facilities. Others have aimed at getting laws and regulations passed that protect the most fundamental rights, such as the right to identity, a name, work and social security. On other occasions, transgender people organizations have sought to participate in decisionmaking spaces regarding the response to AIDS, while others have sought to strengthen their own organizations and develop a national agenda to guide their work. This document presents six case studies that reflect part of the diversity and intense work that has been done by transgender people organizations in defense of their rights. The cases featured give an overview of experiences in Argentina, Bolivia, Ecuador, El Salvador, Honduras and Uruguay. This compilation provides new elements for the analysis of the response to HIV and AIDS, and for the development of actions to defend transgender peopleâ&#x20AC;&#x2122;s human rights, and is thus an advocacy tool. In addition, it contributes to increase the visibility of the situations that transgender people live in and their

UNDP (2010). Strategic framework to strengthen national responses to HIV/AIDS in Latin America and the Caribbean.

El Salvador. Central American survey of safety in sexual behaviour and prevalence of HIV/STIs in at-risk populations. Transsexual, transvestite and transgender sub-population (2010).

iii Salazar, Ximena and VillayzĂĄn, Jana (2009). Guidelines for multisectorial work in transgender population, human rights, sex work and HIV/AIDS. Lima: IESSDEH, REDLACTRANS, UNFPA.

needs, as well as to intensify the active and effective participation of the transgender community so that their rights will be respected, which is one of the main aims of REDLACTRANS (Latin American and Caribbean Network of Transgender People.) This publication is the result of a REDLACTRANS initiative that aims to document the work of different national networks of transgender people, so that it will become possible to share successful experiences. In this way, it seeks to inspire other transgender people organizations and community based organizations in general towards active, coordinated work for the attainment of their rights. After a brief contextualization of the situation of transgender people in Latin America, there is a concise description of the process of collecting data and writing the case studies. In the following section the case studies are presented. They can be used together or separately according to the objectives of advocacy or mobilization of resources of different organizations. Lastly, there is a summary of recommendations, arising from the cases described, for strengthening the work of transgender people organizations in alliance with other actors. It is important to state that this work would not have been possible without the coordinated efforts of UNAIDS, the International HIV/AIDS Alliance and REDLACTRANS, working in synergy for the human rights of transgender people.

Human Rights, HIV and transgender people in Latin America Recent studies have tackled the social and health characteristics of transgender people and have shown how, as a consequence of their gender identity, they have been denied their most fundamental rights, such as the right to life, health, education and work.

Transgender people, a term that is used widely at present to group together transvestites, transsexuals and transgender people with a female identity, have achieved the recognition of their identity as a group, differentiating themselves from the collective of men who have sex with men (MSM), as they had historically been categorizediv, v. This has permitted a better understanding of their particular characteristics and vulnerability.

Although at present some official documents already differentiate transgender people from MSM, this has not been easy and nor has the work finished. Therefore, transgender people organizations and their leaders use diverse public spaces to define their particularities, their characteristics and to promote research into the context in which they live, including the HIV epidemic, and the best practices for responding to this. Transgender people, unlike MSM, live with a gender identity other than the sex by birth, and as a result of this face particular marginalization. In this document we refer to transgender people who have adopted a female gender identity. Recent studies have tackled the social and health characteristics of transgender people and have shown how, as a consequence of their gender identity, they have been denied their most fundamental rights, such as the right to life, health, education and workvi. However, there is still scarce literature regarding transgender peopleâ&#x20AC;&#x2122;s social, economic, cultural and employment situation. At the World Conference on Human Rights in Vienna in 1993, it was reaffirmed that these rights are comprehensive, indivisible and interdependent. At present, nobody denies the importance of promoting and guaranteeing economic, social and cultural rights such as education, housing, adequate food and health, and their relation with the full exercise of political and civil rights and liberties such as the right to life, to physical integrity, to choice, to the freedom of thought or expression. Similarly, it has been established that the impact of one or more rights will have an impact on the others. Thus, if the right to education is violated, this violation will have an impact on the right to housing and the right to health, to name but two examples. Transgender people, as indicated in previous paragraphs, have their most fundamental rights violated, which can be most clearly seen in the violent deaths that are the result of discrimination and transphobia. In recent years, various initiatives have sought to collect information on cases of violent deaths in this community1. The information available for Latin America indicates that around 425 transgender people were murdered between 2008 and 2010vii. iv Ximena Salazar, Jana VillayzĂĄn, Alfonso Silva Santisteban, et al (2010). Transgender people and the HIV/AIDS epidemic in Peru: Social and epidemiological aspects. Lima: IESSDEH, UPCH, UNAIDS, AMFAR.

Salazar, op.cit

Salazar, op. cit

Among the documents available for consultation is the Annual Report on Human Rights in Transgender People, Lesbians, Gays and Bisexuals in Peru, 2010, which provides detailed information on the attacks suffered by transgender people. Furthermore, transgender organizations affiliated or not to REDLACTRANS, as well as other organizations of gays, lesbians, transgender people and bisexuals, have added to the register of cases of attacks on transgender people, gays, lesbians and bisexuals, and have shared their findings via online discussion lists dedicated to areas of diversity.

Report on transgender people murdered between January 2008 and December 2010.

vii

Although some Latin American societies have seen progress in terms of tolerance and respect for sexual diversity and non-discrimination over gender identity, transgender people continue to be the object of human rights violations.

There is evidence that HIV prevention, healthcare and support can only be provided effectively if the dignity and diversity of all people are acknowledged. Otherwise, discrimination will lead to the exclusion and alienation of people from health systems and will discourage care for oneself and others.

Faced with this social rejection, many transgender people are obliged to live on the margins of society, without any opportunities for employment other than sex work; they are exposed to sexually-transmitted infections and HIV; and they do not have access to respectful, caring health services.viii, ix There is evidence that HIV prevention, healthcare and support can only be provided effectively if the dignity and diversity of all people are acknowledged. Otherwise, discrimination will lead to the exclusion and alienation of people from health systems and will discourage care for oneself and othersx.

HIV and transgender people Although information regarding the dynamics of the infection in the transgender population is limited, the few available studies indicate that transgender people represent a significant portion of new HIV infections in Latin America and the Caribbeanxi. This situation is part of the social exclusion in which transgender people live and the situation of violence that surrounds them. In a recent study of the situation of the HIV epidemic in the transgender population and its sociodemographic context, Ximena Salazar argues that “the context of violence and discrimination has an impact on the lack of importance that transgender people give to their health and HIV. (…) Everyday violence generates in them diverse reactions, which range from not caring about health and HIV to reacting with the same violence that they are subjected to.”xii Studies carried out in recent years in Argentina, Peru and El Salvador reflect that the prevalence of HIV in the transgender population stands at between 25% and 35%, much higher than the prevalence among the general population in all these countries, which is below 1%.xiii, xiv, xv Such figures, which are similar to those reported by the countries in 2010 UNGASS reportsxvi, are merely a sample of the impact of rejection and social exclusion of a population that seeks to live a normal life. Ministry of Health of Argentina, UNAIDS, PAHO (2008). Health, HIV-AIDS and Transgender Sexuality.

viii

International HIV/AIDS Alliance (2011). Campaign summary: International Day against Homophobia and Transphobia.

UNAIDS (2006). Guidelines on strategic actions to prevent and fight discrimination over sexual orientation and gender identity. Human rights, health and HIV.

UNDP, op.cit.

Salazar (2011).

xii

El Salvador. Central American survey of safety in sexual behaviour and prevalence of HIV/STIs in vulnerable populations. Transsexual, transvestite and transgender subpopulation (2010).

xiii

Silva Santisteban, op cit

xiv

Ministry of Health of Argentina, op. cit.

UNAIDS (2010). Consolidated Regional Analysis from UNGASS reports presented by 17 Latin American countries in 2010.

xvi

The stigma and discrimination that exists around gender identity extends to healthcare establishments and their staff. This means that these are not a place of support or information for transgender people. Generally, transgender people avoid seeking medical care until their health becomes seriously deteriorated, and in many cases this is too late. Thus, to guarantee the success of HIV programs aimed at transgender people, it is vital that their rights be guaranteed in such a way that they can live freely and access healthcare services without suffering any kind of stigma or discrimination. It is equally essential that healthcare services take into account the specificities of transgender people and MSM in relation to their gender identity.xvii, xviii, xix

Getting to Zero Discrimination: the Latin American response to the situation of transgender people and HIV Exposed to the violence of society and State agents –among other violations of their most basic rightstransgender people are placed in a particularly vulnerable situation with regards to HIV. International agencies and organizations have developed comprehensive strategies in a human rights context, to respond to this situation. UNDP and UNAIDS published the Strategic Framework to strengthen national responses to HIV and AIDS in Latin America and the Caribbean, promoting joint work between governments, civil society and the community affected by this population, to stop the epidemic and reverse its impact. The document vigorously argues that “The fulfillment of human rights is fundamental for people to have and negotiate healthy lives. The fundamental rights of all people, including the rights to free expression, free association, the right to live without violence, and equal access to justice and the right to health, have been formally recognized by all the countries of Latin America and the Caribbean.”xx

With the support of UN agencies, particularly UNAIDS and the UNDP, together with civil society, the transgender people organizations were able to attend the Assemblies of the Organization of American States, attaining resolutions that demanded that countries take measures to prevent and sanction hate crimes towards this population.

In turn, the World Health Organization (WHO) includes in the World Strategy on HIV 20112015 the protection and promotion of human rights as a main guideline. In doing so, the WHO shows the relationship between health and human rights, indicating that “the most vulnerable groups are also those that run the highest risk of HIV infection, and tend to be prone to suffering human rights violations.” Faced with this situation, it is necessary that HIV policies promote human rights and train people to exercise them.xxi

xvii Davenport, Hazel (2009). HIV/AIDS in transgender and transsexual women. Risks of anatomical modification and transsexuality concepts. In: HIV/AIDS and Public Health. Manual for Health Workers (Censida, Mexico).

UNDP (2010). Study of Stigmatization and Discrimination of People with HIV. San Salvador, El Salvador.

xviii

Stigmatization and Discrimination Index of People Living with HIV in Mexico. Unpublished report.

xix

UNDP, op. cit. (p. 16)

WHO strategy project against HIV/AIDS for 2011-2015. Approved at the World Health Assembly, May 2011.

xxi

In their 2011-2015 new strategy, UNAIDS proposes to promote human rights and gender equality in the response to HIV, which means eliminating punitive laws, norms and practices regarding homosexuality and commercial sex work, while reinforcing the countries’ capacities to reduce stigma and discrimination, guaranteeing equal access to services, and working with civil society networks to influence changes in public policies that encourage zero tolerance of gender violence.xxii UNAIDS has also condemned outright the hate crimes committed against transgender people in Honduras, which was expressed in a press statement and repeated by the US Embassy in Honduras.

Lastly, the situation of extreme violence and discrimination against LGBTI people, evidence of which was presented by LGBTI groups and other human rights organizations to the UN Human Rights Council, motivated the countries to request that the UN High Commissioner for Human Rights document the laws and practices that entail acts of violence and which discriminate against these people because of their sexual orientation and gender identity; and devise guidelines for applying international human rights law in order to better protect LGBTI people’s rights.xxiii The report was prepared by November 2011 and was presented at the session of the Human Rights Council in March 2012.xxiv, xxv The Organization of American States (OAS) has played an important role in publically opposing hate crimes in countries of the region. In January 2011, it expressed its concern at the threats towards and murders of transgender people in Honduras, and in June of the same year it approved the fourth resolution “Human rights, sexual orientation and gender identity” (AG/RES. 2653), which requests that the InterAmerican Human Rights Commission “pay special attention to its work plan titled “Rights of lesbians, homosexuals, bisexuals, transsexuals and intersexual people” and, in accordance with established practices, prepare a continent-wide study of the issue; and urge the Member States to participate in the report.” The Member States also requested that the Inter-American Human Rights Commission (IAHRC) and the Inter-American Juridical Committee “prepare a study of the legal implications and conceptual and terminological progress in relation to sexual orientation, gender identity and gender expression and instruct the Committee on Juridical and Political Affairs to include in its program the examination of the results of all requested studies, with the participation of civil society stakeholder organizations.”xxvi In November 2011, the IAHRC formed the Unit for the rights of lesbians, gays, transgender people, bisexuals and intersex people that will follow up on the resolution.

UNAIDS (2010). Getting to Zero. 2011-2015 strategy.

xxii

PAHO (2011). Young People’s Right to Health and Gender Identities. Findings, Trends and Strategic Measures for Public Health Action.

xxiii

United Nations (November 17, 2011) A/HRC/19/41. Discriminatory laws and practices and acts of violence committed against people because of their sexual orientation and gender identity. Report of the UN High Commissioner for Human Rights.

xxiv

UNAIDS. Press Statement: Rights of LGTB people. XIX Session of the Human Rights Council.

xxv

OAS General Assembly Resolution. AG/RES. 2653 (XLI-O/11) Human rights, sexual orientation and gender identity (approved at the fourth plenary session, held on 7 June 2011).

xxvi

The response from transgender people organizations The Latin American and Caribbean Network of Transgender People (REDLACTRANS) was created over six years ago to tackle the human rights violations experienced by the community in the region and make it visible as a population vulnerable to HIV, strengthening its representation in decision-making forums.

At national level, transgender people organizations carry out actions to improve care at health establishments, eliminate violent practices from police agents and promote the sexual and reproductive rights of transgender people and the prevention of HIV.

Their work is based on international principles of greater involvement in the response, which provides the bases so that people who are excluded and deprived of autonomy may participate in actions to tackle HIV, using their abilities and skills in devising the response.

Through national member organizations, REDLACTRANS was able to strengthen the participation of transgender people in various spaces of political decision-making; such actions were furthermore accompanied by the democratization of issue-resolution processes. In addition, the network consolidated itself as an organization through the formation and strengthening of local organizations that broadened the debate around the situation of discrimination and vulnerability to HIV that transgender people experience, implementing their own solutions. To date, REDLACTRANS has member organizations in seventeen Latin American countries. As a consequence, national transgender networks have sprung up which have been strengthened by the development of alliances with other local organizations, whether of civil society or cooperation agencies. The connection between the violation of human rights and vulnerability to HIV was quickly understood and transgender people organizations focused their efforts on promoting regulations and laws that guarantee them a life free of violence from security agents and police, as well as from society in general, and allow them to access all their rights with their female gender identity. Therefore, they strengthened their alliances with organizations of sexual diversity, such as the National Federations of Sexual Diversity and also with international organizations representing gays, lesbians, bisexuals, transgender and intersex people through work with the Inter-American Human Rights Commission (IAHRC) of the Organization of American States (OAS). Similarly, with the support of UN bodies such as UNAIDS and UNDP, they were able to participate in the Technical Horizontal Cooperation Group (GCTH, Grupo de Cooperación Técnica Horizontal) for Latin America and the Caribbean, a space for political dialogue for an integral response to HIV and AIDS. With the political, technical and economic support of the LGTBI Coalition and the UN agencies, particularly the UNDP and UNAIDS, the transgender people organizations were able to attend the Assemblies of the Organization of American States, attaining resolutions that demanded that countries take measures to prevent and sanction hate crimes towards this population. Since 2008 the OAS has issued four resolutions in relation to “Human rights, sexual orientation and gender identity”, the most recent of these –AG/RES. 2653 (XLI-O/11)- requests that the IAHRC prepare a hemisphere-wide report to determine the situation in the countries in relation to the LGTBI population’s human rights.

These efforts have been successful. As indicated in the previous section, in November 2011 the IAHRC formed the Unit for lesbian, gay, transgender, bisexual and intersexual rights. Together with these advances, REDLACTRANS has strengthened its abilities for collecting information on hate crimes, establishing an observatory that contributes to improve the reports it makes. REDLACTRANS also promoted the participation of transgender people in Country Coordinating Mechanisms (CCMs), multi-sector spaces that create and supervise HIV-response projects, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Participation in these spaces is vital if the response is to take into account the needs of the transgender population and adapt actions to their context, according to recommendations of the Global Fund’s strategy in relation to Sexual Orientation and Gender Identity (SOGI). As a result of these efforts, 12 of the 15 CCMs included participation from transgender people in 2009, according to a regional study.xxvii At national level, transgender people organizations carry out actions to improve care at health establishments, eliminate violent practices from police agents and promote the sexual and reproductive rights of transgender people and the prevention of HIV. In some countries work has been strengthened towards recognition of sex work within labor regulations, so that it is possible to access social security and, in almost all countries of Latin America, proposals have been presented to guarantee and protect the identity of transgender people, permitting name changes on identity documents as the first step towards this.

Lamb, Alexandra (2010). Make Your Voice Heard. Women’s and Transgender’ Participation in Global Fund Processes in Latin America and the Caribbean. Observatorio Latino, AID for AIDS

xxvii

Methodology for the compilation of case studies The compilation of the case studies was a joint effort of the regional coordinator and six national consultants, all with the permanent support of the International HIV/AIDS Alliance (the Alliance), REDLACTRANS and UNAIDS. At first, a training workshop was held in the city of Buenos Aires, Argentina, facilitated by the regional coordinator with the support of the Alliance. During the workshop, the national consultants consolidated their interview-based data collection skills and were trained in areas of writing and photography necessary for the case studies. The reference framework for all of this was the “Guidelines for case studies of experiences of transgender organizations in Latin America”, an adaptation of the document “How to do a case study. A development guide.”xxviii In their respective countries, the national consultants met with REDLACTRANS national leaders to present the objectives of the case studies and discuss various experiences to be analyzed in depth. In line with one of the objectives of the present project aimed at empowering REDLACTRANS members, they participated actively in the process of identifying relevant actors to be interviewed and in inviting transgender people to focus groups and interviews. The project has contributed to the development of skills for creating case studies in REDLACTRANS and among its national leaders. The writing-up of the case studies was the responsibility of the national consultants, who received comments from the regional coordinator to strengthen some aspects of these and expand on the information where necessary. The final editing and style correction work was done by the regional coordinator and the Alliance team. The case studies combine the description of transgender organizations’ experiences and an analysis of their achievements and lessons learned.

Some ethical considerations The persons who were interviewed or who participated in focus groups for the case studies received an informed consent form which was explained to them in detail by the national consultant. This document was signed by the interviewee(s) who kept a copy for themselves. The persons who participated in the photo session also gave their consent verbally and in writing for these photos to be used in case study publications.

Alliance (2007). How to do a case study in HIV/AIDS?

xxviii

Case Studies

In Argentina, Gender Identity Law Now!

democracy. We come for more dignity and equality, and we come to make history with this Law.” The concept of a dignified life means access to education, health, employment, housing, ultimately, to full citizenship.

On November 30, 2011, the Gender Identity Law was partially approved by a majority vote of the legislators of the Chamber of Deputies. However, for final approval, it needs to be passed in the Senate. The struggle for this Law was initiated in 2007, but summarizes 18 years of resistance by the Association of Transvestites, Transsexuals and Transgender persons of Argentina (ATTTA, Asociación de Travestis, Transexuales y Transgéneros de Argentina). The agreed bill, which takes the ATTTA proposal, includes the right to identity, allows gender reassignment and modification of the given name without further requirement than the person’s expressed will, promotes the autonomy of the decision, does not consider the transgender condition as a disease, and does not require surgery intervention for sex reassignment. It also guarantees access to comprehensive health care. What changes will the passage of the Law allow? In this regard, Marcela Romero, President of ATTTA, identified a horizon of possibilities: “We come (to Congress) to claim the right to identity so that transgender people are no longer the forgotten of

When speaking of the right to gender identity, we are talking about being who each one is, and not being somebody else. This claim of identity is essential to access a whole range “of rights denied to transgender people and places on the same level the guarantee of access to health care, treatments and interventions according to each individual’s deep desire and project of life,” said Esteban Paulón, president of the Argentine Federation of Lesbians, Gays, Bisexuals and Trans (FALGBT, Federación Argentina de Lesbianas, Gays, Bisexuales y Trans). The process leading to the submission of the Law synthesizes different times of strengthening of the organization ATTTA, which originated with the initiative of 15 transvestites who, in 1993, opposed to police repression and created the first

organization: the Association of Transvestites in Argentina (ATA, Asociación de Travestis de Argentina), which later became ATTTA.

“We come for more dignity and equality, and we come to make history with this Law”, Marcela Romero, Regional Secretary of REDLACTRANS.

Influenced by the development of other sexual diversity organizations, ATTTA focused on spreading the transgender people’s rights1 and eradicating the police edicts. These edicts were judicial rules that were enforced directly by the police, and which led to violent repression and unjustified deprivation of liberty throughout the country. That first claim resulted in increased organizational strength, and to date almost all Argentine provinces have repealed the police edicts.

In the 80’s, rulings were issued in Argentina in favor of the change of name and gender to individuals who had undergone sex reassignment surgery. These interventions were performed in other countries, since they were banned in Argentina. While there is a history of provincial rulings in response to claims of members of the LGTBI community, ATTTA was the first organization of transgender people to resort to justice through a campaign of judicial actions of amparo. (See T.N)

By reviewing the process initiated in 2007 it is possible to clearly see the leadership skills of the transgender collective, its degree of organization, and its progress in political advocacy. “The organizations of transgender people in Argentina have made great efforts to make their people visible, fighting for their rights, assembling safety nets to support their sisters and reporting instances of discrimination and mistreatment,” said Carlos Falistocco, Director of AIDS and STD’s of the Argentine Ministry of Health.

From the year onwards 2009 provincial resolutions were obtained promoting respect for gender identity, and judicial actions for amparo were filed requesting a change of name and sex registration. As an effect of the activities undertaken by ATTTA and its affiliates around the country, academic institutions made positive resolutions, recognizing in their official documents the adopted or self-perceived gender identity for those studying in these institutions. Some of the institutions that resolved on this matter were the University of Buenos Aires, the National University of Rosario, the Litoral University, the National University of La Plata and the University San Juan Bosco de Patagonia Austral, among others.

Background of the Law The passage of legislation granting the right to identity of transgender people dates back to 1972 in Sweden. Currently, eleven European countries (Spain, Portugal, Norway, Italy, Sweden, Austria, Denmark, UK, Finland and the Netherlands), four Asian countries (Japan, South Korea, Taiwan and Nepal), two Latin American countries (Uruguay and the Federal District of Mexico), an African country (South Africa), Australia and New Zealand, and some U.S. states and Canadian provinces, have incorporated this right into their legislation.

Finally, the passage of the Equal Marriage Law for same sex couples in 2010 was a landmark in Argentine society, where sexual diversity was a source of much debate. Since the adoption of this law, the Gender Identity Law became the first demand of the LGTBI community. From this achievement, all coordinated actions by ATTTA and FALGBT were focused on advocacy for advancing the discussion of bills submitted. “Rather than advocacy I prefer to speak of ‘parliamentary lobby’. There we were

(T.N: A constitutional remedy aimed at preserving the rights and freedoms established by the Federal Constitution from legislative acts, acts of authority and court decisions) 1

A transgender person has a gender identity other than the sex by birth. In this study we refer to transgender people as those with a feminine gender identity.

“The turning point when the Law began being talked about in all sectors was when the issue of the HIV epidemic was introduced, and also when data of a 2006 study that indicated an HIV seroprevalence in transgender population of 34.47% was disclosed”, Claudia Pía Baudracco.

that were distributed to all provincial affiliates of ATTTA. “We did not want thousands of signatures calling for a referendum, but the request of signatures had people comment and ask for information on the scope of the Law. This made the transgender people visible, as well as their national and provincial organizations, and also raised awareness on the issue. That was our concern,” said Baudracco. In addition, national representatives participated in meetings, forums and chats with politicians and scholars in all provinces.

constant, both nationally and in the provinces, always supported by FALGBT, which has spaces in different political parties,” said Claudia Pía Baudracco, National Coordinator of ATTTA.

The road to the Law The transgender issue first emerged in the country with the epidemic of HIV. According to Claudia Pía Baudracco, “the turning point when the Law began being talked about in all sectors was when the issue of the HIV epidemic was introduced, and also when data of a 2006 study that indicated an HIV seroprevalence in transgender population of 34.47% was disclosed”. This study was released by UNAIDS, the Pan American Health Organization (PAHO) and the Argentine Ministry of Health.

Since 2010, ATTTA and FALGTB began filing judicial actions for amparo. And in December 2010 a landmark ruling was issued by the Administrative Courts of the City of Buenos Aires that recognized in the National Identity Document of a famous actress the change of name and gender registration without conditions. In this context, ATTTA filed 87 amparos, of which 30 were favorable.

During the First National Meeting of ATTTA, held in Buenos Aires in 2007 with the participation of provincial leaders from the whole country, the need to train its members was identified, the goal being that they could conceptually take ownership of the content of the Law and develop skills and abilities for awareness raising and advocacy actions.

A list of strategies that best helped to generate interest about the need for the Law is as follows: working together with FALGBT; support for the first bill submitted in Congress in 2007, with which the parliamentary lobby began; the efforts among transgender peers to conceptually take ownership of the contents of the Law and expansions of their citizens’ rights; and the promotion of academic debate on transgender issues, challenging the construction of gender linked to sex (or biologicist binarism).

In parallel, a communication strategy was designed with messages including binders with information on the contents of the Law, a guide to social communicators and sheets of signatures of adherence

Final thoughts Throughout the process, progress was made, both in support for the passage of the Law by a wide spectrum of political, social and cultural organizations, and in the orientation of public policies that favored the creation of areas of sexual diversity

at the national, provincial and municipal government levels. These areas helped spread ATTTA’s initiatives, incorporating provincial reference persons in their activities, which promotes the strengthening and visibility of the organization.

In this context there were also difficulties, such as the lack of awareness of transgender issues and the force of social and cultural stereotypes. In turn, sex work as livelihood hinders the participation of transgender people in the organizations. Furthermore, the family, educational and social marginalization of the transgender population produces high vulnerability in the collective. Among the lessons learned, ATTTA’s leaders mention the importance of working together with other LGTBI organizations to attain presence in the different areas of government and civil society related to the Law. They also emphasize the need to establish agreements from a complementary and not confronting position. The technical and financial support from agencies and organizations like the International HIV/ AIDS Alliance broadened the use of information technologies that facilitated communication among members of the national network. Knowledge

management with distribution of information, brochures and audiovisual material production increased visibility and empowered the peers and the organization. ATTTA’s members believe that the process lived in Argentina may be useful in other countries of the region. In the words of Baudracco, “Argentina’s experience can be replicated in other countries if there exist the conditions of a political order, a national and popular democracy, involving many actors and respecting differences.” Meanwhile, for Argentina and all countries in the world: Gender Identity Law now!

The process lived in Argentina to obtain the Identity Law will be useful for other countries in the region on the path to the conquest of their rights.

International HIV/AIDS Alliance The Alliance is an international non-governmental organization whose mission is to support communities to reduce the spread of HIV and face the challenges of AIDS. It was founded in 1993 and its head office is in the United Kingdom. In a context of a greatly concentrated epidemic, the Latin American and Caribbean team focuses its work on key populations, such as people living with HIV/ AIDS, gay men and other MSM, sex workers, and transgender people. Its mission is to offer support to community groups so that they are at the forefront of the response to the epidemic. At national level, the Alliance works with liaison organizations and partners in Mexico, Peru, Bolivia, Ecuador, El Salvador, Haiti and the Caribbean. At regional level, the Alliance works with strategic partners: regional community networks of key populations, with coverage in most countries in the region.

Red Latinoamericana y del Caribe de Personas Trans (REDLACTRANS) REDLACTANS is a Latin American and Caribbean network of organizations of transgender people, working towards the goal of the recognition and exercise of human rights in the transgender population, through strategies of advocacy, visibilization, participation and the strengthening of the organizations, through actions in the health, education and justice fields. The recognition of transgender people as full citizens in all the countries of the region, with the guarantees and obligations of the law without discrimination, is REDLACTRANS’ vision. The organization strives for a region without discrimination or violence with respect for gender identity, and access to healthcare, education and justice.

Asociación de Travestis, Transexuales y Transgéneros de la Argentina (ATTTA) The Association of Transvestites, Transsexuals and Transgender persons of Argentina (ATTTA) is a national network made up by coordinators from each of the provinces, that seeks to eradicate stigma, discrimination, transphobia and the repeal of laws which criminalise gender identity. ATTTA promotes different projects to improve the quality of life of the transgender population and help them attain the full exercise of their citizen rights. ATTTA is part of the Latin American and Caribbean Network of Transgender People – REDLACTRANS (Red Latinoamericana y del Caribe de Personas Trans)

International HIV/AIDS Alliance International Head Office – United Kingdom Tel: +44 (0) 1273 718900 Fax: +44 (0) 1273 718901 mail@aidsalliance.org www.aidsalliance.org

REDLACTRANS Regional Secretariat Callao 339 6º Piso C1022AAD Buenos Aires - Argentina Tel/Fax: +54 11 5032 6335 secretariaregional@redlactrans.org.ar www.redlactrans.org.ar

Asociación de Travestis, Transexuales y Transgéneros de la Argentina (ATTTA) Callao 339 6º Piso Ciudad de Buenos Aires, Argentina Tel.: +54 11 5032 6335 www.attta.org.ar

The transgender people movement in Bolivia The transgender people1 movement organization in Bolivia is the result of a relatively recent process which has seen significant progress in the last three years. The formation of a national network came about from the initiative of local leaders who reflected on the importance of articulating their fight and taking on a leading role in the search for answers to their particular needs. Thus was born the National Trans (transvestite, transsexual and transgender) Women’s Network of Bolivia (TREBOL, Red Nacional de Mujeres Trans -travestis, transexuales y transgéneros- de Bolivia).

Background Until recently, transgender people in Bolivia were grouped with other sexual diversities and there was no socially visible transgender movement. Bolivian society did not understand the meaning of the construction of gender identity. One transgender leader from the city of Santa Cruz commented: “In all programs aimed at gays, lesbians, bisexuals and transgenders, we transgender people were invisible, and lumped together with men who have sex with men (MSM)”. A few years ago there were few transgender leaders at national level. Contact and liaisons between them were scarce, which limited articulation and sustained work. The area of sex work was the only space that brought them together and in this area they suffered considerable violations to their integrity from police and neighbours

The formation of the network Trans leaders in the states (departamentos) of Beni, Potosi, Santa Cruz, Cochabamba and Oruro came together for the First Conference for Transgender People of Bolivia, held in the city of Santa Cruz de la 1

A transgender person has a gender identity other than the sex by birth. In this study we refer to transgender people as those with a feminine gender identity.

they did before. Before we would let them trample us underfoot, now times have changed thanks to the TREBOL Network teaching us our rights.”

Sierra in 2008, with the support of the International HIV/AIDS Alliance, through its representative organization, the Institute for Human Development (IDH, Instituto para el Desarrollo Humano) and the National Working Group (MTN, Mesa de Trabajo Nacional). The conference was attended by leaders of five local transgender people organizations and seventy grassroots members. The importance of organizing at national level to articulate a common agenda to meet the needs of the population was discussed at this conference. This led to the founding of the TREBOL Network, and a local leader was elected for each of the five states.

The TREBOL Network came into being in response to a collective need: to diminish discrimination towards and the stigma of transgender people. The Network’s mission is to work in the defence and protection of the human rights of transgender people for them to attain full citizenship and legal and social recognition of female gender identity, the identity that they have constructed. The TREBOL Network’s strengthening strategy is based on the identification of local leaders, transgender leaders who act in coordination with the Network in each state in Bolivia. Little by little transgender people are occupying spaces that previously were occupied by gay men, job positions in civil society organizations that work for human rights and the prevention of HIV and AIDS, decision-making and advocacy spaces.

Since the first conference, the TREBOL Network has continued to grow, with many new members joining each year. At present, the Network has representatives in six Bolivian states and has around 350 transgender people affiliated. Over the years, two national conferences have been held, as well as congresses and various training workshops in human rights, leadership and HIV and AIDS prevention. All these activities have contributed to the empowerment of the transgender population and its visibility in society. One Network leader in Santa Cruz commented: “The TREBOL Network has strengthened us through the workshops on how to use condoms correctly, prevention of HIV and AIDS and sexually transmitted infections, the use of silicon, how to enforce our rights, where to go when we are discriminated against (…) They can’t discriminate against us just like that, like

With the articulation of the TREBOL Network, transgender people undertake advocacy work to defend their rights through the support of the empowered leaders in each city, who accompany their transgender colleagues and refer them to legal services if their rights are infringed. In addition, the Network has channelled continuous technical support to members who act in political advocacy or prevention. Furthermore, the Network has promoted

“The TREBOL Network has strengthened us through the workshops on how to use condoms correctly, prevention of HIV and AIDS and sexually transmitted infections, the use of silicon, how to enforce our rights, where to go when we are discriminated against (…) They can’t discriminate against us just like that, like they did before. Before we would let them trample us underfoot, now times have changed thanks to the TREBOL Network teaching us our rights”, Network leader in Santa Cruz.

“In all programs aimed at gays, lesbians, bisexuals and transgenders, we transgender people were invisible, and lumped together with men who have sex with men (MSM)”, Transgender leader from Santa Cruz.

and transgender people have won an important space as citizens who exercise their rights. TREBOL Network President Raiza Torriani states: “A law is needed that enforces respect for my identity and the general identity of all of us (…). The new Political Constitution of the State of Bolivia is important, because it recognises gender identity.”

access for transgender people to spaces of training and empowerment, conferences and congresses, as well as peer support. The positioning achieved by the TREBOL Network nationally and internationally has led to greater funding opportunities which make it possible to consolidate the ventures and projects that benefit the transgender population of Bolivia. The Network has channelled funds to hold workshops in leader training, prevention of HIV and AIDS, and to strengthen the organization, with the support of the United Nations Development Program (UNDP), the United Nations Population Fund (UNFPA), UNAIDS and the American Foundation for AIDS Research (amfAR).

The quest for respect for the right to identity is one shared by other civil society organizations. The director of the Institute for Human Development (IDH, Instituto para el Desarrollo Humano), a long-standing ally of transgender people organizations, commented: “(…) we, as a civil society, want transgender people to have their place and be respected as they are, and improve their living conditions. (We want) society to accept this community as part of life itself, no one should be excluded. That is our objective.”

The TREBOL Network and the right to identity

The bill was submitted in November 2011 at the National Consultation of Authorities and Presentation of the Gender Identity Law in the city of La Paz. The recognition of general identity in the Political Constitution of the State of Bolivia was emphasised to the national authorities.

One need that is highlighted by transgender people in the TREBOL Network is that of legal and social recognition of their feminine gender identity. Therefore, political advocacy to introduce the Gender Identity bill into the Bolivian House of Deputies was one of the priorities taken on by the Network in its political advocacy agenda. Demonstrating the importance of the law, transgender activist Vanina Lobo said “I want to be called Vanina, so there should be a document that certifies that my name is Vanina (…) to get this we want the Gender Identity Law.” The right to gender identity has positioned itself in a short time, both in the country and within the TREBOL Network, in a context in which gay, lesbian, bisexual

Final thoughts With the formation of the TREBOL Network great progress has been made in protecting rights and reducing stigma. However, many other challenges remain in training in human rights and local leadership. It is necessary for new transgender leaders to emerge, be trained and empowered, to strengthen and drive advocacy work to promote their rights and respect for gender identity.

have only just begun the journey and we will continue walking together, stronger, taking advantage of the opportunities that were denied to us before, because there is still a lot for us to do as a national network.” The articulation and coordination of common goals is a forte recognised by various actors, and one that must consolidate the attainment of transgender people’s rights.

Torriani concluded: “We have advanced in advocacy work so that our rights are no longer infringed; we

Red TREBOL Red TREBOL (TREBOL Network) was created in 2008 under the initiative of transgender people of Bolivia in order to attend to their needs. TREBOL’s mission is advocacy to get transgender people’s rights respected. It also undertakes HIV and AIDS prevention actions, as the transgender population is one of the most vulnerable to the epidemic and one of the most neglected ones in terms of access to healthcare. TREBOL has a presence in 6 states (departamentos) of Bolivia, with leaders in each of these. Its work mostly depends on volunteers, and its economic resources have been channelled through the National Working Group (MTN, Mesa de Trabajo Nacional). At present, the TREBOL Network is focussing its efforts on promoting and getting Parliament to pass the Gender Identity Law, in addition to consolidating its actions in prevention, access to healthcare and defence of rights, as well as strengthening the skills of leaders in different cities.

International HIV/AIDS Alliance International Head Office – United Kingdom Tel: +44 (0) 1273 718900 Fax: +44 (0) 1273 718901 mail@aidsalliance.org www.aidsalliance.org

REDLACTRANS Regional Secretariat Callao 339 6º Piso C1022AAD Buenos Aires - Argentina Tel/Fax: +54 11 5032 6335 secretariaregional@redlactrans.org.ar www.redlactrans.org.ar

Red TREBOL Av. San Martin, Esquina Heroínas. No 123 Edificio Raquel 4to Piso Oficina 4D Cochabamba, Bolivia Tel: + 591 450 3143 / 7740 2120 e-mail: jhannet5@hotmail.com

Promoting heathy transitions in young transgender people

Young and adolescent transgender people in Ecuador

Faced with the absence of an integral health policy covering the specific needs of the transgender population1, The Silueta X Association, as part of the “Project for information, education and communication on the proper use of feminizing hormone regimens in young transgender people aged 15-29”, became the first organization to work in Ecuador in promoting health among young transgender people and preventing the risks involved in non-professional feminizing hormone regimens.

Faced with a lack of specialist services in the health system, it is common for young and adolescent transgender people to opt for unregulated alternatives to harmonise body and mind through non-assisted feminizing hormone regimens; however, these processes imply some risks, such as liver, renal and cardiac conditions. This reality is directly related to the high death rates among transgender people and low life expectancy which, according to Diane Rodríguez, legal representative of the Silueta X Association, is around 30-35 years. This situation is aggravated in Ecuador, where there are no specialised endocrinologists sufficiently aware of the issue and with proper training to work with this population. The project’s goals did not include prohibiting feminizing

The project was undertaken with funding allocated from the HIV-Young Leaders Fund (HIVYLF), Kimirina Corporation and the Tades Foundation between September 2010 and September 2011, in the city of Guayaquil.

A transgender person has a gender identity other than the sex by birth. In this study we refer to transgender people as those with a feminine gender identity.

“(…) when we refer our peers to public health centres, the centre should guarantee proper treatment, with quality and cordiality, but the reality is that this is not the case for the transgender population (…) When one of these teenage sisters receives assistance from one of these doctors, they do not touch her, they do not examine her, they do not check her body for any conditions; that person comes away with a bad perception which she naturally passes on to the rest. No one wants to access medical services, and this way the process of selfmedication continues”, Silueta X member.

hormone regimens, as this helps in the consolidation of identity in transgender people.

intervention areas. Following this, the target group was brought in to validate and get feedback on the proposal.

Transgender teens and young people opt for selfmedication or follow the recommendations of peers, with whom they share personal experiences, especially with those transgender people who, due to the phenomenon of migration, have lived abroad and received feminizing hormone regimens. However, these practices have not always been successful, and risks of abuse from foreign substances in the body must be taken into consideration as these can have serious consequences, including death.

The project included the participation of public health staff; however, despite the time devoted to raising awareness, doctors and nurses refused to facilitate workshops in the Association during the times the transgender population had available. Diane Rodríguez believes that this refusal and inflexibility concealed a lack of specialised knowledge about the issue. For this reason it was necessary to incorporate into the project a private sector doctor and an Ecuadorean endocrinology specialist based in Chile to train both the Association activists and the target group. As a result of this activity, 160 teen and young transgender people aged 15-29 benefited directly.

An innovative experience According to the information provided by Diane Rodríguez, before this project was implemented the risks and procedures for feminizing hormone regimens were unknown in Ecuador. Therefore, a participative design was used for a project that focused on meeting demand for information regarding this issue. Rodríguez states: “It was not a matter of teaching people to use feminizing hormone regimens, but rather educating them on the precautions they should take with these procedures.”

Another innovative aspect of the experience was the strategy used to reach the beneficiaries. Existing peer communication was taken as a main strategy for spreading word of mouth about the activities, which was done via invitations on social networks and other interactive virtual communication channels. This allowed for the identification of the new generation of potential feminizing hormone regimens users.

The methodology implemented was developed by activists of the Silueta X Association, who met and drew up a tentative project profile with various

Project sustainability and expansion

was formed in 2006. Although the agendas of both organizations follow the specific demands and needs of the groups with which they work (age, geographic location, etc.) successful activities and experiences are shared or replicated, creating a chain reaction reaching a larger number of people.

The sustainability of the project and its achievements have been possible thanks to the incorporation of these issues in diverse Silueta X activities. Although funding granted for the project ended in September 2011, Silueta X continues with the issue of proper feminizing hormone regimens as part of its training when carrying out actions related to HIV and AIDS prevention. The same approach is used in recreational and social events, such as beauty pageants.

Challenges It is still necessary to educate widely on the risks of feminizing hormone regimens in order to get other organizations of transgender people in Ecuador to face up to the issue and treat it as priority. It is essential to meet the needs and demands of transgender teens and young people, and implement intervention projects that promote and take into consideration the direct participation of this population to benefit their own lives.

The work coordinated between Silueta X and other transgender organizations has been fundamental for the success of the activities. Under the principles of autonomy and respect for internal processes, the Trans Network of Ecuador (Red Trans del Ecuador)

Another challenge pending is to set up permanent work with the Public Health Ministry so that awareness of the issue, as well as of the risks to which those who use feminizing hormone regimens without due professional aid are exposed, is relayed via the mass media. Doing this would bring about debate and put on the public agenda the need for the State to take on the responsibility of safeguarding the integral health, sexual health and reproductive health of the transgender population, all the more so when dealing with teenagers and young people. In this regard, a Silueta X member explained: “(…) when we refer our peers to public health centres, the centre should guarantee proper treatment, with quality and cordiality, but the reality is that this is not the case for the transgender population (…) When one of these teenage sisters receives assistance from one of these doctors, they do not touch her, they do not examine her, they do not check her body for any conditions; that person comes away with a bad perception which she naturally passes on to the rest. No one wants to access medical services, and this way the process of self-medication continues.”

Final thoughts Diane Rodríguez believes that it must be made clear that it is crucial for the population to whom the actions and messages are directed to participate in the design of the projects or activities the Association undertakes; otherwise it will not be possible to tackle their needs and concerns, and as a result the approach will have limited success.

Organization m e m b e r s stressed that working on this issue for the last year has meant a great step forward, but at the same time it is insufficient, and at least three to five years more are needed to get teen and young transgender people to gain awareness of the use of hormones and seek professional help. This lack of work time has meant that it has not been possible to follow up on the trained population to measure the impact achieved.

Work among peers and the use of simple language are strategies that have achieved excellent results in the activities and in sharing feminizing hormone regimens-related activities and content.

Asociación Alfil Asociación Alfil has been working with the transgender population since December 2005. Its actions are geared towards promoting and defending the human rights of the LGBTI community in Ecuador. Through advocacy work with the administration and civil society it aims at creating and participating in political decision making forums and mechanisms for the benefit of transgender people. In pursuit of its goals it provides consulting and training to the LGBTI community, especially to transgender people in the areas of STI, HIV and AIDS prevention, health and sexual care and legal advice to transgender sex workers for the defense of their rights. It has also founded the folk dance group Ñunca Trans, an important initiative to raise social awareness and promote the rights of the trans community. Asociación Alfil is REDLACTRANS’ main representative organization in Ecuador and together with other 16 organizations of the transgender community it is part of the Red Trans del Ecuador (Transgender Network of Ecuador), which was founded in 2006.

International HIV/AIDS Alliance International Head Office – United Kingdom Tel: +44 (0) 1273 718900 Fax: +44 (0) 1273 718901 mail@aidsalliance.org www.aidsalliance.org

REDLACTRANS Regional Secretariat Callao 339 6º Piso C1022AAD Buenos Aires - Argentina Tel/Fax: +54 11 5032 6335 secretariaregional@redlactrans.org.ar www.redlactrans.org.ar

Asociación Alfil Armero Oe5-222 y Av. Universitaria Quito, Ecuador Tel: +593 22549 919 aso_alfil_glbth@hotmail.com

Transforming health access in El Salvador The “Somos Saludables” (We are Healthy), project was formulated as an innovative proposal that uses the unique tools, knowledge and strengths of transgender people to help them achieve a better quality of life, free from HIV.

In response to a context of great social vulnerability and deficient access to health services for the transgender1 population in El Salvador, the Solidary Association for Driving Human Development (ASPIDH, Asociación Solidaria Para Impulsar El Desarrollo Humano) launched the “Somos Saludables” (We Are Healthy) project, aimed at creating health services for transgender people. This project arose as an innovative idea with the tools, knowledge and strengths of transgender people themselves, via specific actions to access information, education, services, care and the promotion of human rights in order to attain a better quality of life, free of HIV.

20.7% had syphilis. These high rates of sexuallytransmitted infections and HIV are evidence of deficient health care for this population. Due to attacks, mistreatment and discrimination experienced by transgender people at health institutions, they are late in turning to the health system; and when they do, many are already in a highly deteriorated state. This lack of information and deficient health care come in addition to the high degree of self-medication and exposure to unregulated treatments in the context of hormone regimens and surgery to feminize their bodies. All this clearly has an impact on transgender people’s health and vulnerability to HIV.

Health and transgender people Until recently, transgender people in El Salvador were perceived as a stereotype of homosexuality. Now, being transgender is also understood as an expression of gender identity. Thanks to this, the transgender people movement has taken on a leading role and found a better foothold politically. In addition, they have managed to differentiate themselves from gay men and men who have sex with men (MSM), vindicating their identity and specific characteristics. In the Central American survey of sexual behaviour and prevalence of HIV and STIs in at-risk populations carried out in 2009, the prevalence of HIV in the transgender population was 25.8%. Some 71.1% tested positive for herpes simplex virus type 2 and 1

A transgender person has a gender identity other than the sex by birth. In this study we refer to transgender people as those with a feminine gender identity.

Yamileth Gallardo explains: “I’ve just had a breast operation as a result of injecting myself with oil 12 years ago in a desperate bid to become female. The process leading to the surgery to remove the oil took two years, going from one appointment to another, even though the doctors knew my life was at risk (…) The worst thing was that they left me in the men’s ward and the justification was that there were no protocols for hospitalizing transgender people. It has all been painful and traumatic, and when I asked the doctor to refer me to a psychologist, he told me I didn’t need one, that I’d soon get used to living without breasts.”

and reflection about safe sex, family relationships, education, work and other important issues in the lives of transgender people. In addition, it guaranteed access to information and HIV tests with pre- and post-test counselling.

The friendly health service centre

The centre has a monthly schedule of activities to permanently distribute condoms, lubricants, informative leaflets, internet access for specific tasks, advice and legal advice and assistance. The centre also provided accompanying for transgender people during visits to public hospitals to guarantee the right care, and has permanent staff providing direct health care, as well as twelve transgender volunteers and five volunteers from the Universidad Tecnológica de El Salvador.

The project included the creation of the We Are Healthy Health Centre (Centro de Salud “Somos Saludables”), which was opened as a care and support centre for transgender people. This was possible thanks to funding from the Foundation for AIDS Research (amfAR) in 2009 that ended in December 2010. It was possible to continue this centre’s services in 2011 thanks to funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Pan American Social Marketing Organization (PASMO).

The support of The Foundation for AIDS Research (amfAr) and the United Nations Development Program (UNDP) has allowed ASPIDH’s actions to grow and become consolidated. Lissa Alfaro, We Are Healthy Project Coordinator, stated that “at first we only had small premises for offering advice, but with this project we were able to rent other adjacent premises for health care. The centre is located in the old town of San Salvador, which facilitates the health care of around twenty transgender people every day.”

The aim was to generate a space free of stigma and discrimination for the transgender community. In this context, spaces were promoted for socialization

Recently a new project has been signed with PASMO and funding has been found from the US development agency USAID for the next five years. Although this

“I’ve just had a breast operation as a result of injecting myself with oil 12 years ago in a desperate bid to become female. The process leading to the surgery to remove the oil took two years, going from one appointment to another, even though the doctors knew my life was at risk (…) The worst thing was that they left me in the men’s ward and the justification was that there were no protocols for hospitalizing transgender people. It has all been painful and traumatic, and when I asked the doctor to refer me to a psychologist, he told me I didn’t need one, that I’d soon get used to living without breasts”, Yamileth Gallardo.

project focuses on providing leisure activities, it will also allow the centre to continue functioning at the times already established, thus guaranteeing access to services for hundreds of transgender people. In this regard, Gabriela Miranda, education promoter and ASPIDH member, commented that “at present we can continue to put on film screenings, forums, debates, workshops, trainings and coordination meetings. Also, the space is useful so that all those who come here can receive information on correct and consistent condom use and a prevention kit. The centre also provides training on human rights and gender identity.”

Final thoughts health services for this population, including assistance in feminizing hormone regimens as well as training processes for health staff to guarantee better health care.

In 2009 the Ministry of Public Health and Social Welfare of El Salvador passed a series of actions to reduce homophobia and any form of discrimination based on sexual orientation in the health services. A ministerial decree guaranteed access to health services and respect for human rights, but did not make explicit mention of transgender people and their differences. This was a significant step, but not enough, as it is necessary to include gender identity in this agreement.

ASPIDH members consider that in the short term it is necessary to broaden and improve advice and access to feminization treatment, the permanent availability of HIV testing and other sexual and reproductive health services. Likewise, it is important to apply for additional funding to broaden the centre’s services and strengthen coordination and communication with health centres nationally.

Transgender activists consider that the strengthening of their community will bring better living conditions in the short term. “The response for the transgender community hasn’t been the right one because there wasn’t a voice or any direct actions for our community”, explained Monica Hernandez, member of the Latin American and Caribbean Network of Transgender People (REDLACTRANS, Red Latinoamericana y del Caribe de Personas Trans).

The centre has not only become a point of reference for the transgender population of San Salvador, but it has also succeeded in improving the quality of life of many people. In this respect, Katerin, a young transgender beneficiary and team volunteer, commented: “It was here that I had my first HIV test. Now I come here for condoms, I’m studying thanks to the encouragement they’ve given me and I can come here to do my homework. I feel good because we are all equal.”

As a result of the community’s actions, health care for transgender people was incorporated into the National Strategic Plan for the prevention, care and control of STIs/HIV-AIDS (period 2011-2015) which includes the provision of sexual and reproductive

ASPIDH ARCO IRIS The Solidarity Association for Driving Human Development (ASPIDH, Asociación Solidaria Para Impulsar El Desarrollo Humano) is a non profit apolitical non- governmental association that aims to promote, defend, demand and generate respect for the human rights of transgender people in El Salvador. ASPIDH carries out actions in awarenessraising, education, technical-vocational and advocacy training in the area of human rights. In addition, it provides preventative and care services for HIV, STIs and sexual health in general. ASPIDH ARCO IRIS seeks to be a leading, nationally and internationally-recognised organization in the area of protecting the human rights of transgender people, contributing to reducing transphobia, homophobia, stigma and discrimination, channelling efforts towards access to work, education, health and social security among the transgender population on El Salvador.

International HIV/AIDS Alliance International Head Office – United Kingdom Tel: +44 (0) 1273 718900 Fax: +44 (0) 1273 718901 mail@aidsalliance.org www.aidsalliance.org

REDLACTRANS Regional Secretariat Callao 339 6º Piso C1022AAD Buenos Aires - Argentina Tel/Fax: +54 11 5032 6335 secretariaregional@redlactrans.org.ar www.redlactrans.org.ar

ASPIDH “ARCO IRIS TRANS” Plaza Orleans, Calle Arce e/ 21º y 19º Avenida Norte, dos cuadras arriba del edificio del Programa Nacional de VIH /MINSAL Local Nº 18 Nivel A Centro de San Salvador, El Salvador Tel: + 503 21310268 org_unionarcoiris10@yahoo.com

The conquest of the Country Coordinating Mechanism On three years of participation by transgender people in the Honduras Country Coordinating Mechanism. On 4 February 2009, seven years after the birth of the Country Coordinating Mechanism in Honduras (CCM-H), a transgender person1 participated in the representation of her population as a full member of this body. The responsibility was that of Nahomy Otero of the Transvestite, Transgender and Transsexual Collective (CTTT, Colectivo Travesti, Transgénero y Transexual) of San Pedro Sula. From this moment onwards the transgender community has been able to make its voice heard in this multi-sector coordination space in response to AIDS, tuberculosis and malaria. Clearly, the participation of transgender people in the CCM-H contributes to sharing the needs of this community and giving greater legitimacy to this multisector, democratic and inclusive space.

Background concerns of transgender people, as most of the proposals or issues came from men who have sex with men (MSM) and sex workers’ groups. Although in 2008 Nahomy Otero was elected to represent the civil society sector, only in 2009 were transgender people fully included as full members of CCM-H.

The Country Coordinating Mechanism of Honduras (CCM-H) was set up in 2002 as a condition for approving funding and execution of a national proposal financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to stop and reverse the impact of these three diseases in Honduras. The CCM would be responsible for submitting proposals and supervising their implementation, acting as a gathering point to record the needs of the most affected groups, including transgender people.

Step by step The first quarter of 2009 was important for the inclusion of transgender people in the CCM-H. Claudia Spellmant, leader of San Pedro Sula and current representative of transgender people in the CCM-H, explained: “It was we, as Colour Pink Unit Collective

In its initial form, government and civil society representatives participated in equal numbers. However, neither of these sectors transmitted the 1

A transgender person has a gender identity other than the sex by birth. In this study we refer to transgender people as those with a feminine gender identity.

(Colectivo Unidad Color Rosa) who lobbied and advocated to get a transgender representative into the CCM-H, as we were included in the chair in the sector of men who have sex with men.” Following an explicit recommendation of the Global Fund to include in the make-up of the CCM those populations most vulnerable to the three diseases, the Colour Pink Unit Collective submitted a request for inclusion to the Mechanism. In addition, at meetings with civil society members, Nahomy Otero advocated for the direct participation of transgender people and requested backing to carry the proposal to the Assembly to grant transgender people a place in the Mechanism, in the capacity of full members. On 4th February, the CCM Assembly approved restructuring to include the transgender community as a full member, with direct participation, voice and vote. In turn, in a full and democratic election, transgender people elected Otero as their representative.

“It was we, as Colour Pink Unit Collective (Colectivo Unidad Color Rosa) who lobbied and advocated to get a transgender representative into the CCM-H, as we were included in the chair in the sector of men who have sex with men”, Claudia Spellmant, leader of San Pedro Sula.

The continuous desire and struggle to give visibility to and identify transgender people was decisive in attaining their participation in the Mechanism. In addition, they stated firmly and on numerous occasions that they did not wish to be included within the gay or MSM population. Spellmant acknowledges the importance of regional alliances, commenting: “the Latin American and Caribbean Network of Transgender People (REDLACTRANS, Red Latinoamericana y del Caribe de Personas Trans) helped us to reflect on the importance of being present in the CCM-H and making our voice heard in this space.”

the Global Fund are decided, and as a representative I put forward the needs and demands of the transgender community to the CCM-H.” Being a member and participating in the CCM is an achievement in itself. Spellmant explains: “It has meant a lot. Now we know what business is dealt with there, we know the opinion of the government, donors and agencies and their interest in working with the transgender issue. We have started to demand fairness and equality in the proposals that are approved by the CCM-H.”

In addition, it is important to acknowledge the support of UNAIDS in organizing the 1st Congress of Transgender People. Here, they were able to organize as a social collective, developing skills and leadership to attain important spaces and forums, such as the CCM.

Achievements

Finally, participation in the CCM has given them the opportunity to develop new political and work alliances with various civil society organizations and international aid agencies, such as UNAIDS. They were congratulated on this by Professor Michel Kazatchkine, former Executive Director of the Global Fund, who highlighted the participation of transgender people in the CCM-H as genuine proof of inclusion and democratization.

With their inclusion in the CCM, transgender people are now recognised as leading figures in the response to AIDS in Honduras. Claudia Spellmant believes that “it is of great importance for the transgender population to be present in this democratic, inclusive and transparent decision-making space, as it is here that the actions to be taken as regards funding from

Growth in CCM participation

Challenges to participation

Trans people are one of the groups most vulnerable to the HIV epidemic in Honduras. However, up to now the projects submitted by the CCM-H to the Global Fund have scarcely included them, and consequently the funds allocated to activities for this population have been quite low: only 3% of funding is allocated to the MSM population, and of this fraction, very few resources are allocated to actions specifically aimed at transgender people.

The recent political participation of transgender people organizations in the CCM-H has shown the weakness of the population in the technical skills necessary for negotiating and submitting their demands in the decision-making spaces. Technical support, in this context, is of great importance. The transgender people organizations have stated their need for technical support to improve available information and knowledge about their population, to build a better structure as an organization and receive technical support so that their participation can be more effective in different political spaces, including the CCM.

There lies the importance of participating in decisionmaking spaces for the national response to AIDS. The CCM-H is one such space, and guaranteeing the allocation of resources for preventive actions, strengthening the organization and promoting human rights for transgender people and other more exposed groups (the Garifuna ethnic group, people deprived of their freedom, sex workers, men who have sex with men), is now very significant.

They have also reflected on the differences within their organizations and the importance of maintaining a coordinated movement with a clear political agenda. This has led them to discuss the need to maintain channels of communication and awareness-raising in the transgender community about the CCM-H, to contribute to determining the necessary actions to attend to this population and position it on the public agenda.

Participation at meetings and in negotiation processes within the CCM-H has contributed to the political growth of the transgender people representatives. In addition, as Claudia Spellmant highlights, there is now more understanding about the CCM and the importance of support among civil society organizations: “I understand the structure, the platform, now I know where I stand, I know what contributions I can make, when I can vote in favour, when I can negotiate, this is the time when I have to be present (…) I feel very important having a voice and a vote (…)”

“It has meant a lot. Now we know what business is dealt with there, we know the opinion of the government, donors and agencies and their interest in working with the transgender issue. We have started to demand fairness and equality in the proposals that are approved by the CCM-H”, Claudia Spellmant.

Final thoughts The efforts to attain the participation of transgender people in the CCM-H have been encouraged by the support of REDLACTRANS, UNAIDS and civil society organizations. The importance of this population’s participation in the Mechanism was evident, due to their condition of social exclusion, violence and violations of rights and their risk of HIV infection.

would be possible if information were available on the community’s living conditions, and by establishing communication mechanisms, holding meetings with leaders and transgender organizations for decision-making in the CCM-H, and by consolidating the exchange of experiences with organizations and CCMs from other Latin American countries.

It is necessary, nevertheless, to continue with these efforts to strengthen the participation of transgender people in the CCM. This

Colectivo Unidad Color Rosa The Colectivo Unidad Color Rosa (Colour Pink Unit Collective) is a social organization for the protection and recognition of human rights of sexually-diverse populations, committed to obtaining full enjoyment of opportunities, respect, and legal, social and institutional recognition, without discrimination for transgender people and their organizations. The Colour Pink Unit Collective aims to improve key populations’ skills and capacities so that they can implement effective community responses to defend and exercise their human rights —mainly civil and political rights, sexual and reproductive rights—, building alliances with other civil society organizations and participating in political decisionmaking spaces. In addition, it works for the reduction and prevention of HIV in the Honduran transgender population and for access to integral health care.

International HIV/AIDS Alliance International Head Office – United Kingdom Tel: +44 (0) 1273 718900 Fax: +44 (0) 1273 718901 mail@aidsalliance.org www.aidsalliance.org

REDLACTRANS Regional Secretariat Callao 339 6º Piso C1022AAD Buenos Aires - Argentina Tel/Fax: +54 11 5032 6335 secretariaregional@redlactrans.org.ar www.redlactrans.org.ar

Colectivo Unidad Color Rosa (CUCR) San Pedro Sula, Barrio Cabañas, 12 Calle y 12 Avenida, Casa Nº 1141 Tel/Fax: +504 2554 3038 ctravesti@yahoo.es

The formalization of sex work by transgender people in Uruguay Legalizing our reality, a process of advocacy for the formalization of sex work to ensure welfare benefits for transgender people.1

First steps in implementing these actions

Is it possible to change the current perspective society has of transgender people who perform sex work? Does the legalization of sex work as performed by transgender people really change their lives?

The political context was ideal for attaining equality of opportunities and conditions for all persons. In addition, a progressive government provided a favourable environment for new low-cost labour normalization. It was towards this goal that ATRU moved in its advocacy process.

In search of answers to these questions, the Transgender Association of Uruguay (ATRU, Asociaci贸n Trans del Uruguay) began a process of advocacy in June 2010 which gained recognition and even the inclusion, by decree, of transgender people who practice sex work, in a work category. At present, they have the right to benefits such as health insurance, pension, and the same welfare benefits as any worker.

ATRU also took advantage of the location of the BPS in the city of Montevideo and its proximity to different congressmen to strengthen its advocacy actions with continuous approaches to and meetings with the corresponding authorities.

To develop and implement the process, ATRU took into account the legal precedents: In 1995, the social security institute Banco de Previsi贸n Social (BPS) recognised sex work by women; in 2002 the Sex Work Law (Law no. 17,515) was passed, defining the legal conditions for its practice; and finally, December 2009 saw the passing of a law to extend these rights to men and transgender people who practice this work. Despite these advances in the law, full exercise of these rights was limited by the high cost of social security contributions and difficulties in administering and following up registration procedures in the social security system that would ensure access to pensions, as well as integration into the National Health Fund.

In addition, ATRU realized that success in the advocacy process would require political allies as

A transgender person has a gender identity other than the sex by birth. In this study we refer to transgender people as those with a feminine gender identity.

with other populationsâ&#x20AC;&#x2122; proposals as part of a more inclusive strategy.

well as articulation with other governmental and civil sectors. To make the existent reality visible, special emphasis was given to meetings with the UNAIDS focal point and with representatives of other organizations of activists working in the area of sexual diversity and human rights.

Overcoming obstacles The triumph of this initiative was possible thanks to the fact that transgender people fully understood the benefits of the legalization of sex work and, more importantly still, the low cost that this would entail in the new social security system.

With some alliances in place, information was gathered on transgender people who had unsuccessfully attempted to get pensions, and a database was also created of transgender people who practiced sex work and could not formalise their work due to the high costs involved. The initiative showed that transgender sex workers lived in a situation of social exclusion and economic marginalization.

One factor that had to be overcome was the lack of initial interest from transgender people in approaching the BPS. The challenge was to educate people in the social benefits to be attained from the legalization of their work.

With this information, ATRU raised the issue in each and every meeting it attended. As a result of these actions, they managed to secure a meeting with the national director of the BPS. With this, there began a process to discuss and draft a decree proposal for a new regulation that would allow other social security contribution options for those who practiced non-conventional work that was not included in the social contributions system in force. In addition, the observations made to the current legislation were systematically documented to be sent to the Executive Power along with an initiative of reforms to be considered.

The process included the identification of key transgender people, trained and experienced in advocacy actions, as their participation was needed in meetings and in putting forward a well-articulated discourse, which would meet the needs of a carefully designed strategy to attain the success of advocacy actions with BPS authorities. To advance towards the attainment of social benefits, it was necessary to make transgender sex workers visible, help them to express themselves about sex work and to develop skills for negotiating and speaking with the authorities, demanding and advocating for change. For all this a training process was planned within the transgender people community in parallel with advocacy actions.

Although for ATRU the key population that would benefit from this initiative were transgender people who practiced sex work, it had to resort to its capacity for dialogue and its skills in order to partner

The most important challenge was to identify the key players within the transgender community to carry forward the advocacy process. For this, key players were involved at national level, and a communications campaign was developed that took in the particularities and inputs of the other Uruguayan states (departamentos) so that they could participate and join in the initiative.

â&#x20AC;&#x153;All our colleagues become aware of the advantages of legalization and social security contributions, so that all of them can register with the BPS and access the social benefitsâ&#x20AC;?, Gloria Alves, ATRU president.

Furthermore, it was necessary to raise awareness among fundamentalists, religious groups and any organization opposed to the initiative, as the action strategy would give visibility to sex work exercised by transgender people, something which is commonly hidden in society. This awareness-raising process included dialogue actions with leaders of other groups, as well as participation in public debates.

Lessons learned

“Uruguay is one of the pioneering countries in this type of decree, and can be used as an example by other countries that may learn about the achievements and replicate our actions according to their own idiosyncrasies and realities”, Gloria Alves, ATRU’s director.

An important factor in attaining new regulations that would allow transgender sex workers to access social benefits was the capacity for articulation with other social organizations from different populations, such as women sex workers, rural workers, artisans’ cooperatives, among others, as well as bodies such as the United Nations, where the emphasis was always on the importance of teamwork. The work to systematise the laws and regulations in force, as well as the analysis and consolidation of proposals to regulate the pensions and social benefits system coming from different sectors was of great importance to the development of this initiative. This made it possible to find and document the existing information and helped to identify the points to be strengthened, which in turn highlighted the opportunity provided by organized actions.

of legalization and social security contributions, so that all of them can register with the BPS and access the social benefits.” There remains one pending task: to develop a mass communications strategy with the requisites for and benefits of registering in this new social welfare system, so that more transgender people can legalise their situation and get the benefits that this entails, including the right to pension and comprehensive coverage with the national health fund for them and their immediate family.

Training and direct permanent work with transgender people provided the necessary tools for the design and creation of a proposal that the whole community agreed on. In addition, the inclusion of transgender people throughout the whole process helped to show their legitimacy and showcased to the authorities the situation of the transgender population that needed a legislative change. The economic investment of ATRU members in the project activities helped us meet our goal of guaranteeing transgender sex workers’ rights; they themselves paid for the necessary costs of travel and communications.

ATRU will continue to encourage the full exercise of transgender people’s rights, especially the right to equality, so as to eliminate differences in Uruguayan society, where there still exist first and second class citizens.

Looking to the future ATRU president Gloria Alves expressed her wish that “all our colleagues become aware of the advantages

Final thoughts The new social security contributions mechanism implies an option for the formalization of sex work by transgender people, one of the activities that, as a result of stigma, had been left out of BPS coverage, and consequently left this group of workers without access to social security.

people grouped together in ATRU. But what made the initiative successful was the work to promote among the general population awareness of rights and social inclusion. This is certainly a great advance for the recognition of human beings with their own identity, orientation and occupation. And it is a cultural and political breakthrough whose impact has yet to be measured.

This social security system is an option whereby in complying with certain conditions, people can access all social security benefits by paying a small sum.

ATRU’s director stated that “Uruguay is one of the pioneering countries in this type of decree, and can be used as an example by other countries that may learn about the achievements and replicate our actions according to their own idiosyncrasies and realities.”

The initiative was developed at an ideal time for labour inclusion and the formalization of sex work. Various efforts came together under the coordinated action of different bodies and social organizations, and as systemized by the transgender

International HIV/AIDS Alliance (la Alianza) The Alliance is an international non-governmental organization whose mission is to support communities to reduce the spread of HIV and face the challenges of AIDS. It was founded in 1993 and its head office is in the United Kingdom. In a context of a greatly concentrated epidemic, the Latin American and Caribbean team focuses its work on key populations, such as people living with HIV/ AIDS, gay men and other MSM, sex workers, and transgender people. Its mission is to offer support to community groups so that they are at the forefront of the response to the epidemic. At national level, the Alliance works with liaison organizations and partners in Mexico, Peru, Bolivia, Ecuador, El Salvador, Haiti and the Caribbean. At regional level, the Alliance works with strategic partners: regional community networks of key populations, with coverage in most countries in the region.

Asociación Trans del Uruguay (ATRU) ATRU (Transgender Association of Uruguay) has been working since 1994 in support, motivation and peer-counselling activities with a focus on building self-esteem, social support networks, and prevention of the transmission of STIs and HIV, as well as promoting damage-reduction strategies. Its work is mostly voluntary, and it has received funding on some occasions. ATRU directly supports transgender people and sex workers. In addition, it visits and provides emotional support for people who have been admitted to hospital, and in processing the health care card and free passes on urban transport for transgender people living with HIV. ATRU participates in different national and international networks and is REDLACTRANS’ main representative organization in Uruguay. It is a full member of the National AIDS Commission and the Country Coordinating Mechanism, and is part of the Commission for the Regulation of Sex Work.

International HIV/AIDS Alliance International Head Office – United Kingdom Tel: +44 (0) 1273 718900 Fax: +44 (0) 1273 718901 mail@aidsalliance.org www.aidsalliance.org

REDLACTRANS Regional Secretariat Callao 339 6º Piso C1022AAD Buenos Aires - Argentina Tel/Fax: +54 11 5032 6335 secretariaregional@redlactrans.org.ar www.redlactrans.org.ar

Asociación Trans del Uruguay (ATRU) Tel: +598 2411 1335 atru2006@yahoo.com.ar

Conclusions 1.

There has been intense work in recent years by organizations that defend transgender peopleâ&#x20AC;&#x2122;s rights. Their groups and other civil society organizations, as well as international bodies, have contributed considerable work in tackling the needs of transgender people.

The case studies include some interventions aimed at strengthening transgender people organizations, promoting their participation in decision-making spaces, providing friendly health services and information, advocating on changes to laws to guarantee the social security of those transgender people who are sex workers and to respect gender identity. All these interventions have received the support of other civil society organizations and international cooperation agencies.

Being fledgling organizations, the transgender peopleâ&#x20AC;&#x2122;s organizations are still in a process of organizational consolidation, development of alliances with other movements and definition of the national agenda. Despite this, it can be seen from the different case studies that there is a tendency to broaden the response of the organizations to those decisive social factors that place transgender people in a situation of vulnerability to HIV.

In the various case studies there is clear evidence of support for the initiative coming from a broad social movement. A broad community base, trained and participative, makes it possible to show the effects of the actions to UN agencies, State organizations and society as a whole and thus get them to trust the work that is being done.

Some of the case studies reflect the challenges that organizations have had to face due to membersâ&#x20AC;&#x2122; technical weaknesses. It is therefore important to develop a technical assistance plan which will allow them to develop skills for the success of the interventions planned by transgender people organizations.

Recommendations 1.

Using the initial interventions as a starting point, the transgender people organizations should consolidate and construct long-term plans, conceiving and devising effective strategies that allow them to achieve lasting changes and mobilize resources.

To attain structural changes in society, long-term actions are needed. It is therefore important to generate and strengthen new leaderships that in turn can bring in other people and thus renew and strengthen the transgender people movement.

The various case studies show the advantages of strengthening the identity of the transgender collective and also maintaining alliances with other groups vulnerable to HIV/AIDS. To do so, it is necessary for transgender people organizations to develop an agenda and establish goals that they wish to attain. In this way, it will be possible to approach other groups and develop beneficial alliances.

Due to their recent creation, the transgender people organizations need strengthening in different areas, primarily in the area of administrative work. It is therefore important to clearly identify the technical assistance needs and to consolidate these in a technical assistance plan that will allow them to develop skills for succeeding in the interventions planned by their organizations.

Many of the cases studied had not been sufficiently shared previously, and their achievements and lessons learned had been reserved only for the closest organizations. Sharing of experiences can bring the organization not only prestige, but also new opportunities for consolidation and development.

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