“We're Going to Leave You for Last, Because of How You Are”: Transgender Women's Experiences of Gender-Based Violence in Healthcare, Education, and Police Encounters in Latin America and the Caribbean

Abstract

Transgender (trans) women experience gender-based violence (GBV) throughout their lives, which impedes their access to services and contributes to poor health outcomes and quality of life. To inform policies and health programs, trans women worked with the United States Agency for International Development (USAID)- and President's Emergency Plan for AIDS Relief (PEPFAR)-supported LINKAGES project, the United Nations Development Programme, The University of the West Indies, and local organizations to document experiences of GBV and transphobia in healthcare, education, and police encounters. Trans women conducted 74 structured interviews with other trans women in El Salvador, Trinidad and Tobago, Barbados, and Haiti in 2016. We conducted qualitative applied thematic analysis to understand the nature and consequences of GBV and transphobia and descriptive quantitative analysis to identify the proportion who experienced GBV in each context. A high proportion experienced GBV in education (85.1%), healthcare (82.9%), from police (80.0%), and other state institutions (66.1%). Emotional abuse was the most common in all contexts and included gossiping, insults, and refusal to use their chosen name. Participants also experienced economic, physical, and sexual violence, and other human rights violations based on their gender identity and expression. At school, participants were physically threatened and assaulted, harassed in bathrooms, and denied education. In healthcare, participants were given lower priority and received substandard care. Healthcare workers and police blamed participants for their health and legal problems, and denied them services. From police, participants also experienced physical and sexual assault, theft, extortion for sex or money, and arbitrary arrest and detention. Participants had difficulty obtaining identification documents that matched their gender identity, sometimes being forced to alter their appearance or being denied an identification card. Service providers not only failed to meet the specific needs of trans women but also discriminated against them when they sought services, exacerbating their economic, health, and social vulnerability. Although international and regional resolutions call for the legal protection of transgender people, states do not meet these obligations. To respect, promote, and fulfill trans women's human rights, governments should enact and enforce antidiscrimination and gender-affirming laws and policies. Governments should also sensitize providers to deliver gender-affirming services.

The promise of an intersectoral network in enhancing the response to transgender survivors of sexual assault

“…Trans survivors of sexual assault who have accessed services have reported having experienced fear, victim-blaming, unequal treatment, feeling unwelcome, verbal harassment, and culturally incompetent service providers [12,16]. The lack of available and accessible affirming services can make trans individuals feel invisible and vulnerable [17].…”

Transphobic Violence in Educational Centers: Risk Factors and Consequences in the Victims’ Wellbeing and Health

“…Findings show that transgender and gender-questioning subjects present a higher vulnerability to violence in comparison to their peers, and they are also the most likely to suffer deeply because of it [37]. As argued in other evidence, transgender female identities are more highly susceptible to any form of transphobic violence [57]. A combination of being part of both a sexual and a gender minority, such as being transgender and lesbian or gay, is also a heightened risk for suffering different forms of distress due to transphobic violence [37].…”

“…Findings point to a range of factors that can influence transphobic violence, as well as its intensity and consequences due to sociocultural factors [37,[51][52][53][54][55][56][57][58][59]. This subsection is divided into two given the pertinence of these factors: internal factors, such as felt gender identity, sexuality, and self-perception, and external factors, such as circumstances and judgments.…”

“…When approaching transphobic violence in educational centers, it is necessary to study how it can be detected and identified, as this configures the possibilities of understanding the real damage, impact, and consequences of this problem. Evidence points to people who perform and execute transphobic violence as the most relevant when mapping this type of violence and developing successful strategies to detect and intervene [51,52,57,58,61].…”

“…Beyond the family context, the environments and the people that have been characterized as the most influential and with a higher impact on the life of TNBAY are those sharing the educational centers: school staff and peers [51,52,57,58,61]. A very wide range of abuse and violence has been found in educational centers against TNBAY exerted by peers, teachers, and school administrators while growing up [51,57], of which the perpetrators were classmates in most cases [57]. The reason for this kind of violence in most cases was TNBAY displaying gender nonconforming behaviors or being perceived as lesbian or gay, linking the abuse against nonconforming gender expressions and sexual orientation as very close problems: transphobic and homophobic violence [51].…”