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By Dr. Verity Sullivan

Imagine if being “you” meant that you were more likely to be murdered, catch HIV and to suffer at the hands of the authorities that are designed to protect you? A concept incomprehensible to many, this is the brutal reality faced by countless transgender (trans) people around the globe.

Argentina is a country with a prominent trans community, possessing some of the most advanced trans legislation in the world. Passed by the Kirchner government in 2012, its Gender Identity Law allows anyone to legally change their name and sex without the need for medical or legal approval. It also provides access to gender-reassignment care via the public health system. To date, over 10,000 people have changed gender on their official documents, although the true number of people identifying as trans in the country remains unknown.

The positive impact of the legislation is indisputable with countries around the world modelling their own laws on Argentina’s success. Its effects include less discrimination within the public systems, a growing self-motivation from men to pursue stable relationships with trans women and a feeling of promise that the trans voice is finally being heard.

However, unacceptable levels of stigma, abuse and social isolation still torture this community. The majority lack economic, social and political rights and whilst headway is being made, for example the Argentine law that now requires at least 1% of jobs in public agencies be allocated to the transgender community, progress remains painfully slow. And with the spotlight currently shining on trans issues worldwide, such as the brute opposition in the US against trans students simply wanting to use the toilet they wish, it’s clear that we still have a long way to go.

Worldwide, a disproportionate number of trans people are sex workers, with over 80% of trans women in Argentina reported to have been sex workers at some time in their lives. Being a sex worker comes with baggage, with unprovoked verbal, physical and sexual abuse a daily occurrence for trans women working on the streets.

“The main reason sex work happens is because girls are kicked out of their homes young and don’t finish school,” says Nadir Fernanda Cardozo, a trans woman, activist and representative for the Association of Transvestites, Transsexuals and Transgenders Argentina (ATTTA). “They come searching for a new life in the city and the only work they can get is on the street.”

Prostitution itself is not formally criminalised in Buenos Aires, though a federal “anti-trafficking” law is in place to safeguard victims of coercion. A recent report from Amnesty International that uses Buenos Aires as a case-study has called for the decriminalisation of sex work and clear distinctions between what constitutes trafficking and the consensual selling of sex. Alongside a number of women’s rights groups such as AMMAR, they feel this will provide sex workers, both cis and trans, with more rights and reduce the unacceptable rates of police persecution.

Unsurprisingly, high rates of sexually transmitted infections (STIs) are seen, with HIV prevalence rates in trans women estimated at 34% in Argentina versus 0.4% in the general population. Consequently, the average life-expectancy of a trans woman in Argentina is just 35-years-old.

Whilst prevention efforts have had a significant effect, shockingly high levels of discrimination within the health system itself remain problematic. This phenomenon exists in health systems worldwide to various degrees, often due to lack of knowledge and inexperience in managing the needs of trans people. Discriminatory behaviour can range from not being called from the waiting room by one’s chosen name to being sexually assaulted by a healthcare professional. The result is low numbers of a high-risk population attending for HIV tests and care, leading to late diagnosis and more HIV passed on.

“These women just aren’t coming to the hospital,” says Dr. Claudia Frola, a HIV and trans health specialist. “We don’t understand enough about how their lives work and the health system needs to adapt to the needs of this population which are totally different than any other.”

Fundacion Huesped is a non-governmental organisation (NGO) in Buenos Aires working to empower trans people in terms of their health and human rights. Their projects include the “test at home” scheme, which involves a specialist team visiting groups of trans sex workers at their homes to perform same-day HIV testing and discuss trans health. The project provides a safe environment for discussion and a positive HIV test result leads to speedy integration into specialist, non-judgemental medical care.

Another project is looking at the use of Pre-exposure Prophylaxis (PrEP) in trans sex workers in Buenos Aires: preliminary studies have shown a significant interest in PrEP from this group and with the effects of PrEP in preventing HIV acquisition indisputable, a study like this is essential.

With Argentina’s new government still in the first year of it’s administration, eyes are firmly on Macri’s cabinet to see that they continue to strive for the rights of the trans community. As is the case globally, discrimination and ill-treatment from the police is a huge problem for trans people, particularly sex workers, who are frequent victims of profiling, police violence and theft. There are even reports of police officers extorting money from clients by threatening to tell their partners that they’ve been found with a sex worker.

Argentina’s trans climate is a revealing one. With advanced legislation but a reality that lags regrettably behind, it starkly demonstrates how developing a safe environment for minority groups worldwide needs more than a bill passed. We need more highlighting of the trans community in the media, education for health professionals and other public service workers about trans issues and clarity over sex work legislation. This is alongside finding better ways of accessing the trans community itself.

So often victimised or portrayed as problematic, trans individuals are rarely acknowledged for the bravery that they have shown to pursue their true identity. And even less so for the patience they have for other people’s attitudes and beliefs, something the non-trans community could do with a lot more of.

“We Have The Right To Be Happy” – Short film produced by James Lovage (@jameslovage) and Verity Sullivan (@DrVesSullivan) – with thanks to Nadir Fernanda Cardozo, Dr. Claudia Frola, Shona Waldron and Matias Coleff

Article first appeared on the Huffington Post.

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