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Redalyc.Transgender Health in Cuba: Evolving Policy to Impact Practice MEDICC Review ISSN: 1555-7960 [email protected] Medical Education Cooperation with Cuba Estados Unidos Gorry, Conner Transgender Health in Cuba: Evolving Policy to Impact Practice MEDICC Review, vol. 12, núm. 4, 2010, pp. 5-9 Medical Education Cooperation with Cuba Oakland, Estados Unidos Available in: http://www.redalyc.org/articulo.oa?id=437542081002 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Policy & Practice Transgender Health in Cuba: Evolving Policy to Impact Practice By Conner Gorry MA Gender Minority Health: Key Concepts & Terms “I never felt like a boy. In school I was rejected, made fun of, and mistreated… There were times I wanted As the field of sexual and gender minority health evolves, so too have the ter- to kill myself. No one chooses this,” confides Mavi minology and concepts for relevant population-based research. One important Susel, protagonist of the 2010 Cuban documentary element is the use of inclusive, non-discriminatory language, which also allows In the Wrong Body (En el cuerpo equivocado). On a person to self-identify. Below are some key terms and concepts currently May 22, 1988, Mavi became the first Cuban to re- used in the gender minority health field. ceive sex reassignment surgery on the island. Her tale of stigmatization, solitude and pain is not uncom- • Gender – social construct of biological, psychological, and cultural factors mon in Cuba or the world at large. typically used to classify individuals as male or female • Gender identity – psychological recognition of oneself, as well as the wish Rejecting one’s biological sex due to the discordance to be regarded by others, as male, female, or other (that which does not between an individual’s genitalia (biological sex) and conform to society’s dichotomous gender distinctions) their gender identity (psychological sex) is the defi- nition of transsexuality. “This incongruity is felt pro- • Gender variance – atypical development between an individual’s gender foundly by transsexual people, is permanent, and identity and their biological sex causes great anguish,” internist Dr Alberto Roque told MEDICC Review. “This anguish can result in • LGBT – lesbian, gay, bisexual, and transgender severe mental health disorders, usually related to • Intersex – term used to describe a biological variation whereby a person is discrimination, stigmatization, and rejection.” In turn, born with both or certain facets of male and female physiology victimization renders some transgender people re- luctant to seek medical care or fully disclose their • Sex reassignment surgery (SRS) – surgical alteration to one’s biologi- gender identity when they do.[1] cal sex; not all transgender people choose, are eligible for, or (in contexts other than Cuba where care is free) can afford SRS Global evidence also shows that transgender people (see box: Gender Minority Health: Key Concepts & • Transgender – umbrella term used to identify people exhibiting gender Terms) suffer from health disparities due to unad- identities and/or expressions not traditionally associated with the sex they were assigned at birth, including transsexuals and cross-dressers; not all dressed health needs and behavioral risk factors transgender people opt to alter their bodies hormonally or surgically specific to this population, coupled with barriers to care such as inequitable access to services and a • Transition – multi-faceted process of altering one’s birth sex which in- lack of knowledgeable and compassionate practitio- cludes legal, medical, and cultural adjustments ners.[2–4] • Transphobia – irrational fear and/or hostility towards transgender people Recognizing that gender variant people have unique health needs and that the Cuban Constitu- • Transsexual – refers to individuals who are in the process of altering, or tion enshrines their right to health care, the struggle have already altered, their birth sex; not all transgender people identify as transsexual to guarantee that right was begun in Cuba in the 1970s, opening the way for a more comprehensive Source: Lesbian, Gay, Bisexual & Transgender Community Center, New York. Trans approach and Mavi’s sex reassignment surgery by Basics: Glossary of Terms. 2010 1988. However, the fact that it would be two decades before another such surgery was performed speaks to the medical, legal and sociocultural complexities of developing rights-based policies and practice in a minefield of ty, JR had begun altering his appearance and behavior to incor- widespread and sometimes overwhelming gender-related bias. porate traditional male attributes. As he matured, he continued to construct a male gender identity. Towards a Rights-Based Approach Over the past 50 years, policies affecting sexual and gender mi- The ensuing debate reached the Federation of Cuban Women norities in Cuba have evolved from discriminatory, exclusionary (FMC) led by Vilma Espín, which proposed creating a multidisci- and even punitive, towards a more inclusive, rights-based ap- plinary team to better understand gender variance. The team was proach.[5] The uphill battle waged in the health arena against established in 1979 and, reflecting the conceptual framework of traditional gender constructs, as well as homo- and transphobia, that time, was called the National Task Force for the Diagnosis & was spurred among other things by diagnosis of the first Cuban Treatment of Gender Identity Disorders;[7] it was coordinated by transsexual in 1972. Then 23, “JR” was a hard worker noted for the National Working Group for Sex Education (later the National his “dedication, responsibility and discipline,” and was “well liked Center for Sex Education, CENESEX). The Task Force reviewed and respected by his co-workers.” Yet, he felt like “a man trapped leading scientific evidence in the field and, advanced for its time in in a woman’s body” from a very young age.[6] Even before puber- Cuba, convened a group of specialists to provide services and sup- MEDICC Review, October 2010, Vol 12, No 4 5 Policy & Practice port for transsexual people. These included clinical services such as of health care, but go well beyond to address a broader notion of psychological counseling, hormonal therapy, and sex reassignment health and well-being. They include: developing integrated clini- surgery. As a result of the Task Force’s work, including lobbying and cal and mental health care for gender minorities; setting trans- legal guidance over the next decades, Mavi’s sex reassignment sur- sexual research priorities; designing public education and com- gery became the country’s first, and 13 transsexual Cubans were munication strategies; implementing sensitivity training programs; able to change their names and photos on their government-issue and proposing legal mechanisms to protect the social and civil identity cards in 1997. Small, but important first steps. rights of transsexual people. Several observations on these early experiences are pertinent The Strategy mandates intersectoral cooperation among the Minis- to later developments: first, the initial impetus for change came tries of Health and the Interior, Supreme Court, Attorney General’s from health care institutions that joined forces with the national office, and social and political organizations such as the FMC, labor women’s organization. This enabled the right to health care to unions, and neighborhood block associations. Organizationally, it trump other arguments, and underscored the need for a broader is coordinated by the National Commission for Comprehensive At- focus if that essential right were to be fully guaranteed. In turn, tention to Transsexual People, established in 2005. Like its precur- this opened the way to wider discussion of lesbian, gay, bisexual sor the National Task Force, the Commission is a multidisciplinary and transgender (LGBT) issues. team. It brings together representatives of various ministries and other specialists to provide informed, integrated health care and In Their Own Words other services to address the needs and rights of the island’s trans- “People don’t understand—they think it’s sexual population. Thus, Commission members include medical and non-medical professionals, such as: cosmetic surgery, something to smooth out Psychologists Psychiatrists wrinkles, but it’s a person’s life at stake.” Sociologists Lawyers – Mavi Susel, In the Wrong Body Educators Social Workers Gynecologists Dermatologists It is useful to note that Cuban media historically have shied away Internists Nurses from talking about sexual diversity because “it bothers people,” Geneticists Otolaryngologists and government at one point had cited “angry letters” as a reason Endocrinologists Surgeons to defer debate on civil unions and discrimination based on gen- (general and cosmetic) der identity.[8] The national discussion currently emerging reveals that traditional gender constructs, including machismo, contain Others, such as historians, anthropologists, and media and com- deeply-rooted societal perceptions about LGBT people, present- munication professionals, also collaborate with the Commission. ing tough obstacles to change. “In my day they would keep out of sight to do their things, while outside they looked just like the Nevertheless, the first policy shifts have targeted health care, no- next
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