Virtual Media Launch for Trans Day of Visibility:
The title of the study is Desires for Care and Access to Services among Transgender Persons in Guyana. Semi-structured interviews were conducted with 22 trans and gender non-confirming persons from four regions of Guyana, along with stakeholder interviews, to gain a better understanding of service barriers encountered by trans persons and subsequently, help guide programmatic decisions. The interviews were transcribed, coded, and analysed thematically.
Gender identity and expression and sexuality
- There was initial confusion about gender identity. For example when participants were asked to describe their gender identity a lot of persons made reference to their sex assigned at birth.
- Similarly, when participants were asked to describe their sexual orientation, 7 persons said trans confusing a gender identity category with sexual orientation. However after some conceptual definitions were offered, some participants were better able to describe their gender identity and sexual orientation.
- 18 persons identify as trans women, three as trans men and one as GNC. The largest sexual orientation category was homosexual or gay which was chosen by 6 persons.
- Many persons knew their gender identity from an early age and exhibited gender non confirming behaviour.
- Almost everyone had experiences of stigmatization and harassment because of their gender identity and this occur across a range of spaces – public, private, professional.
- Experiences include: discrimination in seeking job; neglect or being ignored when seeking healthcare; police harassment or abuse; three people mention challenges in using public transportation – assault, being put out; and experience of violence from community members or intimate partner.
The trans experience
- Trans people risk for violence & discrimination increase if they would have experienced family rejection, grew up in a hostile community, have no sense of LGBTQ community, engage in sex work; other factors include: moral & religious beliefs and ignorance.
- Conversely, protective and mitigating factors against violence and discrimination include: being in a profession education/ work environment, having supportive families & teachers, established familiarity with institutions & actors, and a sense of LGBTQ solidarity & belonging.
HIV and access to care
- All participants had sexual experience, with trans women having had male or mostly male partners, while trans men and gender non-conforming persons reported female partners.
- All participants had been tested for HIV in the past and approximately 1/3 were living with HIV and in care.
- Persons living with HIV (PLHIV) relayed their experiences in treatment and care, which included issues with medications and adherence (side-effects and medications being stolen), long waits, authoritative and patronizing staff, discriminatory procedures such as social workers who only deal with PLHIV – thus making identification of status easy.
- Suggestions for improving testing and care were made, with most agreeing that pairing either service with hormone provision would work.
- Other suggestions included educational workshops for trans persons on why they should engage with HIV services; having LGBTQ+ inclusive and friendly spaces; and integrating care with general medical services.
Desire for gender affirming care
- Most persons had not legally changed their name, although many were using non-birth names. Some wanted to have a name change but were unaware of the process.
- About half the participants had accessed mental health counselling or psychotherapy, and for two of those it was a bad experience or unhelpful.
- Most persons would change their gender markers if they could, and one person had successfully done so on their National Insurance Service documents.
- Seven persons had either used hormones in the past or were currently using them. All of them used these medications, bought over-the-counter, without professional guidance from a doctor.
- A minority of trans women wanted vaginoplasty, with others either definitely saying no to the option or being undecided. While a majority of trans men wanted chest surgery.
- Barriers to gender affirming care include: availability, affordability, lack of awareness of service, fear of family or situation, bad past experience.
General recommendations
This study supports the global narrative that transgender people remain one of the most marginalised groups in society with very limited access to economic and social resources, despite having increased visibility in the media and public spaces. The findings also suggest strategies that can be used to change this present narrative in our local context:
- Education and training of service providers across all sectors in gender and sexuality diversity, for example, train trainee nurses, police officers, teachers, and medical and law students in gender diversity and sensitivity and inclusion before they venture out into the service industry.
- Also, there should be non-discriminatory policy at institutions and redress mechanisms where people are held accountable.
- Amendment of legislations to prohibit discrimination in employment on the basis of sexual orientation, gender identity, and expression.
- Finally, a recognised need for capacity building and empowerment sessions for trans community members to address intra-group and inter-personal issues within the community.
