Transgender and gender non-conforming people face many factors that contribute to adverse health outcomes, such as social and structural exclusions and multidimensional poverty. In the Colombian context, trans people are more likely to experience violence in multiple contexts, including police violence, gender-based violence as a result of the armed conflict and structural violence within legal and judicial systems. Within the Colombian Healthcare System, trans individuals further experience exclusions and stigma, barriers to care and violence. The larger aim of this project, working together with a local NGO, Red Comunitaria Trans, seeks to map and characterize the social networks of trans women within this context, eventually creating a cultural adaptation of TransAction, an existing public health and HIV intervention initially designed for trans communities in Hollywood, CA, to meet the needs of trans communities in the Santa Fe neighborhood of Bogotá. The initial phase of this participatory action research project seeks to begin to observe and build relationships within these social networks and spaces. One important narrative is that of Maximo, a pregnant transman and community leader, who throughout his pregnancy experienced numerous difficulties, violent language and exclusion within the Colombian health system. His experiences shine light on the particularly urgent need to address these injustices within the health system and better educate medical professionals on trans sexual and reproductive health issues, not only in Colombia, but globally.
The larger 6-phase project conducted over 12-month period will utilize mixed qualitative and quantitative methodologies. Consistent with a community-based participatory research approach, the first phase primarily consisted of trust building and participant observation with the marginalized trans communities and trans activists. Participant observation was conducted for 7 weeks and systematic field notes were written for all time spent with the community. These data were manually coded and analyzed to find cross cutting themes emerging from the data.
The most urgent and present health priority expressed by the community surrounded Maximo’s pregnancy and his daily difficulties and experiences of exclusion within the health system. Repeatedly highlighted by him, his partner Daniela, and other community members, were experiences of structural exclusion, violence, erasure and invisibility.
Maximo’s experience, highlighted and prioritized by the trans community in Bogotá, underscores the need to urgently implement trans health protocols within the Colombian Health Care System and, moreover, to better educate health care providers on trans health issues, particularly around pregnancy and reproductive health. These findings highlight that as physicians, we have a duty to our patients be better educated about these issues, to do the research when we do not know enough and be humble in the face of patients who are experts of their own experiences.