Despite a unique constitution passed in 2008 that granted them with various fundamental rights, trans people in Ecuador still face stigma and discrimination, often forcing them to resort to illegal and risky medical treatments — like self-prescribed hormones, street drugs and clandestine silicone surgeries.
“Sometimes we take hormones, there are some hormones that make you feel well and others that don't so we experiment with ourselves, we don't know what to take when something happens to us, the medical system doesn't know either and just prescribes us paracetamol,” Carolina Alvarado, President of the Quito Association of Trans Sex Workers told teleSUR.
As doctors lack proper training in how to treat transgender people, many wait until the last moment for a consultation — often too late, as many of them die trying to transition to their proper gender identity.
The trans community has been struggling to make the public health system change and start addressing their specific requirements: “We need psychologists, we need surgeons, it is a very expensive process, and we need to be taken into account,” said Leonel Yepez, a transmasculine community
"Pacto Trans", or "Transgender Pact", is an initiative launched in June by several organizations and transgender leaders in order to promote better health systems, practices and policies.
“The state has to understand that transgender health isn't a whim, it isn't just about aesthetics or unnecessary expenses,” Maria Laura Andrade, activist at the Proyecto Trans.
This kind of mentality makes the trans community invisible, ignoring their rights and needs, she believes, while the state should cover the expenses and support trans people's right to self-determination and autonomy.
“The public health system should support and protect their life projects, so they can be in the body in which they feel good, be that binary or not binary, in any of the multiples identities of the trans world that they want,” added Andrade.
Trans patients are not always perceived as human beings, she explained, but can be seen as potential transmitters of sexual diseases — especially in the case of trans sex workers.
Doctors also focus on their sexual health without taking into account other aspects of their wellbeing, such as the psychological impact of hormonal treatment.
The project is careful not to demand an excessive state interference in the transition process. The idea is to leave trans people with the full autonomy of their bodies, but providing nondiscriminatory support whenever they require it.
Ecuador's Constitution guarantees fundamental rights including the right to formal and material equality (article 66), the liberty to decide one's sexuality and sexual orientation, recognizes “gender identity” (article 11) and condemns discrimination on gender identity grounds (article 83). Ecuadoreans can also change their sex on identity documents once they have completed the medical surgery.
After a 3-year campaign by trans rights groups, the Congress passed a bill in December 2015 allowing trans people to change their gender, instead of their sex, on their identity documents.
That was yet only a partial victory for trans activists, who demanded gender identity to become the universal rule, not the option, arguing that a person's biological sex should remain private, while everyone should be allowed to define the specific gender identity he or she wants to projects to society.