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A Lesson in Holistic Care: What I Learned from Working with Transgender Women and Health Providers in the LAC Region

Posted by  on Wednesday, November 20th 2013     

November 20 is Transgender Day of Remembrance.

I have collaborated closely with transgender women and health providers in Latin America and the Caribbean to learn more about the needs of transgender populations and to train health workers to provide quality services. Working alongside transgender women on needs assessments, trainings for health providers, and in the development of a blueprint (PDF) for comprehensive transgender services, opened my eyes to their experiences, gaps in existing programs that limit access to critical services, and the opportunities we need to pursue. To help you understand my recommendations, I would like to share a story I heard repeatedly from transgender women:

I was 13 years old when my family threw me out of the house because of who I am. I tried to continue my studies, but I dropped out of school because my classmates insulted me every day and sometimes hit me, and I was afraid to use the boys’ bathroom (the only one I was allowed to use) because I was afraid of being assaulted by male students. The teachers looked the other way or called me names. I have developed a thick skin because when I step out of my home, people stare, make comments and give menacing gestures. Going to a clinic is also unpleasant. I get sick like everybody else, but the nurses always assume that I am a sex worker and that I have HIV. Frequently, they give me condoms and an HIV test and send me home. One time I was jumped by four guys in the street, and I ended up in the emergency room. When one of the nurses opened my robe and saw that I am a transgender woman, she gave me a look of disgust and called me a homosexual. She must have told others about me because several nurses came, opened my robe and walked away laughing. I waited for a long time before a doctor saw me. He told me that real men do not dress like women, and that I should cut my hair and stop wearing make-up so I could get a job. I had a cut in my head that needed stitches and the doctor did not even clean the blood in my hair.

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

This story, and the others that I heard through this work, underscored the need for a new approach to transgender health:

  1. Prevention efforts must engage families and schools to foster supportive environments.  Transgender teens frequently experience rejection from their families and bullying in school. Homelessness, low literacy, and lack of family protection not only increase the likelihood that these teens will experience exploitation, but also severely limit their opportunities to find jobs.
  2. Many people, including health providers, do not clearly understand the spectrum of sexualities, genders, and identities. Their confusion often leads to stigmatizing attitudes and discriminating practices in health care settings, which in turn discourages transgender women from seeking care.
  3. Increasing access to counseling and testing and other HIV services should not be an end in itself. Securing the human rights of transgender communities and creating a safer environment where they can access appropriate services without fear of violence or discrimination should be the focus.
  4. Increasing access to condoms and HIV information are cornerstones of HIV prevention, but national prevention programs need to go beyond these two strategies. Policies and programs should also support employment and education opportunities for transgender persons. The pressure to put food on the table and a roof over their families’ heads can lead to poor decision making, resulting in risk-taking behaviors.
  5. Engaging transgender persons in program activities as facilitators or data collectors strengthens their technical capacities and allows them to engage with health providers and communities as professionals and peers. This can effectively dispel myths and negative beliefs about transgender women, their capacity, and their behavior.

By sharing my observations and the stories I heard, I hope to raise awareness of the issues that come into play and to encourage all of us to reconsider how our programs can better contribute to the well-being of transgender persons and their communities. We can make that commitment today on Transgender Day of Remembrance, an internationally recognized day to memorialize those who suffered or died as a result of anti-transgender hatred or prejudice.

Aysa Saleh-Ramirez, MPH is AIDSTAR-One Senior Technical Advisor at John Snow, Inc. AIDSTAR-One is funded by PEPFAR through USAID.

Why the Arts and Youth Matter for LGBT Global Development

Posted by  on Sunday, November 17th 2013     

Last month, I had the opportunity to join Urooj Arshad of Advocates for Youth in a conversation following a performance of The Laramie Project, Moises Kaufman’s play about Matthew Shepard at the Ford’s Theatre in Washington, DC. As I watched characters like the Muslim Bangladeshi-American university student and a skeptical university student slowly learning about lesbian, gay, bisexual and transgender (LGBT) people, I was reminded of the importance of the arts and youth in international development.

USAID Administrator Rajiv Shah dances with a Family Ayara Youth Foundation dancer in a trip to Bogota, Colombia in April 2013. Photo credit: USAID

USAID Administrator Rajiv Shah dances with a Family Ayara Youth Foundation dancer in a trip to Bogota, Colombia in April 2013. Photo credit: USAID

The power of images and storytelling moves people and societies. USAID has been at the forefront of using the arts as a tool for social change in countries where we work:

  • In Lebanon, USAID supported youth in photography, painting, writing, and drama as a way to express fear about “the other” and find a way to understand those different from themselves.

  • Most recently, in Colombia, the Canal Capital television network broadcast a one-hour documentary on LGBT issues and the diversity of families in Colombia. Local television networks throughout the country are re-broadcasting this documentary, contributing to increased awareness of LGBT families in Colombia. Promoting LGBT issues is a core part of USAID’s efforts to help civil society build a culture of human rights in Colombia.

USAID’s efforts to protect and promote the rights of LGBT persons in Colombia is not unique. We take hate crimes and the vulnerability of LGBT persons seriously by focusing on the resilience and power of LGBT persons as change agents.

These efforts are part of USAID’s overall focus on inclusive development. We believe that men, boys, girls and women, persons with disabilities and the LGBT community, internally displaced persons, indigenous peoples, ethnic and religious minorities, and youth, are an integral part of the development process. USAID’s suite of policies include the first ever Agency-wide Youth in Development Policy, as well as Gender Equality and Female Empowerment Policy (PDF), U.S. Strategy to Prevent and Respond to Gender-Based Violence Globally (PDF), and U.S. Government Action Plan on Children in Adversity. Our Youth in Development policy highlights many of the challenges and opportunities facing youth as a specific population group and simultaneously emphasizes the fact that youth are not a homogeneous group.

Based on data in the U.S. and anecdotal evidence in my travels worldwide, we know that LGBT youth are at increased risk for being abandoned by their families and rejected, barred, or deterred from accessing schools, all of which undermine their ability to learn and develop the skills that are necessary for a productive life. In an online survey sponsored by Vietnam’s Center for Creative Initiatives in Health and Population showed that 77% of LGBT youth experienced verbal abuse and 44% experienced physical assault in school. 42% of these youth lost interest in school, 33% skipped school, and 6% abandoned school.

The Laramie Project and data on LGBT youth underscore the importance of ensuring marginalized youth have a voice and are able to engage in policy-making processes in their communities. Focusing on LGBT youth is critical to global development.

The data may be daunting; however, based on a track record ranging from the arts to inclusive development to human rights programming and our expertise on NGO organizational development, USAID is leading in addressing the challenge of integrating vulnerable populations, particularly youth and LGBT persons in our programming.

Empowering LGBTI people in Colombia to Advocate for Their Own Rights

Posted by  on Friday, September 20th 2013     

I recently had the privilege of traveling to Bogotá and Cartagena, Colombia to observe the incredible work USAID is doing to support Lesbian, Gay, Bisexual, Transgendered and Intersex (LGBTI) populations advocate for their own rights under the law. As an advocate and supporter of the LGBTI community here in the United States, I know firsthand the importance of LGBTI physical safety, the issues of workplace discrimination, and access to education and health care.

As part of USAID’s historic LGBT Global Development Partnership launched earlier this year, we are expanding our support to local civil society organizations in Colombia through our partnership with the Astraea Lesbian Foundation for Justice. Activities include partnering with the Gay and Lesbian Victory Institute to conduct trainings on how to run for office and participate in democratic processes. This partnership forms part of USAID’s wider commitment to inclusive development, and to engaging LGBTI communities as important actors in international development who have the potential and power to advance human rights, promote broad-based civic participation, and drive inclusive economic growth.

Victory Institute, with support from USAID, conducts training on on respecting and protecting LGBTI rights in Cartagena

Victory Institute, with support from USAID, conducts training on on respecting and protecting LGBTI rights in Cartagena. Photo credit: Victory Institute

Since 2006, USAID/Colombia has been a flagship bilateral mission for its work in supporting LGBTI community efforts fighting discrimination and stigmatization. In addition, USAID/Colombia has provided training for police and other public servants on respecting and protecting LGBTI rights. These continued efforts and strong ties to grassroots LGBTI organizations made Colombia a good fit for piloting the LGBTI Global Development Partnership trainings.

As reported in the Washington Blade, from August 29th-September 1st, the Victory Institute – with support from USAID – led a four-day training in Cartagena for 30 Colombian LGBTI activists interested in running for political office or managing campaigns. These inspiring individuals, who hailed from as far away as the Amazon rainforest, rural regions along the Atlantic Coast and Bogota, came together to learn the art and craft of running successful political campaigns in an effort to become more effective advocates for LGBTI rights in their own communities.

One such activist I had the pleasure of meeting was Jhosselyn Pájaro, a transsexual woman who ran for municipal council in the city of Arjona outside of Cartagena. She ran for office to let her community know that LGBTI people like her lived in the community and wanted to make a difference. Although she did not win a seat on the council, she was successful in raising awareness about LGBTI people and the rights and concerns they have living in Colombia. She attended the USAID-supported training to learn new skills as she hopes to again run for political office, and next time, win.

It is inspiring stories like these, from LGBTI individuals who face discrimination on an almost daily basis that makes the work of USAID all the more important. Through the LGBTI Global Development Partnership, USAID is working with our partners to strengthen LGBTI civil society organizations, enhance LGBTI participation in democratic processes, and undertake research on the economic impact of LGBTI discrimination.

At USAID, we are bringing together local activists and community leaders. In Colombia, organizations such as Colombia Diversa, Caribe Afirmativo, and Santamaria Fundación illustrate the dedication and service to their constituents that USAID values.We are helping these community leaders to advocate for a more inclusive society that embraces what LGBTI people have to offer in the development of their own societies, economies, and local institutions. Together, in partnership, we are working to ensure LGBTI people have equal rights as enshrined in international human rights and domestic law, and access to education, employment, health care and housing – what we consider as important elements of inclusive sustainable development.

Learn more about how USAID is advancing and protecting the human rights of the LGBTI community.

LGBT Families at USAID: Integration and Solidarity in Nicaragua

Posted by  on Wednesday, May 15th 2013     

In 2009, Secretary Clinton announced that the U.S. State Department would extend benefits to the same-sex partners of Foreign Service officers. Although I didn’t officially begin working for USAID until September 2012, I had applied to the agency’s Development Leadership Initiative program that summer and had little idea just how much this and other policy advancements towards LGBT equality would impact me, my family and my work just a few years later.

USAID Democracy, Human Rights and Governance officer Jessica Morrison with her wife and newborn daughter. Photo credit: Jessica Morrison/USAID

My wife and I departed for Nicaragua for my first assignment as a Democracy, Human Rights and Governance Officer in August 2012, having just learned that I was pregnant with our daughter. I had the good fortune of being assigned to a Mission with a long legacy of work with the LGBT community through its HIV/AIDS programming, and an incredibly supportive Ambassador, supervisor and Mission Director (who caught me more than once sleeping under my desk at lunch during those exhausting days of the first trimester). My wife, now considered an “eligible family member” under the new policy, was able to apply for and obtain employment at the Embassy, providing a source of income during my maternity leave.

In December 2012, the Mission leadership passed a Mission Order to provide guidance on further integrating LGBT persons and priorities into its programs, which has served as a model in the region. In February 2013, the interagency LGBT Working Group collaborated to host a half-day workshop at the U.S. Embassy for leaders from the LGBT community in order to better understand their needs and priorities and to inform them of policy changes and upcoming opportunities for U.S. Government support of their work.

Unfortunately, despite advances throughout Latin America towards LGBT equality, the LGBT community in Nicaragua still suffers widespread societal discrimination and gender-based violence, issues that USAID will continue to address through its health and democracy, human rights and governance programming. However, our experience here in the capital of Managua – first as a same-sex couple and now as two proud new mothers – has been nothing but positive, giving me hope that the tides are turning in Nicaragua. While we were likely the first same-sex couple to give birth at the main hospital here in Managua, which caused some confusion at City Hall when picking up our daughter’s birth certificate, our Nicaraguan caregivers, colleagues and friends have greatly enriched our experience, and we are delighted with our decision to remain here for her delivery.

As I write this from Managua with my wife, mother, parents-in-law, and newborn baby girl by my side, the theme of this year’s International Day of Families, “Advancing Social Integration and Intergeneration Solidarity,” feels especially appropriate. Not only am I privileged to work for an agency that recognizes the value and importance of advancing the integration of LGBT families both within the agency and in its programming, but I am blessed that our little one has three grandparents and two great-grandparents who embrace and celebrate the diversity of our family almost as much as they celebrate her arrival.

USAID in the News

Posted by  on Friday, April 12th 2013     

President Obama’s 2014 Budget Proposal and Proposed Food Aid Reform

This week President Obama released his 2014 Budget Proposal, which introduced major reform in the delivery of food assistance. The Washington Post reports the White House has proposed “the first major change in three decades to the way the United States supplies food aid to impoverished nations, significantly scaling back the program that buys commodities from US farmers and ships them to the needy overseas.” Under a budget proposal released Wednesday, “nearly half of $1.4 billion in requested funds for the aid could instead be spent to purchase local bulk food in countries in need or to distribute individual vouchers for local purchases.” USAID administrator Rajiv Shah said in an interview, “We’ve made a strong commitment to provide more flexibility,” noting that “local purchase of food allows for a response time nearly 14 weeks faster” than shipping from the US, and also is “30 percent cheaper for certain types of commodities.” Shah added, “We recognize that any transition has to be done in a careful, thoughtful manner,” but argued that over the long term “spending money to build and modernize agricultural systems in current food-recipient countries ‘is ultimately what creates tens of thousands more jobs here in our country.'”

Oxfam’s Paul O’Brien welcomed the proposals, telling the Wall Street Journal: “The Obama administration has taken an important step towards long overdue reforms to bring food aid into the 21st century…This president’s proposal will get food to more hungry people faster, cheaper and more efficiently. Congress should pass them expeditiously.”

Read more about the Proposal in these publications: The Hill, NPR, Washington Post and Huffington Post. 

LGBT Global Development Partners spoke on advancing LGBT equality in developing and emerging market countries on April 8 in Washington. Photo credit: USAID

USAID Announces Initiative to Promote LGBT Rights Abroad

The four-year public-private partnership between USAID and Olivia Cruises, UCLA’s Williams Institute, the Astraea Lesbian Foundation for Justice, the Gay & Lesbian Victory Institute and the Swedish International Development Cooperation Agency “will work with local LGBT groups to provide leadership training, research and other help, lending the imprimatur of the U.S. government to people who in many countries are outcast and vulnerable, ” The San Francisco Chronicle reports. “This partnership leverages the financial resources and skills of each partner to further inclusive development and increase respect for the human rights of LGBT people around the world,” noted Claire Lucas, senior advisor of the USAID Office of Innovation and Development Alliances. “It can be a real game-changer in the advancement of LGBT human rights.”

Building A More Tolerant, Inclusive World

Posted by  on Thursday, April 11th 2013     

David N. Cicilline is a member of the U.S. House of Representatives (D-RI).

USAID is showing extraordinary leadership by establishing the LGBT Global Development Partnership to address serious issues of inequality and discrimination faced by LGBT individuals around the world. Both in the quality of USAID’s work and the way it is doing business, it has recognized that we cannot achieve our development goals unless we first learn to solve problems creatively, partner with our private sector allies, and address how equal treatment can empower individuals to be more effective and impactful members of society.

Former Secretary of State Hillary Clinton took the bold step just a few years ago to assert that “gay rights are human rights, and human rights are gay rights,” and this initiative builds upon her leadership as well as the incredible leadership of President Barack Obama, who addressed the nations of the world at the UN and said, “No country should deny people their rights because of who they love, which is why we must stand up for the rights of gays and lesbians everywhere.”

America’s leadership in the world on the issue of LGBT equality is no coincidence. Equality and equal protection of the law are deeply embedded in the idea of America and the foundation of our democracy. We were, after all, a country that was founded on this radical idea – or at least radical at the time – that people have inalienable rights not because of the generosity of a monarch or a sovereign ruler, but as a result of the natural affairs of human existence and a recognition that every person has a right to life, liberty and the pursuit of happiness.

America’s real power in the world is the overwhelming might of these founding principles, and it is important to understand our responsibility to countless LGBT individuals all over the world who face violence, institutional discrimination, criminalization of their status, and violations of basic human rights. The challenges that USAID addresses – global health, access to food and water, education, and economic growth – cannot be fully met unless we are honoring basic human rights, especially the basic responsibility of keeping LGBT individuals safe. This partnership will do just that.

We must urgently make certain all LGBT individuals around the world are safe from violence and physical harm. In 2011, I introduced and successfully worked to pass an amendment out of the House Foreign Affairs Committee that would have empowered the Secretary of State to discourage foreign governments from sanctioning acts of violence against individuals because of their sexual orientation or gender identity. I will continue to work with my colleagues to strengthen the collaboration between federal agencies and Congressional leaders in order to apply pressure to governing bodies that oppress LGBT communities abroad.

And I know that we can continue to make progress on these issues because LGBT voices are stronger than ever in Congress. I am one of six co-chairs of the LGBT Equality Caucus in the House, and our membership grows every day.

While our work to enact legal prohibitions against discrimination and violence continues, ultimately our progress must not only be reflected in the executive orders of our President, or even in the laws adopted by Congress, but in the words and actions of ordinary citizens in cities and towns all across America and the world who are seeing members of the LGBT community marry, serve their country openly and honestly, raise families, hold office, and distinguish themselves as business and academic leaders.

Seeing the power of these examples will, in the end, help advance the cause of equality all over the world.

Building a More Inclusive USAID

Posted by  on Friday, June 29th 2012     

Earlier this week, Administrator Shah administered the Oath of Office to Peter Malnak, USAID’s new Mission Director to Rwanda.  As USAID works to build a more inclusive agency, Mr. Malnak’s swearing-in took on special significance as it marked the first time a same-sex partner of a new Mission Director participated in the event by holding the copy of the U.S. Constitution.  Mr. Malnak referenced the importance of the occasion in his remarks, portions of which are excerpted below:

Administrator Shah administers the Oath of Office to USAID Mission Director to Rwanda Peter Malnak as his partner John Palmucci holds a copy of the U.S. Constitution. Credit: USAID

I would like to thank Administrator Shah and Deputy Administrator Steinberg for their leadership over the past two and half years. Their vision for reform, and commitment to inclusive leadership, has made us a stronger organization that helps more people than ever before.

I would also like to acknowledge Secretary of State Hillary Rodham Clinton for her commitment to inclusive leadership and tireless support for the LGBT community.

The story [of how I joined the Foreign Service] offers an example of the importance of personal leadership, how using your moral compass can change the lives of others, and provides a glimpse into how USAID has changed over the past twenty years by creating a more diverse, inclusive and global workforce.

When I joined the Foreign Service in 1992, Europe had just broken down internal barriers, and the dramatic changes in the former Soviet Union were still unfolding. Socially, there were important issues society continued to grapple with.  One was gay rights.  Being gay in 1992 was something many people didn’t speak about.  That’s not surprising as being gay in almost all states was grounds for dismissal from your job, removal from housing and within the federal workforce, in many cases, rejection of a clearance, based on security.  With the AIDS epidemic in the backdrop, significant bias continued.

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