The mental health of trans migrant people in Colombia during Covid-19

Article 25 of the Universal Declaration of Human Rights states that all people have the right to a standard of living adequate for the health and well-being of themselves and their families. In this regard, states have an obligation to ensure the provision of and access to the medical care and social services necessary to achieve this, both individually and collectively. In Colombia, people with trans life experiences regularly face discriminatory attitudes from health professionals and institutions, turning their quest for equal access to appropriate health and other services into a constant struggle for the respect and vindication of their rights. GAAT – Fundación Grupo de Acción y Apoyo a personas Trans (2020) Trans-migrations: possible paths. Report on the rights of trans migrants in Colombia (https://drive.google.com/file/d/1CUuyep5UICXRP30G0haLExsnkCUvk2zp/view). This is even more challenging for migrants with trans life experiences, who are already in a situation of high vulnerability as Colombian migration policy does not guarantee protection of their rights and needs.

Box 1: Trans identity and trans life experience

Trans people do not ‘begin’ to feel male or female through the use of certain clothing, undergoing surgery or via a name change. Nor does someone start being trans or start their transition at a particular age. Some people identify as trans or have trans life experiences at an early age, while others hide their identities and experiences to protect themselves against discrimination, violence or even death. Fundación Grupo de Acción y Apoyo a personas Trans (GAAT) believes that identities are not fixed and that each person has their own way of being and living their gender, and should not be made to conform to or be validated against ‘pure’ masculine and feminine identities.  All people should have the right to permanently transition, transform and express themselves in different ways.
Source: GAAT (2020): 8

In recent years Venezuela has experienced the second-largest out-migration in the world, surpassed only by Syria. After Turkey, Colombia is hosting the second-largest number of migrants in the world, most of them from Venezuela. The increasing flow of migrants into Colombia has challenged the state to design strategies to ensure that migrants arriving in the country have access to healthcare. For example, the Ministry of Health and Protection developed a Health Sector Response Plan outlining actions that could be taken to address the health needs of people living in areas affected by migration. While these initiatives are important, the particular needs of migrants with trans life experiences remain largely unmet. Their identities may be denied by pathologising their transgender experiences, with the changes to their bodies regarded as aesthetic procedures, denying them care; or they are provided with health services without taking into account their identity constructions and what these entail. In both cases, the effects on their health, particularly their mental health, are immensely negative, and have worsened over the last two years as a result of the Covid-19 pandemic. Recognising themselves as migrant trans people can trigger feelings of loss, grief and guilt associated with complying (or not) with the categories of cisgender man and cisgender woman, both in terms of appearance and everyday life, and in the context of the cultural norms of both the country of origin and the host country.

Since 2018 the GAAT Foundation has been undertaking research to better understand trans migrant people’s experiences. In 2019, with the support of the Open Society Foundation, we implemented the project ‘Trans-migrations:  possible paths’ in four Colombian cities: Cúcuta, Bucaramanga, Bogotá and Ibagué. The project aimed to answer questions including what happens to trans migrant people in these cities, and their chances of living a full life in a country like Colombia, where transphobia and violence restrict their choices. The results showed that trans migrants are continually confronted with violence and prejudice when they attempt to access social services.

As a result of the study, we decided to promote recognition of the reality of trans migrants in Colombia by opposing prejudice and social representations that contribute to violence towards them, specifically via social and political advocacy with institutions of the state. This work was however interrupted by the Covid-19 pandemic affecting how social organisations operated, while also presenting new challenges and priorities. So, we decided to focus on actions with the community, collecting quality information to identify problems, and then calling for the restitution of health rights by the state.

Using a quantitative methodology, we conducted research with 67 people with trans migrant life experiences. We found that 59.7% faced institutional barriers in accessing and maintaining continuity of healthcare. Another 37.5% of respondents said they had experienced institutional barriers to accessing work, education, housing and health services, mainly caused by the absence of a fixed residence. Some 22% of respondents said that their negative perceptions of health services are caused by xenophobia and discrimination throughout the system. Even when they manage to access health services they still experience discrimination and violence. Those surveyed reported that they do not perceive the healthcare they receive as ‘quality care’ because health professionals, administrative and/or security personnel discriminate against people with trans migrant life experience, based on their prejudices and assumptions about trans people and foreigners, including making derogatory comments and delaying treatments and procedures.

As to why people with trans migrant life experiences encounter discrimination, 12.2% said that it was based on their nationality, 8.9% said that discrimination was because they were a person with trans life experience, and 17.8% said that they faced discrimination because they were people with trans migrant experience who were also Venezuelan nationals. These results demonstrate the double discrimination experienced by trans migrants: xenophobia (for being a migrant) and transphobia (for being a person with trans life experience). It is imperative that the government develops strategies to eliminate these types of discrimination, which in the health system take the form of psychological Psychological violence is any action or omission intended to degrade or control the actions, behaviours, beliefs and decisions of other people through intimidation, manipulation, threat, humiliation, isolation or any behaviour that implies a detriment to psychological health (see https://profamilia.org.co/aprende/violencia-de-genero/tipos-de-violencias/). and symbolic violence.

Another finding from our research is that only 5.9% of trans migrants had access to a mental health service prior to the onset of the Covid-19 pandemic. With the arrival of Covid-19, the need for professional mental health support has increased: 17.9% of people surveyed receive mental health support, of which 2.9% is provided by the health system, 8.9% private care, 4.4% social integration services and 1.4% through mutual support groups.

Maintaining good mental health is not only about being able to access support from health professionals. It also depends on the way people relate to each other in the social context. For example, 11.9% of respondents said they took little interest or pleasure in doing things like hanging out with their friends, eating unfamiliar food or visiting their families, 11.9% that they experienced high levels of anxiety, 19.4% had feelings of sadness and hopelessness and 8.9% said they had little ability to cope with life in general.

In addition, we were shocked to discover that one of the effects on mental health during Covid-19 was that 4.4% of people had thought about committing suicide on more than one occasion:

I was going to my house, and the cars were passing … and I was going to launch. I am neither the first nor the last (trans female migrant).

High levels of stress, loss of support networks due to migrant status and because of bodily transition, family separation and lack of employment and social opportunities: these are all factors that are continuously present in the lives of people with trans migrant life experiences. The GAAT Foundation is responding to these needs by offering peer services to mitigate the damage caused by xenophobia and transphobia. We have programmes to receive trans migrants who arrive without resources, but we also provide psychosocial care and accompaniment to access routes. However, the crisis is so extensive, the needs so many and the resources so limited that we are not enough. The situation of trans migrants must be made visible, alongside programmes and projects that respond to their needs; we call on the Colombian government and the international community to address the needs of people with trans migrant life experiences. We need social allies and politicians, academia, other social organisations and the state to step up and respond to this alarming situation.

Daniel González-Pérez is a biomedical engineer and Co-director of Research at the GAAT Foundation. Dani Verástegui-Mejía is a psychologist and a Project Manager at the GAAT Foundation. He has a doctorate in psychology and a master’s degree in Socialisation, Gender, Diversity and Migration.