Health care

human rights and citizenship:

Issues faced by trans
people in Mexico
Víctor Manuel Enriquez Estrada
Health care, human rights and citizenship: Issues
faced by trans people in Mexico
UNAM 2018
E-mail: vicmanuel280@gmail.com

Abstract
The aim of this work is to provide an overview of issues faced by trans people in Mexico.
A holistic approach is utilized, integrating human rights, citizenship a nd health care. The
main issues addressed are : lack of adequate legal recognition, scarse sanitary, work
and legal resources, and the high prevalence of discrimination, violence and morbidity,
among the trans population in Mexico. Lack of adequate legal reco gnition leads to the
invisibility of said citizens, while common health problems include HIV, substance abuse
and suicide. Overall, this study strengthens the need for strategies that promote the
inclusion of all social strata by raising awareness on the d ifficulties endured by trans
people.

Introduction
In 2011, Mexico enshrined human rights in its constitution. However, minorities such as
indigenous people, those afflicted with mental illnesses and LGBTI Mexicans, are yet to
fully enjoy their human rights in their diverse and contrasting country.
According to the Mexico statistics ministry, Instituto Nacional de Geografía y Estadística
(INEGI), 119,938,473 people lived in Mexico in 2015 across its 32 federal entities.
Women represented 51.4% of the population. Moreover, the largest concentration of
people has taken place in Mexico City (CDMX). Furthermore, indigenous languages are
spoken by more that 15 million individuals (1). A variety of traditions, living languages
currently spoken, plus the customs and traditions governing many communities, show

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the multiculturality of the country. Nevertheless, Mexico is also a centra lized country

considering its institutions, population and resources.

Indigenous, mentally ill, and LGBTI Mexicans are commonly deprived of their rights. It

should be noted that the census does not provide information about LGBTI or mentally ill

people. These groups face victimization, discrimination, reduced educational and

employment opportunities, harassment, and violence . While some of the violence faced

by these groups is verbal, it can also reach death as in feminicides . Some feminicides

occur because the victim is a trans person.

Throughout this work, the word trans refers to people who self-identify as either

transgender, or transsexual. The definition of these terms embod ies a multitud e, and

sometimes overlapping, concepts related to sex and gender. Furthermore, trans people

might have a sense of belonging to a gender which is different from the one assigned at

birth. They can also express themselves in said gender. Additionally, they c an also

strive to shape their bodies in accordance to the gender they identify as. Besides self-

identification, trans people might express themselves, have a sense of belonging to, or

strive to shape their bodies as a gender different from the one assigned at birth.

Human rights in Mexico

To encourage a human rights culture in Mexico, the constitution was amended in 2011.

The first article in the Mexican constitution prohibits all forms of discrimination on the

basis of ethnic or national origin, gender, age, sexual preference o r anything else that

threatens human activity. Further, article four lists people’s rights:

· Equality between men and women · Right to housing

· Freedom of procreation · Right to identity
· Right to food · Right
Rightstoofculture
minors
· Right to health · Right to physical education
· Right to the environment · Freedom of work
· Right to water

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People’s rights are both recognized and protected under its laws. On the other hand,

these rights are not equally enjoyed by all Mexicans. Many human rights are still to be

fully attained by some Mexicans, such as the rights to food and health.

I) Right to food. A large population in the southern part of Mexico suffers from

undernourishment. Malnutrition afflicts mostly indigenous people.

II) Right to health. Several states record plenty of child deaths due to curable

diseases, such as gastrointestinal disorders, and lack of food preparation

hygiene. Some of these states include Oaxaca, Guerrero and Chiapas. All of

them have considerable indigenous communities affected. Moreover,

substantial poverty exists in these regions. (3)

Human rights among the trans population

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A number or secondary laws exist in Mexico meant to promote human rights and avoid

discrimination. In contrast, transgender, trans sexual and transvestite Mexicans have yet

to fully benefit from those laws.

This is certainly true in the case of freedom of work. In 2013, 71.2% of the respondents

to a survey, agreed that there is discrimination against the trans population, according to

the Consejo para Prevenir la Discriminación en el D.F. (COPRED) (4). The lack of

employment opportunities severely excludes trans people subjecting them to social

alienation.

Further, the right to identity is violated as many trans people do not have iden tity

documents reflecting their name and gender. Therefore, trans people are to take the

following jobs: stylist, transvestite show performer, informal trade, and sexual work. In

Mexico City, HIV positive trans gender women who are sexual workers account for 62%

of transgender women in meeting places, 24% of Clínica Condesa trans gender patients,

and 30% of trans gender people deprived of their liberty (5). These figures were the

result of a survey carried out by the Ins tituto Nacional de Salud Pública (INSP), a

Mexican public health institute. The survey included 21 meeting places and 585

participants. It is titled “Primera Encuesta de Salud con Seroprevalencia d e VIH a

Mujeres Transgénero en la Ciudad de México.” Up to now, far too little attention has

been paid to finding the prevalence of transgender people in Mexico.

Moreover, trans people right to health is yet to be fully attained. At the federal level, the

Health Sector law does not consider the trans population. A t the local level, only Mexico

City health law takes into consideration trans people. In 2009, the right to

psychotherapy, hormone replacement therapy and access to sexually transmitted

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3

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diseases prevention services for trans people became part of the healt h law (4). It

should be noted that only one clinic provides those service in the city : Clinica Condesa

(4).

Historic perspective and current state of the right to identity

The Mexican Constitution establishes the right to identity and specifically refers to the

birth certificate. In 1964, the first birth certificate gender marker change happened. The

bearer was a lawyer who was legally recognized as female after the change. Víctor

Hugo Flores describes five cases of birth certificates corrections. The oldest one

occurred in Mexico City in 1996, while the others were carried out in the states of

Guanajuato, Durango and Nuevo León (7).

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Moreover, Víctor Hugo Flores states that the Mexico City Registry has refused to correct

birth certificate s even when the High Court of Justice has ruled for the correction to be

made. He details that the Registry delays the Court’s ruling which amounts to a

contempt of Court and a crime (7).

The first academic summit on trans issues was organized jointly by the activis t group

Eón Inteligencia Transgenérica and the sexology institute Instituto Mexicano de

Sexología (IMESEX) (8). Eón broke up in 2008.

In 2004, the transsexual population in Mexico City was granted the right to identity

through a trial. Said trial could be expensive and therefore, unattainable for many trans

Mexicans, such as young people expelled from their home by their families, migrant sex

workers, and low income people (8).

Sexologists were instrumental in the 2008 Mexico City Civil Code reforms, which

allowed a birth certificate gender marker correction but required an expert witness.

Specifically, sexologists and doctors’ references were compulsory. This drove up the

cost of getting a corrected birth certificate as the expert witnesses ran private practices.

It is worth noting that the correction process was done through a trial which called for

specialized lawyers and a judge who would make the final call on the correction request.

Consequently, the right to identity of the trans population at that time was bounded by

the medical and legal perspectives (8).

Mexico City has been the only state where the gender marker correction has become

law. In April of 2015, the Civil Code was modified to allow the gender marker correction

to be as an administrative process, without the need of a trial (9).

Many states in Mexico do not consider gender marker corrections in birth certificates so

the right to identity of trans people is yet to become a reality.

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Hate, phobia and discrimination

In 2015, Mexico took the second place among Latin American countries in hate crimes

having 257 trans people being murdered. Mexico was second only to Brazil where 868

trans people were murdered in that sa me year. The Mexican Federal Criminal Code

does not regard LGBTTI murders as hate crimes. In that account, sexual diversity

groups are in disadvantage (5,11).

Discrimination against trans people is deeply interwoven in Mexican culture. Employers

routinely discriminate against diverse Mexicans, families frequently expel their members

who are different , and the educational system is not fully prepared to recognize the

identity of all individuals.

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Between 2009 and 2010, 93 complaints from LGBTI people were received by the

Mexico City human rights council. These complaints accuse government-controlled

institutions of violating human rights (5,12).

In 2010, a nation -wide survey on discrimination was p resented during the International

Day Against Homophobia events in Mexico. Several interesting results were produced

by this research. Six out of ten people from the Durango state would allow a

homosexual at home, but only four out of then people from Guan ajuato state would do

that. Looking at education levels, six out of ten people without a university degree would

not allow a homosexual at home but the intolerance is reduced to three out of ten when

people with university degrees were interviewed. Income does play a role in

discrimination, too. Seven out of ten upper and upper middle -class Mexicans would live

in a house where people with diverse sexual preferences live but only three out of ten

middle-class Mexicans would do that.

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Mexican authorities have warned that homophobia can not only diminish people’s lives,

it can even kill them. Results by age group show interesting information. 30% of those

interviewed aged above 40, believe it is harmful and very harmful for society to include

people with di fferent sexual orientations or preferences. Around 80% of those surveyed

aged 50 and older reject the idea that sex -same men couples should be able to adopt a

child. Finally, three of out then Mexicans across all age ranges think it is quite or well

justified to oppose same-sex marriages (5,12).

Trans women homicides

Violence against sexually diverse people in Mexico goes all the from way from mocking

and humiliation to murder. Letra S claims 1,310 LGBT people have been killed since

1995: 1,201 men, 265 trans people, and 24 women. During the las three years, an

average of 71.1 killings per year have taken place. The states where most executions

occurred were: Mexico City (36), State of Mexico (22), Chihuahua (20), Veracruz (19),

Nuevo León (17), Puebla (1 5), Guerrero (15), Michoacán (14), Jalisco (11) and Sinaloa

(10) (13).

Homicides of trans women stand out for two reasons. Firstly, they are usually cruel.

Secondly, impunity is the norm. As an example, Paola, a 25 years -old trans woman and

a sexual worker was shot by a male client just after she got into his car. Paola’s peers

witnessed the murder and called the police. The police found the man still holding the

gun and took him to the Public Prosecutor. Later, a judge ruled the was not enough

evidence to hold the man accountable for the crime. Paola’s peers and activists’

organizations accused the state attorney -general of both negligence and apathy. They

also held public demonstrations to push the public prosecutor seeking it to appeal the

judge ruling, p rovide safety to their jobs and to issue a new warrant for the alleged

murderer who is still at large (13, 14).

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 7

Legal Recognition
Identifying populations is a key requirement to citizenship recognition. Nevertheless, the

Mexican decennial census does not p rovide information on trans identities. The census

collects information on male and female gender identification only, making trans people

invisible. As a result, little government resources are aimed to a n population whose size

is unknown . A proposal to measure the trans population has been put forward by Yani

Limberopolus. She stated that in the last quarter of 2017 the Mexican statistics institute

(INEGI) did a public consultation on the 2020 census planning process. Her proposal,

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numbered 0040, asked INEGI to include questions to identify said population such as,

Which gender to you identify with? Do you consider yourself transgender or cisgender?

and, Do you feel identification with your biological sex? Further, she expects these

questions to make the population noticeable, just as the Afro -Mexican population was

put in sight in the Inter-Census survey (15). Limberpolus’ proposal has not been properly

supported, given media attention or gained enough traction to become a reality.

A recent proposal on trans citizenship in Mexico

The Mexican voting institute established a key directive regarding trans people to be put

in practice before the 2018 presidential election. This directive allows all trans,

transgender and transsexual citizens to vote regardless of their gender expression, even

when their gender expression does not match their picture on their voting card (16). It is

worth noting that allowing a person to vote even when a gender expression mismatch

happens is an important achievemen t in respect of both human rights and trans people

citizenship.

Healthcare for trans people

The Mexican government provides access to health care through three large institutions:

Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servic ios Sociales

de los Trabajadores del Estado (ISSSTE), and the Seguro Popular (SP).

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 Government institutions

People IMSS ISSSTE SP Private Other

covered institution

United 9,922,540 38,488,615 7,568,987 49,018,903 3,210,771 1,522,022

Mexican

States

(Mexico)

Mexico 7,000,305 3,233,124 101,922 20,099,093 605,038 152,624

City

Government provided healthcare by institution for Mexico City and the whole country.

Source: INEGI (17).

Healthcare institutions in Mexico f ace significant challenges, such as diabetes and

obesity epidemics, and the use of illegal substances. Despite that, there is a single clinic

which provides specific trans healthcare. This clinic is in Mexico City and belongs to the

government-run Secretaría de Salud (SS).

In 1994, a transgender program was created in the Condesa Clinic (Clínica

Especializada Condesa) as mandated by a change in the General Health Law. Andrea

González, the Condesa Clinic director, explained that the transgender program aims to

be a model for other clinics in Mexico City. She added that the program looks to

decrease harm to human health, provide hormonal therapy, psychotherapy, as well as

the prevention, detection and treatment of sexually transmitted infections (18).

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Rebasa ( 2018) lists the milestones of the Condesa Clinic as follows: it was founded in

1938, it became a HIV/AIDS specialized clinic in 2009, and it started offering

transgender and transsexual treatments in 2009 (18).

Expanding the coverage provided by the Condesa Clinic to a broader Mexican trans

population poses significant challenges. Professor Eusebio Rubio (2002) highlighted

some limitations in the trans knowledge among health professionals. He noted that

healthcare professional might incorrectly diagno se a trans person as a conflicted

homosexual. He added that healthcare professionals typically reject trans people (19).

Despite the importance of informed healthcare professional, there remains a paucity of

evidence on whether Professor Rubio statements a re still valid. Given the volume of

human rights violations complaints against healthcare institutions they might still hold

true.

Condesa Clinic, a unique clinic in Mexico

The Condesa Specialized Clinic is the largest HIV/AIDS clinic in Latin America. The

Mexico City government formally started it on November 1 st, 2015, as part of a broader

public health strategy on prevention and treatment. The str ategy itself is based on a

2014 agreement where countries from all over the world signed the Paris Agreement

looking to eradicate HIV by 2030. Overall, the Condesa Specialized Clinic seeks to bring

HIV/AIDS prevention, support and treatment services closer to the population (20).

Between 201 5 and 2018, the Transgender Clinic in the Condesa Specialized Clinic

(CEC) has admitted 1,100 people. It worth mentioning that this clinic services are free of

charge, yet they are only available to Mexico City residents (20).

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Every month, 18 persons request to be admitted to the CEC. Well over 30% of them are

HIV positive. Among CEC trans patients (n=1,100), approximately 40% are HIV positive,

while around 87% of them are on anti -retroviral treatment. Services offered by the CEC

can be listed as follows: hormonal replacement therapy, timely detection of HIV and

other STI’s, access to treatment, and specialized medical care for trans people. One of

the current projects on the CEC is a trans health clinical practice guide. It would be the

first such guide in Mexico. Moreover, it is based on the World Professional Association

for Transgender Health’s Standards of Care ( WPATH SOC) version 7 and other

international guides (20, 21).

Prevalence of trans people in Mexico

There is little published data on the exact number of transsexual people in Mexico.

Nevertheless, Robles, et al (2016) suggest that, as a conservative estimate, 26,700

transsexuals live in Mexico City and 63,600 transsexuals live in greater Mexico City (22).

Trans population healthcare issues

Firstly, there is a gap for trans people to start treatment. Cruz (2014) estimated such gap

as 19 years from childhood and 12 years for teenagers (23).

Colchero (2013) found that 30.1% of the persons deprived of their freedom surveyed

has had at least one suicide attempt in their lives, followed by 21.3% of the people

surveyed in the CEC, and 14.9% in meeting places. Those frequencies are significantly

higher than the general population average (2.8%) (24).

Further, Hiratha, et al (2015) researched violence in the trans population. They point out

that 57.8% of HIV positive both women and trans women have had suffered violence

throughout their lives; such as intimate partner and family violence. This violence affects

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their adherence to the anti-retroviral treatments (25). Additionally, Robles (2016)

proposed that the handicaps and stress levels experienced by this population are not

directly linked to their trans identify; but they can be associated to the violence and

rejection in several aspects of their lives (22).

CEC protocol

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The Condesa C linic purpose is to provide healthcare to transgender Mexico City

residents. As stated earlier, it is the first trans health clinic in Mexico and one of the first

ones in Latin America (23, 26). The CEC has proposed an integral health protocol based

on current scientific evidence, and international guides. T his protocol has been tailored

to suit the urban Mexican population (21, 27).

The CEC protocol establishes free services in three stages: Firstly, an initial evaluation

in the mental health department, based on a semi -structured psychiatric questionnaire

and sexology oversight, ii) six months real -life experience in the self -identified gender in

two or more live areas, and iii) hormone replacement therapy administered by the

endocrinology service (21, 27).

CEC shortcomings
Critics question the Condesa transgender clinic in vari ous ways, such as its location, the

minimum age for its services as its protocol theoretical foundations.

The CEC transgender clinic was created in an HIV/AIDS clinic. Several trans activists

and users have questioned why they are to receive treatment in a HIV clinic. They refer

to the stigma associated to HIV i n the Mexican society, and appeal for a specialized

transgender center (18).

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The CEC protocol establishes a minimum age of 18 years for its services. This limitation

excludes transgender minors from receiving adequate treatment according to their

gender id entity. Additionally, the transgender clinic also restricts its services to the

population of Mexico City, excluding people from other states. The CEC is the only

transgender clinic in the country; thus, it curbs trans healthcare for the rest of the

country.

Pons (2018) points out a mix of theoretical and political elements in the CEC

transgender program leading to contradictions. These elements included biologist

references, human rights, stopping trans pathologization, and a psychiatric paradigm.

Pons (2018) suggests an analytical and deep re -examination to obtain a coordinated

and coherent strategy (18).

Following Pons (2018) critics to the CEC, its current transgender protocol abides by the

heteronormative standards. Further, these standards call for a person to identify as a

member of the opposite gender as a requirement to receive treatment. This “one size fits

all” model is used in the Norwegian healthcare system at the Oslo University Hospital for

30 years. Moreover, the Norwegian model has receive d critics from activists and civil

society associations who urge for a human-rights centered approach (28, 29).

Consequently, the heteronormative standards model is far from being ideal.

Before the CEC transgender clinic

Trans people in Mexico have seek a variety of body modifications, such as shaping the

body through surgery, hormones and oils, and gender reassignment surgery.

In August 2011, the group Trasvestis México presented the results of a community

diagnostic survey aimed at trans people in Mexico City. Interestingly, the survey results

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highlighted the use of oils and other substances to shape the body, as well as self -

administered hormone replacement therapy. Th ese body -shaping procedures were

promoted mostly done in meeting places such as hairdres sing salons, trans groups and

social media. Anecdotal evidence suggests some people have been able to get

hormone replace therapy from government institutions such as IMSS, ISSSTE and the

Health ministry. A person working for those institutions, a relative or a sensitized health

professional would have helped getting HRT prescribed.

A search of the literature revealed few studies which address the number of trans

people in Mexico who has gone through gender reassignment surgery. David Barrios,

psychotherapist and director of th e Caleidoscopia civil organization, argues that some

gender reassignment surgeries are done in veiled places, including public hospitals. He

added that in one year he has attested six surgeries at the Manuel Gea González public

hospital; five from male to female, and one from female to male. Finally, he warned that

some people go through gender reassignment surgery without psychotherapy, which

can carry serious consequences (7).

Further, Juan Luis Álvarez Gayou, director at Instituto Mexicano de Sexología

(IMESEX), commented that eight persons show interest in gender reassignment surgery

at IMESEX every month. Moreover, Dr. Landa detailed he has worked with IMESEX on

a gender reassignment surgery protocol which ha s been presented to public health

authorities. However, these public health institutions have different priorities for their

limited economic resources, so they have rejected the protocol so far , Dr. Landa

concludes. Dr. Landa has over 10 years of experien ce in gender reassignment and

gender differentiation surgeries.

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Finally, several private clinics in Mexico perform gender reassignment surgeries, such

as the Mexico Transgender Center and Sexchangemexico. Both clinics are in

Guadalajara city, but they do n ot provide casuistry, patients follow up or results

information.

Conclusions
This study set out to discuss issues faced by trans people in Mexico regarding human

rights, citizenship and health. This study has shown that trans people in Mexico face

significant problems in a culture where discrimination is dangerously commonplace.

Institutions exist to pr event discrimination at both the federal and local levels in every

state. This suggests the Mexican society is willing to change for the better, but with lots

of work to do.

Greater efforts are needed to ensure key needs regarding trans human rights and

citizenship: i) legally, there is a demand to include trans homicides in the Federal Penal

Code, ii) the General Health Law should be improved to get a better coverage of the

trans population by establishing programs in more states, increase resources availa ble

for those programs, train healthcare professionals and create adequate infrastructure, iii)

government policies should consider awareness programs so the general population

understands the needs of sexually diverse Mexicans, and iv) government statisti cs

institutions, such as INEGI and ISP, and health institutions, such as IMSS, ISSSTE and

SS, should tally the trans population respecting their human rights. This would reduce

the current trans population invisibility and encourage its acceptance.

There are a number of important changes that need to be made to improve the

healthcare coverage of the trans population. Current problems include: a high

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prevalence of VIH, suicide, and substance abuse, lack of healthcare access, high rates

of violence and widespread social struggle. Unless the institutions recognize Mexicans

gender identities, the population will not fully enjoy healthcare access. Public, private,

and educational institutions should be included in these programs. Additionally,

transgender clinics should be improved and be created close to the population who

needs them.

Special acknowledge to:

Susana Estrada for the development of the human rights and citizenship section,

Daniela Aguirre for the guidance and orientation of all the informatio n and translation of

the complete work, and Carlo Magno for the design and coun seling in the format of the

final paper.

Groups and places aimed at trans people in Mexico

· Clínica de la Diversidad Sexual de la UNAM
· CEC
· Apoyo sexológico humanista (CECASH)
· Grupo activista Crisalida
· Grupo activista Eón Inteligencia Transgenérica• Gen-T
· Humana Nación Trans
· Red Trans
· Frente Trans
· Centro Border
· La gozadera
· Inspira
· Musas del metal
· Centro comunitario de la atención a la diversidad sexual
· Centro Border Jauria Trans

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se ha logrado abrogar en casi todos los códigos penales del país.
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