HAVANA, June 9, 2008  (IPS) – New horizons opened up for transsexuals in Cuba with the approval of a Public Health Ministry resolution that establishes guidelines for their health care, including free gender reassignment operations.“It was just approved. The operations will begin to be carried out as soon as the Cuban medical team is ready to start,” Mariela Castro, head of the National Centre for Sex Education (CENESEX), told IPS.

Since 2004, Castro, President Raúl Castro’s daughter, has been the driving force in the effort to achieve integral health care for transsexuals in Cuba. With the support of international experts, a team of Cuban specialists has been preparing for months to carry out sex change surgery, said Castro, who added that the operations may begin this year.

Only one sex reassignment operation has ever been carried out in Cuba, in 1988. Resolution 126, which was signed Jun. 4 by Public Health Minister José Ramón Balaguer, establishes the creation of a centre that will provide integral health care for transsexuals. It will be the only institution in Cuba authorised to carry out gender reassignment therapy. The decision also “legitimates the work of the National Commission for Integral Care of Transsexual People,” created by CENESEX in 2005 as the continuation of a multidisciplinary team that has functioned since 1979, said Castro.

“This resolution establishes all of the aspects of care for transsexuals, including the operation for those who qualify and are interested, because not all transsexuals want the surgery,” said the sexologist.

The functions of the National Commission include drafting, implementing and coordinating the national policy on integral care for transsexuals, approving gender reassignment surgery on a case-by-case basis, promoting research and advising the Public Health Ministry on policy-making questions.

The new centre, meanwhile, will provide integral care, including pre and post-op interviews, diagnosis, treatment and follow-up for transsexuals undergoing sex change surgery as well as those who only receive hormonal treatment.

Several transgender persons taking part in the activities of the International Day against Homophobia and Transphobia on May 17 in Havana told a crowd of hundreds of people about their lives and wondered how long they would have to wait to win society’s respect and be able to solve what for them is a serious health issue. “Even if I’m 90 by the time the operation is approved, I’ll do it if I’m still alive,” said Juani, who was officially diagnosed as a female-to-male transsexual back in 1972. “I would ask the doctors to complete the surgery even if I die on the operating table, so that I could be in death what I could not be in life.”

A pamphlet put out by CENESEX states that transsexualism is a term created by medical science to define those people who, from early childhood and throughout their lives, identify strongly with the gender opposite to the one they were assigned at birth.

Since its creation as a working group in 1979, the National Commission for Integral Care of Transsexual People has received 92 applications and has confirmed the diagnosis of 27 transsexuals, two transvestites and two effeminate male homosexuals, according to “La transexualidad en Cuba” (Transsexualism in Cuba), a book published by CENESEX in May.

Of the 27 diagnosed transsexuals, 19 hope to undergo surgery. The other eight do not, but they want to legally change their gender identity. So far, 13 have been able to change their names and replace the photo on their identity cards, and seven are waiting for approval of the process by the Justice Ministry.

Only two of the 27 are female-to-male transgender persons, and the statistics include the male-to-female transsexual who underwent surgery in 1988 and has lived as a woman since then.

More than half of them live in Havana, and they range in age from 31 to 40. Most are white, only five completed secondary school, and eight have been accepted as members of the Cuban Women’s Federation (FMC), the only women’s association in this Caribbean island nation. “We see transsexualism as a special reality that requires a special response from society,” said Castro, who pointed out that many transsexuals drop out of school because of rejection by society and the incomprehension they face in the classroom, from other students and their families, and from teachers as well.

Stepped-up efforts to train teachers and to promote awareness-raising strategies on sexual diversity in the media are among CENESEX’s current priorities, as it awaits passage of a proposed reform of Cuba’s Family Code. The reformed Family Code would stipulate that the family has the responsibility and duty to accept and care for all of its members, regardless of their gender identity or sexual orientation. It would also recognise the same civil, patrimonial, inheritance and housing rights for homosexual and heterosexual couples, while opening the door for legal recognition of same-sex civil unions.

In addition, CENESEX is working on the implementation of a National Strategy of Care for Transsexuals, involving the ministries of public health, education, higher education, labour and social security, the interior and justice, the Supreme Court, and the Attorney General’s Office.

“We have also presented the arguments for a decree law on gender identity that would legally establish that a sex reassignment operation is not necessary for obtaining a change of identity, in the case of diagnosed transsexuals. That would basically amount to social recognition of their identity,” said Castro.

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