(This is the final of a two part series. Part one focused on Jessica’s personal journey to becoming the “ultimate” her. Part two focuses on health care issues facing transgender persons in Jamaica and how she plans to change it. This interview was edited for length and clarity.)
Do you plan to remain in Jamaica?
I’ve thought about it. One of the things I look at is the treatment cascade. The treatment cascade is services provided by the government in the public health system. You have an entry level which is when you get tested (for everything: diabetes, HIV, STIs etc), then you move from treatment to medication. You may need to be referred to a psychologist by a social worker.
Is this in relation to HIV treatment or transitioning?
No, just in general. The health system is supposed to provide you with a minimum package. There are some issues. Accessing the treatment cascade is a problem. For some persons even walking to a health centre can be a problem. If you don’t look as feminine as society requires you to look you might fraid seh somebody run yuh down. This means you have to take a taxi instead which is expensive. [To fund that] you need to work and you may lose your job if you go to work dressed as how you are. You may then have to start a business, likely supported by the LGBT community. All of this depends on money! That’s why I say that when you face the question on whether or not to transition you need to take a lot of things into consideration. You need family and friends. If you don’t have a family, try to mek one.
So how does the transgender community gain access?
They’re not going out to the health centres. One or two of us may be at a workshop. Where transgender persons do come out is at the big gay parties. But when they’re there they don’t want to be tested. [It’s uncomfortable to face] in that environment. I am one of the lucky ones who got tested.
If you manage to enter the treatment cascade, as a transgender person wanting to transition, there is nothing there. Just a doctor, if you have one, to do regular check ups, and maybe a psychologist who doesn’t really know how to deal with transgender issues. The doctors are reluctant to prescribe the hormone medication because of the country’s prohibitive environment. They don’t know anything about the treatment, they don’t know if it’s against the law, if it’s against their practice. They have to consult with others before they treat you.
The treatment cascade here is also not designed in a way to make transgender persons feel comfortable. I may want some linguistic skills to make my voice more feminine, and transgender men (female to male) may want techniques to help lower the voice etc. If you look at women like Caitlyn, they look beautiful, but they still have that male voice. There’s nothing in the treatment cascade for that.
You have to go abroad.
Yes. However, I did apply for a grant to help me develop a treatment cascade for the Jamaica health system — to create a treatment cascade for transgender persons. It will not be the best, but I want to at least allow for access to hormones and linguistic skills development. And we need to get psychologists on board because going through all of this is a big process. Even [as a transgender woman] to move from the male to the female bathroom….
I spoke to someone about that and it was a big issue for them. Regardless of which one they chose it was uncomfortable.
Moving from one to another is like a whole new world. When I went into a female bathroom for the first time I gasped because there were no urinals. [laughter]
Yeah, we don’t necessarily need those.
And then you start to look within yourself and think, Am I looking at the women in any way…? Do I fit in with them? For me, now, it’s not a problem. Others may not look as feminine and so other women using the bathroom get uncomfortable. Why dis man come in the bathroom dressing like a woman? Many don’t mean anything by it, they just have security concerns. Is this person an impostor who intends to rob me? So a lot of trans persons think twice. I know a lot who wait until they reach home to use the bathroom.
Doing that may cause health problems, though, like UTIs and kidney infections.
Yes. So the referral manual I want to create for the treatment cascade will be Colour Pink’s first TransHealth project that targets the transgender community. It will also involve educational plans for sexual reproductive health plus gender and sexuality to learn about the terminology. When transgenders are out they should be able to firmly articulate who they are.
We are grateful for the time spent with Jessica and look forward to working with her on future initiatives. Please like the Colour Pink Facebook page to keep current with its activities and learn how you can help.