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This April, Rock Around the Blockade held its 14th solidarity brigade to socialist Cuba, celebrating 60 years of the Cuban revolution. 17 activists spent two weeks visiting schools, nurseries, grandparents’ groups, community centres and cooperatives. We held meetings with trade union officials, representatives of the Cuban women’s federation and journalists. In a political act to break the blockade we brought case-loads of musical instruments and children’s toys and donated over £900 to the repair fund following a tornado that tore through Havana in January. A major highlight was the opportunity to visit CENESEX – the National centre for sexual education and discuss with research specialist Anabelise Perdomo Caceres about Cuba’s approach to LGBT rights, including the new constitution and Cuba’s approach to trans-healthcare.

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I am a trans woman who has been navigating the NHS care pathway for the last 4 years, so I was keen to find out how my experience compares with Cuba’s approach.

In order to access support for gender dysphoria in the UK, a person must be referred by their GP to one of 7 gender identity clinics (GICs). Treatment is provided free on the NHS, however the waiting times for an initial appointment range from 1-3 years (against a target time of 18 weeks). This is before any care is provided. Because of this, many trans people resort to self-medicating; obtaining hormones via the internet or through other means and administering them at home, without the supervision of a qualified doctor.

One of the main reasons for these delays is the lack of funding for this type of care. There is a lot of waiting throughout the process and things move at a snails pace even once you reach the GIC. Funding bottlenecks mean a lack of staff at these clinics and often mean large waiting times to recieve surgery.

I decided to have gender reassignment surgery early in 2017, having already waited 10 months for an initial appointment at the GIC, and a further 6 months to begin hormone treatment. It would be another year before I would finally meet with the surgeon who will carry out the procedure and put me on the waiting list. Then after a six month wait, I was told that the clinic had run out of funding for that financial year. NHS England only allocates a limited amount of money for these operations to be carried out and they are performed under a contract with the private sector, so when the funding runs out, NHS appointments are postponed until the next financial year. You can of course pay for the treatment yourself, but this is not an option for most. If you are trans in Britain, you either need a lot of money, or a lot of patience.

The approach at CENESEX is radically different. If you are trans, you talk to your local family doctor, or visit a polyclinic and then you are referred to a type of support network which is integrated with CENESEX and you can very quickly access support for transitioning if this is what you decide to do. There is virtually no wait time for referrals and mental health and wellbeing support is provided not just for the person transitioning, but for family members as well.

We asked about the process of transitioning in Cuba and what care is provided.

‘Here in CENESEX we coordinate one of the largest social networks, going on for more than 17 years, called TransCuba. Now the name has changed because it includes not just people who are transgender, but their partners and family, even elderly people who are 50 or 60 and want to change gender: it is now called “TransCuba Network Couples and Families”.’

‘This commission is integrated with different doctors and specialists such as social workers and mental health specialists, so we have a team of specialists supporting this community. They can access this commission through the network itself, through their health area, the polyclinic or family doctor’s office, or they can request CENESEX directly.’

‘Any Cuban citizen can knock on the door and they can see someone. They can talk about this with any doctor at the polyclinic, or at the consultation office at a hospital for sex education.’

Shortages imposed by the US blockade mean that sometimes there is a delay in providing surgery for those who require it. But again, CENESEX does everything in its power to provide the necessary care. The Cuban state will pay to have doctors flown in from elsewhere in the world, bringing their own equipment and materials. Anybody can access this service free of charge, meaning that in Cuba trans healthcare is not a privilege afforded only to the rich.

We also asked about the recent consitutional debates and the issue of same-sex marriage which has generated a lot of interest in the international media.

The draft of the recent constitution originally contained an article to define marriage as being ‘between two persons’ rather than being ‘between a man and a woman’. This generated a lot of controversy among Cuba’s population and ultimately resulted in the definition being removed entirely. This is not the end of the debate however and instead the National Assembly of People’s Power will, within a period of two years after the Constitution takes effect, begin the process of popular consultation and referendum for the Family Code program, which must include the form that a marriage may take. [1]

As Anabelise told us, although this is being portrayed by some as a failing, the fact that this article was even in the draft was a step forward. But it was a highly controversial issue and generated more debate in the popular consultations than any other subject.

‘We have more than five articles that protect LGBT people. We do consider that the constitution does not allow discrimination against people based on gender identityor sexuality.’

‘The first articlesays that all citizens are treated equally with the same rights and responsibilities; this includes all members of the LGBT community. It is true that this chapter was held over from the previous constitution, but the next articles say that there will be no discrimination against LGBT people, as well as religious groups and others, so we are included as Cuban citizens.’

Rights are not something which can be simply legislated from above, there is an ideological struggle that needs to be carried out in every community and workplace to change people’s minds and this is part of the work that CENESEX carries out. With the type of mass participatory democracy that Cuba has, how could it be any other way?

Lucy Roberts

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