Invisibilities: Exploring Identities & Stories of Trans Community Members & Leaders in Santo Domingo, Dominican Republic

As a public health professional and as a child of immigrants, I have always been drawn to diving into the diverse perspectives that shape different populations’ realities and, ultimately, their health outcomes. When the opportunity arose to embark on a project focused on interviewing and surveying HIV positive trans community in Santo Domingo, I knew it was a chance to engage in meaningful conversations and shed light on stories often overlooked – especially in the Latin American context. Now that I have finished my summer practicum with the Unidad de Vacuna e Investigación at the Instituto Dominicano de Dermatología y Cirugía de la Piel (IDCP), I have taken some time to reflect on the diversity and layered experiences shared with me by trans community members.

From the moment I stepped into this project, I was captivated by the resilience, strength, and diversity amongst the trans individuals I had the privilege of speaking with. Each person had a unique story to tell, shaped by their experiences, struggles, and triumphs. These stories painted a vivid picture of the challenges the trans community faces in a patriarchal society that often misconstrues, mistreats and marginalizes them. Machismo is rampant in Dominican culture, as is it is in all of Latin America, that is very much a remnant of the country’s colonization period. As one trans leader explained, that individuals – particularly men – who exhibit chauvinistic behavior are often called “Trujillista”. This term comes from the country’s brutal dictator that reigned between 1930 to 1961, Rafael Trujillo, referring to the belligerent behavior implemented by his armed forces at the time. It was fascinating to see how the country’s dark past informs the coinage of a term that oppresses such a marginalized community.

One of the most important aspects of this project, whether in qualitative interviews or administering surveys, was creating a safe and welcoming space for these vulnerable conversations – which often covered topics such as sexual/domestic abuse, drug use, and mental health. It was crucial to establish an environment where individuals felt comfortable sharing their thoughts, feelings, and experiences. We held the interviews and surveys in locations where participants felt secure, facilitated them through a consent process and assured them that their identities would not be tied to the information that would be shared with us. Many explained that their biggest fear was having their HIV status disclosed to other trans sex workers in the study, which could cause a domine effect that may trigger rival trans sex workers to tell potential clients and thus hindering their ability to secure customers.

The entire research team – including primary investigators, participant recruiters,
psychologists, and MPH Practicum students.

Throughout the conversations, all participants shared annecdotes reflecting the preconceived notions and misconceptions Dominican society have against the trans community, particularly those that are HIV positive. It was disheartening to hear about the discrimination, stigma, and lack of compassion the community faces, typically perpetrated by their own family members, employers and law enforcement. Nonetheless, it was also inspiring to witness many of their determination to challenge these misconceptions and advocate for their rights through grass roots efforts. What struck me the most was the sense of responsibility of older trans women to give back and carve a path for the younger generations of trans women. Several community leaders I spoke were all involved some form of capacity building – supporting local trans NGOs through health education, political advocacy, or vocational training efforts. All shared how there is a dire need to equip trans women, at a young age, with education as their main armor to be used against the patriarchy. Despite the hardships the community endures, there is overwhelming pride in the visibility of trans women that continues to grow due to the growing presence of trans-serving NGOs in the area such as TRANSSA and COTRAVETED. These organizations are committed to unifying the community, empowerment, and personal/professional development opportunities for LGBTQI+ individuals in the DR.

Leading a mock survey interview to test interview facilitation best practices.

The experiences and stories shared during my interviews and surveys underscored the urgent need for advocacy, education, and awareness. It is the responsibility of the Dominican government to give legitimacy and a platform to amplify the voices of trans women, challenge stereotypes, and work toward creating a more inclusive and accepting society. I am immensely grateful for the opportunity to have connected with the trans community in Santo Domingo. The Dominican Republic will always have a piece of my heart – from its kind people, delicious food, rhythmic music, balmy nights and the ice-cold Presidente beer shared with friends at the park during the sunset – it is truly a gem in the Caribbean. I can’t wait to go back and, not only see how the study has unfolded, but also to be enveloped by the lively feel of the country.  As I continue to process the insights gained from this experience, I am reminded why I chose to become a public health professional. By lending our ears, hearts, and actions to those who often go unheard, we can collectively build a world where everyone’s story is celebrated, valued, and ultimately, respected.

Stunning sunset from Las Terrenas beach in the northwestern region of the country.

-Tiffiany Portacio

CONTINUING GILLING’S LEGACY OF COMMUNITY ENGAGEMENT AND COLLABORATION WITH TRANS WOMEN IN THE DOMINICAN REPUBLIC

¡Hola! My name is Tiffiany Portacio and I am an incoming second-year MPH student at UNC Gilling’s School of Global Public Health in the Health Behavior concentration. This summer I have the privilege of completing my summer practicum in Santo Domingo, Dominican Republic (DR) along with HB classmate, Sophia Mus.

Tiffiany Portacio (middle left) and Sophia Mus (right) reviewing a study survey with
Dr. Yeycy Donastorg at IDCP.

I am currently working with the Instituto Dermatologico y Cirugia de Piel (IDCP), which is a private non-profit institution, located in the capital city of the DR, Santo Domingo. Their mission is to provide specialized integrated services in dermatology, mycology, leprosy, sexually transmitted infections, among other conditions. IDCP also offers accessible health services and education for the local community. Dr. Clare Barrington, professor and director of doctoral program in the Department of Health Behavior, had established a collaboration with the HIV Vaccine and Research Unit at IDCP, led by Dr. Yeycy Donastorg, nearly twenty years ago. This partnership has served as a pathway for several Gillings students to have completed practica and other research collaborations with IDCP.

Tiffiany and Sophia with team of psychologists at the office of investigations at IDCP.

 

For general public health context, the DR has experienced an epidemiological transition, where the burden of non-communicable disease is increasing, while the country continues to struggle with ongoing burden of infectious disease, including HIV. Populations who disproportionately experience worse health outcomes are transgender women and cisgender female sex workers living with HIV and type 2 diabetes. My practicum experience will support two ongoing applied research studies led by Drs. Barrington and Donastorg focused on HIV and other chronic conditions, including type 2 diabetes and hypertension.

Colonial building on the notable street, Calle El Conde.

The first study is to develop a model of integrated care for HIV and noncommunicable diseases, specifically Type 2 diabetes and hypertension, tailored for cisgendered female sex workers. The other study will determine preliminary efficacy of a multilevel intervention (called GAP – Gender Affirming Abriendo Puertas) to improve HIV outcomes among transgender women by reducing stigma and increasing social cohesion as well as provide insight into the use of sequential implementation at the individual and community levels. My two practicum deliverables, which will support each study respectively, will be to conduct qualitative interviews with healthcare providers who work on HIV and/or noncommunicable diseases and to develop a detailed plan for monthly community support sessions to guide implementation of the community engagement component of the intervention.

It has been about a week since Sophia and I have arrived to Santo Domingo, and I believe we have acclimated quite quickly. We both are fluent in Spanish and have traveled extensively throughout Latin America. Nonetheless, novelty fills our day – from getting familiarized with new vocabulary and the neighborhood, to taking public transportation and the general pace of life. The team at IDCP have been incredibly sweet and accommodating both in and out of work. In just a matter of a couple of days, they have dedicated many hours to proofreading and providing feedback for an important survey we have been working on in RedCap, which will allow us to jumpstart on our practicum deliverables. I have done data entry work on RedCap before, yet this is the first time I have dived into the deep end on this software and it has been quite exciting to be able to dissect questions and think of more efficient ways to gather data while still capturing key measures. It has also been especially rewarding to be able to implement survey method skills, with my favorite so far being thinking through and executing code for branching logic. Outside of nerding out to study intervention logistics, many of our colleagues have also made themselves available to give us a tour around the city and even take us out to do a beach-front Zumba class!

We are lucky to live right in the middle of the colonial city in Santo Domingo. Sometimes I find it hard to wrap my head around the history that is dripping from every corner of the city – from the first church and hospital built in the new world to Christopher Columbus’ son’s living quarters just around the corner from our apartment. It is wild to know that in the shores of this island is where the cancer of colonization in the new world would set its foundation to then metastasize its turbulent and bittersweet fate onto the rest of Latin America. The effects of this on the health of populations across the region are seen to this day. However, that is an idea I hope to explore on my next blog entry.

As a pastime and coping mechanism against the infernal summer heat, I have taken it upon myself to jot down intriguing typical sayings colleagues and neighbors have shared with me. The Dominican culture is rich in expressions and idioms that reflect the culture and people’s values, humor, and outlook on life. One that I will leave you all with, which has been sitting on my mind lately as I have commenced my practicum experience, is “El que busca, encuentra”. This saying translates to “She/He who seeks, finds.” It highlights the idea that effort and persistence can lead to successful outcomes and, to me, symbolic of my time here. Although I am working in a new country and with a population I have not worked with before – I seek to learn and, collectively, define and reach success for all parties involved.

¡Hasta pronto!

– Tiffiany