Alesandra Ogeta


“Trans people are not sick; we are not confused. We are poorly understood, negatively portrayed, and even invisible in some settings. We experience discrimination and violence, and suffer from a lack of access to justice, housing, education, employment and health care. HIV-related deaths among trans people, as a result of failure to seek medical services due to provider ignorance, discrimination and stigma, require urgent intervention. We need gender-affirming HIV and other medical services that respect us, that acknowledge trans people as unique population, and that treat us as partners.”


Discrimination in healthcare


64.6% of Afrocensus respondents in Germany report experiencing discrimination in health and care services. Respondents relate this experience to skin color (74.4%), followed by racism and ethnicity (72.7%).

Trans, inter- and non-binary Afrocensus respondents are the gender group with the highest levels of discrimination, experienced by 81.7% of them, compared to cis women (67.1%) and cis men (50.3%).

In addition, 83.3% of respondents with disabilities were discriminated against, compared to 60.3% without disabilities.


Barriers in the health care of trans and gender-diverse people. 


Knowledge and attitudes of health care professionals can be a barrier to health care for trans populations. Some trans persons have stated being refused treatment, or experiencing verbal abuse and disrespectful behaviour from healthcare providers.

On another blink, medical education does not routinely encompass trans population health issues. More than half of medical schools and public health school curricula lack instruction about the health concerns of trans people.

The transgender population is much more likely to live in poverty and less likely to have health insurance than the general population. Most went without care when they were sick because they could not afford it. In addition, the barriers that trans people face in accessing care may be compounded by other factors including racial status, education and income level, geographic isolation, immigration status, knowledge and cultural beliefs.


A space born out of necessity


Physical and mental health cannot be considered in isolation from one’s overall life situation, says Nahuel of Casa Kuà, a self-organised health center in Berlin for trans, inter- and non-binary BIPoC, i.e., black, indigenous and colored people. “Casa” means house in Spanish and “Kuà” means “trans” in Mandarin, Nahuel explains.

“We understand health as holistic.” Aspects of community and care play a central role, Nahuel says. “People come with all kinds of problems: visa and residency issues, physical pain, psychological difficulties. Finding housing is also a big problem in our communities.”

However, the German healthcare system was designed according to white cis-male standards, criticize the activists of Casa Kuà. Therefore, people who do not conform to these norms have to repeatedly face uncomfortable and discriminatory experiences.

In September 2020, a group of people who know each other from queer activist circles opened the Casa Kuà space in the Schokofabrik women’s center in Kreuzberg: There are two treatment rooms, a workshop space, a large kitchen and a small library. “The place was born out of necessity. Most of us are immigrants and many of us come from working-class backgrounds.”