Nayer, a twenty-one-year-old trans woman living in Havana, Cuba, didn’t imagine herself being where she is today. But as Nayer says, that’s how life works for the LGBTQ+ community in Cuba.
Nayer, who lives in 10 de Octubre with her mother, works as a freelance digital illustrator and makeup artist, and hopes to one day complete her medical transition. If she has to leave Cuba for the United States or Canada to do so, Nayer will say goodbye to her family and cross the border illegally.
While Nayer was born in Cuba, she spent her teenage years in Canada with her mother, but she forfeited her visa and returned to Cuba after facing sexual and domestic violence. “I was young, and didn’t know what I was doing," Nayer says. "I should have stayed in Canada, it would have been hard, but things are also hard now.”
While Cuba has attempted to brand itself as a haven for LGBTQ+ individuals like Nayer, her experience illustrates how the country is falling short of its promise to provide comprehensive access to healthcare for its trans and gender-nonconforming population — and in many cases, enables violence against them. While a right-wing driven movement to regulate access to gender-affirming healthcare makes its way through the U.S. and U.K., Cuba faces a different problem: it publicly affirms the trans community’s right to equal protection under the law, it just doesn’t have the resources to keep its promise.
“So what do trans people do? When you go to see a doctor, there is no medicine,” Nayer says during an interview in Havana. Despite the promises of the Cuban government, Nayer hasn’t been able to access Hormone Replacement Therapy. She tried scheduling an appointment at Cuba’s National Center for Sex Education, (CENESEX), last year, but Nayer says that she never heard back.
Founded in 1988 and currently headed by Mariela Castro, Fidel Castro’s niece, CENESEX is the country’s government-funded body dedicated to supporting the needs of Cuba’s LGBTQ+ community. At the forefront of Cuba’s efforts to equalize access to healthcare on the island, in 2008, after years of lobbying, Cuba's minister of public health signed Resolution 126, making Cuba the first country in Latin America to fully cover gender-affirming surgeries.
Her account matches others’ experiences with Cuba’s healthcare system. While Cuba has the highest per capita of medical doctors anywhere in the world, due in large part to the US embargo, doctors can’t access the supplies they need to treat their patients, and years of budget cuts by the Cuban government have forced many to leave the practice in search of higher-paying work.
Medicine is also in short supply, so doctors must triage patients into low and high priority. Nayer, like other trans people on the island, has come to discover the Cuban government "won't provide a timeline for treating her gender dysphoria," so she, like others, has turned to self-medication.
“When I first took contraceptives, that was the happiest I’d ever been in my life. I felt one step closer to who I am,” Nayer says. Nayer has been self-medicating for years, which typically involves injecting oneself with hormones obtained on the internet. While there are times when she can’t find the contraceptives that she takes in hopes of feminizing her body, Nayer tries not to miss a dose. The alternative is trying to find Estradiol per World Professional Association for Transgender Health (WPATH) guidelines, a near-impossibility on the island due to the ongoing shortages.
When asked about where she’d like to see herself in five years, Nayer says, “I hope I’m alive, self-medicating. I see myself happier. Everything I am now, but five years better.” Nayer knows the risk that she’s taking by self-medicating, but she feels she doesn’t have any other option. Nayer says of her transfeminine friends, “They do what they want with their body, but when they get older, they’re in danger.” While Nayer, still 21, doesn’t include herself in the “they,” she too is at high risk of blood clots, infertility, and cardiac arrest.
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The odds that she’ll be seen by a doctor at CENESEX, according to sources who spoke with Teen Vogue on the condition of anonymity, are unlikely. CENESEX director Mariela Castro couldn’t be reached for comment. When I visited CENESEX in October 2023 on a Tuesday afternoon to interview staff at the facility, I was told by a security guard that the office was closed and only seeing patients “on an as-needed basis.”
Cuba continues to face an all-out embargo by the United States which has wrecked its economy, further exacerbating food insecurity and poverty rates in Cuba. Nayer’s story illustrates how despite public–facing inclusive policies, the island nation has been left unable to meet the healthcare needs of its LGBTQ+ population.
Nayer told me that one of her closest friends detransitioned due to the side effects of taking over-the-counter contraceptives. “She couldn’t take the psychological effects,” Nayer says, casting a long look at the floor of the apartment in Old Havana. Nayer's friend is no longer in contact with her, but Nayer hopes she is still alive.
Nayer insisted that I accompany her in a taxi to the location of the apartment; as soon as she was done with the interview, I had to wait with her until the taxi arrived. For sex workers like Nayer, the threat of violence is very real, and she knows that if she isn’t careful, she could end up becoming another statistic.
Many sex workers in Cuba identify as trans women and cater to the international sex trade, with tourists visiting from across the world to solicit the services of sex workers in Havana. It’s an open secret in Cuba that despite decriminalizing prostitution in 1976, there are still laws that target sex workers, and violence against sex workers is routine.
According to Nayer, the police will say loitering and soliciting is “anti-social conduct,” which they deem to be criminal.“When they see a trans or gay person on the street, the police will harass them,” Nayer says.
To make matters worse, there is a long history of anti-LGBTQ hate at the highest levels of Cuban society. In 1968, Cuba’s then-President Fidel Castro said, “No homosexual could ever embody the conditions and requirements of conduct that would enable us to consider him a true revolutionary, a true communist militant." In 1965, Fidel set up the countrywide Military Units to Aid Production, a set of concentration camps in the Camagüey Province with the aim of “rehabilitating” non-normative members of society, including gay men and trans women. Men in the camps were forced to labor in the heat for eleven hours each day, with widespread reports of deaths.
The situation today in Cuba is in stark contrast to the United States, where there is an abundance of wealth and medical supplies yet access to gender-affirming healthcares continues to be limited by right-wing activists. Either way, whether in Cuba or the U.S., it appears that the trans community will continue to face restrictions in access to healthcare.
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