The social integration of transgender people in Cuba

Mariela Castro Espín

Centro Nacional de Educación Sexual, Havana, Cuba.

Received 6 February 2019; accepted 27 June 2019

Summary. In political practice, skills are generated to identify the expressions of social inequality, and to develop actions to overcome them. This research advises about the conditions of discrimination, exclusion and social segmentation that transgender people still experience in Cuba, with the main idea of providing concrete proposals for public policies that facilitate the development of critical awareness in decision-making groups and in transgender people, in relation to the difficulty in the processes of social integration and their causes.

Key words. Transgender, social integration, Cuba.

L’integrazione sociale delle persone transgender a Cuba.

Riassunto. Con la pratica politica si creano gli strumenti in grado di identificare le manifestazioni di disuguaglianza sociale e di sviluppare le azioni necessarie per il loro superamento. Questa ricerca fornisce informazioni sulle condizioni di discriminazione, esclusione e segmentazione sociale che le persone transgender vivono ancora a Cuba, con l’obiettivo principale di fornire proposte concrete per politiche pubbliche che facilitino lo sviluppo di una consapevolezza critica nei gruppi decisionali e nelle persone transgender, in relazione alle difficoltà che si riscontrano nell’analisi dei processi di integrazione sociale e delle loro cause.

Parole chiave. Transgender, integrazione sociale, Cuba.


Although they have the same origin, the various forms of discrimination are expressed according to specific socio-historical contexts. They were created within societies whose economies are based on the exploitation of human beings. Among these economic relations of exploitation and the cultural and moral processes, there is a series of mediations and articulations often conflictive with social values, perceptions, and leading to stigmas and stereotypes that subdue certain human groups, condemning them to social exclusionA.1

The Cuban socialist experience inherited these historical codes, that contradict with the emerging emancipatory positions, typical of the development of a revolutionary project that achieved significant changes in the field of justice and social equity, and whose benefits are notable in women, children and youth,2-5 as well as in other groups who had been subject to discrimination.6,7 Despite this progress, however, several recent studies show that situations of inequity associated with skin color, female condition, age groups and territory of residence are still present,8-10 as well as others related to sexual orientation11-13 and gender identity, all of which are issues still to be solved.

Sexual orientation and gender identity are biomedical-normative constructs typical of modern times, with an important development in the field of human rightsB, which has been expressed in principles and new laws-policies that have been currently adopted – albeit by very few countries – aimed at protecting the rights of people whose identities and behaviors do not conform to the models of the dominant ideology, with regard to sexuality and gender; therefore, they are greatly useful resources in the struggles of the social movements claiming these rights.14

From the dualistic thought pattern that has historically characterized Western culture (mind-body, nature-culture, subject-object, biological-social), the man-woman, male-female dichotomies are among the most resistant to change, as well as being the main obstacle to the emancipatory desires of people with identities that do not conform to the rules of the sex-gender binarism.

When questioning the reductionist approach to the diversity and plurality of identity, Spanish anthropologist José Antonio Nieto argues: «Understanding the subject’s identity rigidly through sexuality, and placing genital anatomy at the center of that identity is part of the problem. Especially when the identity of the man and the woman, in addition, is configured within society, and on a permanent basis, through gender roles, male and female. If priviliging heterosexuality over homosexuality is added to gender identity and behavioral rigidity, we find ourselves facing a medical model with dualistic contents: man-woman, male-female, heterosexual-homosexual. This polarized model, constrained by its own limitations that do not admit differences opposed to its dichotomous criteria, forces to pathologize identities and behaviours».15

Thus, the biomedical thought is the first to generate a specific analysis, and that with the greatest social impact on the issue that we now call transsexuality. In the (Western) medical literature, the first references to people who violated the medical-legal gender rules are attributed to the German Richard Freiherr von Krafft-Ebing, in his work Psycopathia sexualis (1886). Since then, the main contributions to the subject come from medicine, and it is not until the middle of the twentieth century that contributions originating from a psychoanalytic and ethno-methodological approach made their appearance.16-18 Later on, other significant contributions came from social psychology, sociology and anthropology.

The impact of the medical-pathological vision on social sciences, within the analysis of the plurality of non-normative identities, contributed to reinforce the stereotypes that lead to their rejection, discrimination and social exclusion. In this context, the notion of transsexuality as a disease is born, and is placed under the social control of psychiatryC. Consequently, transsexual behaviors are negatively recognized as abnormal, perverse, deranged and deviant.

For many years we have worked with the criterion that transsexual people are those who express dissatisfaction and suffering, due to the contradiction between the social imposition of a gender role assigned according to the biological sex at birth, corresponding with the morphology of their genitals, and the gender with which they identify themselves.

These people, from their early childhood, suffer from lack of understanding and rejection within their own family, at school and at work, as well as in other institutional and community contexts. Society persists in arbitrarily “adjusting” and “detaining” them in a body they don’t recognize, based on traditional, historically constructed norms and expectations, which have negative implications both for them and for society19.

The universal references are not only the psychologically and clinically significant uneasiness suffered by transgender people, but also the different forms of violence they experience throughout their lives, ranging from pejorative verbal expressions to hate crimes, exclusion from their family environment, impossibility or difficulty in finding a dignified job, manipulative pathologization, as well as being victims of profit in the exercise of medical sciences, mainly in the field of mental health and surgery. In addition, transgender people are sometimes abused by police and immigration authorities; many of them tend to drop out of school, which leads to a low level of education, and suicidal behaviors.20-31

With regard to this social group, there is sufficient evidence about the suffering generated by the conditions of discrimination, exclusion and segmentation, which obstruct their full integration into social and family networks, as well as a full use of education, healthcare, housing opportunities, work and culture.

It is significant that transgender people, as part of the society that discriminates against them, reproduce the same prejudices and stereotypes in their own social group as well as in others, which makes the situation a vicious circle that produces and reproduces social exclusion and lack of integration, and limits their possibilities as legal persons.

This general picture affects society as a whole, both transgender people, who could be considered direct victims, and those who commit such discrimination, who – whenever they feel angry and outraged – often resort to criminal forms of extreme violence. The latter, in their role of victimizers, diminish their dignity, thereby becoming indirect victims of these assumed social patterns. The hegemonic process of western civilization – and the normalization criteria that it imposedD,25 – obstructed the social inclusion of these people, therefore it is currently difficult to find individual or collective solutions to this problem, which emerges as a demand for attention at the macrosocial level.

Overcoming a type of prejudice or exclusion is a contribution to getting over discriminatory attitudes in a general sense, since exclusions and inequalities reinforce each other, and arise from the same ideological matrix, historically configured within society.

The debate about this type of discrimination and its possible solutions goes beyond the strictly biomedical field, and is to be found in a much wider social scenario, in which the transsexual person changes from the condition of manipulated, stigmatized and discriminated subject to that of a conscious “transformer”.

The order established in modern societies for the categories of sex, gender, desire and sexual practice has maintained over time its original taboo connotation, in order to dominate people by controlling their body and their needs. This explains why the production of opinions and feelings about the mentioned categories is one of the elements of social consciousness and subjectivity more resistant to change in the processes of transformation of society. Prejudices, and the fear to face them, are so strong that they arrest the social capacity to assign emancipatory paradigms to these categories. This leaves a vacuum of content, which is replaced by the old ideology, dressed with new clothing.

Sociology has contributed to reflecting upon how to move forward in the construction of a democratic society in which transgender people could fully exercise their citizenship. Their contributions facilitate the recognition of the deficits of democracy in certain sectors of the population and social groups, while highlighting the need to consider the relationship between citizens, as well as other variables, such as gender. In the case of transgender people, empirical evidence shows a disproportionate distribution of political, economic, cultural, symbolic, autonomy or authority resources, which is expressed in the difficulties in social integration processes.

Socialism, as a social system, proposes the emancipation of the human being. However, when contradictions are left to a spontaneous solution, without a specific intervention, both on the part of the political power and the civil society, the progress of the justice and social equality project is impeded, and discriminatory policies – generated during previous historical stages, in response to the interests of classes now deprived of power – are perpetuated.

In Cuba, since the triumph of the Revolution (1959), the State and the government showed their political will to attend to the different forms of discrimination identified in each moment of its history. The institutional treatment of transgender people began on the initiative of a civil society organization, the Federation of Cuban Women (FMC, Federación de Mujeres Cubanas), and was established within the National Health Service since 1979, for which the only internationally approved scientific reference model was assumed, that same year, by the International Association of Gender Dysphoria Harry Benjamin (Asociación Internacional de Disforia de Género Harry Benjamin). The comprehensive healthcare of transsexuals, including sexual reassignment surgery, is coordinated by the National Commission for the Comprehensive Care of Transgender People (Comisión Nacional de Atención Integral a Personas transexuales), created by Resolution no. 126 of 2008 of the Minister of Public Health, which included this type of healthcare – universal and free – in the national public health system.

In scientific practice, the biomedical paradigm gradually changed into the social one. This meant changing the direction of the problem – centered on the pathologized and manipulated figure of the transsexual persons – towards society, and more specifically towards patterns that deprive them of their rights and impose power relations. However, the efforts made are not enough to avoid the occurrence of mechanisms of discrimination and social exclusion that make the transgender population vulnerable, and create difficulties in their integration processes.

Taking into consideration the negative connotations that for a long time, before its depathologization, the term “transsexual” has had as a mental disorder, in recent years we adopted the terms trans-person and trans-people32 to refer to people who want to re-define their gender identity.

The estimated number of trans-people in Cuba is 3,700, 52.1% of whom practice transactional sex, according to the 2017 Survey on HIV/AIDS infection prevention indicators of the Center for Population and Development Studies (CEPDE, Centro de Estudios de Población y Desarrollo) of the National Statistics and Information Office (ONEI, Oficina Nacional de Estadísticas e Información) of the Republic of Cuba.33

During the last ten years, CENESEX has promoted the modification of legal regulations to guarantee the legal recognition of gender identity of trans-people; however, it is still necessary to prove one’s sexual reassignment surgery as a requirement to legally modify the gender status at the Registry Office. After the new Constitution of the Republic of Cuba was approved by popular referendum in 2019, an exhaustive review of all legal regulations related to this issue has been decided, which creates the possibility of legally modifying the rule, in order to dejudicialize the recognition of gender identity.

In political practice, skills are generated to identify the expressions of social inequality, and to develop actions to overcome them. Therefore, the central idea of this research is to provide concrete proposals for public policies that facilitate the development of critical awareness in decision-making groups and in transgender people, in relation to difficulties in social integration processes and their causes.

Characteristics of the study

The research adopted a theoretical-methodological approach, in order to obtain useful input data to demonstrate the processes of discrimination, exclusion and segmentation these people undergo, and to propose solutions, in this case through a strategy for their social integration in Cuba, in light of the provisions of the public policies.

The scientific issue addressed by the study is about how to promote the social integration of transsexuals in the current Cuban context, and for this purpose a series of objectives was set.

This is, essentially, an analytical, critical and proactive study. As research methods, a documentary analysis, a questionnaire and a detailed semi-structured interview were used. The information was examined both from a qualitative and quantitative perspective. The content of the tools was then evaluated by specialists.

The results of this study include: the identification of the main contributions of sociology to the understanding of transsexuality; the systematization of the evidence of the processes of social exclusion, discrimination and segmentation that affect transgender people, and their causes; the characterization of the state of social integration of transgender people in current Cuban society; the identification of the social conditions that favor and limit their integration, as well as a strategy proposal for all this to take place.

Main conclusions

At the base of the discrimination against transgender people lies a type of socio-political organization whose logic is characterized by the anti-human nature of its own foundational, propositional and functional elements, and by the need for a social fragmentation for instrumental purposes, for the benefit of the dominant classes.

The mechanisms most used by these organizations within Western societies have been the Catholic Church, medicine and law. The systematization carried out within this study allowed to identify how, over different historical phases, specific pathways related to the control of bodies and identities – as well as the corresponding production of senses, and the use of knowledge, science and morals – emerged at international level, depending on the transphobic power.14 Together with a series of sectarian, alienating and discriminatory public policies, these entities used pathologic stigmatization and social exclusion as their main modus operandi, each according to their own needs and peculiarities.

Paradoxically, also transsexual people take part in the process of producing and reproducing their own discrimination, whether by sharing beliefs, ideological patterns, stereotypes and discriminatory prejudices about themselves and/or other social groups, or by recreating a gender binarism anchored to the naturalization of sexual differentiation. In either case, they express insufficient critical awareness about their historical expropriations, and limit their possibilities as bearers and promoters of law.

Social and human sciences made substantial contributions to the understanding of the system of contradictions within the relationship between society and transsexuality. Likewise, the influence of feminism and anthropology is also well known.

Despite its delay in approaching the debate on the gender issue, the most prominent contributions of social science originate from the theories of social deviation, stigma, labeling, power, knowledge and discussion. It is necessary to point out that the sociological conclusions regarding the subject can be considered an essentially critical theory, since they have been elaborated and socialized from a reflection that not only describes, but pursues the rules and the contradictions, and makes proposals. A current example is the analysis of the contradiction “pathologization-depathologization of transsexuality”, as well as the formulation of concrete proposals that help the emancipation and dignity of these people.

The contributions made by this discipline revealed the democratic and human limits of the domination systems; they give visibility to the inequalities based on gender, gender identity and sexual orientation, and the relevant consequences in terms of discrimination, exclusion and segmentation of the groups affected; they contribute to the empowerment of socially excluded and disintegrated groups based on gender and gender identity; and they offer an integrative and integral interpretative picture that highlighted the mechanisms of domination associated with gender inequalities and identities, which are established by policies, institutions, laws, public services, programs and projects, among others.

The main outcomes of social sciences concerning transsexuality issues allow to state that the identification and overcoming of the latter essentially go through the social conditions in which these processes are generated and reproduced, and not through approaches focused on the individual or the group.

This point of view affected the emphasis placed by this study on the social conditions in which discrimination occurs, and on the role of the socializing agents and their manifestations and implications for transgender people. This induced the adoption, from the methodological point of view, of the social integration category, assumed as the main research variable.

It is important to point out that the fundamental objective pursued by this category within the context of the study was to facilitate the access to information that evidenced the elements of discrimination, exclusion and segmentation to which Cuban transsexuals are subjected and, from there, to formulate a strategy for their social integration as an input for public policies.

Among the conditions of discrimination and social exclusion experienced daily by this group, the following can be emphasized:

difficulty in accessing opportunities and manifested needs in relation to their well-being;

obstacles in the formulation of requests, in planning solutions for problems that concern them directly, in the participation in the decision-making process related to their own interests, and in the execution and control of what is decided in the areas where they operate, which has a direct correspondence with their needs, aspirations and motivations;

extraneousness and lack of participation of transgender people with regard to the rules and values shared within their group, and with respect to society, basically in relation to gender identity and sexual orientation. This allowed, on the one hand, to know the functional internal dynamics of this Cuban social group and, on the other, to identify their perception about their connection with other groups;

as for the conditions in which their integration process is carried out, according to the areas studied, it can be stated that the impact of social justice and participation is limited, with the relevant implications for social cohesion. These are integration difficulties of a general nature, with peculiarities in each of the areas analyzed. However, the main issues regarding such integration are expressed within the family, educational, work, legal and cultural contexts.

It was interesting to learn how in the most immediate environments the skills of these people is limited in terms of autonomous development, influence within society and social transformation, despite the general framework of justice developed in Cuba by the Revolution, which acts as a buffer for the process of social disintegration of transgender people. It is also important to confirm an aspect of the matter recognized by international research: the relationship between the different disintegrating conditions, how some people prejudge others and how the people who accumulate the most discriminatory experiences are the most affected. In the case of the present investigation, transsexual people not subjected to sexual reassignment surgery, those who have no employment relationship and those under thirty, are the most disintegrated. These results show the need to consider the matter as a subject of intervention through public policies, with an integrative and integral approach.

The study also confirmed the idea that transsexuality has created a gender crisis, in the sense that it breaks with the construct of the sex-gender system. However, the solution that transgender people are looking for within this conflict reproduces the normativity of gender binarism, and legitimizes it according to the dominant stereotyped patterns, which demonstrates their limited criticality in relation to the traumatic situation they are living. Naturally, this is consistent with the actions of the social mechanisms of power, that aim to legitimize sexual and gender differences through the symbolization of sexuation.

To this end, the study contains the author’s proposal for a strategy for the social integration of this group in Cuba, which covers the dimensions “personal-group” and “social in general”, as well as four specific inputs: a system of actions for the social integration of transsexual people by public policies; an process of sensitization of those who decide on the issue; the training of specialists belonging to the National Commission for an Integral Attention to Transsexual Persons (Comisión Nacional de Atención Integral a Personas Transexuales) on the new approaches on the subject; and a system of courses on human development and citizen leadership aimed at transsexuals.

Social transformation processes are accompanied by different changes in the structures, organizations and social groups these people are part of. The society-transsexuality relationship includes the obvious reciprocity between these elements.

Transsexual groups are constituted and developed based on their interrelations with the other social institutions; they never were nor can they be an alien space, isolated from the broader social determinations. Their problems must be studied and analyzed taking into account the material, economic, symbolic, cultural and political aspects which are present in – and converge into – each of the events and social relations of everyday life.

At the international level, the proposals to address the problems of gender and gender identity are increasingly progressing through sub-policies (political initiatives arising from outside the institutions). This has given a particular dynamism to this issue and to the functions of the policies, which removes the State from fulfilling its responsibilities and gives a leading role to civil society: the participation of civil society appears as mandatory in order to address transgender people social and healthcare problems. Nothing is more similar to the game of neoliberalism in its eagerness to weaken the national States without protecting the most disadvantaged populations.

The legitimacy of the gender and gender identity issues in government practices presupposes, on the part of specialized institutions, a permanent process of deliberation, preparation, incorporation of scientific results and advice to the decision-makers. This institutionalization process does not take place in a linear manner, and does not achieve results corresponding with the expectations of the groups that need them. In this sense, it is very important to reinforce a more active participation of the institutions, and at the same time support the dialogue between them and civil society organizations, so that the cultural diversity of identities is taken into account and exclusion, discrimination and social injustice are avoided.

Working on the social integration of transgender people, through strategies that articulate the responsibilities of the States and civil society, can contribute to the creation of objective and subjective conditions that facilitate the emancipation of human beings, without any absurd fragmenting and discriminating differentiations.


A «Social exclusion should be understood as the accumulation of processes that converge in the subsequent breaks originating in the heart of economics, politics and social structure, which gradually distance and place people, groups, communities and territories in a position of inferiority in relation to centers of power, resources and predominant values», Estivill J, p. 19.1

B According to the principles concerning the application of the International Human Rights Law in relation to sexual orientation and gender identity, known as Yogyakarta Principles, sexual orientation refers to the ability of each person to feel a deep emotional, affective and sexual attraction for people of a different gender, or of their same gender, or of more than one gender, as well as the ability to maintain intimate and sexual relationships with these people; while gender identity refers to the internal and individual gender experience each person deeply feels, which may or may not correspond to the sex assigned at the time of birth, including the personal experience of the body (which could involve the modification of the appearance or body function through medical, surgical or other means, provided that such modification is freely chosen) and other gender expressions, which include the way to dress, talk and behave, Yogyakarta Principles 2006, p 8.14

C The word transsexuality or transsexualism was defined as a diagnostic category by endocrinologist Harry Benjamin; later on, Norman Fisk called it gender dysphoria, which marked a milestone in the treatment of transsexuality.

D I emphasize the connection between Western hegemonic culture and discrimination against transgender people, among other gender identities, because, although it is not the only cultural matrix that discriminates against them, there is a reference to their inclusion in other cultures. «In the cultures and traditions of the aboriginal people of North America, in times before colonization, there was no such thing as the duality of sexes», Shelley C, p. 22.25


1. Estivill J. Panorama de la lucha contra la exclusión social. Conceptos y estrategias. Ginevra: Oficina Internacional del Trabajo; 2003. p. 19.

2. Castro Espín M. El programa nacional de educación sexual en la estrategia cubana de desarrollo humano. Sexología y Sociedad. 2002;8(20):4-9.

3. Martínez Puente S. Revolución cubana: hechos más que palabras. La Habana: Editorial José Martí; 2008.

4. Centro de estudios demográficos. Cuba. Población y desarrollo. La Habana: CEDEM; 2009.

5. Proveyer C, Ruiz F, González Omedo G, Múnster Infante B, César MA. 50 años después: mujeres en Cuba y cambio social. La Habana: Oxfam International; 2010.

6. Pérez E, Lueiro M. Raza y racismo. La Habana: Editorial Caminos; 2009.

7. Morales Domínguez E. La problemática racial en Cuba: algunos de sus desafíos. La Habana: Editorial José Martí; 2010.

8. Espina M, Martín L, Núñez L, Ángel G. Desigualdades en la agenda. Historia y perspectivas. In: Domínguez Garcìa MI, Castilla Garcìa C, Rodriguez Velazco CL, et al. Experiencias de investigación social en Cuba. La Habana: Editorial Caminos/Cips; 2008.

9. Prieto ME. Desarrollo, desigualdad y políticas sociales: acercamientos de una perspectiva compleja. La Habana: Publicaciones Acuario; 2010.

10. Zabala Argüelles MC. Familia y pobreza en Cuba: estudio de casos. La Habana: Publicaciones Acuario; 2010.

11. Pereira Ramírez RM. El derecho a la libre orientación sexual: un derecho sexual sin protección legal en Cuba. Tesis de maestría en sexualidad. La Habana: CENESEX; 2007.

12. Castro Espín M. A cuban policy approach to sex education. Cuban Studies. 2011;2:23-34.

13. Castro Espín M. La educación sexual como política de Estado en Cuba desde 1959. Sexología y Sociedad. 2011;17:4-13.

14. Principios de Yogyakarta. 2006. p. 8. Available from:

15. Nieto Piñeroba JA. Transexualidad, intersexualidad y dualidad de género. Barcelona: Edicions Bellaterra; 2008, p. 320.

16. Stoller RJ. Sex and gender. The development of masculinity and feminity. Londres: Karnac Books; 1968.

17. Garfinkel H. Conditions of successful degradation ceremonias. AJS. 1956;61:420-4. Available from

18. Garfinkel H. Studies in Ethnomethodology. Los Angeles: University of California; 1984.

19. Castro Espín M, comp. La transexualidad en Cuba. La Habana: CENESEX; 2008.

20. Marcasciano P. Tra le rose e le viole: la storia e le storie di transessuali e travestiti. Roma: Manifestolibri; 2002.

21. Gómez Gil E, Esteva de Antonio I, Fernández-Tresguerres JA. Causas o fundamentos fisiológicos, in Gómez Gil E, Esteva de Antonio I, eds. Ser transexual: dirigido al paciente, a su familia y al entorno sanitario, judicial y social. Barcelona: Glosa; 2006. pp. 113-24.

22. Alfonso AC, Rodríguez RM. Personas transexuales y familia. En el límite de la invisibilidad, in Castro Espín M, La transexualidad en Cuba. La Habana: CENESEX; 2008, note10.

23. Rodríguez RM, García CT, Alfonso AC. Trastorno de identidad de género y personas transexuales. Pautas de atención psicológica, in Castro Espín M, La transexualidad en Cuba. La Habana: CENESEX; 2008, note 10.

24. Nieto Piñeroba JA, Transexualidaded, intersexualidaded y dualidade de género, in , La transexualidad en Cuba. La Habana: CENESEX; 2008, note 7.

25. Shelley C. Transpeople: repudiation, trauma, healing. Toronto: University of Toronto Press; 2008.

26. Consejo nacional para prevenir la discriminación (Conapred). Carta a mi padre: testimonio de una persona transexual con discapacidad. Città del Messico: Conapred; 2008.

27. Marcasciano P, Arrietti L, Ballarin C, Cuccio G (Eds), Elementi di critica trans, Roma: Manifestolibri; 2010.

28. Lamas Encabo M, Transexualidad: identidad y cultura, Tesis de Doctorado, Instituto de Investigaciones Antropológicas, Facultad de Filosofía y Letras, UNAM, México, DF, 012.

29. García Nieto I, Interacción de los distintos factores de exclusión en los adolescentes transexuales: dificultades para la integración social y laboral. In: Moreno Cabrera O, Puche Cabezas L, eds, Transexualidad, adolescencias y educación: miradas multidisciplinares, Barcelona: Editorial Egales s.l.; 2013. pp. 151-71.

30. Puche Cabezas L, Moreno Ortega E, Pichardo Galán JI, Adolescentes transexuales en las aulasaproximación cualitativa y propuestas de intervención desde la perspectiva antropológica. In: Moreno Cabrera O, Puche Cabezas L, eds, Transexualidad, adolescencias y educación: miradas multidisciplinares, Barce34lona: Editorial Egales s.l.; 2013.

31. Skagerberg E, Parkinson R, Carmichael P, Self-harming thoughts and behaviours in a group of children and adolescent with gender dysphoria», International Journal of Transgenderism. 2013;14:86-92.

32. Winter S, Chalungsooth P, Teh YK,Rojanalert N, Maneerat K, Wong YW, Aquino Macapagal R. Transpeople, transprejudice and pathologization: a seven country factor analytic study. International Journal of Sexual Health. 2009;21:96-118.

33. Centro de Estudios de Población y Desarrollo. Encuesta sobre indicadores de prevención de infección por VIH/sida-2017. Publicación de resultados. La Habana: PNUD-ONEI-CEPDE; 2019, p. 25.

Conflict of interest statement: the Author is the director of the Centro Nacional de Educación Sexual, Havana, Cuba

Correspondence to:

Mariela Castro Espín

Centro Nacional de Educación Sexual

Calle 10 n 460 esquina 21

El Vedado, La Habana Cuba