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Dear Laura Camus, First of all, I sincerely thank you for your willingness to collaborate in your role as representative of the Ministry of Health. I am writing to you about the delicate state of health of Paris López, based on her own account and at her request, along with some observations I have made while accompanying her to the hospital and the clinic (there are undoubtedly some inaccuracies in the technical terms, although we hope the underlying message is clear): Paris López is a forty-year-old trans woman who has lived on the streets for practically her entire life, has been living with HIV for fifteen years, and has been intermittently in the AIDS stage for the last two years. In addition, she was diagnosed with TB (tuberculosis) two years ago. The TB began to manifest as a massive swelling in her knee, where she was treated with corticosteroids. About a year and a half ago, her HIV antibody count dropped so low (20) that when she started HIV therapy along with tuberculosis treatment, she developed immune reconstitution inflammatory syndrome (IRIS), which led to cancer (Hodgkin's lymphoma). She was sent for a scan, but fortunately, the lymphoma disappeared within weeks. She lost all her hair, and for months her face was covered in scabs due to the stress and toxicity of the combined HIV and tuberculosis treatments. Paris's last medical check-up was in April 2017 at the Salvador Hospital. Since then, she has received conflicting information and responses, both at the Salvador Hospital and at the Alessandri clinic in the Providencia district, where she is registered. Paris told me that, given the complications, her HIV treatment was changed to one compatible with her TB treatment, and that this decision was made by a medical board, since her treating infectious disease specialist, Dr. Ballesteros, was on leave. The medical board prescribed a new HIV therapy, this time consisting of two pills, which helped improve her health. However, when Dr. Ballesteros returned from leave, he told Paris that he absolutely did not agree with the two-pill HIV therapy, questioning how she could have been given that, arguing that it would worsen her condition when combined with the TB treatment, and that she should take the three-pill therapy instead. Indeed, after an initial period without complications, new symptoms appeared: swollen lymph nodes, complete loss of appetite, dizziness that left her unable to get up all day, drowsiness, and difficulty moving and speaking. She was never able to access the single-pill therapy, which is expensive and exclusive. Paris also points out that she went to both the hospital and the clinic several times—her friends and family accompanied her on several occasions—to clarify the confusion regarding the prescribed treatments, but she was not treated properly or her request was dismissed, leaving her without treatment. She was aware of the contradiction in the prescription, unable to consult Dr. Ballesteros, whom she trusts, and ultimately fearing for her life. Therefore, we demand clarification of the information in such a serious case. All the information about the danger of taking certain HIV treatments concurrently with TB treatment was flatly denied by those in charge of the TB program at the Alessandri clinic, where samples are taken and TB treatments are distributed, and which is—or should be—coordinated with the Salvador Hospital. I myself went to the Alessandri clinic last Friday, and that is the information I received. However, the day before yesterday, while accompanying Paris again to try to get her an appointment, we managed to speak with one of the head nurses at the Salvador Hospital, who was aware of the discrepancies between the hospital and the Alessandri Clinic. Evidence of these contradictions is reportedly in Paris's medical record. Dr. Ballesteros is once again on leave, so we haven't been able to contact him. Earlier this year, I even accompanied Paris because there was an error in scheduling her appointment at the Salvador Hospital, and she couldn't get an appointment. Her appointment was moved more than a month and a half from the original date without notice, and then Dr. Ballesteros went on leave and couldn't be reached. Although Paris has abandoned her treatments, after my recent inquiries, it became clear to me that her account is true, and that her poor adherence during certain periods is directly related to the negligence and contradictions on the part of the healthcare institution. Currently, Paris is experiencing symptoms: green phlegm (TB), lethargy, drastic weight loss, depression, difficulty walking, and skin lesions and sores—characteristics of both AIDS and TB. But everything is so delayed and contradictory that she still doesn't have a precise medical diagnosis. I met Paris while she was hospitalized at the Salvador Hospital about a year and a half ago. I met her insisting that she be addressed by her chosen name, not her legal one. She wanted them to erase the legal name—which doesn't identify her and which they used to call her out loud—from the whiteboard in the hallway and from the foot of her bed. Something so basic, yet it made her extremely uncomfortable… The name is all that public health recognizes for the trans population. That is, when they remember… We had to insist five separate times, despite the expressions of doubt and skepticism from the healthcare professionals. They were completely unaware of Circular 21, which mandates respect for the chosen name of trans people and whose text itself includes the definition. A recent survey by OTD Chile revealed that 96% of the trans population had their identity questioned in healthcare facilities, and 25% were mocked by staff. The day before yesterday, we spent five hours at the Salvador Hospital. We politely requested to be addressed by his chosen name, Paris, which was confirmed at the reception desk with a "yes, love." However, a little further inside, when we went to get a chest x-ray to check the progress of his tuberculosis (which will be ready in fifteen days... We're also waiting for a second sputum sample; the first one came back negative, but Paris is already showing clear symptoms, as I mentioned. The second, more in-depth sample will be ready in a month), the staff member came out shouting several times, "Hey, where's Mr. XXX (legal name)?" drawing the attention of everyone around, "You have to put on this mask, because otherwise I can't take the x-ray, okay, Mr. XXX?!" Is it normal that, besides being unaware of Circular 21 regarding the treatment of trans patients, the use of a mask is demanded at length? Paris felt very offended, as she had never been required to do so before. And shouldn't all of us accompanying her be wearing masks? Why didn't the head nurse, who spoke at length with us, demand masks, but the radiology staff member did? Regarding the chosen name, the same staff member who takes X-rays (office 11) added, "I don't know anything about that; you have to check that at admission. It's not my responsibility." So whose responsibility is Circular 21 then? It's not the responsibility of the Patient Information and Complaints Office (OIRS), it's not Radiology's, it's not the Hospital's… (Another issue is Circular 18 (2015), and the subsequent Circular 7 (2016) concerning intersex issues. The latter is a shameful step backward, denounced even by intersex activists worldwide.) That's all we have available in terms of public health regulations for trans and intersex people. Trans organizations and individuals have conducted several public health training sessions, but there's still so much to be done. During 2016, I made numerous efforts to get El Carmen Hospital in Maipú to modify its Florence admission protocol, thus ensuring minimum standards of respectful treatment for the trans population. It was a waste of time, since the administration changed and all the progress was undone. I had… 15 meetings, only to get nowhere? There are, for example, absurd regulations that force Paris to go every single day to pick up her medication. She's a slave to the Alessandri clinic. It's worth mentioning that Paris has a significant history of crack cocaine use (which doesn't mentally impair her…). "But can she reason?" another staff member asked me. Yes, of course she can. Together with Paris and other colleagues, we recently created a transvestite magazine, and 50% of the profits went to her. Paris has been a speaker at several university talks and events, but these spaces have offered her nothing in the way of support. It seems her experience only serves to validate a “dissident” academic perspective. We hope to start a small business, continue with our magazine, try to find housing, and be able to access proper healthcare. When I was arrested and tortured at Police Station 1 in Santiago after a demonstration (August 2016), Paris stayed with me in the days that followed. That's how we became friends. She visited me occasionally afterward, but I no longer have the means to house her. She also stayed for months in other places I know, but they eventually stopped accepting her. The two places that have been somewhat willing to help so far won't take her in without concrete proof of her infection level… For now, we are trying to reach out to more people through this letter. Paris has lost her belongings and her HIV medications, which were confiscated by the police while she was staying outside the Salvador Hospital. It is extremely serious and unacceptable for the police to confiscate medication! Every now and then, police officers appear, accompanied by a municipal truck. The people being evicted say the confiscation is illegal. They take everything, leaving them with only the clothes on their backs. The day before yesterday, before going to the hospital, I witnessed the eviction of all the people who sleep (and live) in another area, outside the Recoleta Franciscan Church, where Paris also occasionally spends the night. With Evelyn Matthei as the mayor of Providencia, it doesn't surprise me, but Recoleta confiscating the belongings of homeless people? In place of material poverty, after a lot of bleach and water, a banner appeared hanging on the front of the church with images of Fray Andresito and the transphobic Pope Francis. The day before yesterday, we were able to return with the HIV therapy and the nutritional supplement in hand. During the visit, we managed to get an extra appointment, and finally, yesterday, she was seen in the HIV/AIDS ward of the Salvador Hospital. We have to wait for the results. Paris tells me that if they don't end up removing her with dogs and trucks, her favorite place to be is the small plaza outside the Salvador Hospital. They say Matthei will fence off the plaza. What will Coco, for example, do? She's lived there for thirty years. She's just another neighbor, and so is Paris. Does the new Providencia Non-Discrimination Office handle these cases? We'll have to write to them, since the municipality is confiscating belongings and medications from trans women with AIDS. Once, while sitting on a bench in that plaza, Paris was aggressively confronted by police officers because a neighbor called to report that "a man was going through a purse." Probably a criminal, because if she's homeless... Many homeless trans women have had their physical transitions reversed. They don't stop being trans women! And human beings can use purses or whatever they want. Paris: “And it would be really stupid to steal a wallet and go through it in front of everyone… Closing your eyes and pretending not to see is foolish.” Who reasons more clearly? We have decided to make this letter public because there are people on this side who have been waiting for far too long. There is a map of trans and transvestite people on the streets in terrible health conditions. For example, trans people on the streets who have “feminized” their bodies but still have male ID cards are not accepted in Christian shelters. Some of us are tired, but for others, it has been a truly hard and cruel end to the year. Tomorrow, Paris López turns 41. Tomorrow is World AIDS Day. We live in a context of a lack of public policies on HIV, in a context of crisis, compounded by the silence of gay rights groups more concerned with marriage equality and election campaigns than anything else. Who cares, mobilizes, and advocates for the most vulnerable bodies? What about trans*/travesti health? Greetings and many thanks for your support. Sincerely, Paris López and Niki Raveau, transgender/travesti people