When HIV-positive transgender activist Nairovi Castillo goes to her local clinic in Santo Domingo, Dominican Republic, she’s insulted, misgendered, or ignored by everyone from the doorman to the receptionist to the doctors. “Nobody is asking what your situation is, what medications you’re taking, or if you have any allergies,” she says. “The staff won’t look at you, and they’re afraid to talk to you.”

Nobody needs to tell Castillo that stigma and discrimination can be lethal for LGBT people. As the director of COTRAVETD, an organization that works with trans sex workers in the Dominican Republic, Castillo has seen firsthand the damage it can wreak, especially for people living with HIV. She knows of four trans women who died of HIV this year alone. “We had to bring the last woman who died to the hospital ourselves, because when we called 911, emergency services refused to enter her house and bring her to the hospital by ambulance because she was trans,” she says. “When we finally got her to the hospital, she died from lack of treatment.”

Roughly 1.2 percent of the Caribbean population is living with HIV/AIDS — the second-most affected region after sub-Saharan Africa. For transgender women, HIV prevalence is thought to be 49 times higher than the general population. In both the United States and the Caribbean, transgender women are disproportionately at risk for HIV, but in the Caribbean there’s a dearth of data on HIV rates in LGBT people, precisely because they’re so stigmatized that they’re driven underground, making them difficult to count.

Christian King is the director of Trans Siempre Amigas (TRANSSA), an organization that defends the rights of transgender people in the Dominican Republic. He says that homophobia and transphobia not only prevent transgender women from accessing life-saving HIV treatment but also abet a “near-complete exclusion” from society, making it practically impossible to keep an apartment, get an education, or hold down a job.

“When a trans woman goes to apply for a job, they don’t look at her résumé. They look at her ID card and ask, ‘You’re a man, so why aren’t you wearing men’s clothes?’” Castillo says. One industry that doesn’t require a résumé is sex work, something Castillo turned to after she was kicked out of her parents’ house at the age of 13 for being trans. “I had to sleep on the streets,” she says. “The police would routinely throw me in prison, steal my money, tear out my wig, and beat me, all for the fact of being a trans person. I still have scars on my body from what the police did to me when I was practicing sex work.”

The relationship between sex workers and the police is delicate, King says, because often the police are the ones perpetrating the abuses — from arbitrary arrests to robberies to sexual exploitation. “Here, there are lots of laws, but they’re not enforced,” Castillo says. “The same people who are supposed to be the ones enforcing the laws are the ones who are breaking them.”

For trans people and activists in the United States, the Dominican Republic gives a terrifying glimpse into a life where federal authorities don’t recognize transgender people. Since his administration took office, in January 2017, President Donald Trump has begun to systematically chip away at the rights of the 1.4 million transgender people in the United States, including an October 2018 proposal limiting the definition of a person’s sex to what was recorded on their birth certificate.

Trump has reversed a number of Obama’s pro-trans executive orders, like the rule that prevented medical practitioners from discriminating against transgender people. He has attempted to ban trans people from the military, and in the 2020 census, LGBT people in the United States will not be counted unless they’re in a relationship. All the while, the number of transgender women killed in the United States continues to rise.

In the Dominican Republic, 45 trans women, many of them sex workers, have been killed since 2006. This year, three trans women have been murdered. One 13-year-old who identified as a trans girl was found raped, beaten, and strangled with a bedsheet. In another case, a sex worker of Haitian descent was found on the side of the road, gruesomely beaten and with a fatal head injury. “Considering we’re a small country with a population of 11 million, and the LGBT community is somewhere between 6 and 10 percent of the population, it’s really alarming,” King says.

Activists in LGBT communities from the Dominican Republic to Guyana know that while stigma and discrimination are dangerous in their own right, when prejudice is state-sanctioned, it rapidly becomes a public health hazard.

Yet tackling prejudice and transphobia does not have to begin with cutting-edge, million-dollar campaigns — one regional coalition is seeing results with a simple database.

TRANSSA’s in-house human rights observatory has been documenting hate crimes against transgender women since 2006. It has become clear to King and his colleagues that the burden of documentation and seeking redress falls squarely and exclusively on their shoulders. Police and federal authorities rarely take violations against LGBT people seriously, allowing attackers to act with impunity. “When the police abuse trans women, the women are afraid of reporting, because often when you go to the police, the person you’re accusing is one of their colleagues,” King says. The media often won’t report hate crimes or will euphemize the violation by calling it a crime of passion or a domestic dispute between “two gays.”

This pattern repeats itself across the Caribbean. Much of the region still has laws against buggery and gross indecency that prohibit same-sex conduct. Lethal hate crimes against transgender people are just the more extreme end of stigma and discrimination that permeate police stations, hospitals, schools, and people’s homes.

But if Caribbean states refuse to protect the rights of their most vulnerable citizens, human rights defenders are compelled to take matters into their own hands. Out of a number of grassroots documentation efforts in the Dominican Republic and Jamaica, the region’s first human rights monitoring platform was born. Launched by Caribbean Vulnerable Communities (CVC), a coalition of civil society organizations in 2016, the Caribbean Civil Society Shared Incident Database (SID) is a coordinated, standardized online reporting tool for community organizations across the region.

The project supports victims of attacks through access to paralegals, but it’s also building a solid record of violations from country to country and providing evidence for advocates. Carolyn Gomes, MD, the former executive director of CVC who spearheaded the development of the database, says the idea came out her first year working with the organization. “People were coming to me and telling me that all these abuses were happening,” she says. “But without any documentation to back up interventions, it became that much easier for authorities to say to people, ‘Oh, no, that’s just one person,’ or ‘This doesn’t really happen as a pattern.’ So documentation became critical.”

“The very act of telling their story and having somebody listen and document it can sometimes be enough,” Gomes says. “To tell their story and have it believed.”

Thirty civil society organizations (CSOs) that work with LGBT people, sex workers, and people living with HIV in 10 Caribbean countries — Jamaica, Guyana, the Dominican Republic, and Haiti among them — have used the database to document more than 1,400 violations in their communities, which historically have been hard to access in terms of HIV research and outreach. Violations run from hate crimes and physical violence to verbal abuse and being denied access to public spaces. After documenting the violation, the client decides if they want to press charges, ask for an apology, or just let it be recorded. “Often, in the absence of the desire or ability to move forward with the case, the very act of telling their story and having somebody listen and document it can sometimes be enough,” Gomes says. “To tell their story and have it believed.”

John Waters, MD, program manager at the CVC, recounts the story of being in a meeting with Kouraj, a Haitian NGO, when a man came rushing into the office with a bloody head wound. The NGO was able to refer the person to a clinic, Waters says, “But in a situation like that, you realize that for these grassroots organizations, documenting events such as that one is often of little consolation.”

In the past, when Caribbean NGOs would make presentations to international human rights bodies, most of the information on violence perpetrated against transgender women was anecdotal — transgender women would testify with their personal stories, but offering up actual numbers was difficult, which would make their experiences easier to cast aside. “Essentially, governments would deny that these things were happening,” Waters says.

A breakthrough moment came when organizations in the Dominican Republic wrote a report that documented a significant number of cases of transgender violence and presented it to the Inter-American Commission on Human Rights (IACHR). “It was hard data, and so it wasn’t so easy for the government representatives to dismiss it,” Waters says. “I think that’s when, at least in the Dominican Republic, there was a real recognition amongst NGOs that going through the effort of documentation can be worthwhile,” he says.

Documentation efforts like the SID database make it easier to pick up patterns — related to numbers, but also related to perpetrators and sites of abuse — that would keep transgender women from dying of HIV because EMTs don’t want to enter a transgender person’s home. “If you can pick up a pattern of abuse at a particular clinic and document it adequately, you can take it to the responsible authorities to make a change,” Gomes says. “And if they don’t make a change, then you go to the next level and the next level.”

Advocates like Castillo and King have reason to be hopeful. King says their presentation at the IACHR sparked a roundtable dialogue with the state dedicated to developing human rights policies focused on transgender people. “There wasn’t a strong political will for the cases of transgender killings to be resolved,” King says. “But in the last few years, and thanks to the documentation we’ve been doing, we’ve seen that the cases are being treated differently — they’re being processed properly.”

Now, out of the 45 cases of killings of transgender women in the Dominican Republic, King says, there have been five convictions.

Documenting human rights violations not only holds authorities and decision-makers to account, but it also has the potential to empower the communities that are most vulnerable to HIV, like transgender women, who have been driven underground.

“When you’re treated so badly by society, you don’t have any self-esteem, and you think that what people say about you is true. You don’t think that you’re deserving of any rights,” King says. “A lot of my colleagues feel that way. Despite all our efforts, it’s not changed completely yet, but we’re on the right path.”

For transgender people in the Caribbean, there is strength in numbers — and to document the ways society has erased you is to stand up and be counted.