“We live with the uncertainty,” said Verónica López, a trans woman and board president of ASTRANS, one of El Salvador’s leading trans rights organizations. “We do not know if we will come back home, or come to work the next day. You get accustomed to it. We have little choice. We know if we do something that is not liked we can be killed.”

“I help trans women at our clinic, and when I think about going there I think, they’re going to kill me in this office,” said Dr. Modesto Mendizábal, an ASTRANS board member who oversees the medical and psychological help and hormone therapy ASTRANS offers to over 100 clients. “Colleagues of ours have gotten killed. It’s very painful, but it is something that happens. I am not surprised.” (ASTRANS stands for Asociación Salvadoreña de Transgéneras, Transexuales y Travestis, or translated: the Salvadoran Association of Transgender, Transsexual and Transvestite Women.)

A brightly lit room with cups of coffee and glasses of water in Midtown Manhattan seemed far from El Salvador. But the stories of extreme violence and persecution endured by lesbian, gay, bisexual and particularly transgender people as told by the members of ASTRANS felt sharply near.

As we sat in the offices of the American Jewish World Service (AJWS), the international human rights organization which funds and supports the work of ASTRANS, a member of the trans campaigning and support group related the story of two female colleagues who had been attacked and assaulted. They were both raped, suffering fissures in their anuses.

Gang members asked one of the victims where her family lived. “That family had to move, far, far away, and the family completely disintegrated as a result. They took everything they needed to take, and left,” an ASTRANS member said. (For all gang-related and other deemed-sensitive stories in this article, the group’s members asked for their individual names not to be used.)

One of ASTRANS’s clients who had been forced to leave her mother and family wanted to kill herself.

“It’s impossible for her to go home. When someone receives a threat that they will be murdered they have to leave. You can’t come back. If you do, gang members will murder you. This woman lost communication with her mother and brothers. She decided to commit suicide. Luckily we got her some help and anti-depressants. It’s a small example of a much deeper problem. It is not just individuals being threatened, but entire families. Gangs tell them, ‘We’ll not just kill you, we will kill all your loved ones too.’”

Trans women are already at risk of suffering disproportionately from poverty, violence, and social exclusion, said ASTRANS. Fleeing persecution, they go to Guatemala, Mexico, and the U.S., among other countries.

The level of persecution faced by El Salvador’s LGBTI community made international headlines recently, with the widely publicized murders of three trans women in the San Luis Talpa municipality of the La Paz department of El Salvador, between Feb. 18 and 21.

One accompanying report stated that the average life expectancy of a trans person in the Central American nation was 35 years. While the El Salvadoran government has vowed to investigate the murders as hate crimes, activists suspect that they will not be—and the perpetrators not be caught.

In a wide-ranging report on LGBT violence in Central America, the Blade reported that “more than a dozen” trans women were killed in El Salvador in 2015. Karla Guevara, director of trans advocacy group, Colectivo Alejandría, told the Blade that the country was “totally full of hate.”

An ASTRANS member said, “We’re not exactly sure what happened with these most recent murders. The gangs have stopped the media talking to family members. There’s a particular threat in that city and that state against LGBT people. Some have left everything behind because they are afraid of being killed. All this is combined with high levels of impunity—cases that are either not investigated, or criminals who have gotten off ‘scot-free.’

“After the civil war (which took place between 1980 and 1992), we hoped the situation was going to get better or be better controlled. But the murder rate is so high (there were headlines in January when the country recorded its first homicide-free day in two years), and LGBTI people are much more vulnerable. This part of the country specifically has more criminal acts and threats than any other places, and violence too. This is a very violent country: There is not even enough space for dead bodies in morgues.

“There was a document released after the murders of the three women around hate crimes, and the district attorney has promised to reopen the cases—under pressure from international press and media—but it hasn’t happened yet.”

Gangs typically shoot LGBTI people, and disfigure them with bullets to the face, the ASTRANS member said. “One of our friends, a gay professor at a university, was killed this way, and so was another activist. Both were shot in the forehead.”

Both murders have gone unsolved. “The district attorney has not pursued them, no witnesses had come forward, and the judgment of judges is usually prejudiced,” an ASTRANS member said.

In gang killings, the ASTRANS member said, trans people have their clothing removed to humiliate them even more, “exposing their genitals, so revealing a person who looks feminine and who has a penis. In some cases they have been stoned to death, or murdered with a machete, but usually it is a firearm. There is a very high level of violence and hatred in the murders of trans people. In the code of the gangs, being trans is seen as something negative: People do not differentiate a trans person as distinct from a homosexual person.”

As well as supporting trans people and speaking out on the issue of their life-or-death forced migration—either within the country or having to leave it altogether—ASTRANS said it is the only organization in El Salvador to provide gender-affirming hormone therapy.

The organization’s clients are learning how to interpret their laboratory results, identify risks, and act accordingly, ASTRANS says. “As part of their care, they are complying with hormone treatment and changing nutritional and physical habits to optimize their treatment. They are also avoiding risks such as self-medication and intoxication.”

Anti-LGBT and trans prejudice is rooted in stereotypes of machismo, said Mendizábal, who is gay, “as well as a very religious society where it is considered a sin or vice to have a different orientation than the one society expects of you. You can’t be sure that the crimes against these women were done just because they were trans. The ways they were murdered was the same, but this is a mix of criminality, violence, and transphobia.”

Since 2014, AJWS has been working with ASTRANS to advance the rights of trans people by conducting human rights training, carrying out workshops with key public officials, providing health services for trans people, and contributing to national and international advocacy forums.

Through a grant from AJWS, ASTRANS is providing health services and psychological support for new and returning trans patients through their health clinic.

ASTRANS is also leading local and national advocacy efforts around Transgender Identity Law and for the investigation of LGBTI hate crimes.

While marriage equality and recognition of same-sex unions seem at-present distant possibilities, Presidential Decree 56, issued in 2010, prohibits discrimination based on sexual orientation and gender identity in the public sector, and created a Directorate For Sexual Identity within the Secretariat For Social Inclusion.

However, violence and prejudice against LGBTI people remains high, as does police and official inaction over tackling them as outlined in a 2015 State Department report (PDF). That same year, Francela Méndez Rodríguez, a prominent Salvadoran trans rights activist, was murdered.

“I think we have to talk about culture,” said López. “They are not willing to create laws that protect human rights in El Salvador. There is reform to address hate crimes, and some institutions are doing investigations but not applying laws.”

The aim of ASTRANS is to work within states, district attorneys, organizations, and various state and government departments, she added. Other LGBT groups include Asociación Entre Amigos, Generación de Hombres Trans de El Salvador, and Espacio de Mujeres Lesbianas por la Diversidad.

Mendizábal said: “We need space to demonstrate our qualities that we are not something bad for society, that our lives are sustaining for our country. The Department of Social Inclusion leads work on LGBT work from central government, but there are very few resources. We want to improve visibility of the trans community, and show our skills, and create a window for LGBT people.”

Sebastián Flores Cerritos, a trans man and communications officer for ASTRANS, said that the political conflicts in El Salvador were harmfully reflected back on to LGBT people. “The political forces are constantly at war and social issues, like LGBT, are seen as an instrument to regain power. Every time the issues comes up in our country, it’s as a strategy, and then the homophobic people get really crazy, and aggression and homicides happen.”

***

Aside from being murdered or attacked, trans people are excluded from many other social spaces and often rejected by their families, said Mendizábal. They can be forced into sex work or selling drugs. “Some are accepted by their families, but very few. They experience exclusion in schools. Bullying is very, very hard, so many abandon their education.

“We assembled a focus group of 20 trans women; the majority—18 of them—talked about the importance of spirituality for them. They looked to church, and went there to listen to messages, because they felt tormented by their exclusion from society. The majority of their experiences was negative. They could find no space to be themselves, had psychological violence done to them, and experienced aggressive stereotyping at home and hospitals.”

López said her efforts to access a proper education and health care had been hindered because her gender identity was not recognized.

The experience of trans people and the civil, military and municipal police forces in El Salvador is mostly negative. “The experience of trans women in particular is that they suffer all kinds of violence, including sexual violence, and extortion at the hands of the police,” said one ASTRANS member. “We also know of a physically small guy who was beaten by the police, who were much bigger than he was, and then he was accused of beating the police himself.”

Another member told a story of a young trans man, thrown into jail by police after Pride celebrations in 2015, who considered him—without evidence—to be a delinquent. “The police assume young people are gang members.”

When the ASTRANS member and their friends went to the police station “they looked at us like they wanted to hit us,” then confiscated the member’s cellphone. “My friend was treated in a very inhumane way. He was being criminalized as if he had done something wrong. The police should have been protecting us.”

“There is a lot of violence from the police and army, but you cannot say the entire police is bad,” said Mendizábal. “There are good police and there are bad police. There are police that are in communication with LGBTI people, but only a few of them. Sometimes the police take care of trans people, as in the case of some trans women who had been kidnapped by a gang. That time the police intervened, and saved their lives.”

What would help would be a full non-discrimination law, said López. “It would not solve our lives, but it would help make society to be more inclusive and respectful of LGBTI human rights. A gender identity law for trans people would be good, so we can access our rights, because without a law that doesn’t identify us we don’t exist in our country.” Mendizábal said hate crimes needed to be prosecuted fully under the country’s penal code.

The prevalence of gangs, and their control is all-pervasive. One ASTRANS member said that if someone asks to see your ID, which shows that you live somewhere else, you can be asked why are you in that particular neighborhood.

“You have to be very careful and very aware of where you’re going to, and the certain zones of a city. I once got a wrong bus, and ended up somewhere I shouldn’t be. I was somewhere where gangs killed people. I was able to get out. Nobody is safe. You have to try and be careful. It can have an impact on family and friends, because they can go and kill someone else in my family. Some projects have to pay off gang members to reach trans people in various communities.”

With such tough work, how do the ASTRANS members remain committed? Jorge López, who defines himself as a queer man and who oversees the organization’s finances and administrative matters, said: “Trans individuals have disadvantages when it comes to being members of the community. I want to help them have a right to live better and have jobs.” He stifled tears. “I get very emotional when I think about this. It’s about how you are as a citizen.”

Mendizábal added, “Many people say here that they are proud of being American. Like you, we are proud of being from El Salvador, and we love our country. We don’t want to leave our country. We want to develop our rights and equality. We believe our country will get better one day.”

Next, ASTRANS wants to launch a campaign against the stigmatization of trans identities, and the phenomenon of trans women “over-hormoning” themselves. AJWS gave them a sum of money which helped expand their clinical services. Mendizábal is a volunteer, and there is also a volunteer psychologist. They hope to be able to secure funds to be able to pay a nurse.

“More than trans social rights, good health, well-being, and psychological stability are all part of someone’s self-realization,” said Mendizábal. “We hope we can help people become more confident and affirmed with their identity and happier with themselves.”

***

The changing priorities from an Obama to a Trump administration, in terms of foreign aid and advocacy, has alarmed activists.

“There is a lot of uncertainty,” said Mendizábal. “We are very dependent on the United States. What happens here has an impact globally. The anti-trans law that was just announced was a big alarm for us. It gives more value to anti-trans activists in El Salvador.”

While there hasn’t been an outbreak of bathroom-related panics and bills in El Salvador, the country “takes its cues from the U.S.,” said Mendizábal, “so they go as far as they can get away with things one way or another. Under Obama, the administration moved toward human rights. When there is no human rights advocacy and when foreign aid may be dependent on ramping up the fight against terrorism, rather than human rights, we may see some negative effects for what that might mean for more marginalized populations and the advocacy for their own rights.”

The ASTRANS activists are determined to persevere. When Cerritos wanted to start hormone therapy in 2013, he went to a hospital and was told “that I was crazy, that I should think about it, that I wouldn’t be able to pay for it, that my parents wouldn’t support me. I didn’t feel confident. I didn’t want to see a psychologist who would make me feel bad about myself. I had to seek other help, and other trans men, and self-medicate.”

Cerritos said he had to leave El Salvador and go to Guatemala to access the care he needed, “but it took me a year and a half to be able to start my transition because I needed to save money for the trip and consultation. It was very expensive. I had no economic support from my parents and I was also a student. It wasn’t easy.”

How is his family now? “Well, it’s a process for my family. Because they have been living with someone for 20 years and that person is now doing a very radical change. It is not easy, it is hard for them. They fear how society is. They are afraid something might happen to me. They are frightened for my safety, but they try to be strong.”

How is Cerritos feeling? Is he living the life he wants in El Salvador?

“Yes, I feel very motivated right now. Activism and starting my treatment have [totally] changed my perspective on life… Before, I didn’t want to study or see anyone. Now that has all changed. The support of my parents has been fundamental. They didn’t abandon me. They never abandoned me. And I have been able to find people in activism that lend me a hand in different ways and make me motivated to continue to fight for something bigger.”

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