A Black Trans Sex Worker Died After Paramedics Failed To Take Her To The Hospital

“They killed Alejandra ... Because of the stigma that her body carried, for being trans, for being Black, for being poor, for living with HIV, for being a sex worker.”

We may never know what killed Alejandra Monocuco.

It might have been COVID-19. That’s what her housemate feared when she called the emergency hotline. She said Monocuco was struggling so hard to breathe that it seemed like she was choking, or maybe suffocating.

It might also have been something else. After the paramedics who arrived to treat Monocuco learned that she was living with HIV, her housemate Leidy Tatiana Daza Alarcón said they told her it looked like an overdose. Daza said the paramedics told her not to give Monocuco any food or water since she was in respiratory distress, and to calm down, saying, “Take it easy...nothing will happen to her.”

When a second ambulance arrived a few hours later, Monocuco was dead.

For Daza and many others, though, the real reason that Monocuco died is clear: The paramedics didn’t provide appropriate care because Monocuco was a Black trans sex worker living with HIV.

Monocuco — which is a nickname, her given last name is Ortega — was born in a small Colombian city called Magangué in 1981, around the time that a conflict between drug cartels and guerillas flared up, and the same year that homosexuality was decriminalized in Colombia. She told researchers in 2014 that she had faced violence and harassment throughout her life because of her identity.

As historic protests over racial injustice and the murders and mistreatment of trans people have ricocheted around the world, Monocuco’s death has provoked outrage in the Colombian capital of Bogotá, where she lived, and beyond.

The alleged negligence by medical personnel, in the middle of a pandemic, has galvanized local advocates who say her death is an “x-ray of the the situation of abandonment, discrimination, and exclusion” that trans sex workers in the city face.

As multiple investigations into the case have begun at the city and national level, those advocates now hope that Monocuco’s case will open the door to greater recognition of the rights of trans people and sex workers in Colombia.

“They killed Alejandra. Alejandra was killed by a negligent State that never cared for her throughout her life, and that in her last moments left her to die,” Juli Salamanca from the Red Comunitaria Trans (RCT) — or Trans Community Network, a trans-led organization that advocates for sex worker rights and other marginalized trans communities in Colombia — told BuzzFeed News via Whatsapp. “Because of the stigma that her body carried, for being trans, for being Black, for being poor, for living with HIV, for being a sex worker.”

Although Bogotá has become more inclusive in recent years and elected a lesbian as mayor in 2019, conservative views on sexual and gender norms are still a motivating political force in the country, and Salamanca said the situation for trans people in Colombia is dire. In June alone, the RCT recorded six trans women killed in Colombia, and others allegedly assaulted by the police. And Salamanca said policies that were put in place to address the pandemic have only made matters worse.

“We feel persecuted, exterminated, and we have a sensation of helplessness that is hard to describe without tears,” she said.

As in the US, Salamanca said that sex workers have been at the forefront of a movement to demand an end to violence against trans people, and the RCT has organized protests, created a petition that now has nearly 12,000 signatures, and is calling for legal action.

“The death of Alejandra has become a flag for our march because we want justice, but above all we want this to stop,” Salamanca said.

On May 29, the night that Monocuco died, Daza got up to pee and heard someone gasping. She had heard the sound earlier too, but thought it might be one of the housemates having sex. When she heard it again hours later, she went to check, and found Monocuco struggling to breathe, so she called an ambulance.

“With her I can tell the difference,” said Daza. “Seven years with me, sharing the good and the bad. She was always getting sick, a flu, a cough, or short-lived things like that. But I have never seen her like this. So I said ‘No, Machi, my god, I’m going to call the ambulance.’”

Daza explained Monocuco’s symptoms over the phone, and the emergency hotline operator told her Monocuco might have COVID-19.

It took about 45 minutes for the ambulance to arrive, and when paramedics finally got there, something was off, Daza said. As soon as they noticed all the gay and trans people around, Daza said the urgency of the situation seemed to disappear.

“When the ambulance arrived and [saw] we have many maricas here, they already started to relax,” said Daza, using a slur for gay people that is sometimes reappropriated.

It took another 20 minutes for the paramedics to get dressed in their protective gear, according to Daza, before they finally began to examine Monocuco. Daza said after they took her vital signs, one of the paramedics said he didn’t think it was COVID-19.

At that point, Daza said a paramedic started to draw blood. Daza had already told the operator that Monocuco was HIV-positive, but the paramedic asked again about Monocuco’s medical history and Daza repeated that she had HIV.

That’s when everything changed, Daza said. She said he seemed alarmed.

“He was terrified and by now he had told me, ‘This could be symptoms of overdose. Don’t give her water, don’t give her food, don’t give her absolutely anything, because she seems to be in respiratory arrest. She could choke and that would kill her,” Daza recalled.

“I said ‘No,’” said Daza. “I kept insisting the whole time that they take her, that they take her, that they take her.”

“That was when he said, ‘No, take it easy… It's no longer a symptom of COVID, it could be a suspected overdose. Leave her be, relax, nothing is going to happen to her,’ and look at what happened!” Daza said.

After the paramedics left, Daza claimed they stood on a street corner smoking cigarettes and drinking.

“And while the girl lay there dying — she kept suffocating, they [were] outside smoking cigarettes and drinking red wine. Imagine!”

The RCT — which both Monocuco and Daza participated in — put out a statement early the next morning decrying the paramedics’ treatment of Monocuco. But in the weeks since her death, the injustices have only continued to pile up, Salamanca said.

In the immediate aftermath, the city health secretary’s office released a statement claiming that Monocuco wasn’t taken to the hospital because her companion — meaning Daza — had signed a form saying she shouldn’t be transferred. But as Daza told BuzzFeed News, she had in fact begged the paramedics to take Monocuco to the hospital.

The district health secretary, Alejandro Gómez apologized for the “error” and acknowledged that no such form existed. However, the statement put out by his office said Monocuco herself had declined to be transferred, which Daza and the RCT have also disputed.

The treatment of Monocuco’s body after her death has also added to the outcry.

According to Daza and the RCT, Monocuco’s body was left in the apartment for more than 15 hours before the city retrieved it. Monocuco died in bed some time before 2:40 a.m., when the second ambulance arrived, and according to Daza her body was not retrieved from the apartment until about 5:30 in the evening.

The city’s health department declined to answer questions about the long wait, but the press release from June 3 indicates that the procedure for the removal of Monocuco’s body was complicated by bureaucratic hurdles and the fact it was not immediately obvious who should be responsible for Monocuco’s body after her death.

The press release says that city officials began to make arrangements early the next morning, but because “the deceased person did not have a family member to register the death,” the city required additional documentation to work around the standard procedure.

Monocuco had not been, by all accounts, in close contact with her family recently, but she did have living relatives, and the family and the RCT have criticized accounts that she did not.

The fact that Monocuco’s body was cremated has also raised questions.

The same press release says that the city followed procedures for a COVID-19-related death, based on the “certified cause.” But according to Jorge Perdomo, who was deputy attorney general of Colombia for four years and briefly the attorney general and is now working with the RCT and the family on the case, Monocuco’s death certificate does not indicate that she had or was suspected to have had COVID-19. Perdomo said that given “they had already said that this was not a suspected case of COVID and on the [death certificate] there is absolutely nothing about this,” the decision to cremate her body is an indication of “irregularities” in the city’s response.

A spokesperson for the city health secretary’s office also declined to answer a number of other questions from BuzzFeed News about the case, saying the information could not be disclosed due to the investigations underway.

The cremation means that there will never be a clear answer as to why Monocuco was ill on May 29, but advocates say that regardless of the cause, she should have been taken to a hospital for a treatment.

Monocuco’s death came as a shock to her family. A cousin saw a report on the news and told an uncle, who eventually called Monocuco’s immediate family in Magangué.

“What happened to [her] was terrible,” said her sister Isbelia Cardona Ruidiaz, who moved back and forth between feminine and masculine pronouns to refer to Alejandra during the interview over Whatsapp. “I never thought my [sister] would die in that sad way for being trans and because [she] had HIV.” Cardona said the family hadn’t heard anything from the city until they called about collecting the ashes.

Mauricio Albarracín, who is a human rights lawyer and LGBTQ rights activist in Colombia, said part of the reason that Monocuco’s death has sparked such outrage is that on paper LGBTQ people in Colombia are well-protected. Advocates have made enormous progress in terms of advancing LGBTQ rights through the court system, but Albarracín said legislation and the lived reality of those rights have lagged behind.

“It’s really bad how the health system treats the trans people,” said Albarracín. “It has created a debate about how the city is treating the LGBTI people after 30 years of the most liberal constitution, after 30 years of progressive rulings by the court, after, you know, with a lesbian mayor.”

Claudia López, who was elected in 2019, is the first woman and the first LGBTQ person to be mayor of Bogotá, but Salamanca says that despite pledges to fight discrimination, she has been a poor ally to trans people and sex workers.

To slow the spread of the coronavirus in Bogotá, which has had nearly 75,000 confirmed cases as of Thursday, López instituted a gender-based quarantine policy called Pico y Género in April. The policy said that men could go out in public on some days, and women on others, and López said that trans people should leave the house on the day matching their gender identity.

The policy — along with similar measures in Peru and Panama — was met with a backlash from global human rights organizations that said it infringed on the rights of trans people, and Albarracín said he believes the policy was unconstitutional. Sex work has been recognized by Colombia's judicial system as a legal form of labor, but sex workers still face significant police harassment, and the RCT saw an increase in reports of harassment from both the public and police while the Pico y Género policy was in place. It has since been rolled back in Bogotá but Salamanca said that it was emblematic of López’s disregard for trans people.

“The mayor … appears to have an agenda against the rights of trans people and sex workers,” said Salamanca. “The attitude and response from López to the trans community has been police-based and lazy.”

New quarantine measures have since been brought back in various neighborhoods in Bogotá, including Sante Fe, where Monocuco lived along with Daza, and other sex workers. But Salamanca said sex workers have not gotten the help they need to survive if they can’t work.

In the 2014 interview, which was part of a research project on the impact of Colombia’s armed conflict and police violence on historically marginalized communities, Monocuco said she faced discrimination at every turn in her life. She was forced out of Magangué by paramilitaries when she started dressing in women’s clothes, jailed, and assaulted. There are differing accounts as to whether Monocuco was doing sex work at the time of her death; however, she told researchers in 2014 that she had faced violence as a sex worker at both the hands of the police and clients. Around a decade ago, Daza estimated, she also contracted HIV.

Although the prevalence of HIV among sex workers in Colombia has declined due in part to efforts by sex workers’ rights advocates, according to Dr. César Nuñez, who is the director of UNAIDS’ regional support team for Latin America and the Caribbean, trans people in the country still face an HIV infection rate higher than 20%. Nuñez said that high rates of HIV are common among trans communities around the world. “It’s not the fact of being transgender that makes people more vulnerable to HIV. It’s the combined social, economic, and psychological consequences of marginalization,” said Nuñez.

For Monocuco, that marginalization was deadly. “It was already a death sentence from even this moment many years ago when Alejandra was crying out against police brutality in her life,” said Amy Ritterbusch, who interviewed Monocuco in 2014 along with Salamanca, and is now an assistant professor in the Department of Social Welfare at UCLA.

As attention to the case has grown, various investigations at the city and national level have begun, and Perdomo said he believes that Monocuco’s case could be a landmark for trans rights in Colombia. “I believe that the case of Alejandra is the … most important for advancing the recognition and visibility of this community.”

The city health secretary’s office has announced three separate investigations into Monocuco’s death, and on Twitter López has promised to seek justice, acknowledging that there was an “error” and “inadequate service” in the case.

Colombia’s inspector general has opened an investigation that could result in disciplinary sanctions for the public officials involved — up to and including removal from their post, but Perdomo and the RCT hope the attorney general’s office will go further and pursue criminal charges. A spokesperson for the attorney general’s office confirmed to BuzzFeed News that they have opened an inquiry, but said it’s in a preliminary phase.

If charges are pursued and successfully brought against public officials in relation to Monocuco’s death, Daniela Diaz, a lawyer for LGBTQ rights group Colombia Diversa, said it would be the first time a public official in Colombia was held criminally accountable for discrimination on the basis of gender identity. (A previous case attempted to charge school officials after a nonbinary gay boy killed himself, Diaz said, but the attorney general’s office moved slowly and the statute of limitations passed before anyone was indicted.)

Diaz said the case would also send a message that the most vulnerable members of Colombian society have access to legal protection.

“This victim was a transgender woman, a victim of forced displacement, a sexual worker, and HIV positive. All those situations here in Colombia are frequently used to prevent access to the justice system for transgender people,” said Diaz. “If successful, the petition before the prosecutor’s office will send a statement about intersectionality, saying that the most vulnerable deserve to be treated equally and when not, public officials must be held accountable, and particularly criminally accountable, for those discriminatory behaviors.”

Most of the interview that Monocuco did in 2014 focuses on the violence that she suffered throughout her life, but she said that around the time she was 18, she had a realization. She went to see family in Venezuela, who pressured her to dress in men’s clothes and date women, and she realized that she couldn’t pretend.

“They bought me men’s clothes. And I felt bad. Honestly, it made me feel bad. It showed what I was — that I couldn’t hide that way,” said Monocuco. “So I decided to be what I am.”

When Monocuco was returning to Colombia, she was fearless.

“I didn’t have any fear because I was coming here. I came happy,” Monocuco said.

“I was happy because...I was starting to live my life, no? There was no knowing then everything that would happen to me in all of this,” she said. “And I was saying, ‘yes, now I’m going to make my dreams come true.’”

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