jazeera. "america tonight" is next. i'll see you again in an hour on "america tonight" - living in fear. >> when threats and the threat of violence is something that is part of your every day life, you kind of get to the point where it just comes second nature "america tonight"s lori jane gliha meets a woman determined to change lives for gays and lesbians on the island nation also tonight - jay den's journey. >> i didn't know what i saw, i knew it was not bad.

>> "america tonight"s lisa fletcher explores the behind for transgender surgery, and how u.s. hospitals are not making the cut. good evening, thanks for joining us, i'm adam may. joie chen is on assignment. >> it's interesting that thousands of americans want sex re assignment surgery but can't get it. through the cause of celebrities like caitlyn jenner, the demand for the procedures outweighs the ability of u.s. hospital to meet the need. "america tonight" lisa fletcher explores how things have changed, why the surgeries are viewed as medically necessary, and the efforts to address the unique medical needs of the transgender community. >> i have a couple of photos. >> from the age of 7, jaden ty

knew he was different. >> i realized there was something wrong, that i don't smell as much. i didn't feel i belonged anywhere. >> reporter: jayden's differences did not make him a star athlete or an academic. >> in the second raid i remember being pull the out by my dacher saying i -- teacher saying i can't return to school until i wear girl's clothes. >> reporter: his differences trapped him in a body that disguised who he thought he was. >> the world saw me years ago, i didn't know what i saw, i know it was bad. >> confused. ashamed. jayden spent 16 years struggling to find a sense of self that fit. >> who do you sigh when you look at the pictures? >> i see me. it has always been me. it has always been me, it's not a complete me, if this makes sense. >> reporter: it wasn't until the

summer of 2012 when jayden came out as transgender that he began to feel whole. a few months later he said he knew it was time to change his outer appearance. >> up to a certain point, i can't run away from it. i have to address it and talk about it and deal with it. i ran away so long, i didn't know how to begin. >> little did he know, beginning his journey would mean confronting a medical system ill-prepared and unwilling to embrace transgender patients. >> i remember getting a phone call in my office one day from the chief of surgery, who was screaming at me on the other end of the line, saying - and i'll never forget this - don't you even think about bringing those freaks into my hospital. that is - you know, that's what i was dealing with when i

started this. >> reporter: dr john taylor is a plastic and reinstructive surgeon, one of the few specialising in sex reassignment journey. when you take the 30,000 foot few of the medical care available to people in the transgender community, what does it look like? >> sparse. from 30,000 feet, you can't see anyone. i think i'm the only surgeon right now in the tri-state area who is doing the surgery. >> in new york, new jersey and connecticut, you are the only surgeon doing the procedures. >> as far as i know, i think i am. >> an online search making it apparent that doctors that specialise in transgender procedures are few and far between. this site with 9,000 followers lift 30 physicians nationwide. while the numbers may be higher, it's not that far off, according

to dr fairl and other professionals. >> i didn't get into this in medical school or surgical residency, and the issues that go along with it. >> reporter: dr taylor's practice took a turn 20 years ago after a psychologist friend asked if he would be willing to see transgender patients in need of surgery. >> i started researching it and became more interested in it, and started to develop a passion for these patients, so i started travelling to montreal. >> so it was kind of on-the-job training for you. >> exactly. >> reporter: starting in 2001, the doctor travelled to canada every two or three months, to learn. taking copious notes in a book he keeps in his or to this day. >> when did you start the

journal? >> i started in 2001. no textbook with this information in it, you won't find it anywhere. you said you developed a passion for the patients, why? >> they had something i felt was real, a life-long struggle. a high rate of depression, suicide for patients who co could not find treatment for their gender identity disorder. i thought if i am not going to help them, who is. god has given us the ability to treat the disease, whether it's high blood pressure, diabetes, we have the knowledge and capability to treat it. why not gender identity disorder. >> you are progressive in your view, particularly 10 or 20 years ago. what roadblocks did you encounter. >> i was labelled as the sex

change doctor. at that point in time it was less than 1% of my practice. there was a strong push back from the medical community. >> something that a few of the nations prestigious hospitals are addressing head on. >> it hasn't been a legitimate mainstream field of medicine, and we have to work on training existing providers to get up to speed. >> reporter: this is the director of l.g.b.t. policies for the mt sinai health system in new york, where she and others are racing to build a system of care to support transgender patients, whether in for a flu shot, hormones or sex reassignment surgery. complicating the task is influx of patients seeking surgeries. >> we really don't have a system set up to meet how much it is. than there are now people available to do it.

>> fl last year those wanting surgery have been out of pocket. now it's allowed for insurance coverage. when word got out. mt sinai was covered with requests. >> i had calls from the greater metropolitan area. >> reporter: hard numbers are difficult to come by, few doctors or hospitals tracked patients based on gender identity. how a person sees him or herself. it estimated that one to three people in 1,000 identifies transgender. that works out to about 700,000 americans, and according to the national transgender survey of those about 290,000 would have sex reassignment surgery if they could. others are content with hormone therapy and degrees of surgery, like jayden. who opted for top surgery.

>> i was able to take my shirt off. this is who i see and felt i could be, and here i am. >> publicity is helping to drive acceptance. >> people, unlike caitlyn jenner, have empowered the transgender community to not be afraid to come out without fear of retribution. >> as more identify themselves, dr taylor hopes they have the full support of the health care industry. i'm hoping that we see more of the scientific community coming out, and studying from a biologic standpoint. not just now because it's politically correct thing to do. because they'll hang up instead of the pink rhythm, maybe the transgender.

i hope the medical community embraces it. >> reporter: for jayden, it begins with him. >> my dream is to come back here, and open a gender clinic for trance folks. >> it has inspired jayden to use his ph.d. and run the clinic. >> i sincerely hope that everyone, they get to walk through the life and the world. everyone deserves to be happy next - the little known battle for gay marriage rights. heating up in navaho nation. and later, a pioneer for lesbian rights in al jazeera america, how a woman used her own terrifying experience to stand up against l.g.b.t. violence in

her country and hot on the websites the colorado green crush. in video, lori jane gliha takes you inside a marijuana grow house in colorado. learn more at aljazeera.com.

it's been called the biggest civil rights victory of the decade. gay marriage in all 50 states. there are some places in the u.s. where same sex couples cannot tie the knot. some native american reservations. we travelled to navaho nation to find out more about the

continued fight for marriage equality that you haven't heard about. >> reporter: tradition is law of the land on navaho nation. a society in which family is the location. >> the car of what it means to be navaho. >> this 29 ireland, the only son in a large carla suarez navarro family, remembers his childhood fondly. >> it was probably the best time of my life. >> i had so many cousin brothers and sisters, that we live in a very rural area. you had all this hand to just explore, ride horses, build pud houses and be outside, and i rex doing that growing up. it's important to me if i plan to raise a family in the future, that my children live the happy

time in their lives, in the future. >> dreaming of building a family of his own in a legally recognised family is out of reach. for this man and his partner, marriage is banned by the government. >> it says marriage between persons of the same sex is void and prohib itted. >> reporter: it is a law denying him the right to marriage, despite the supreme court legalizing same sex marriage. >> i want tribal leaders to understand it's foreign to me, gay and lesbian couples and navaho people. it is still navaho law today the laws regarding same-sex marriage vary greatly depending on which reservation you travel to. 11 tribes have bans on same sex

marriage, including two of the largest, the cherokee and the navaho. combined they have 600 members. >> right now, there are some tribes that have had same-sex marriage longer than the united states, and other tribes, it is opposed to same-sex marriage that are in ways no longer true. >> this is a professor of native american studies at the american university. >> what is the status? >> under tribal law, they have freedom to create their own system, and when it comes to domestic relation, tribes can deviate from what happens in the rest of the united states. challenge is that there are two things that i believe is true. that is that same-sex marriage is a human right, and that tribal right to self-discrimination and sovereignty is a human right.

there's an obvious conflict there, where the self-discrimination goes against the other human right, and that's what we are seeing in same-sex marriage. >> reporter: he is leading the charge to change nava law. >> so far attempts failed. >> we need 24 votes to we peel or amend the law. >> reporter: our request for comment from navaho nation president ben shelley went unanswered. with marriage laws changing across the country, he feels his tribe will have to come along eventually. >> 10 years from now i see myself having a home here. i see kids running around, bringing smiles to my mum and grandparents. i see birthday parties in our backyard. we know we'll make it happen.

>> on a land where tradition rules, for now it's a dream still out of reach. >> back in 2005, sponsors of the navaho gay marriage band says it was to prevent traditions and prevent nations from infiltrating navaho laws. >> next, the story of a woman coming out of the shadow, fighting for gay rights in jamaica. and tomorrow, an "america tonight" special report - katrina - after the storm. joie chen reports from new orleans. 10 years after the devastation left behind by hurricane katrina. katrina.

♪ ♪ ♪ get excited for the 1989 world tour

with exclusive behind the scenes footage, all of taylor swift's music videos, interviews, and more. xfinity is the destination for all things taylor swift. welcome back to "america tonight". the recognition of equal rights for people of different sexual

orientations has made great strides in the u.s. but in main corners of the world, gay and lesbian men and women live in fear, they are prayed on and hunted, "america tonight" lori jane gliha went to jamaica to meet a brave woman who chose to come out of the shadows and let her voice be heard. the guy came up and grabbed me at the back of the shirt, and held a gun to my neck. i said "oh, jesus", life flashed before my ice. this is a lesbian in jamaica, a country where being gay can get you killed. ankle een was 19, when a group of rapists targeted her for using a targeted site. a pair of attackers lured her and a friend to a remote area. >> i was forced to do oral sex

on the gunman, step brother and my friend. my friend had to do oral sex on the gunman, the stepbrother and then... ..then i had to watch as she was raped by both guys. >> anningel een -- anningel een believes she was the victim of a hate crime, collective rape, a crime in which they hope to change the victim of homosexuality. anningel een's story is not unique. this is video from a jamaica tv though. >> police had to be called on to rescue to homosexuals from an irate crowd.

>>reporter: the 2014 report from human rights watch documents 56 targets. l.g.b.t. people live in constant fear, the report says, and are taunted, threatened, beaten and killed because of their sexuality. here in jamaica, how are you treated as a lesbian woman. when the threat of violence is part of your every day life. you get to the point where it's second nature >> reporter: according to human rights watch, the justice system that should protect the l.g.b.t. community is part of the --. the report found jamaica has laws. the police were leave the lifestyle, go back to church. >> if i was not adamant, for me

it was i have to reclaim something. this has been taken from me. i'm not one to sit down quiet will. what can i do short of taking place. >> reporter: anningel eeb group up in a conservative group. where it was understood marriage was between a man and woman. >> when i first came ut i was 13. i said to mum "i think i may be gay." that was the best way to put it. i think because i used the word think, it wasn't as bad as it could have been. she prayed for me. for me, one of the things we learnt is that god loves you. my reason is if god loves me how can he not love me if i'm a lesbian. >> it took years. anningel een felt campbelled

westbounding com -- felt compelled to put herself in the lime light. >> all people need the same rules. she co-founded quality of citizenship jamaica, with her friend who experience the threats because of her sexuality. >>people shout slurs at me. when i live with my partner, they threatened to kill us and burn our house down, it's very, very scary, and you are constantly on edge, and it affects your psyche. >> their organization is the first registered group for lesbian and bisexual women in jamaica. >> what we aim to do is educate, empower and strengthen the community to become the visible voices. and the way forward for the

community, and encourage all women to empower themselves. >> the two became pioneers, and the work received a boost from president obama. >> angeline jackson is here today. where is angeline? there she is. >> reporter: the president recognised angeline during a speech. >> as a woman and lesbian, justice and society were not always on her side. but she started to speak out. >> what was it like when you heard him say this woman is paving the way for jamaica and other people around the world? >> i was scared. i was happy, elated and scared because i had to give the consent to being recognised. because it means that it's what you can possibly get. i had to be ready for everything that would come after that. and i was.

>> i was jumping up and down and dancing for joy. if you could have heard me scream, i had a smile on my face, it was recognition of hard, hart work that we do. >> the two say president obama's speech opened doors to conversation about sexual violence against lesbian and bisexual women in jamaica. angeline and her friend are encouraged by the progress in the united states, but are not naive about what that means for jamaica. >> it gives me hope. i don't put a lot of stock into it. we will hear all that's the united states, in is jamaica, we do things differently there, which we do. >> how would you compare where jamaica is to where the united states is. >> jamaica is about 30 yards

behind. for me, to get close to that we have to review marriage and citizenship. if you don't have hope, there's no point doing the work. it makes me hopeful of that, i'll see change by the time i'm 40. >> do you feel you have changed some people's minds? >> yes there are those in jamaica that gained a new acceptance. her family is not among them. she says it will take time before they accept it. in your heart you make progress, yet the family can't accept that. what does that do in your heart. >> it's painful. at the end of the day, it doesn't matter how many friends you have, or what are the kind of new family you create, family and friend, people close to you.

with all of that, at the end of the day what you still crave and want is the support of immediate family. >> for now, she will have to settle for support from her colleague. that's "america tonight." >> tell us what you thing rat aljazeera.com/"america tonight". be sure to come back, we'll have more of "america tonight" here

tomorrow. i'm ali velshi "on target," the tale of two cities - the haves, or have not in new orleans. 10 years after katrina, and why the mentally ill are more likely to land in prison than a hospital. hospital. saturday is the 10th anniversary of hurricane katrina making land fall in louisiana. while the category 3 storm brought destruction. nowhere suffered more than new orleans. that's where the levy system that the city depends on fa