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HAVANA - Looking in the mirror used to make Yiliam Gonzalez sick to her stomach.
"I would see myself, and my body didn't match who I was," says the 28-year-old wedding pianist, who went by the name William before receiving a sex change under Cuba's universal healthcare system.
Gonzalez is living proof of a small but remarkable transformation for the rugged revolution of Fidel Castro, Che Guevara and a band of ever-macho, bearded rebels, who long punished gays and transsexuals but now are paying for sex changes.
Gonzalez underwent the procedure in 2008. She was one of eight Cubans to do so through a programme begun in 1988, then suspended for two decades after many complained the communist government had better ways to spend its scarce resources.
The operations have begun anew under President Raul Castro's daughter Mariela, Cuba's top gay rights activist, and 22 more transsexuals are waiting to have it performed.
Mariela Castro says the government is moving cautiously, doing only a few per year.
"There has been a lot of resistance because homophobia remains strong in our culture," she says.
In the 1960s, Cuba was ferociously anti-gay, firing homosexuals from state jobs, imprisoning them or sending them to work camps.
Many fled into exile. Transsexuals, though not gay, were considered the same.
While gay jokes remain as common as shots of strong espresso in Cuba, government media campaigns now discourage homophobia.
Hundreds of gay Cubans marched down Havana's spiffy "La Rampa" boulevard last spring, just a year after authorities had forbidden a gay-pride parade.
"I'd like to think that discrimination against homosexuals is a problem that is being overcome," former president Fidel Castro said during a series of interviews with French journalist Ignacio Ramonet between 2003 and 2005.
"Old prejudices and narrow-mindedness will increasingly be things of the past."
Mariela Castro has seen to it that the state formally recognises transsexuals. A state-trained kindergarten teacher with a degree in sexuality, she runs the National Sexual Education Centre. It spent years lobbying communist officials, who finally agreed to lift bans on sex changes in 2008 - though the resolution was never made public to avoid unwanted attention.
She now says that financial concerns in the past were simply used to hide prejudices.
That's not unusual, says Denise Leclair, executive director of the Washington-based International Foundation for Gender Education.
"In many countries people complain bitterly. It's primarily driven by religious beliefs," Leclair says.
Leclair says a male-to-female change can cost $10000 to $25000 (about R74000 to R185000) in the US, or up to four times higher than that, depending on all the procedures performed. About a dozen American doctors do between 1000 and 2000 such operations a year, she says.
Canada, Britain, France and Brazil offer government-financed sex changes, among other countries.
San Francisco began paying for sex changes for city and country employees in 2001, and Fort Worth, Texas, is considered following suit.
Some large employers, including IBM and the University of California, negotiated contracts with their private insurers to cover the procedure known medically as "sexual reassignment surgery" and other insurance companies have begun covering at least part of the treatments.
Still, Leclair says most of the largest US insurers don't cover the surgery.
Cuba won't say how much its sex change costs, but doctors earn state salaries worth an average of about $20 (about R148) a month.
Despite a global recession that has hit Cuba especially hard, prompting Raul Castro to announce unspecified cuts in healthcare spending, his daughter says the state can't afford not to perform the surgeries.
Gonzalez says opponents "don't know what a person who is transsexual suffers. It's a prison you can't get out of".
She knew she was different almost from birth. By four, she was already so partial to girl's clothing and toys that her parents put her in therapy. The government formally designated her transsexual in 2000.
Six years later, Mariela Castro won approval to restart the procedures, and Gonzalez was among the first recipients.
Gonzalez declined to say the exact date of the operation or how she was chosen. Two specialists from Belgium performed it over eight hours with a team of Cuban doctors.
Leclair says 40percent of transsexuals become suicidal. But Gonzalez says her boyfriend of seven years kept her from getting depressed.
"He always saw the woman in me and accepted me how I was," she says, "but we couldn't have sex in a complete way until now."
Gonzalez can't get married, however, as she is still waiting for permission to change the name on her government ID card. Until then, she also cannot work in another wedding venue, though she would like to, or go back to school because her name no longer fits the woman she has become.
It's a problem that Cuban Olivia Lam knows all too well. She was born Alfonso Manuel but has been waiting for sex-change surgery for two years.
While her name has not been changed, authorities allowed her to take a new picture for her ID card - one where she is dressed as a woman.
Both women say they think the delay in getting ID cards is because of the slow Cuban bureaucracy and not any kind of government resistance. - Sapa-AFP