Questioning Transphobia

cross posted at Harlot’s Parlour

Since yesterday was World AIDS day I thought I’d drop some stats about seroprevalance amongst trans women, especially sex workers, worldwide.

Studies about HIV infection rates amongst trans women populations overall:

*  14% amongst trans women in Puerto Rico (Rodriguez-Madera and Toro-Alfonso 2005) and Chicago (Kenargy and Boswick 2005)
*  21% in Sydney (Alan et al 2005)
*  24% in Amsterdam (Gras et al 1997)
*  25% in Houston (Risser et al 2005)
*  35% in San Francisco (Clements-Nolle 2001)

Specifics (transsexual unless noted, some included transvestite or travesti sex workers)

*  63% of trans women of colour in San Francisco indicated HIV positive (Clements 2001)
* 74% in Rome among transsexual and travesti who use drugs.  Most notably, the same study found 100% seroprevalence of people who had been in the same milieu for more than four years (Gattari et al 1992).
Rates amongst trans sex workers

*  46% in Lisbon (Bernardo et al 1998)
*  68% in Atlanta (Elifson et al 1993)
*  63.8% in Rio de Janiero (Surratt et al 1996)
* 62% amongst transsexual and travesti sex workers in Bueno Aires (Berkins and Fernandez 2005)

All of these statistics have been taken from Viviane Namaste’s recent research paper “Undoing Theory: ‘The Transgender Question’ and the Epistemic Violence of Anglo-American Feminist Theory” (Hypatia journal, vol 24, no. 3, summer 2009) where she argues that a feminist emphasis on what transsexual and transgender bodies mean has neglected the very real crises of violence and HIV infection amongst our communities.  Namaste argues compellingly that HIV has ravaged communities of transsexual women worldwide, a “lost generation” whose disappearance has largely gone unnoticed.  Looking at these statistics, I can’t say I disagree with her.

Story here:

The federal government would be banned from funding sex change operations and other services for transgender individuals if social conservative activists get their way.

There’s no sponsor yet for an amendment to the health care overhaul – and it may remain in the dustbin of unrealized wedge issues – but culture warriors are shopping the proposal to Republican senators.

The language is written: “None of the funds authorized or appropriated under this act (or an amendment made by this Act) shall be used to cover any part or portion of the costs of any health plan that includes coverage of” any sex or gender reassignment procedure, surgery related to such a sex change, hormone therapy for a sex change or pre- and post-operation treatments for a sex change.

A senior aide to a Republican senator said that a public insurance plan could easily end up covering sex-change procedures if that’s not specifically banned in the bill.

“It’s not that hard to imagine that a new federal health plan crafted and implemented by this administration would cover sex-change surgeries. Anything not explicitly prohibited in the bill is effectively on the table. Most Americans probably would prefer that their tax dollars not pay for or subsidize transgender surgery,” the aide said.

Advocates for transgender people note that it is often difficult for them to obtain insurance that covers medical needs related to their transition and say that sometimes basic medical care has been unfairly denied.

“Unfortunately, some insurance companies broadly interpret language excluding transgender-related care and services to deny coverage for non-transition-related procedures for transgender individuals. Insurers justify these exclusions by stating that your current medical problem is somehow related to your transition,” the Transgender Law Center wrote in a fact sheet posted on its Website.

The ironclad language of the funding-ban amendment suggests the type of prohibition conservatives want to see on coverage of abortion if a new health care exchange includes a government-backed insurance option.

House Democrats say they have a plan that would segregate federal funds to prevent taxpayer support for abortion services, but abortion critics say the proposed firewall would not fully shield taxpayers from footing the bill for the practice. In its first iteration, the House version of the health care bill didn’t mention the word abortion – though it carried significant implications for the availability of insurance coverage for the procedure.

Several Democratic aides – and Sen Roland Burris (D-Ill.) – declined to comment on the proposal.

All I can say is: Contact your representatives. This is vile and ridiculous.

h/t Aureantes on the Transgender LJ Comm

Massachusetts Transgender Political Coalition (MTPC) has available for free download the following two brochures addressing the issue of trans suicide:

• Saving Our Lives: Transgender Suicide Myths, Reality, and Help

  Information for transgender people, family, friends, and allies. Includes warning signs, do’s and don’ts, helpful tips, contact information, and myths and realities.

  Click here to download PDF

• Preventing Transgender Suicide: An Introduction for Providers

  Includes definitions, warning signs, victimization and PTSD, systemic stressors, protective factors, where to learn more, and references.

  Click here to download PDF

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Cross-posted at Bird of Paradox

The Massachusetts Department of Public Health (DPH) has published the results of “the largest survey to date comparing the health of lesbian, gay, bisexual and transgender (LGBT) residents to heterosexual and non-transgender residents in Massachusetts”.

[Click here to download a PDF copy of the report, The Health of Lesbian, Gay and Transgender Persons in Massachusetts]

The Executive Summary points out that the health of trans people is worse than amongst cis people; and that we also have “worse outcomes with respect to self‐reported health, disability status, depression, anxiety, suicide ideation, and lifetime violence victimization”.

Some of the results do stand out – they may not be particularly surprising, given the amount of anecdotal evidence one hears from conversations with other trans people, but they do seem to confirm it:

• While 10.4% of heterosexual respondents and 7.8% of gay men and lesbian respondents did not have a personal doctor, 17.6% of bisexual respondents and 17.3% of transgender persons indicated that they did not have a personal doctor.
• With respect to overall health, respondents were asked if their general health was excellent, very good, good, fair or poor. Heterosexual respondents had 82.5% responding Excellent or Very Good while gay men or lesbian respondents reported 78.0%, bisexual respondents 73.5% and transgender persons 67.3%. Self‐reported general health has been found to be a good indicator of an individual’s actual health status.
• Respondents were asked to report how many days in the past 30 days they have felt sad, blue or depressed. Heterosexuals reported 3.97 days, gay men and lesbians 4.18 days, and bisexuals 6.38 days. Transgender persons reported 7.79 days, higher than non‐transgender respondents (4.29 days).
• Respondents were asked if during the past 12 months they had seriously considered attempting suicide. Among heterosexuals, 2.3% reported having considered suicide and among gay men and lesbians, 4.4% reported suicide ideation. Transgender persons (30.8%) and bisexuals (7.4%) reported higher rates of suicide ideation.
• Respondents were asked if they had ever been threatened with physical violence by an intimate partner. Among heterosexuals (12.3%) reported a lifetime history of being threatened with intimate partner violence victimization, compared to gay men and lesbians (14.0%), bisexuals (18.4%). Transgender persons (34.6%) were more likely to report being threatened with physical violence by an intimate partner than non‐transgender persons (13.6%).
• Respondents were asked to report whether they had ever had an HIV test. Gay men and Lesbians (72.2%) had the highest rate, followed by bisexuals (66.7%), transgender persons (65.4%) and heterosexuals (49.0%).

To my mind, what’s missing from a lot of these data is the “why” aspect: why are trans people less likely to have access to a doctor than gay and lesbian people, why do we feel depressed more often than cis people, why do we feel suicidal more often, why are we more likely to report being threatened with physical violence by an intimate partner than cis people, and so on. Of course, those reasons will undoubtedly vary widely between individuals, but it would have been interesting to know if any patterns had emerged, and if there were any differences between trans and cis populations.

Overall, I think the report is to be welcomed, cautiously – but I also hope that a more rigorous (and bigger) survey can be carried out in the near future. If nothing else, it suggests that the problems we face in our everyday lives are in urgent need, not only of study, but positive and supportive action by the mainstream cis society which oppresses us in so many ways. However, I also think that for there to be any real improvements in our circumstances there first needs to be a substantial change in cis people’s attitudes to us – and that doesn’t look likely to happen any time soon.

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Curtsey to Stefani for the heads up

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Cross-posted at Bird of Paradox

Via The Center:

GIP Presents: NYAGRA’s 1st Public Directory of Trans-Sensitive Providers Launch Event

Event Date
Tuesday, July 21 2009 : 7:00pm

Location
The Center

Description
Gender Identity Project will be hosting the following event:

The New York Association for Gender Rights Advocacy (NYAGRA) has compiled the first public directory of transgender-sensitive providers in the New York City metropolitan area and will be distributing hundreds of copies of the directory to members of the transgender community.

NYAGRA’S 1st Public Directory of Trans-Sensitive Providers

The 26-page directory – which includes of physicians, mental health professionals, acupuncturists, and AIDS agencies as well as other health care providers – is a project of the Transgender Health Initiative of New York (THINY), a community organizing project established by the Transgender Legal Defense & Education Fund (TLDEF), NYAGRA, and the Center GIP in 2004.

Some of the providers listed in the provider directory will be on hand at the event, along with light refreshments. Come get your own copy of the directory and meet some of the providers!

Find this event on Facebook, and invite your
friends!

Price
Free

For More Information
For more information please contact: Kelly White (760) 473-2476 or Pauline Park (212) 675-3288, ext.338

If only there was a similar initiative here in the UK, she murmurs, wistfully…

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Cross-posted at Bird of Paradox

New Orleans Women’s Health Clinic has allowed me to post their response to my query about health care and their policy of excluding trans women.  It’s pretty depressing reading all round – they’re not able to sustain care because of the difficult of finding non prejudiced doctors here, not only with trans women but women of color, women with disabilities, and GLBTI etc.   This raises serious questions with me about the possibility of finding more than the odd good doctor on trans health care anywhere. 

They’re currently evaluating the possibility of providing any health care at all.  I have offered to work with them to educate any doctors on trans women specific care, and to work on fundraising to help achieve that, however we’ll have to see if that pans out. 

ETA: NOWHC have requested I post the entire exchange, in the name of transparency.   Because of privacy concerns, I have removed my email address from the exchange. 

The email exchange in full:

Queen Emily —-

Hi y’all.
 
I’m a young trans woman moving to the area and I’m looking for good, safe health care (something that is almost an impossibility in many areas).  Your website says you do not provide services for (“male” assigned) transgendered women.  I’m wondering:
 
1.  Is this still the case? (sometimes people can be slow on the website updating)
2.  If so, why is this the case?  I don’t understand how providing hormones (or the contraceptive pill to post GRS women) is any different from caring for menopausal cis women.   This seems especially arbitrary given that you state you care for female assigned people with DSD who may have had similar operations.
and 3.  If so, do you have any referrals for trans women friendly clinics? 
 
Regards,
Emily.

NOWHC —-

Emily,
 
Thanks for emailing us your request.  We apologize for the delay in getting back to you.  We receive hundreds of emails a week about services, volunteer and internship opportunities, and tons of junk mail unfortunately.  As a result, and due to our capacity, we have about a week-turn-around rate with email responses.
 
Currently, we are not providing medical services, as these services have been suspended since late last Fall.   We are in transition as we seek a new Medical Director, while continuing all of our other programs.  Unfortunately, we have not had an opportunity to update our website detailing all of our programs and our current list of services. 
 
As you have accurately noted, few health care resources exist for trans women in general, and this is particularly true in New Orleans, despite the fact that New Orleans had the largest Black queer population in the country pre-Katrina, with trans women of color, almost exclusively working class and low-income New Orleans natives, struggling to get decent affordable health care in the city for decades.  The destruction caused by Hurricane Katrina took a terrible toll on our health care system and it has been very difficult for us to not be in a position to provide trans affirming medical services to women in our community who need them, despite our local efforts.
 
The following resources may be of some help to you as relocate to the area:

The Drop-in-Center Clinic ? located at 428 N. Rampart Street.  The Drop-in-Center provides trans-affirming care.  The Center provides medical and social services to youth between the ages of 13 and 24 years-old. Services at the Center are geared toward homeless, at-risk, and queer youth.  They can be reached at 504-897-948-6701.
Planned Parenthood of Louisiana ? located at 4018 Magazine Street.  Their number is 504-897-9200.

You may also consider contacting the Lesbian, Gay, Bisexual and Transgender Community Center of New Orleans, which is located at 212 Decatur Street in the French Quarter.  The Center?s number is 504-945-1103.  The St. Thomas Community Health Clinic is also a local resource to contact.  St. Thomas is located Uptown in the Lower Garden District at 1020 St. Andrew Street, and they can be reached at 504-529-5558.
 
We agree that the questions and concerns you raise are very important.  The priorities we hold in providing safe, accessible, and unbiased care to women regardless of their race, income, sexuality, gender identity, body type, citizenship status, work sector, legal history, ability, age, language, and family size and status are often regarded as a “risk” and “liability” by many medical professionals.   This reality has delayed our efforts to hire a new Medical Director and created many barriers for many members of our community, including you, in seeking safe, quality, and respectful services.
 
In making the statements “we are currently not able to provide care to trans people who were male assigned at birth or who have had genital sex reassignment surgery. Please call for referrals,” we were referencing the lack of experience and training that our former medical staff had in providing trans affirmative care to all women regardless of their body types, and gender identities and expressions.   We recognize that the current language on our website marginalizes trans women in particular, even though it says elsewhere that we provide services to “all women.”  Although “services” provided at the Clinic are not restricted to our medical programs, we recognize that the way it is written implies that we offer no services at all to trans women, which is marginalizing and confusing.   It would be more accurate to say that our goal is to provide medical services to all women, though we are having a difficult time reaching it.   We take responsibility for this inaccurate representation, and for the ways in which the language is disrespectful, and we sincerely apologize.
 
Collectively and organizationally, we are committed to creating institutions and environments that challenge gender-policing and trans and homophobia by dismantling racist, heterosexist, patriarchal, classist, and xenophobic ideologies of exclusion, discrimination, hatred, and violence, which creates barriers for many members of our community, particularly those persons who are women of color, poor, LGBTQ, immigrant, differently-abled, homeless, heads of households, disabled, sex workers, incarcerated and formerly incarcerated, young, and living in racially and economically segregated communities.   Our website doesn’t reflect this politic effectively and we are currently in the process of modifying it.
 
Besides language, we share the concern about the core issue of offering safe, quality, and respectful services to all women.  Since our founding, we have struggled to hire medical staff who don?t pathologize, demonize, and criminalize the bodies of undocumented women, women with disabilities, l/b/t/q/i women, women of color, low-income women, homeless women, and women working in the sex industry because of our sexuality, reproductive decisions, and gender expressions.  Currently, we are evaluating if we can realistically find medical staff that meet this expectation, particularly given the current conditions of the city.
 
We hope the resources we have shared are helpful.  If not, please contact us at 504-524-8255 or via email again and we will work with you and do our best to find the resources that you need. 
 

New Orleans Women’s Health Clinic
1406 Esplanade Ave.
New Orleans, LA 70116
504-524-8255 (Office)
504-524-8285 (Fax)
www.nowhc.org

Queen Emily —

Hi, thanks for that.  That’ll be very helpful.
 
I’m sorry to hear about the lack of medical services.  I may have inadvertedly started a blog firestorm when I posted a rant on my blog (questioningtransphobia.wordpress.com) about it.  I’m sorry about that, I should have waited for a response.  Do you think I could let people online know about the situation?  I don’t want to break confidentiality, but obviously there’s a lot of people online interested, and a good many trans women and/or women of color feeling hurt and angry about the policy.
 
About the situation, is there anything I can do to help?  If medical services are to return (which I really hope that they do), I’d be happy to lend my time to educating medical personnel on trans women specific needs. 
 
The second is, if there’s a need for more funds to pay doctors and nurses, I’d be happy to use my contacts in the trans and radical women of color blogospheres and organise through social media to conduct a fund-raising drive directing people to your website to donate.  I’ve seen people raise thousands of dollars with just a little Paypal button, so that’s one option.   
 
Regards,
Emily.

Queen Emily —

Oh, just to clarify, the fundraising drive offer is conditional on trans women inclusion if/when the medical services become available.  No trans woman is likely to get behind that, otherwise.

NOWHC —

Emily,

Thank you for reaching out.  There is a lot going on right now as we determine whether or not we can sustain the kind of clinic we want, so we will have to follow up with you about your offer of support in the future.  In the meantime, it would be alright with us if you posted this entire e-mail exchange on your blog.

Queen Emily —

Ok.  I hope you can work out something sustainable, and once again do keep me in mind for later. 
 
Regards,
Emily.

NOWHC —

Emily,

Thank you for posting our email response to you on your blog.  We also appreciate your apology and taking responsibility for not allowing us the opportunity to follow up with you before you posted your original blog post.  Because of the nature of this matter and all of the blog posts that have circulated, we feel that it is important to communicate not just our response, but the entire email exchange as we confirmed below.  We want to have an open process about this and we think it’s important to be transparent about all of the communication between us.

Queen Emily —

Oh ok, no problems.  I’ll post the rest up now.

Just wanted to let y’all to know that New Orleans Women’s Health Clinic have gotten back to me.  I’m not sure what I can really make public right now (an email is not a press release yeah?), but we are talking.  Some alternatives for possibly trans friendly health care in NOLA that they’ve given me are:

The Drop-in-Center Clinic:  located at 428 N. Rampart Street.  The Drop-in-Center provides trans-affirming care.  The Center provides medical and social services to youth between the ages of 13 and 24 years-old. Services at the Center are geared toward homeless, at-risk, and queer youth.  They can be reached at 504-897-948-6701.
Planned Parenthood of Louisiana:  located at 4018 Magazine Street.  Their number is 504-897-9200.

The Lesbian, Gay, Bisexual and Transgender Community Center of New Orleans, which is located at 212 Decatur Street in the French Quarter.  The Center’s number is 504-945-1103. 

The St. Thomas Community Health Clinic, located Uptown in the Lower Garden District at 1020 St. Andrew Street, and they can be reached at 504-529-5558.

Voz_latina has a RFC out in connection with a media piece she plans to make on trans women speaking out on healthcare, tentatively titled:

Our Lives Matter Too! Holding Cissexually Privileged Women’s Healthcare Accountable To All Women.

She’s asking for initial thoughts and ideas, etc and the details are up at her LJ – link here.

As she says, all our experiences matter, so click over to hers to sign up.

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Cross-posted at Bird of Paradox

So I was doing some scouting around online, trying to find some trans friendly health services in Louisiana, when I found this website for the new Orleans Women’s Health Clinic.    About them:

NOWHC provides sexual and reproductive health services to all women regardless of their race, ethnicity, sexual preference, gender identity and expression, ability, faith, income level, citizenship status, work sector, or age – in a caring, respectful, and confidential environment.

Sounds perfect, right?  Women, especially women of color centered, trans inclusive, intersectional, partly operated by Incite! Women of Color organisation.  Sounds really awesome, the rare kind of radical space that a trans woman could actually feel safe getting medical care in.  But wait just a second.

* We provide care to hetero, bi, lesbian, queer, and questioning women; trans and gender non-conforming individuals; and women with DSDs who were female assigned at birth.  We are currently working to expand of trans and gender non-conforming affirmative health care services and enhance our health information and referral services to people and families affected by disorders of sex development.  We are committed to working with all of our clients to provide care that respects individuals’ relationships with their bodies and gender identities. We are currently not able to provide care to trans people who were male assigned at birth or who have had genital sex reassignment surgery. Please call for referrals.

Silly rabbit, “trans” doesn’t mean you, let alone “woman”.  So what is it that makes trans women untreatable?  It’s not specified, simply waved away.

What kinds of health needs do trans women have that other women don’t, that they’d be so unable to provide?  A prescription for hormones?  A blood test to make sure we don’t get blood clots?  Not exactly different from other forms of HRT or the contraceptive pill.  Scans for breast cancer?  Oh they have those, just not for us.

How is that we’re implicitly figured as a resource drain (“not able”), as taking up too much space..  in an organization that specifically labels itself as trans friendly?

I’m sure they do good things for their clients, but especially given the number of trans women of color in and around NOLA, this is seriously and bitterly disappointing.

ETA: added for clarity the link to the page where the second quote is taken from.

One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don’t do anything at all…

Medical News TODAY carries a report (link here) on a presentation given to the Endocrine Society by Henk Asscheman, MD, PhD, a clinical researcher at Vrije University in Amsterdam.

A study undertaken by Dr Asscheman and his team suggests that, while long term estrogen use does not protect trans women from death due to cardiovascular disease, neither does it appear to raise our overall death rate.

It’s hard not to conclude that, if the transphobic bigots don’t kill us, then our meds probably will.

Asscheman and his colleagues followed up 1,330 transsexuals who received cross-sex hormone therapy for an average of about 15 years. They compared the number of deaths in their study population with the expected death rate by age and sex in the general population.

Male-to-female transsexuals receiving estrogens were more likely to die of heart disease and stroke between the ages of 40 and 64 than men of the same age in the general population. They had 1.8 times the risk of dying of coronary artery disease and twice the risk of dying of a stroke.

However, Asscheman said they have not yet analyzed how many of the transsexuals smoked cigarettes, a major risk factor for heart disease. In their clinical experience, more male-to-female transsexuals smoke than does the average population, he said.

“This increased cardiovascular death rate adds to recent research [in women] that estrogens are not cardioprotective and suggests that estrogen-alone treatment may even increase the risk of cardiovascular disease, especially in smokers,” Asscheman said.

Possibly the most disturbing paragraph of the Medical News TODAY report is this:

Overall, the male-to-female transsexuals receiving estrogen had a 46 percent higher death rate than would be expected in the general population, but this was due to causes that the authors considered unrelated to sex hormone treatment. Among the 25- to 39-year-olds, their higher death rate was due to increased numbers of suicide, drug-related deaths and AIDS. The suicide rate also was higher (eight times higher than expected) in the 40- to 64-year-old male-to-female transsexuals. Transsexuals already are known to have a higher rate of suicide before starting hormone therapy, and estrogen use is not associated with increased suicide rates in women, Asscheman said.

There’s no question that there’s very little empirical medical evidence available on the various specific health risks faced by trans women. And although these results are as depressing as they’re scary as they’re alarming – we’re at twice the risk of dying from heart disease or a stroke and eight times more likely to commit suicide – there’s no doubt in my mind that much, much more research in this area is needed urgently.

Finally, it should go without saying that all the research in the world is ultimately useless if healthcare systems fail to provide suitable, adequate and accessible services and support for us.

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Cross-posted at Bird of Paradox