Download The Politics of Transgender Health

The Politics
of
Transgender Health
Bobbi Williams, Ph.D.
This presentation is available at
http://members.tgforum.com/bobbiwilliams
17 April 2005
The Health Issues
 Cancer
 Nutrition
 Aging
 Violence & Hate Crimes
 Mental Health
 Alcohol and Other Drug Abuse
 Sexually Transmitted Diseases
 HIV / AIDS
[Unless otherwise indicated, all quotes are from the LGBT Health
Companion Document]
17 April 2005
The Health Issues
 CANCER
• “TS hormone therapy over an extended period
of time might be expected to increase the risk
of certain hormone-related cancers.”
(p. 104)
• “Estrogen is a risk factor for cancer of the
breast…and it has been suggested that
testosterone therapy may be a risk factor for
such cancers in FtoM transsexuals.”
(p. 107)
17 April 2005
The Health Issues
 NUTRITION
• “No empirical studies on the
nutritional and weight
management practices of
transgender persons have been
conducted.”
(p. 246)
• “…it is reasonable to expect individuals who
are transitioning…(to) modify their diet, eating
behaviors, or perception of weight to appear
more like the desired gender.”
(p. 264)
17 April 2005
The Health Issues
 AGING
• “Little research on health promotion or special health
concerns for older transgender individuals.” (p. 135)
• As the ‘boomers’ grow older so do we
• No research on long-term hormone use
• No research on the interactions of hormones with
other medications
• Effects of decreases or elimination of hormones.
• “Polycythemia Vera”
17 April 2005
The Health Issues
 Violence & Hate Crimes
• Majority of assaults against TG’s are never
reported
• TG’s likely to experience victimization as a direct
result of TG identity or gender expression.
• Link between TG experience and mental health
disorders (e.g. post-traumatic stress disorder)
widely suspected, but not documented.
17 April 2005
The Health Issues
 Mental Health
• DSM-IV:
being transgendered
does not in itself constitute
a mental disorder
• GID is generally applied to transsexuals
• “Transvestic Fetishism” is applied to
crossdressers
• Depression
• Suicide
17 April 2005
The Health Issues
 Alcohol & Other Drug Abuse
• Lack of data
• Substance use programs
not sensitive to the needs of TG’s
• Few programs address the realities faced by the
TG population.
17 April 2005
The Health Issues
 Sexually Transmitted Diseases
• Chlamydia
• Genital warts
• Hepatitis B
• Genital herpes
• Pubic lice (crabs)
• Scabies
• Trichomoniasis ("trich")
17 April 2005
The Health Issues
 HIV / AIDS
• HIV infection estimates among
TG ‘s range from 14% - 69%
• HIV/AIDS risk behaviors reportedly
high among TGs, but many selfidentify as having low risk
• Few TG-sensitive HIV/AIDS prevention
activities
17 April 2005
The Political Issues
Activism
Needs
Government Agencies
Insurance
Education
17 April 2005
The Political Issues
 Activism
1992 - Transgender Nation
1993 - Annual meeting of the APA calls attention to the
pathologization of TG
1994 - Transexual Menace
1994 – It’s Time America
1995 – GenderPAC
1996 – First National Conference on
Gender Activism
1999 - National Transgender Advocacy Coalition
2001 – National Coalition for LGBT Health
2003 - National Center for Transgender Equality (NCTE)
17 April 2005
The Political Issues
 Activism
GenderPAC’s 2004 Budget
•
•
•
•
•
•
17 April 2005
22% Public Education & Advocacy
22% Conference & Outreach
15% Children & Youth Advocacy
14% Workplace Fairness
14% Member Education & Support
13% Fundraising & Development
The Political Issues
 Needs
Transgender Needs Assessments
• 1999 – Minnesota
• 1999 – San Francisco
• 1999 – New York City
• 2001 – Philadelphia
• 2002 – Chicago
• 2003 – Washington, D.C.
The focus of these has been on social services and
health, primarily HIV/AIDS
17 April 2005
The Political Issues
 Needs
17 April 2005
The Political Issues
 Insurance
• Federal law does not protect employees from
workplace discrimination based on their gender
identity or expression.
• A number of states and localities have enacted
laws prohibiting discrimination based on sexual
orientation.
• Today, three-quarters of Fortune 500 companies
include sexual orientation in their written nondiscrimination policies.
[Human Rights Campaign Foundation]
17 April 2005
The Political Issues
 Insurance
• More than 50 percent of transgender people did
not have any form of health insurance
[San Francisco Dept. of Public Health, 1999 ]
• Health insurance companies and medical
providers have denied coverage to transgender
people
[Transgender Law Center]
• More than 30 percent of TG’s indicate they
were discriminated against while trying to
access health care.
[National Center for Lesbian Rights and the
Transgender Law Center]
17 April 2005
The Political Issues
 Insurance
Even when a TG has insurance most plans exclude
procedures medically necessary for transsexuals.
Disqualified treatments include:
• psychological counseling
• hormone replacement therapy
• doctor’s office visits
• SRS
17 April 2005
The Political Issues
 Government Agencies
• Social Security Administration (SSA) runs periodic
audits of company records to match gender
markers
• Washington, D.C., Boston, New York, Chicago and
Los Angeles have offices or senior officials
designated to address LGBT health
• Motor Vehicle Department of New Jersey: if a
transperson has legally changed their name
through the courts, and presents a letter from their
therapist affirming that the transperson is a preoperative transsexual, all New Jersey Motor Vehicle
agencies must allow that person to choose their
preferred gender for their driver's license
17 April 2005
The Political Issues
 Education
• The lack of training in professional schools
on issues related to transgender health
has further marginalized transgendered
people and places them in situations of
greater health risk
• Professional associations are insensitive
to the alienation felt by transgendered
people with regards to their health care
system and providers,
17 April 2005
The Political Issues
 Education
• Social service organizations are
insensitive to the fact that transgendered
people have varying levels of unease
when accessing services.
• Transgendered people presume that
they must hide, or camouflage their
gender identity in their interactions with
health care and social service
institutions and providers in order to
receive adequate and equitable care.
17 April 2005
A Comprehensive Approach to the Problem
Members of the
Transgendered
Community
A
TWO-PRONGED
APPROACH
Members of the
Health & Human Services
Community
http://www.rainbowaccess.org
17 April 2005
A Comprehensive Approach to the Problem
THE CURRICULUM
Module 1:
• Barriers to Quality Health Care Services
Module 2:
• Gender & Identity
• Understanding Cross-Gender Expression
Module 3:
• Domestic Violence
• Sexual Abuse
• Sexual Assault
• Bias-Related Violence
• Other Trauma Issues
17 April 2005
A Comprehensive Approach to the Problem
THE CURRICULUM
Module 4:
• Relationships and Parenting
Module 5:
• Substance Abuse
• Addictions
• Recovery Issues
Module 6:
• Sexual and Gender Development
• Children and Youth Issues
17 April 2005
RAI’s Funding
• New York State Department of Health
- Two-Year Grant
• New York State Health & Human
Services Network
- Development Grants
• Memberships & Donations
17 April 2005
Funding
• “At Risk”
• LGBT (as opposed to ‘T’)
• Faith-based Initiatives
• 501(c) Non-Profit Status
• Partnerships and Co-op Arrangements
• Appeals to Corporate “Missions”
17 April 2005