International Rights-Based Advocacy for Trans Health Acknowledgements
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OPEN SOCIETY FOUNDATIONS PUBLIC HEALTH PROGRAM Transforming Health International Rights-Based Advocacy for Trans Health Acknowledgements OSF would like to acknowledge the creativity, energy and dedication of the advocates around the world who took the time to tell the stories of their personal and organizational efforts to improve health and access to care for trans communities. Advocating for the rights of trans and gender non-conforming people is a critical issue of our time and one that demands untold courage and commitment. Thanks to these individuals and groups, we hope these stories may provide inspiration to other advocates and guidance to governments and others in taking concrete steps to advance trans health. Kellan Baker brought insight, knowledge and humor to his role as author of the report and advisor to SHARP on the overall project. His work at the Center for American Progress and formerly at the National Coalition for LGBT Health has been dedicated to improving the health of trans communities and seeking justice for all in health and health care in locations as diverse as the United States, Russia, and the Central African Republic. We thank Kellan for his gentle but truthful guidance, combined with unflagging enthusiasm and flexibility. We would like to thank the following experts for their guidance and input in the conceptualization and finalizing of the report: Silvan Agius (Policy Director at ILGA-Europe), Hua Boonyapisomparn (General Manager at Trans Dignity), Mauro Cabral (Co-Director of Global Action for Trans* Equality), Charles Cloniger (Clinical Director at St. James Infirmary), Julia Ehrt (Co-Chair of Transgender Europe), Justus Eisfeld (Co-Director of Global Action for Trans* Equality), Rebecca Fox (Program Officer at Wellspring Advisors), Nick Gorton (Physician at Lyon-Martin Health Clinic), Jamison Green (President-Elect of the World Professional Organization for Transgender Health), Sel Hwahng (Social and Behavioral Scientist at the Center for the Study of Ethnicity and Race at Columbia University), Ksenia Kirichenko (Legal Assistance Program Coordinator at the Russian LGBT Network), Eszter Kismodi (Human Rights Advisor at the World Health Organization), Tatiana Lionço (Professor of Psychology at the University Center of Brasilia), Ian Southey-Swartz (Program Coordinator for the LGBTI Special Initiative at the Open Society Initiative for Southern Africa), Dave Scamell (Program Officer at OSF), Paul Silva (Communications Advisor, formerly at OSF), Brett Davidson (Director of the Health Media Initiative at OSF), and Simona Sileikyte (Seminar Coordinator at the I Can Live Foundation). SHARP's Assistant, Romina Kazandjian , provided invaluable support to all aspects of the project and report. TRANSFORMING HEALTH 1 Table of Contents 2 Glossary and List of Acronyms 4 EXECUTIVE SUMMARY 5 Key recommendations 6 Case study contributors 7 Methodology 7 Report limitations 8 LINKING TRANS HEALTH AND HUMAN RIGHTS 9 Introduction 9 UNDERSTANDING TRANS HEALTH 9 The meaning of trans 11 Discrimination against trans people 13 What is trans health? 10 CASE STUDIES: IN FOCUS 14 MAJOR THEMES IN TRANS HEALTH 15 Health services 18 Provider training 23 Public education 25 Research and data collection 26 Trans community organizing 27 Policy change 28 RECOMMENDATIONS FOR BUILDING THE FUTURE OF TRANS HEALTH 28 To governments 29 To human rights advocates 29 To trans communities 30 To health professionals 30 To the World Health Organization and the American Psychiatric Association 31 To funders 32 References 34 Appendices 34 Appendix A: English-language call for case studies 36 Appendix B: Seminar meeting agenda and list of invitees 39 List of participants TRANSFORMING HEALTH 2 Glossary and List of Acronyms Assigned Sex Gender Identity Health Care Services The sex assigned to an individual by An individual’s deeply-rooted internal Services used to protect or promote medical, legal, or other social authori - sense of gender. For most people, gen - health, such as preventive screenings, ties. Assigned sex is often determined der identity aligns with assigned sex, but health education, and treatment. to be either male or female on the this is often not true for trans people. Health care services may be delivered basis of genitalia at birth, and it may in formal medical settings (such as hos - not align with gender identity. Gender Identity Disorder (GID) pitals or doctors’ offices), or they may A controversial psychiatric diagnosis for be services provided in other settings Diagnostic and Statistical trans people listed in the DSM-IV-TR by fellow community members (such as Manual (DSM) and the ICD-10. community health workers) or pur - A classification standard for psychiatric chased on the street (such as off-pre - disorders, published by the American Gender Nonconformity scription hormones). Important aspects of health care services include availabil - Psychiatric Association and currently in Having a gender identity or gender ex - ity, quality, and cost. its fourth edition (DSM-IV-TR). The pression that does not conform to a DSM-IV-TR includes the diagnosis of given society’s dominant gender roles. gender identity disorder (GID). Health Disparities Genderqueer Avoidable differences in health status Gender that are linked to persistant socioeco - Genderqueer is a Western term for nomic disadvantages such as racism, The socially constructed roles, behav - people who identify as a gender other poverty, transphobia, and other forms iors, and personal characteristics that a than male or female. given society considers appropriate for of discrimination and inequality. men, women, and others. People whose Harm Reduction gender is neither man nor woman may Health Equity Policies and programs that help man - describe themselves as being in an in - The goal of achieving equality in health age the potential health risks of actions termediate state between man and status for all by promoting access to such as self-medicating with off-pre - woman, being both man and woman, high-quality health care services, im - scription hormones or relying on sex being neither, or belonging to another proving the socioeconomic determi - work for income. A core principle of gender altogether. Some examples of nants of health, and eliminating health harm reduction is helping individuals genders aside from man and woman in - disparities. take whatever steps they can to protect clude two-spirit among Native North their health, rather than rejecting, crimi - Americans, muxe in southern Mexico, Health Status nalizing, or punishing their behavior. hijra in South Asia, genderqueer in The measure of an individual’s overall North America and Europe, and many Health degree of physical, mental, and emo - others in societies around the world. tional health. A concept of physical, mental, and emotional well-being that comprises Gender Dysphoria Homophobia health status, health disparities, the so - A diagnostic label used to describe the cioeconomic determinants of health, Prejudice and hatred directed at some - distress and discomfort experienced by and health care services. one because of their actual or per - some trans people as a result of an in - ceived sexual orientation. congruence between their gender identity and their assigned sex. Informed Consent A model of providing transition-related Gender Expression care that supplies each individual with An individual’s personal traits, manner - the information necessary to choose isms, and other manifestations of gen - how to navigate transition, rather than der identity. requiring adherence to a single stan - dard approach. TRANSFORMING HEALTH 3 International Classification Sexual Orientation Transgender of Diseases (ICD) An individual’s sexual, physical, and/or An adjective referring to a person The international standard classification romantic attraction to other people of whose gender identity or expression is for diseases and other health problems; the same or different gender; usually different from their assigned sex. maintained by the World Health Organ - described as gay, lesbian, bisexual, or ization and currently in its tenth edition heterosexual. Transition (ICD-10). The ICD-10 includes the diag - The process that many trans people un - nosis of gender identity disorder (GID). Socioeconomic Determinants dergo to physically, legally, and/or so - of Health cially change from one sex or gender to Intersex The social and economic circumstances another. An adjective referring to a person in which people are born, live, work, who has some mixture of male and and age. These circumstances, which Transphobia female genetic and/or physical strongly affect who stays healthy and Prejudice and hatred directed at some - characteristics. Many intersex people who gets sick or injured, include in - one because of their actual or per - consider themselves to be part of the come, occupation, housing, political ceived gender identity or expression. trans community. systems, and social forces such as racism, sexism, and transphobia. Transsexual LGBT Another term for transgender; usually Standards of Care for A blanket term that refers to people refers to people who have undergone the Health of Transsexual, who identify as lesbian, gay, bisexual, or want to undergo transition-related Transgender, and Gender and/or trans. Despite the often sub - medical procedures such as sex reas - Nonconforming People stantial overlap between sexual orienta - signment surgery. tion and gender identity in community Clinical guidelines