ArticlePDF Available

Barriers to well-being for Aboriginal gender-diverse people: Results from the Trans PULSE Project in Ontario, Canada

Authors:

Abstract

Purpose – Despite health inequities experienced by Aboriginal and transgender (trans) communities, little research has explored the well-being of Aboriginal trans (gender-diverse) people. This paper aims to describe barriers to well-being in a sample of Aboriginal gender-diverse people in Ontario, Canada. Design/methodology/approach – In 2009-2010, 433 trans people in Canada's most populous province participated in a multi-mode health survey. In all, 32 participants identified as First Nations, Métis, or Inuit (Aboriginal); unweighted frequencies were calculated to describe their characteristics. Findings – Participants expressed diverse gender identities; 44 per cent identified with the pan-Aboriginal term two-spirit. High levels of poverty (47 per cent), homelessness or underhousing (34 per cent), and ever having to move due to being trans (67 per cent) were reported. In all, 61 per cent reported at least one past-year unmet health care need. Most participants had experienced violence due to being trans (73 per cent) and had ever seriously considered suicide (76 per cent). One-fifth had been incarcerated while presenting in their felt gender. Aboriginal spirituality was practiced by 44 per cent, and 19 per cent had seen an Aboriginal Elder for mental health support. Research limitations/implications – Action is needed to address the social determinants of health among Aboriginal gender-diverse people. Using principles of self-determination, there is a need to increase access to health and community supports, including integration of traditional culture and healing practices. Larger study samples and qualitative research are required. Originality/value – These first published data regarding the health of Aboriginal gender-diverse Ontarians illustrate both their heterogeneity and all-too-common experiences of individual and systemic discrimination, and barriers to care. Results highlight potential impacts of colonialism and social exclusion, and suggest priorities for ameliorative action.
Barriers to well-being for Aboriginal
gender-diverse people: results from the
Trans PULSE Project in Ontario, Canada
Ayden I. Scheim, Randy Jackson, Liz James, T. Sharp Dopler, Jake Pyne and Greta R. Bauer
Ayden I. Scheim is a PhD
Student and Greta R. Bauer is
an Associate Professor, both
are based at Department of
Epidemiology and Biostatistics,
Schulich School of Medicine &
Dentistry, The University of
Western Ontario, London,
Canada.
Randy Jackson is a PhD
Candidate and Jake Pyne is a
PhD Student, both are based
at School of Social Work,
McMaster University, Hamilton,
Canada.
Liz James is with the Trans
PULSE Project, based in
Vancouver, Canada.
T. Sharp Dopler is a Regional
Outreach/Support Services
Worker, at Ontario Aboriginal
HIV/AIDS Strategy, Ottawa,
Canada.
Abstract
Purpose Despite health inequities experienced by Aboriginal and transgender (trans) communities, little
research has explored the well-being of Aboriginal trans (gender-diverse) people. This paper aims to
describe barriers to well-being in a sample of Aboriginal gender-diverse people in Ontario, Canada.
Design/methodology/approach In 2009-2010, 433 trans people in Canada’s most populous province
participated in a multi-mode health survey. In all, 32 participants identified as First Nations, Me
´
tis, or Inuit
(Aboriginal); unweighted frequencies were calculated to describe their characteristics.
Findings Participants expressed diverse gender identities; 44 per cent identified with the pan-Aboriginal
term two-spirit. High levels of poverty (47 per cent), homelessness or underhousing (34 per cent), and ever
having to move due to being trans (67 per cent) were reported. In all, 61 per cent reported at least
one past-year unmet health care need. Most participants had experienced violence due to being trans
(73 per cent) and had ever seriously considered suicide (76 per cent). One-fifth had been incarcerated while
presenting in their felt gender. Aboriginal spirituality was practiced by 44 per cent, and 19 per cent had seen
an Aboriginal Elder for mental health support.
Research limitations/implications Action is needed to address the social determinants of health
among Aboriginal gender-diverse people. Using principles of self-determination, there is a need to increase
access to health and community supports, including integration of traditional culture and healing practices.
Larger study samples and qualitative research are required.
Originality/value These first published data regarding the health of Aboriginal gender-diverse
Ontarians illustrate both their heterogeneity and all-too-common experiences of individual and systemic
discrimination, and barriers to care. Results highlight potential impacts of colonialism and social exclusion,
and suggest priorities for ameliorative action.
Keywords Ethnicity, Health, Transgender, Aboriginal, Transsexual, Two-spirit
Paper type Research paper
Background
Aboriginal peoples in Canada include First Nation (status or non-status), Inuit, and Me
´
tis
peoples (Adelson, 2005). In English-speaking western cultures, individuals who do not conform
to the Eurocentric belief that gender is binary and stable are commonly described as trans,
including those who are transgender (an umbrella term for those who do not conform to societal
gender expectations) or transsexual (a more specific term for those who identify with a sex other
than that assigned at birth) (Bauer et al., 2012). Aboriginal people who are trans might also
describe themselves using the term two-spirit, an umbrella term for Aboriginal individuals who
live between socially defined male and female gender roles (Balsam et al., 2004). They may also
use terms from their own Aboriginal languages, such as ogokwe-nini in Ojibwe or a’yahkwew in
Cree, reflecting the many culturally-distinct concepts of gender diversity, and traditional spiritual
roles of gender-diverse persons as seers, healers, and medicine people (Anguksuar, 1997).
rAyden I. Scheim, Randy Jackson,
Liz James, T. Sharp Dopler, Jake
Pyne, Greta R. Bauer.Published by
Emerald Group Publishing Limited.
This article is published under the
Creative Commons Attribution (CC
BY 3.0) licence. Anyone may
reproduce, distribute, translate and
create derivative works of this article
(for both commercial & non-
commercial purposes), subject to full
attribution to the original publication
and authors. The full terms of this
licence may be seen at http://
creativecommons.org/licences/by/
3.0/legalcode
PAGE 108
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013, pp. 108-120, Emerald Group Publishing Limited, ISSN 1757-0980 DOI 10.1108/EIHSC-08-2013-0010
Owing to cultural and linguistic diversity across Aboriginal groups in Ontario, there is no single
agreed-upon term to describe Aboriginal trans people, and therefore we have opted to use the
term gender-diverse.
As posited by intersectionality theory (Hancock, 2007), Aboriginal gender-diverse peoples’
experiences and health statuses cannot be understood by simply summing together what
we know from research on broader Aboriginal or gender-diverse populations. Nevertheless,
the health inequities documented in studies using one or the other of these identity categories
provide important context for understanding the well-being of Aboriginal gender-diverse
peoples. Aboriginal people in Canada face inequalities in access to health care, and are
disproportionately impacted by chronic and infectious diseases such as diabetes and HIV/AIDS
(Adelson, 2005). Trans and gender-diverse populations also experience elevated levels of
conditions attributed to social exclusion, such as depression (Rotondi et al., 2011) and HIV
(Baral et al., 2013), and face systemic barriers to accessing respectful and competent health
care (Bauer et al., 2009; Grant et al., 2011).
For Aboriginal and other Indigenous peoples, patterns in the prevalence of disease mirror
broader patterns of social and economic inequity. Colonization is viewed as a key determinant
of health for Aboriginal communities (Czyzewski, 2011; King et al., 2009; Reading and Wien,
2008). Aboriginal people have been displaced from their lands, separated from their cultural
traditions and languages, and forcibly removed from their families and communities through
residential schools and the child welfare system (Blackstock, 2007). Evidence also suggests that
gender-diverse and two-spirit people were particular targets of violence in Canada’s history of
colonization, due to the challenge they posed to European Christian worldviews (Tinker, 1993).
This legacy of colonial violence is reinforced by ongoing structural violence and inequity,
including inadequate housing, education, and food security, as well as frequent exposure to
violence (Adelson, 2005). Thus, health inequities in Aboriginal communities are understood,
in part, as a consequence of historical and intergenerational trauma and deprivation (Evans-
Campbell et al., 2012). Moreover, Aboriginal gender-diverse people encounter both institutional
and interpersonal racism (Marcellin et al., 2014), homophobia, and transphobia.
Walters and Simoni’s (2002) indigenist stress-coping model posits that such life stressors are
largely responsible for negative health outcomes among Aboriginal people. They also suggest
that Aboriginal cultural resources (e.g. spirituality, ceremony, and traditional health practices)
can be mobilized to moderate the negative health impacts of life stressors. Moreover, Aboriginal
health scholars argue that eliminating the disproportionate burden of life stress for Aboriginal
peoples requires addressing colonialism as the fundamental determinant of health, through
self-determination of Aboriginal peoples over their lands, institutions, and health care systems
(Czyzewski, 2011; Fieland et al., 2007). For Aboriginal gender-diverse peoples, decolonization
also involves the reclamation, and incorporation into contemporary Aboriginal life, of traditional
knowledges that value gender diversity (Maracle, 2000).
The literature focused on the health of Aboriginal gender-diverse people is sparse. This is
due to a lack of studies focused specifically on the experiences of this group. Moreover,
in studies of broader populations, most health research has not included or adequately
captured gender-diverse identities (Bauer, 2012), and Aboriginal participants comprise a small
proportion of most transgender health study samples (in the absence of targeted recruitment or
oversampling). However, a small number of studies have had samples sufficiently large to
analyze, or have focused specifically on Aboriginal gender-diverse peoples. In a large US
transgender survey, 5 per cent of respondents were American Indian or Alaska Native (n ¼ 350),
and they had lower incomes than non-Native participants overall (National Transgender
Discrimination Survey, 2012), higher levels of lifetime suicidality than all other ethnoracial
groups, and higher prevalence of HIV than white, Asian-American, and multiracial participants
(Grant et al., 2011). American-Indian participants comprised 4 per cent (n ¼ 152) of another
large US survey sample, and reported higher levels of gender-based harassment than all other
ethnoracial groups (Beemyn and Rankin, 2011). Two studies have focused on migration to urban
centres among Aboriginal two-spirit and gender-diverse peoples in Ontario and Manitoba
(neighbouring Canadian provinces) (Teengs and Travers, 2006; Ristock et al., 2010). Participants
reported that migration increased their access to gender-diverse communities and services,
VOL. 6 NO. 4 2013
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
PAGE 109
but that they also encountered racism, violence, homelessness, health challenges, and a lack of
accessible services. Finally, in a study of safety concerns among 27 Aboriginal gender-diverse
people in Winnipeg, Manitoba, participants reported experiencing violence in multiple life
domains, and high levels of mental distress, substance dependence, self-harm, and suicidality
across their lifetimes. Participants varied widely in their experiences of family support or rejection
of their gender identities; some indicated that Aboriginal communities were quite supportive,
while others identified religiosity as a barrier to social inclusion (Taylor, 2009). Need has
been identified for increased awareness of the history of gender diversity in Aboriginal nations,
to support inclusion and celebration of gender-diverse people by Elders, Chiefs, and communities
(Stratton, 2008; Brotman et al., 2002).
To provide an evidence base for efforts to improve the health and human rights of trans and
gender-diverse people in Ontario, the Trans PULSE community-based research project was
initiated. The Trans PULSE Project survey and sampling strategy aimed to reflect the broad
range of trans and gender-diverse communities in Ontario (Bauer et al., 2012). This paper seeks
to describe the 32 Aboriginal survey respondents, and to identify implications for health care,
social services, and research in Ontario.
Methods
Study sample
The Trans PULSE Project survey was funded by the Canadian Institutes of Health Research.
In 2009 and 2010, 433 people participated in an onli ne or paper survey. Eligible participants
self-identified as trans or as having trans experience, were 16 years of age or above, and were living,
working, or receiving healthcare in Ontario. Recruitment was conducted using respondent-driven
sampling, a form of chain-referral in which participants subsequently recruit their peers, with
tracking of recruitment patterns (Heckathorn, 1997). Methods are described in greater detail
elsewhere (Bauer et al.,2012).Participantscouldremainanonymous,andwereoffereda$20
honorarium (gift card or donation toatransortwo-spirit-relatedcharity). Of 433 participants, 32
self-identified as First Nations, Me
´
tis, or Inuit, and were included in this analysis. Ethics approval was
obtained from The University of Western Ontario and Wilfrid Laurier University. As the study was not
designed to specifically focus on Aboriginal participants, Aboriginal-specific ethical review was
not obtained. In keeping with the community-based research principles of the project, and reflecting
our commitment to meaningful engagement and leadership of Aboriginal peoples in research,
this paper was conceptuali zed, collaboratively written, and edited by a team including Aboriginal
and non-Aboriginal authors representing a range of gender identities.
Measures
All mea sures were based on self-report, an d participants were free to skip any items.
A copy of the survey is available online (http://transpulseproject.ca/resources/trans-pulse-
survey/). As part of the su rvey development process, measu res were reviewed and rev ised
by Aboriginal researchers and gender-diverse community members (including authors L.J.
and R.J.).
Characteristics
Socio-demographic measures included Aboriginal identity (including those of mixed ethno-racial
backgrounds), having an Indian Status card, gender identity, intersex status, sexual orientation,
gender transition status, age, education, income, household poverty, employment, and current
residence (region, urbanity, and whether they lived on a First Nations reserve). Participants were
asked if they had an Indian Status card as part of an item about the sex designated on one’s
government-issued identification. Gender spectrum was categorized as male-to-female (MTF)
or feminine or female-to-male (FTM) or masculine based on assigned sex at birth; participants
did not necessarily identify as MTF, FTM, female, or male. Household poverty was coded based
on the 2008 Statistics Canada formula for low-income cut-off (Statistics Canada, 2009), using
the mid-points of the household income categories. Region of residence and rurality were coded
based on the first letter and first number of participants’ postal codes.
PAGE 110
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013
Life experiences
Participants were asked about current homelessness or unstable housing, lifetime homelessness
while presenting in their felt gender, past-year food security, HIV status, lifetime Hepatitis C
diagnosis, history of incarceration in their felt gender, history of migration due to trans status,
experiences of transphobic violence, and both lifetime and past-year suicidality. Participants were
coded as currently homeless or under-housed if they reported being homeless; living in a motel,
boarding house, or rehab facility; couch-surfing or squatting; or having difficulty meeting housing
costs while living below the low-income cut-off.
Health service access
Measures of health service access included having a regular family doctor, reported past-year
need and unmet need for health care, ever having seen an Elder for mental health support, and
HIV testing history.
Family, community, and spiritual supports
Participants were asked about their current religion or spirituality; degree of religiosity or
spirituality; the level of support for their gender identity or expression from parents, siblings,
and extended family.
Data analysis
Unweighted frequencies and proportions were calculated using SAS Version 9.3 (SAS Institute
Inc, 2012). Proportions excluded respondents who did not complete the item. Although
previous Trans PULSE results have been weighted to represent the networked Ontario trans
population using respondent-driven sampling analytic methods, results presented herein are
unweighted due to the small sample size and corresponding lack of precision (i.e. wide
confidence intervals) in weighted estimates.
Results
In all, 7 per cent of Trans PULSE survey participants (n ¼ 32) identified as First Nations (n ¼ 14),
Me
´
tis (n ¼ 17), or Inuit (n ¼ 1). Socio-demographic characteristics are presented in Table I.
Most (n ¼ 28, 90 per cent) spoke English as a first language. One participant spoke
Anishinaabemowin (Ojibwe) as a first language, and four additional participants (13 per cent)
spoke Ojibwe or Cree as a second or third language. In all, 37 per cent (n ¼ 11, including six First
Nations and five Me
´
tis participants) reported having an Indian Status card. Me
´
tis identity cards
were not directly inquired about, but Me
´
tis participants may have meant to indicate recognition
from a Me
´
tis organization. Aboriginal participants were also approximately evenly split between
MTF (n ¼ 18, 56 per cent) and FTM (n ¼ 14, 44 per cent) gender spectra. While many participants
selected more than one term to describe their gender identity, two-spirit was the term most
commonly endorsed (n ¼ 14, 44 per cent).
The majority of Aboriginal participants were under 35 years of age (n ¼ 18, 58 per cent), and 26 per
cent (n ¼ 8) were under 25. Three-quarters (n ¼ 24) had at least some post-secondary education,
while 19 per cent (n ¼ 6) had not graduated from high school. Almost half (n ¼ 15, 47 per cent)
were living in poverty. A small number of participants lived in rural areas (n ¼ 3, 11 per cent), and
45 per cent (n ¼ 13) lived in metropolitan Toronto, the largest urban area in the province. None
reported living on a reserve at the time data were collected.
Life experiences of Aboriginal participants are presented in Table II. Approximately one-third of
Aboriginal participants were homeless or unstably housed (n ¼ 10, 34 per cent), and 29 per cent
(n ¼ 8) did not have enough food in the past year. One participant indicated that they were living
with HIV, and another had been diagnosed with Hepatitis C. In all, 20 per cent (n ¼ 6) had been
in jail while presenting in their felt gender, of whom two had been in jail in the past year. In all,
67 per cent (n ¼ 20) had to move at least once in their lifetimes due to being trans.
Most (73 per cent) had experienced some form of violence due to transphobia, including
43 per cent (n ¼ 13) who reported experiencing physical and/or sexual violence. Lifetime
VOL. 6 NO. 4 2013
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
PAGE 111
Table I
Characteristics of Aboriginal gender-diverse participants (n ¼ 32): Ontario, Canada
n%
Aboriginal identity
First Nations 14 44
Me
´
tis 17 53
Inuit 1 3
First language (n ¼ 31)
Anishinaabemowin (Ojibwe) 1 3
English 28 90
French 1 3
German 1 3
Has Indian (or Me
´
tis) Status card (n ¼ 30) 11 37
Gender spectrum
Male-to-female or feminine 18 56
Female-to-male or masculine 14 44
Gender identity
a
Two-spirit 14 44
Boy or man 8 25
Girl or woman 9 28
FTM 8 25
MTF 6 19
Trans boy or man 9 28
Trans girl or woman 10 31
Intersex 8 25
Cross-dresser 1 3
Genderqueer 6 19
Bigender 1 3
Medically recognized intersex condition
Yes 5 16
Unsure 9 28
No 18 56
Sexual orientation (n ¼ 31)
a
Two-spirit 14 45
Bisexual or pansexual 12 39
Gay 5 16
Lesbian 2 6
Queer 13 42
Straight or heterosexual 6 19
Asexual 2 6
Unsure or questioning 4 13
Social transition status (n ¼ 31)
Full-time in felt gender 23 74
Part-time in felt gender 6 19
Not living in felt gender 2 6
Medical transition status
Complete 13 41
In process 10 31
Planning but not begun 4 13
Not planning 0 0
Concept does not apply 3 9
Not sure if they will transition 2 6
Age (n ¼ 31)
16-24 8 26
25-34 10 32
35-44 7 22
45-54 5 16
55-64 1 3
Education
Did not finish high school 6 19
High school diploma 2 6
Some post-secondary 13 41
Graduated from post-secondary school 11 34
(continued)
PAGE 112
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013
suicidality was high, with 76 per cent having ever seriously considered suicide (n ¼ 22) and
48 per cent (n ¼ 14) having attempted suicide at least once.
Health service access data are presented in Table III. Most (77 per cent, n ¼ 24) had a regular
family doctor. However, 61 per cent (n ¼ 19) reported at least one past-year unmet health care
need. Substantial proportions reported that they needed, but were unable to obtain, each of the
following types of service: shelters, hormone therapy, trans-related surgery, trans-related mental
health, sexual health, and addictions. However, most reported needs were met for general
health services, emergency care, and HIV or sexually transmitted infections testing. More than
half had been tested for HIV in the past year (n ¼ 17, 55 per cent).
Finally, information about family, community, and spiritual sources of support is presented in
Table IV. Aboriginal spirituality was the most frequently endorsed religious or spiritual affiliation
(n ¼ 14, 44 per cent), and 56 per cent (n ¼ 18) reported that they were fairly to extremely religious
or spiritual. Approximately one-fifth had ever seen an Elder for mental health support. A range of
family and community support for gender identity and expression was indicated.
Discussion
Participants reported a wide range of gender and sexual identities; while two-spirit was most common,
fewer than half identified with the term. This suggests that two-spirit may not be an appropriate
umbrella term for Aboriginal gender -diverse people. While some identify with both Aboriginal-specific
terms (e.g. two-spirit) and Euro-Canadian terms (e.g. transgender ), others may only use one of these,
depending on how they understand their gender(s) and their sense of connection to Aboriginal cultures
and communities. Others yet may identify exclusively as transitioned men or women.
Most participants had low personal incomes and were not employed full-time. This reflects low
incomes (Bauer et al., 2012), employment barriers, and trans-related discrimination (Bauer et al.,
2011) experienced by trans Ontarians. For Aboriginal gender-diverse people, this may also relate
to impacts of colonization and systemic racism on economic and employment opportunities
(Reading and Wien, 2008). That one-fifth of Aboriginal gender-diverse participants had ever
Table I
n%
Household poverty
In poverty (below low income cut-off) 15 47
Not in poverty 17 53
Personal annual income (n ¼ 29)
o$15,000 16 55
$15,000 to $29,999 2 7
$30,000 to $49,000 5 17
$50,000 to $79,000 5 17
$80,000 or over 1 3
Current employment (n ¼ 30)
Full-time 11 37
Part-time 6 20
Unemployed/disability/on leave 7 23
Student or retired 6 20
Region of Ontario (n ¼ 29)
Eastern 3 10
Central 6 21
Metropolitan Toronto 13 45
Southwestern 3 10
Northern 4 14
Rural residence (n ¼ 27) 3 11
Currently lives on reserve
No 32 0
Notes: Proportions are rounded and may not add up to 100 per cent.
a
Participants could select all that
apply; proportions will not add up to 100 per cent
VOL. 6 NO. 4 2013
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
PAGE 113
been incarcerated while presenting in their felt gender may demonstrate the impacts of social
exclusion and the over-incarceration of Aboriginal peoples in Canada (Office of the Correctional
Investigator, 2012; Scheim et al., 2013).
No participants lived on a First Nation reserve at the time of data collection. This may reflect
a combination of factors, including that Aboriginal peoples increasingly live in urban centres
(Environics Institute, 2010), migration by individuals who previously lived on reserve, Me
´
tis
or Inuit identity (i.e. non-reserve populations of Aboriginal peoples), or barriers to survey
recruitment or participation. Over 50 per cent of participants did not have an Indian Status card.
Under the Indian Act, only status First Nations are eligible for federal government recognition as
Status Indians. Although formal requirements for identity recognition present an obstacle, Me
´
tis
people can obtain identity cards through local or national Me
´
tis organizations. We recognize the
determination of status for Aboriginal peoples as a colonial project which, nevertheless, has
important consequences for access to rights and services (e.g. health care and education) owed
to Aboriginal peoples (de Leeuw and Greenwood, 2011).
Our participants reflected the younger age distributions of Ontario’s Aboriginal (Reading and Wien,
2008) and gender-diverse (Bauer et al., 2012) communities. This suggests that our findings
are particularly relevant for organizations working with gender-diverse and Aboriginal youth.
The vulnerability of both Aboriginal (Adelson, 2005) and gender-diverse youth to suicidality (Liu and
Mustanski, 2012) was reflected in our findings. Almost half of participants had attempted suicide
at least once. Initiatives to increase parental support (and other forms of social support) for
Aboriginal gender-diverse youth are necessary, as only one-fifth of participants had parents who
were strongly supportive of their gender identity. Parental support is a protective factor for mental
health and housing stability among trans and gender-diverse youth (Travers et al., 2012).
Table II
Life experiences of Aboriginal gender-diverse participants (n ¼ 32): Ontario,
Canada
n%
Currently homeless or unstably housed (n ¼ 29) 10 34
Ever homeless while presenting in felt gender (n ¼ 29) 11 38
Household did not have enough to eat in past year (n ¼ 28) 8 29
HIV Status (n ¼ 29)
HIV-positive 13
HIV-negative 23 79
Don’t know 5 17
Ever diagnosed with Hepatitis C (n ¼ 31) 1 3
Ever spent time in jail presenting in felt gender (n ¼ 29)
Yes, in a provincial jail 3 10
Yes, in a federal prison 1 3
Yes, both provincial and federal 2 7
No 23 79
Spent time in jail in the past year, presenting in felt gender (n ¼ 29) 2 7
Ever had to move because of trans status (n ¼ 30) 20 67
Had to move away from friends/family because trans (n ¼ 29) 16 55
Moved to a different city or town for own safety because trans (n ¼ 27) 10 37
Moved to a different city or town to be closer to trans-related services (n ¼ 29) 9 31
Ever been asked or told to leave parent’s or guardian’s house for being trans (n ¼ 28) 6 21
Experienced violence due to being trans (n ¼ 30)
None 8 27
Verbal harassment or threats only 9 30
Physical and/or sexual violence 13 43
Suicidality (n ¼ 29)
Ever seriously considered suicide 22 76
Ever attempted suicide 14 48
Seriously considered suicide in past year 8 28
Attempted suicide in past year 4 14
Note: Proportions are rounded and may not add up to 100 per cent
PAGE 114
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013
Due to being trans, 67 per cent of Aboriginal gender-diverse participants had ever had to
move and 43 per cent had experienced physical or sexual violence. This underscores the need
for action to increase acceptance of gender diversity, prevent transphobic violence in
communities across the province, provide greater support for survivors of transphobic violence,
and increase the number of localized trans-specific services (including outreach to reserve
communities).
Unmet need was reported for almost all types of health services we inquired about. Unmet need
may be due to Aboriginal and gender-specific barriers (e.g. a lack of culturally competent
services, gender-segregated services that exclude trans people), or due to more general factors
(e.g. cost, distance, wait lists), which may nevertheless have a disproportionate impact on
Aboriginal gender-diverse people. The highest level of unmet need was reported for transition-
related surgery, but sex-reassignment surgeries were re-instated under Ontario’s public health
insurance plan one to two years before surveys were completed, so access may have now
improved. However, the requirement for comprehensive mental health assessment at a single
Toronto site still presents barriers for many. Unmet need for addictions services was also high,
Table III
Health service access among Aboriginal gender-diverse participants (n ¼ 31):
Ontario, Canada
n%
Has a regular family doctor 24 77
Any unmet need for health care in past year 19 61
Unmet need for health care in past year
Addictions services
Needed 7 23
Able to obtain
a
2 29
Sexual health services
Needed 10 32
Able to obtain
a
7 70
General health services
Needed 28 90
Able to obtain
a
26 93
Emergency services
Needed 13 42
Able to obtain
a
11 85
Hormone therapy
Needed 22 71
Able to obtain
a
14 64
Trans-related surgery
Needed 12 39
Able to obtain
a
3 25
HIV or sexually transmitted infection testing
Needed 13 42
Able to obtain
a
13 100
Shelters
Needed 8 26
Able to obtain
a
5 63
Mental health services (trans-related)
Needed 12 39
Able to obtain
a
7 58
Mental health services (not trans-related)
Needed 9 29
Able to obtain
a
7 78
Ever been tested for HIV
Yes, in the past year 17 55
Yes, but not in the past year 9 29
Never 5 16
Notes:
a
Of those who needed the specified service. Proportions are rounded and may not add up to 100
per cent
VOL. 6 NO. 4 2013
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
PAGE 115
and suggests that despite the existence of LGBT and Aboriginal-specific addictions services in
Ontario, the needs of Aboriginal gender-diverse people are not being met by existing services.
While participants did not report unmet need for HIV or sexually transmitted infections testing,
the professional experience of those working with Aboriginal gender-diverse Ontarians through
the Ontario Aboriginal HIV/AIDS Strategy suggest that barriers to testing remain a challenge
(TS Dopler, 24 July 2013, personal communication). Moreover, our measure was contingent on
participants’ perceptions of need, which may not reflect actual HIV risk. Previously published
evidence from Trans PULSE suggests that Aboriginal people do not differ significantly from
other trans and gender-diverse Ontarians with respect to HIV-related sexual risk behaviour
(Bauer et al., 2012). While Aboriginal participants appeared to have a higher prevalence of HIV,
this must be cautiously interpreted in light of the small sample, and the lack of available data
regarding HIV seroprevalence among trans people in Ontario.
In addition to barriers and challenges, some participants reported family and community support
for their gender identities, and high levels of spirituality. Supportive Aboriginal communities and
positive integration of Aboriginal identity and culture may buffer the impacts of life stressors,
including impacts of colonialism (Chae and Walters, 2009). It is important for health policy and
practice to build on these strengths. For example, about one-fifth had ever seen an Elder for
mental health support. Other participants may have experienced barriers to accessing Elders,
such as cost (for travel, honorarium, and gifts), distance, or a lack of access to local Elders
knowledgeable about gender diversity. Traditional culture, ceremonies, and healing practices
may play an important role in health promotion for Aboriginal peoples (Currie et al., 2013;
Table IV
Family, community and spiritual supports among Aboriginal gender-diverse
participants (n ¼ 32): Ontario, Canada
n%
Current religion or spirituality
a
Aboriginal spirituality 14 44
Agnostic or no religion 11 34
Buddhist 2 6
Catholic 4 13
Christian 6 19
Hindu 1 3
Jewish 1 3
Muslim 2 6
Wiccan/Pagan 2 6
Degree of religiosity or spirituality
Not at all, a bit, or somewhat 14 44
Fairly, quite, extremely 18 56
Ever seen an Elder for mental health support (n ¼ 31) 6 19
Are parents supportive of gender identity or expression? (n ¼ 25)
Very 5 20
Somewhat 8 32
Not at all or not very 8 32
n/a 4 16
Are siblings supportive of gender identity or expression? (n ¼ 25)
Very 9 36
Somewhat 5 20
Not at all or not very 8 32
n/a 3 12
Is extended family supportive of gender identity or expression? (n ¼ 25)
Very 6 24
Somewhat 9 36
Not at all or not very 4 16
n/a 6 24
Notes:
a
Participants could select all that apply; proportions will not add up to 100 per cent. Proportions are
rounded and may not add up to 100 per cent
PAGE 116
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013
Dell et al., 2011). With respect for principles of self-determination, we believe that Aboriginal
cultural resources should be integrated into community-led health and social services for
Aboriginal gender-diverse people.
To the best of our knowledge, the current study represents the largest research sample of
Aboriginal gender-diverse persons in Canada. While the proportion of Aboriginal participants
in Trans PULSE was larger than the proportion of Ontarians overall who are Aboriginal (7 vs
2 per cent; Statistics Canada, 2012), we caution that results cannot be generalized to the
Aboriginal gender-diverse population of Ontario, given the small sample size, our corresponding
inability to use weighted RDS statistical procedures to produce population estimates with any
precision, and the networked (non-random) nature of our sample.
In conclusion, our findings draw attention to social and economic exclusion, barriers to health
service access, and high burdens of violence and suicidality among Aboriginal gender-diverse
people, and to culturally specific coping factors that may promote well-being. These results
suggest that increased access to health and social services is required for Aboriginal gender-
diverse people in Ontario, in addition to further research that could help to identify strategies
for improving well-being. We concur with Blackstock (2009) that quantitative methods are not
inherently antithetical to Aboriginal or Indigenous research, but that Aboriginal research
(in contrast to research about Aboriginal persons) should be grounded in Aboriginal epistemologies,
worldviews, and community-identified policy change needs. The current study was grounded
in principles of (trans) community control and accountability, but would not be considered
Aboriginal research, as conceptualized here. Thus, Aboriginal research with gender-diverse
persons is needed, particularly research that uses Indigenous approaches and responds
to community-identified priorities. Methodologically, this may involve larger samples for quantitative
studies, and qualitative research to understand lived experiences. Such research could more fully
define determinants of health for Aboriginal gender-diverse peoples and their impacts, including
historical determinants or traumas such as residential schools; explore cultural understandings of
gender diversity in ways that allow Aboriginal communities to rebuild from colonial assaults; and
provide information to reduce the multiple and interlocking barriers to health services.
Finally, we believe that it is imperative for health and social service providers and researchers
to consider decolonizing social, economic, and political changes as crucial interventions to
eliminate the health inequities experienced by Aboriginal peoples of all genders in Canada
(Czyzewski, 2011).
Acnowledgement
The research presented here was supported by an operating grant from the Canadian Institutes of
Health Research, Institute of Gender and Health (Funding Reference No. MOP-106478). Partners
in Trans PULSE included the Sherbourne Health Centre (Toronto), The 519 Church Street
Community Centre (Toronto), The University of Western Ontario (London), Wilfrid Laurier University
(Waterloo), and Rainbow Health Ontario. The Trans PULSE Steering Committee members were
Greta Bauer, Robb Travers, Rebecca Hammond, Anjali K, Matthias Kaay, Jake Pyne, Nik Redman,
Kyle Scanlon (deceased), and Anna Travers. The authors wish to acknowledge the contributions
of the 16 Community Engagement Team members and other Trans PULSE contributors who
worked to develop and promote the survey, and the 433 survey participants.
References
Adelson, N. (2005), “The embodiment of inequity”, Canadian Journal of Public Health, Vol. 96 No. 2,
pp. S45-S61.
Anguksuar, L.R. (1997), “A postcolonial perspective on western [mis]conceptions of the cosmos and the
restoration of indigenous taxonomies”, in Jacobs, S.-E., Thomas, W. and Lang, S. (Eds), Two-Spirit People:
Native American Gender Identity, Sexuality, and Spirituality, University of Illinois Press, Chicago, IL, pp. 217-22.
Balsam, K.F., Huang, B., Fieland, K.C., Simoni, J.M. and Walters, K.L. (2004), “Culture, trauma, and
wellness: a comparison of heterosexual and lesbian, gay, bisexual, and two-spirit Native Americans”,
Cultural Diversity and Ethnic Minority Psychology, Vol. 10 No. 3, pp. 287-301.
VOL. 6 NO. 4 2013
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
PAGE 117
Baral, S.D., Poteat, T., Stromdahl, S. and Wirtz, A.L. (2013), “Worldwide burden of HIV in transgender
women: a systematic review and meta-analysis”, The Lancet Infectious Diseases, Vol. 13 No. 3, pp. 214-22.
Bauer, G.R., Hammond, R., Travers, R., Kaay, M., Hohenadel, K.M. and Boyce, M. (2009), “‘I don’t think this
is theoretical; this is our lives’: how erasure impacts health care for transgender people”, Journal of the
Association of Nurses in AIDS Care, Vol. 20 No. 5, pp. 348-61.
Bauer, G., Nussbaum, N., Travers, R., Munro, L., Pyne, J. and Redman, N. (2011), “We’ve got work to do:
workplace discrimination and employment challenges for trans people in Ontario”, Trans PULSE E-Bulletin,
Vol. 2 No. 1, pp. 1-3, available at: http://transpulseproject.ca/wp-content/uploads/2011/05/E3English.pdf
(accessed 30 July 2013).
Bauer, G.R. (2012), “Making sure everyone counts: considerations for inclusion, identification, and analysis
of transgender and transsexual participants in health surveys”, What a Difference Sex and Gender Make,
Institute of Gender and Health, Canadian Institutes of Health Research, Ottawa, pp. 59-67.
Bauer, G.R., Travers, R., Scanlon, K. and Coleman, T. (2012), “High heterogeneity of HIV-related sexual risk
among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey”, BMC
Public Health, Vol. 12.
Beemyn, G. and Rankin, S. (2011), The Lives of Transgender People, Columbia University Press,
New York, NY.
Blackstock, C. (2007), “Residential schools: did they really close or just morph into child welfare”, Indigenous
Law Journal, Vol. 6 No. 1, pp. 71-8.
Blackstock, C. (2009), “First Nations children count: enveloping quantitative research in an Indigenous
envelope”, First Peoples Child & Family Review, Vol. 4 No. 2, pp. 135-43.
Brotman, S., Ryan, B., Jalbert, Y. and Rowe, B. (2002), “Reclaiming space-regaining health: the health
care experiences of two-spirit people in Canada”, Journal of Gay & Lesbian Social Services, Vol. 14 No. 1,
pp. 67-87.
Chae, D.H. and Walters, K.L. (2009), “Racial discrimination and racial identity attitudes in relation to self-
rated health and physical pain and impairment among two-spirit American Indians/Alaska Natives”,
American Journal of Public Health, Vol. 99 No. 1, pp. S144-S151.
Currie, C.L., Wild, T.C., Schopflocher, D.P., Laing, L. and Veugelers, P. (2013), “Illicit and prescription drug
problems among urban Aboriginal adults in Canada: the role of traditional culture in protection and
resilience”, Social Science and Medicine, Vol. 88, pp. 1-9.
Czyzewski, K. (2011), “Colonialism as a broader social determinant of health”, The International Indigenous
Policy Journal, Vol. 2, pp. 1-14.
de Leeuw, S. and Greenwood, M. (2011), “Beyond borders and boundaries: addressing Indigenous health
through theories of social determinants of health and intersectionality”, in Hankivsky, O. (Ed.), Health
Inequities in Canada: Intersectional Frameworks and Practices, UBC Press, Vancouver, pp. 53-70.
Dell, C.A., Seguin, M., Hopkins, C., Tempier, R., Mehl-Madrona, M.D., Dell, D., Duncan, R. and Mosier, K.
(2011), “From benzos to berries: treatment offered at an Aboriginal youth solvent abuse treatment centre
relays the importance of culture”, Canadian Journal of Psychiatry, Vol. 56 No. 2, pp. 75-83.
Environics Institute (2010), Urban Aboriginal Peoples Study: Toronto Report, Environics Institute, Toronto,
pp. 1-82.
Evans-Campbell, T., Walters, K.L., Pearson, C.R. and Campbell, C.D. (2012), “Indian boarding school
experience, substance use, and mental health among urban two-spirit American Indian/Alaska Natives”,
The American Journal of Drug and Alcohol Abuse, Vol. 38 No. 5, pp. 421-7.
Fieland, K.C., Walters, K.L. and Simoni, J.M. (2007), “Determinants of health among two-spirit American
Indians and Alaska Natives”, in Meyer, I.H. and Northridge, M.E. (Eds), The Health of Sexual Minorities:
Public Health Perspectives on Lesbian, Gay, Bisexual, and Transgender Populations, Springer, New York,
NY, pp. 268-300.
Grant, J.M., Mottet, L.A., Tanis, J., Harrison, J., Herman, J.L. and Keisling, M. (2011), Injustice at Every Turn:
A Report of the National Transgender Discrimination Survey, National Center for Transgender Equality and
National Gay and Lesbian Task Force, Washington, DC.
Hancock, A.-M. (2007), “When multiplication doesn’t equal quick addition: examining intersectionality as
a research paradigm”, Perspective on Politics, Vol. 5 No. 1, pp. 63-79.
PAGE 118
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013
Heckathorn, D.D. (1997), “Respondent-driven sampling: a new approach to the study of hidden
populations”, Social Problems, Vol. 44 No. 2, pp. 174-99.
King, M., Smith, A. and Gracey, M. (2009), “Indigenous health part 2: the underlying causes of the health
gap”, The Lancet, Vol. 374 No. 9683, pp. 76-85.
Liu, R.T. and Mustanski, B. (2012), “Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender
youth”, American Journal of Preventive Medicine, Vol. 42 No. 3, pp. 221-8.
Maracle, A. (2000), “Journey in gender”, Journal of the Canadian Lesbian and Gay Studies Association,
Vol. 2, pp. 36-57.
Marcellin, R.L., Bauer, G.R. and Scheim, A.I. (2014), “Intersecting impacts of transphobia and racism on HIV
risk among trans persons of colour in Ontario, Canada”, Ethnicity and Inequalities in Health and Social Care ,
Vol. 6 No. 4, pp. xx-xx.
National Transgender Discrimination Survey (2012), Injustice at Every Turn: A Look at American Indian and
Alaskan Native Respondents in the National Transgender Discrimination Survey, National Gay and Lesbian
Task Force and National Center for Transgender Equality, Washington, DC.
Office of the Correctional Investigator (2012), “Annual report 2011-2012”, available at: www.oci-bec.gc.ca/
cnt/rpt/pdf/annrpt/annrpt20112012-eng.pdf (accessed 30 July 2013).
Reading, C.L. and Wien, F. (2008), Health Inequalities and Social Determinants of Aboriginal Peoples’
Health, National Collaborating Centre for Aboriginal Health, Prince George, BC.
Ristock, J., Zoccole, A. and Passante, L. (2010), Aboriginal Two-Spirit and LGBTQ Migration, Mobility, and
Health Research Project: Winnipeg Final Report, Winnipeg.
Rotondi, N.K., Bauer, G.R., Scanlon, K., Kaay, M., Travers, R. and Travers, A. (2011), “Prevalence of and risk
and protective factors for depression in female-to-male transgender Ontarians”, Canadian Journal of
Community Mental Health, Vol. 30 No. 2, pp. 135-55.
SAS Institute Inc (2012), SAS Version 9.3, SAS Institute Inc, Cary, NC.
Scheim, A., Cherian, M., Bauer, G. and Zong, X. (2013), “Joint effort: prison experiences of Trans PULSE
participants and recommendations for change”, Trans PULSE E-Bulletin, Vol. 3 No. 3, pp. 1-4, available at:
http://transpulseproject.ca/wp-content/uploads/2013/04/Prison-Experiences-E-Bulletin-7-vFinal-English.pdf
(accessed 30 July 2013).
Statistics Canada (2009), “Low income cut-offs for 2008 and low income measures for 2007”, available at:
www.statcan.gc.ca/pub/75f0002m/75f0002m2009002-eng.pdf (accessed 30 July 2013).
Statistics Canada (2012), “Health profile, Ontario”, available at: www12.statcan.gc.ca/health-sante/82-228/
index.cfm?Lang ¼ E (accessed 30 July 2013).
Stratton, T. (2008), Our Relatives Said: A Wise Practices Guide: Voices of Aboriginal Trans-people, 2-Spirited
People of the 1st Nations, Toronto.
Taylor, C. (2009), “Health and safety issues for Aboriginal transgender/two spirit people in Manitoba”,
Canadian Journal of Aboriginal Community-Based HIV/AIDS Research, Vol. 2, pp. 63-84.
Teengs, D.O. and Travers, R. (2006), “‘River of life, rapids of change’: understanding HIV vulnerability among
two-spirit youth who migrate to Toronto”, Canadian Journal of Aboriginal Community-Based HIV/AIDS
Research, Vol. 1, pp. 17-28.
Tinker, G.E (1993), Missionary Conquest: The Gospel and Native American Cultural Genocide, Fortress
Press, Minneapolis, MN.
Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L. and Papadimitriou, M. (2012), “Impacts of strong
parental support for trans youth”, Trans PULSE project, available at: http://transpulseproject.ca/wp-content/
uploads/2012/10/Impacts-of-Strong-Parental-Support-for-Trans-Youth-vfinal.pdf (accessed 30 July 2013).
Walters, K.L. and Simoni, J.M. (2002), “Reconceptualizing Native women’s health: an ‘indigenist’ stress-
coping model”, American Journal of Public Health, Vol. 92 No. 4, pp. 520-524.
About the authors
Ayden I. Scheim is a PhD Student in the Department of Epidemiology and Biostatistics within the
Schulich School of Medicine and Dentistry at The University of Western Ontario. His research
VOL. 6 NO. 4 2013
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
PAGE 119
includes quantitative, qualitative, and mixed-methods community-based projects focusing on
HIV prevention and the overall health of transgender communities, gay and bisexual men, and
people who use drugs. Ayden I. Scheim is the corresponding author and can be contacted at:
ayden.scheim@schulich.uwo.ca
Randy Jackson is a PhD Candidate and a Pre-Doctoral Fellow cross-affiliated in the School of
Social Work and the Department of Heath, Aging and Society at McMaster University.
Randy’s research focuses on HIV/AIDS in Aboriginal communities in Canada. Key areas of
interest include experiences of depression, stigma, HIV testing, Aboriginal youth leadership
in HIV prevention, community-based research, arts-based approaches in research, and
Indigenous methodologies.
Liz James is an MTF post op transsexual woman who is a two spirit Native American, with
family on both sides of the border. She is a University of British Columbia undergraduate, with a
counselling background, and a talented visual artist, craftsperson, and freelance writer. Liz has
been involved with the struggle for equal civil rights for trans peoples since 1989, as a trans
activist with organizations including the Trans PULSE Community Engagement Team. Liz wields
her father’s Iywasa (sacred War club); her family fought in the War of 1812. She eventually hopes
to obtain a Civil Law degree, as the battle for trans civil rights requires a different type of weapon.
T. Sharp Dopler is an O utreach/ Suppo rt Servic es Worker who has worked in t he Ottawa office
of the Ontario Aboriginal HIV/AIDS Strategy since 2006. Sharp is a Bear clan of Sauk/Fox,
Cherokee and Irish descent. Sharp has an extensive background in working at a grassroots
level in the field of violence against women, as well as educating people about HIV and safer
sex. Sharp has an MA in Canadian Studies and also has a range of experience doing research
and writing.
Jake Pyne is a Community-Based Researcher and a PhD Student in the McMaster School of
Social Work. Jake’s community work has focused on improving access to health and social
services for trans and gender non-conforming people. His research work explores societal
responses to gender non-conformity, with a specific focus on what different theories and
knowledge systems foreclose and make possible for gender non-conforming children. Jake is
a Co-Investigator on the Trans PULSE study.
Dr Greta R. Bauer is an Associate Professor in the Department of Epidemiology and Biostatistics
within the Schulich School of Medicine and Dentistry at The University of Western Ontario.
Dr Bauer’s primary research interests are in sexually transmitted infections and the broader
health of sexual and gender minority communities . Coming from an inte rdisciplinary
background, her work has spanned the biological, behavioural and social, with a strong
emphasis on quantitative research methodology.
To purchase reprints of this article please e-mail: reprints@emeraldinsight.com
Or visit our web site for further details: www.emeraldinsight.com/reprints
PAGE 120
j
ETHNICITY AND INEQUALITIES IN HEALTH AND SOCIAL CARE
j
VOL. 6 NO. 4 2013
... It is well documented that the experience of living through and during the effects of colonization is a determinant of health. Ongoing effects of colonization create barriers to health for many Indigenous Peoples in Canada (Hunt, 2016;Scheim et al., 2013). Understanding the impact colonization has on the present day health of Indigenous Peoples is an important aspect in understanding the current health of the Two Spirit community, as much traditional knowledge including spiritual practices, language, and ways of life were lost to colonization (Beavis et al., 2015). ...
... For Two Spirit people the effects of colonization and residential schools include the enforcement of a gender binary that was not necessarily part of Indigenous communities prior to colonization. This experience erased the historic roles, responsibilities, and experiences of Two Spirit people, and perpetuated homophobia and transphobia within Indigenous communities as well as within Western society (Hunt, 2016;Ristock et al., 2019;Scheim et al., 2013). ...
... Five sources were found through internet searches of grey literature: one government report, one monograph, and three newspaper articles. Ultimately, there are still very few studies that look exclusively at the health of Canadian Two Spirit Peoples, a factor which is often acknowledged in the literature (Hunt, 2016;Issa, 2019;Ristock et al., 2019;Scheim et al., 2013;Waite et al., 2019;Wechsler, 2016). Notably, we did not find any research speaking specifically to nurses about holistic care of Two Spirit people in Canada. ...
Article
Purpose: In response to item 7.1 from the Missing and Murdered Indigenous Women and Girls Report (2019), calling on health service providers to recognize the importance in inclusive services with and for Indigenous peoples including Two Spirit, lesbian, bisexual, transgender, queer, questioning, intersex, and asexual (2SLGBTQQIA) peoples, we undertook a review of the literature to identify the gaps in understanding and to better situate the health and resiliencies of Two Spirit people in Canada. Method: We conducted a review of 13 articles related to the health and wellness of the Canadian Two Spirit community. Overall, there was a dearth of Two Spirit specific health-related information. Results: Identified themes were grounded in the holistic Medicine Wheel teachings. These themes directly parallel holistic nursing in their demonstration that health is complex, and that there are many facets that make up an individuals’ health. Conclusion: Assessing the impact that colonization has had on the intersections of gender, race, sexuality, class, culture, and spirituality, Two Spirit people face unique health concerns. Considering the intersections of identity and structural barriers in place for this community, more research led by and in collaboration with the Two Spirit community is needed.
... Four articles (14.3%) employed a community-based participatory research (CBPR) methodological design. These included a survey of service access and self-reported health for Aboriginal trans people in Canada (Scheim et al., 2013), the development of a research agenda with youth in the Northwest Territories (Logie et al., 2015), a survey of barriers to HIV prevention among Native men who have sex with men in Oklahoma City (Burks et al., 2011), and a survey of the effects of migration on the health of Aboriginal Two Spirit and LGBTQ people in Canada (Ristock et al., 2010). ...
... Of the studies sampled in this analysis, that reported by Scheim et al. (2013) is a review of data from the cross-sectional survey completed as part of the Trans PULSE Project. This study is the most comprehensive that we found. ...
... While this clarity is useful, this use of Two Spirit is disputed. A survey of Native LGBTQ individuals in Canada found that only 44% identify as Two Spirit (Scheim et al., 2013). While we don't know what percentage of Native LGBTQ people in the United States identify with the term, we suspect similar proportions, because it is a recent term and its use differs with regard to specific tribal teachings and is largely absent in some areas. ...
Article
Full-text available
Introduction Two Spirit and Native LGBTQ people have unique health risks and cultural strengths. Method This study analyzes 28 reports published since 1980 examining the health and identity–formation experiences of Two Spirit or Native LGBTQ individuals. Results The majority (68%) of the articles focus on urban populations. Few employ a strengths-based approach. Less than half capture information about gender identity. Conclusion Findings suggest that Two Spirit and Native LGBTQ individuals are underrepresented in current health research. Existing research prioritizes a disease-specific perspective. Future research focused on intersectional identity formation, connectedness, and culture as a protective factor is needed.
... There is a small body of literature on the SCEWB of First Nations LGBTIQ+ young people worldwide (see Balsam, Huang, Fieland, Simoni, & Walters, 2004;Dudgeon et al., 2015;Elm, Lewis, Walters, & Self, 2016;Jackson, & Jim, 2015;Lehavot, Walters, & Simoni, 2009;James, Passante, 2012;Ristock, Zoccole, & Passante, 2010, 2011Scheim et al., 2013;Yuan, Duran, Walters, Pearson, & Evans-Campbell, 2014). This body of research includes young First Nations LGBTIQ+ participants, however, many studies do not disaggregate young peoples' data from that of their adult First Nations LGBTIQ+ peers. ...
... First Nations LGBTIQ+ young peoples do share common histories, cultures and communities with other First Nations Peoples, however, it cannot be assumed that their lived experiences, perspectives and needs are necessarily the same. For both adult and young First Nations LGBTIQ+ peoples, settler-colonial state policies and practices targeted their collective Indigeneities, cultures, communities and spiritualities, as well as attempting to control, shape or eliminate First Nations LGBTIQ+ peoples' sexuality and gender diversity (Balsam et al., 2004;Dudgeon et al., 2015;Elm et al., 2016;Lehavot et al., 2009;Passante, 2012;Ristock et al., 2010;Scheim et al., 2013;Yuan et al., 2014). For First Nations peoples in British colonies such as Australia, the imposition of Christian heteronormative, heteropatriarchal and cis-gendered values played a key role in the attempted erasure of First Nations cultures (Balsam et al., 2004;Dudgeon et al., 2015;Scheim et al., 2013;Yuan et al., 2014). ...
... For both adult and young First Nations LGBTIQ+ peoples, settler-colonial state policies and practices targeted their collective Indigeneities, cultures, communities and spiritualities, as well as attempting to control, shape or eliminate First Nations LGBTIQ+ peoples' sexuality and gender diversity (Balsam et al., 2004;Dudgeon et al., 2015;Elm et al., 2016;Lehavot et al., 2009;Passante, 2012;Ristock et al., 2010;Scheim et al., 2013;Yuan et al., 2014). For First Nations peoples in British colonies such as Australia, the imposition of Christian heteronormative, heteropatriarchal and cis-gendered values played a key role in the attempted erasure of First Nations cultures (Balsam et al., 2004;Dudgeon et al., 2015;Scheim et al., 2013;Yuan et al., 2014). Research from the US and Canada in particular highlights the ways in which First Nations' gender and sexuality diversity were targeted for erasure during colonial expansions into their territory as they were perceived as a threat to settler-colonial Christian values (Scheim et al., 2013). ...
Article
Full-text available
There is little known about the social, cultural and emotional wellbeing (SCEWB) of Aboriginal and Torres Strait Islander LGBTIQ+ young people in Australia. What research exists does not disaggregate young people’s experiences from those of their adult Aboriginal and Torres Strait Islander LGBTIQ+ peers. The research that forms the basis for this article is one of the first conducted in Australia on this topic. The article uses information from in-depth interviews to inform concepts of social inclusion and exclusion for this population group. The interviews demonstrate the different ways in which social inclusion/exclusion practices, patterns and process within First Nations communities and non-Indigenous LGBTIQ+ communities impact on the SCEWB of these young people. The research demonstrates the importance of acceptance and support from families in particular the centrality of mothers to young people feeling accepted, safe and able to successfully overcome challenges to SCEWB. Non-Indigenous urban LGBTIQ+ communities are at times seen as a “second family” for young people, however, structural racism within these communities is also seen as a problem for young people’s inclusion. This article contributes significant new evidence on the impact of inclusion/exclusion on the SCEWB of Australian First Nations LGBTIQ+ youth.
... vs 27.8%), develop suicidal ideation (35.2% vs 31.1%), and attempt suicides (29.6% vs 10.0%). A Canadian community-based study, TransPULSE Ontario, recruited 398 TGD people, of whom 32 identified as indigenous (Scheim et al., 2013), and this study found indigenous TGD participants reported high rates of lifetime suicidal thoughts (76.0%) and lifetime suicide attempts (48.0%). ...
... Jefferson, Neilands, and Sevelius (2013) adapted scales measuring experiences of racism and cisgenderism to explore the combined effects of these experiences on trans women of colour and found that combined discrimination related to the likelihood of depression. Scheim et al. (2013) reported only one-fifth of indigenous TGD people in TransPULSE Ontario had parents who embraced their TGD identity. Many indigenous TGD participants, however, were found to develop a strong sense of their indigenous identity, with 56.0% reporting high levels of spirituality and 19.0% having sought cultural or tribal leaders for mental health support (Scheim et al., 2013). ...
... Scheim et al. (2013) reported only one-fifth of indigenous TGD people in TransPULSE Ontario had parents who embraced their TGD identity. Many indigenous TGD participants, however, were found to develop a strong sense of their indigenous identity, with 56.0% reporting high levels of spirituality and 19.0% having sought cultural or tribal leaders for mental health support (Scheim et al., 2013). A positive integration of indigenous identity and culture has been linked to buffering effects on the impacts of minority stressors, as well as those related to ramifications of colonialism (Chae & Walters, 2009). ...
Article
Full-text available
The effects of health inequities on transgender (or trans) and gender diverse populations have been well documented internationally. Studies that compared the mental health of trans and gender diverse populations to cisgender populations found significant inequities for mental health problems. There has been very little research on this topic, however, from Aotearoa/New Zealand. We conducted database search in the PsycINFO, as well as manual searches for published grey literature in Aotearoa/New Zealand to identify theoretical and empirical literature on social determinants of health and related frameworks to explain the effects of social environments on health inequities experienced by trans and gender diverse people. We also complement international studies by considering Māori and Pacific trans and gender diverse identities and the ramifications of colonisation on the mental health and wellbeing of these populations.
... Assuming an intersectional approach may be beneficial to the design of the health system in general and integrated youth mental health services specifically because the interactions with health providers are sites of social engagement wherein stigma and discrimination are enacted (or vice versa, where respect and affirmation can occur). Research has shown intervenable factors to support TGNC persons and their mental health (39,44,45). This study contributes knowledge to the importance of person-centered care in health system design, taking into consideration the various needs of TGNC young people accessing integrated health services. ...
Article
Full-text available
Foundry is an integrated service network delivering services to young people across British Columbia, Canada. To better understand the needs of transgender and gender nonconforming young people accessing Foundry—this study compares rates of mental health distress between transgender and gender nonconforming young people and cisgender young people accessing services and examines the extent to which race may have amplified the association between transgender and gender nonconforming identity and mental health distress. We analyzed the difference using a two-sample t-test. We used stratified simple linear regression to test the association of race with transgender and gender nonconforming identity and mental health distress. Participants were recruited from a network of community health centers in British Columbia, Canada. The quantitative sample (n = 727) had a mean age of 21 years (SD = 2), 48% were non-white, 51% were white, and 77% were from Metro Vancouver. Compared to cisgender young people, transgender and gender nonconforming young people reported significantly higher levels of mental health distress. Transgender and gender nonconforming youth were more distressed than cisgender youth across both race strata but non-white transgender and gender nonconforming young people were not more distressed than white transgender and gender nonconforming young people. The findings from this study emphasize the need for increased education and understanding of transgender and gender nonconforming concepts and health concerns as well as on promoting intersectoral collaboration of social services organizations beyond simply health care.
... GSD people are significantly well-documented amongst Indigenous/Māori communities [468,469]. Aboriginal GSD people are some of the most vulnerable subpopulations within Aboriginal communities [36, [470][471][472]. Young LGBTQIA+ Aboriginal people in particular can experience powerlessness and isolation which lead to reduced sexual healthcare access [235]. ...
Research
Full-text available
This review was commissioned by the Department of Health WA as part of the development process for the fourth WA Aboriginal sexual health and blood-borne virus (SHBBV) strategy (2019–2023). This strategy aims to prevent and reduce rates of infection in Australian communities.This review has followed the structure of the third strategy, analysing the data through each domain: prevention and education; testing and diagnosis; disease management and clinical care; workforce development; enabling environments, and; research, evaluation, and surveillance. The review aims to provide a broad overview of evidence on the way SHBBV health promotion, care, and research are negotiated with Aboriginal populations across three countries: Aotearoa/ New Zealand, Australia, and Canada. The data were collected through a scoping review of academic and grey literature (2005-2018), and further developed with the guidance of an advisory group. Culturally appropriate reviews can provide inroads to more constructive policy-making and research practices in health [45, 46]. Reviews can help to address the gaps in inclusive practice guidelines that are evident in current Australian Aboriginal health strategies, in part due to significant knowledge gaps [47]. In particular, reviews which utilise ‘decolonising methodologies’ (such as stakeholder consultation and the expansion of what can be considered ‘valid’ knowledge) can include research that is informed by the needs of communities, as well as the data collected through standard literature searches [48]. Decolonisation, the positioning of Aboriginal-led frameworks at the fore of service delivery, is a crucial aspect of positive and constructive health care, promotion, and research for Aboriginal people [49-51]. It involves directly engaging affected communities, keeping Aboriginal voices amplified and considered throughout institutional processes, practicing reflexivity and immersion, and ensuring that any research or health care/promotion outcomes are addressed with an Aboriginal lens in mind [51-53].
Article
Full-text available
Introduction The LGBTQ+ community experiences health inequities that are linked to the social determinants of health (SDH), though the full extent of these health inequities is not fully understood. Methods This study is a comparative thematic content analysis of the Ontario Ministry of Health and Long-Term Care’s (MOHLTC) website and the websites of each of the 14 local health integration networks (LHINs) in 2009 and 2017. It provides a snapshot and evaluation of the amount and type of online content concerning LGBTQ+-specific health needs and determines how well the programs and services aligned with the Ministry’s stated priorities and population health/SDH philosophy. Results We found very little content that suggested a population health approach on the Ministry’s website. We also found very little LGBTQ+-specific content on the LHINs’ websites in both periods, with two notable exceptions in 2017. Our analysis revealed a persistent emphasis on HIV/AIDS risk containment in the LGBTQ + community over the two periods. Conclusions We argue that to promote healthy equity, the MOHLTC needs to acknowledge inequalities and intervene through political and social mechanisms that extend beyond HIV.
Article
Full-text available
In this article, we draw on a recent review of the Canadian literature on poverty in lesbian, gay, bisexual, transgender, queer, two-spirit, and other sexual and gender minority (LGBTQ2Sþ) communities to conceptualize social work interventions that may be used to address material inequities among these groups. Our literature review, which was based on a total of 39 works, revealed distinctive expressions of poverty among younger and older LGBTQ2Sþ groups, as well as racialized, newcomer, and Indigenous sexual and gender minorities. Drawing on these insights, together with theoretical frameworks grounded in intersectionality and relational poverty analysis, we conceptualize these expressions of material inequity as salient sites of social work practice and propose interventions targeting these manifestations of LGBTQ2Sþ poverty at various levels. Given the centrality of anti-poverty work as part of the social work profession's commitment to social justice, and the dearth of social work literature on LGBTQ2Sþ poverty, this article promises to make significant contributions to social work scholarship and professional practice.
Article
There has been little exploration of the social and emotional wellbeing of young Indigenous populations who identify as gender and sexuality diverse. Given the vulnerability of this cohort in settler colonial societies such as Australia, Canada and the USA, wider investigation is called for in order to respond to their needs and aspirations. Using a scoping review, this paper maps existing research on the intersections of youth, gender and sexuality diversity, Indigeneity and wellbeing. The evidence points to the importance of historical and contemporary experiences tied to colonisation and intergenerational trauma. For young Indigenous gender and sexuality diverse peoples, heteronormative colonial value systems converge to produce environments characterised by racism, phobia and marginalisation. The evidence base includes deficit models based on trauma and negative outcomes. However, there is also an emerging body of research highlighting the resistance and resilience of Indigenous gender and sexuality diverse youth.
Article
Human rights instruments are but one of many legal advocacy tools used by trans people. Recent legal scholarship emphasizes that human rights laws are not sufficient to address legal challenges facing trans people, particularly intersectional and systemic barriers. This article looks to Canadian trans case law outside of human rights law to reveal the many instances in which trans people’s fight for legal recognition and redress occur outside of the human rights arena. It focuses on trans case law in three areas: family law, the use of name and gender in court, and access to social benefits. Canadian trans jurisprudence illustrates that not only are trans legal strategies outside of human rights plentiful and effective, they are also imperative. An agile and pragmatic approach to trans rights is necessary, particularly when minority rights are under threat, and for trans people on the margins of trans law reforms.
Article
Full-text available
A population is “hidden” when no sampling frame exists and public acknowledgment of membership in the population is potentially threatening. Accessing such populations is difficult because standard probability sampling methods produce low response rates and responses that lack candor. Existing procedures for sampling these populations, including snowball and other chain-referral samples, the key-informant approach, and targeted sampling, introduce well-documented biases into their samples. This paper introduces a new variant of chain-referral sampling, respondent-driven sampling, that employs a dual system of structured incentives to overcome some of the deficiencies of such samples. A theoretic analysis, drawing on both Markov-chain theory and the theory of biased networks, shows that this procedure can reduce the biases generally associated with chain-referral methods. The analysis includes a proof showing that even though sampling begins with an arbitrarily chosen set of initial subjects, as do most chain-referral samples, the composition of the ultimate sample is wholly independent of those initial subjects. The analysis also includes a theoretic specification of the conditions under which the procedure yields unbiased samples. Empirical results, based on surveys of 277 active drug injectors in Connecticut, support these conclusions. Finally, the conclusion discusses how respondent- driven sampling can improve both network sampling and ethnographic 44 investigation.
Article
Full-text available
A proposed broader or Indigenized social determinants of health framework includes "colonialism" along with other global processes. What does it mean to understand Canadian colonialism as a distal determinant of Indigenous health? This paper reviews pertinent discourses surrounding Indigenous mental health in Canada. With an emphasis on the notion of intergenerational trauma, there are real health effects of social, political, and economic marginalization embodied within individuals, which can collectively affect entire communities. Colonialism can also be enacted and reinforced within Indigenous mental health discourse, thus influencing scholarly and popular perceptions. Addressing this distal determinant through policy work necessitates that improving Indigenous health is inherently related to improving these relationships, i.e. eliminating colonial relations, and increasing self-determination.
Article
Indigenous peoples repeatedly call for disaggregated data describing their experience to inform socio-economic and political policy and practice change (United Nations Permanent Forum on Indigenous Issues, 2003; UNICEF, 2003; Rae & the Sub Group on Indigenous Children and Youth, 2006). Although there has been significant discourse on the destructive historical role of western research with Indigenous communities (RCAP, 1996; Smith, 1999; Schnarch, 2004) and more recently on cultural adaptation of qualitative research methods (Smith, 1999; Bennet, 2004; Kovach, 2007), there has been very little discussion on how to envelope western quantitative social science research within Indigenous ways of knowing and being. This paper begins by outlining the broad goals of Indigenous research before focusing on how quantitative research is used, and represented, in the translation of Indigenous realities in child health and child welfare. Given the rich diversity of Indigenous peoples and their knowledges, this paper is only capable of what respected Indigenous academic Margo Greenwood (2007) would term “touching the mountaintops’ of complex and sacred ideas.
Although depression is understudied in transgender and transsexual communities, high prevalences have been reported. This paper presents original research from the Trans PULSE Project, an Ontario-wide, community-based initiative that surveyed 433 participants using respondent-driven sampling. The purpose of this analysis was to determine the prevalence of, and risk and protective factors for, depression among female-to-male (FTM) Ontarians (n = 207). We estimate that 66.4% of FTMs have symptomatology consistent with depression. In multivariable analyses, sexual satisfaction was a strong protective factor. Conversely, experiencing transphobia and being at the stage of planning but not having begun a medical transition (hormones and/or surgery) adversely affected mental health in FTMs.