Technical ReportPDF Available

Transgender People in Ontario, Canada: Statistics from the Trans PULSE Project to Inform Human Rights Policy

Authors:

Abstract and Figures

The purpose of this report is to summarize key research results from the Trans PULSE Project that may be useful in discussion, debates or policy creation related to human rights in multiple jurisdictions.
No caption available
… 
No caption available
… 
No caption available
… 
Content may be subject to copyright.
!
•••!!!1!!!••!
g!
!
Transgender People in Ontario, Canada
Statistics from the Trans PULSE Project
to Inform Human Rights Policy
Prepared by For the Trans PULSE Project Team
Greta&R.&Bauer,&PhD,&MPH&&
Associate!Professor!
&
Ayden&I.&Scheim,&PhD&candidate&
Vanier!Scholar,!Trudeau!Scholar!
!
Epidemiology!&!Biostatistics!
Schulich!School!of!Medicine!&!Dentistry!
The!University!of!Western!Ontario!
London,!Ontario,!Canada!
!
•••!!!2!!!••!
&
&
&
!
!
!
!
!
!
!
!
!
!
!
!
!
17!October!2014!
Updated!1!June!2015!
!
!
Bauer!GR,!Scheim!AI,!for!the!Trans!PULSE!Project!Team.!!"#$%&'$('")*'+,-').$)/$0#".+1)2#$#(#3)
40#0.%0.5%)0+)6$7+"8)9:8#$);.&<0%)*+-.5=.!London,!ON .!1 !Jun e !20 1 5 .!!
!
!
!
Trans!PULSE!was!funded!by:!
!
!
•••!!!1!!!••!
Purpose of this Report
!
The! purpose! of! this!report!is! to! summarize! key!research! results! fro m ! the! Trans! PULSE! P ro ject! that! may! be!
useful! in! discussions,! debates! or! policy! creation! related! to! human! rights! in ! multiple ! jurisdictio n s .! As! Tra n s!
PULSE!results!have!been!used!by!the!Canadian!Human!Rights!Commission,
1
!and!are!heavily!cited!in!the!Ontario!
Human! Rights! Commission’s! 2014! policy! on! gender! identit y! and! discrim i n a tio n,
2
!we! sought! to! create! a!
summary!of!research!findings!that!have!been!of!greatest!interest!with!regard!to!hum an!rights!issues.!
Trans PULSE Project
!
The! Trans! PULSE! Project! is! a! research! study! of! s ocia l! d eterminants! o f! h ea lth! a m o ng! trans! (transgender,!
transsexual! or! tran sition ed )!p eo ple! in! the !p rov ince !o f!Ontario,!Canada.!Early!capacity\building!stages!and!focus!
groups!were!funded!by!the!Wellesley!Institute!and!the!Ontario!HIV!Treatment!Network.!A!subsequent! survey!
was!funded!by! tw o!operating!grants!from !the!Can ad ian!Institutes!of!Health!R ese arc h.!To!date,!th e!project!ha s!
produced! 14! academic! research! articles! in! peer\reviewed! journals,! 5 ! reports! c rea ted ! at! the! request! of!
government!or!community!service!agencies,!and!8 ! e\bulletins!to!provide!short!summ aries!of!key!findings!in!
easily!accessible!formats.!
!
Data! for! Trans! PU LSE ! com e! from ! community! sou nd in gs! (focu s! grou ps)! con d ucte d ! in! thre e ! On ta rio ! citie s! in !
2006!with!85!trans!com munity!members!and !4!family!m embers,!and!from!a!survey!in!2009\2010!of!433!trans!
Ontarians! age! 16! and! over.! The! survey ! wa s! con d u cte d ! using ! a! me th o d ! called ! resp o n d e nt\driven! sampling!
(RDS),!a!rigorous!method!for! researching!pop ulations!for!w hich!a!random!sample!cannot!be!obtained.!In!RDS,!
participants!are!systematically!recruited!through ! pre viou s! p articipa nts’! so cial! n etw o rks.! A ! key ! fea ture!of!R DS!is!
that!data!on!n etw o rks!is!ga the red!in !the!re sea rch !pro cess,!allow in g!resu lts!to!b e!w eigh ted !for!th e!p rob ab ility!
of!recruitment!(so!those!with!smaller!networks!are!w eighted!more!heavily,!as!they!are!standing!in!for!more!
people!who!were! not!reached).!Thus,! all! statistics!presented!are! generalizable!to! the! population! of!networked!
trans!people!in!O nta rio!(tho se !wh o!kn ow !a t!least!on e!o ther!tra ns!p erso n).!
!
At!the!time!of!survey!data!collection,!gender!identity!and!expression!were!included! implicitly! in!human!rights!
protections!under!the!ground!of!“sex”,!and!in!some! situations!under!“disability”.!Trans!people!were!often!able!
to!change!the!gender!marker!on!their!drivers!licenses!(if!they!had!o ne),!without!being!required!to!have!any!
surgeries,!but!were!not!usually!a ble! to!change! their!Ontario!birth!certificates!or!health!cards.!These!policies!
have!all!changed!in!the!intervening!years,!following!the!addition!of!“gender!identity!or!gender!expression”!as!a!
protected!ground,
3
!and!a!successful!Ontario!Human!Rights!case!regarding!sex!designation!change.
4
!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
1
!Bauer!G,!for!the!Trans!PULSE!Project.!!"#$%)/$0#".#$%>)4'?)@'%.&$#0.+$%)+$)A'('"#-)#$()*"+B.$5.#-)6('$0.0=)@+5:8'$0%3)C)
;',+"0)*"',#"'()7+")0<')2#$#(.#$)9:8#$);.&<0%)2+88.%%.+$.!15!November!2012.!Available!at:!http://transpulseproject.ca/wp\
content/uploads/2012/11/Trans\PULSE\ Sex\Designations\on\IDs\Report\for\CHRC\2012.pdf!!
2
!Ontario!Human!Rights!Commission.!*+-.5=)+$)*"'B'$0.$&)@.%5".8.$#0.+$)D'5#:%')+7)E'$('")6('$0.0=)#$()E'$('")F?,"'%%.+$,!
2014.!Available!at:!
http://www.ohrc.on.ca/sites/default/files/Policy%20on%20preventing%20discrimination%20because%20of%20gender%20iden
tity%20and%20ge nd er% 2 0ex pre ssion .pd f!!
3
!Toby’s!Act!(Right!to!be!Free!from!Discrimination!and!Harassment!because!of!Gender!Identity!or!Gender!Expression),!2012.!
Available!at:!http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=2574!!
4
!XY!v.!Ontario!(Government!and!Consumer!Services).!2012!HRTO!726.!Available!at:!
http://www.canlii.org/en/on/onhrt/doc/2012/2012hrto726/2012hrto726.htm l!!!
!
•••!!!2!!!••!
As! our!study!w as!designed! to!examine! social! determinants! of!health!among!trans!people,! w e!focus!heavily! on!
experiences! of! transphobia.! Transphobia! is! a! broad! term! that! can! encompass! everything! from! hate! crimes!
directe d ! at! tra n s! pe o p le ,! to! str uc tu ra l! ba rrie rs ! to ! inclu s io n ! in! ins titu t io na l! se ttin g s ! (e.g .! sch o o ls,! ho s p ita ls,!
employment),! to! interpersonal! discrimination.! Since! our! study! was! a! stu dy! of! health! and! well\being! rather!
than!a!legal!study,!som e !forms!of!tra nsphobia!we!studied!will!meet!the!threshold!for!h uman!rights !vio lation s!
(e.g.! firing! from! job! due ! to! gen de r! identity )! and ! othe rs! will! in ! m o st ! cas e s! fall! b elo w! the! thres h o ld ! (e.g .!
disparaging!comments).!
Who are Trans People in Ontario?
&
Trans!people!in!Ontario!report!a!full!range!of!ages!and!
occupations,!and!are!geo g ra p hically!d is tri b u te d!across !
the!province!p rop ortio na lly!to!the!p op ulatio n.
5
!They!
belong!to!all!ethno\racial!groups,!and!7%!iden tify!as!
Aboriginal.
6
!Of!course,!trans!people!also!form!families:!
44%!are!in!a!committed!relationship
7
!and!24%!are!
parents.
8
!
!
While! they! may! not! have! had! language! for! it! at! the!
time,& 59%! knew! that! their! gender! identity! did! not!
match!their!body!before!the!age!of!10,!and!80%!had!this!knowledge!by!the !age!of! 14 .
9
!Gender!identity!is!often!
clear!years!before!pe ople!socially!transition!to!live!in!their!core!gender.!While!app roximately!80%!of!Ontario!
trans!people!have!socially!transitioned !to!live!their!day\to\day!lives!in!their!core!gender,!most!full\time,!o nly!
8%!report!that!they!had! b egun!living!in!their!core!gend er!by!age!14.
10
!It!is!imp o rt!to!note!that!there !is!a !lot!of!
sex!and!gender! diversity!within!trans!communities.!Abou t!three\quarters!of!trans!people!indicate!they!need!to!
transition! me dica lly,! which! may ! involve! differe nt ! combination s! of! hormon e s! and/or! surg er y! for! different!
individua ls .
7
!Though!trans!women!have!received!greater!media!attention,!there!are!about!equal!numbers!of!
trans!peo p le!on!male\to\female! and!fema le\to\male!spectrums!in!Ontario.! About!1!in!5!trans!peo ple ! do!not!
identify!as!m a le!or!female,!or!even!as !prim a rily !ma s cu lin e !or!fem in in e .
8
!These!m ore!gender\fluid!people!can!
identify! as! b o th ! male! and! female,! neither! male! nor! female,! or! a s! some th in g ! else! e n tir ely! (e.g.! as! another!
traditional!gender!recognized!by!Aboriginal
6
!or!other!cultural!groups).!!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
5
!Bauer!GR,!Travers!R,!Scanlon!K,!Coleman!TA.!High!heterogeneity!of!HIV\related!sexual!risk!among!transgend er!p eo ple!in !
Ontario,!Canada:!a!province\wide!respondent\driven!sampling!survey.!GH2)*:D-.5)9'#-0<!2012;12(292).!Available!at!
http://www.biomedcentral.com/1471\2458/12/292!
6
!Scheim!AI,!Jackson!R,!James!L,!et!al.!Barriers!to!well\being!for!Aboriginal!gender\diverse!people:!results!from!the!Trans!PULSE!
Project!in!Ontario,!Canada.!F0<$.5.0=)#$()6$'I:#-.0.'%).$)9'#-0<)#$()4+5.#-)2#"'!2013;6(4):108120.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\08\2013\0010!
7
!Bauer!G,!Boyce!M,!Coleman!T,!et!al.!Who!are!trans!people!in!Ontario?!!"#$%)*JK4F)*"+L'50)FMG:--'0.$!2010;!1(1).!Available!in!
English!and!French!at!http://transpulseproject.ca/research/who\are\trans\people\in\ontario/!
8
!Pyne!J,!Bauer!GR,!Bradley!K.!Transphobia!and!other!stressors!impacting!trans!parents!in!Ontario,!Canada.!N+:"$#-)+7)EKG!)
A#8.-=)40:(.'%!2015;11(2):107\126.!Available!at!http://www.tandfonline.com/doi/abs/10.1080/1550428X.2014.941127!!
9
!Coleman!T,!Bauer!G,!Scanlon!K,!et!al.!Challenging!the!binary:!gender!characteristics!of!trans!Ontarians.!!"#$%)*JK4F)*"+L'50)FM
G:--'0.$!2011;!2(2).!Available!in!English!and!French!at!http://transpulseproject.ca/research/gender\characteristics\of\trans\
ontarians/!!!For!additional!breakdowns!by!male\to\female!and!fema le\to\male!gender!spectra,!see:!Scheim!AI,!Bauer!GR.!Sex!
and!gender!diversity!among!transgender!persons!in!Ontario,!Canada:!results!from!a!respondent\driven!sampling!survey.!N+:"$#-)
+7)4'?);'%'#"5<!2015:52(1):1\14.!Available!at!http://www.tandfonline.com/doi/full/10.1080/00224499.2014.893553!!
10
!Coleman!T,!Bauer!G,!Scanlon!K,!et!al.!Challenging!the!binary:!gender!characteristics!of!trans!Ontarians.!!"#$%)*JK4F)*"+L'50)FM
G:--'0.$!2011;!2(2).!Available!in!English!and!French!at!http://transpulseproject.ca/research/gender\characteristics\of\trans\
ontarians/!
!
•••!!!3!!!••!
Discrimination and Violence Experienced by Trans Persons
!
In!ever yd a y !lif e,!trans!peo p le !experience !t h e !e ff ec ts !of!living!in!a!society!in!which!stigma!and!discrimination!
against!trans!peo ple! are! co m m on .!In!ad d ition!to! in st a n ce s! o f! d is cr im in a t io n !a n d ! violence! th a t! would! c o n st itu te !
human! rights!violations,!trans!Ontarians! nearly!universally! report! tha t! th ey ! ha ve ! ex pe rienc ed! some! type! of!
“everyday! transph o bia.
11
!For! example,! 96%! had! heard! that! trans! people! were! not! norm al,! 73%! had! been!
made! fun! of! for! being! trans,! and! 78%! reported! their! family! had! been! hurt! or! embarrassed.! These! daily!
indignitie s!can!take!their!toll;!77%!worried!about!growing!old!as!a!trans!person,!and!67%!feared!they!would!die!
young.!
&
Employment barriers and discrimination
!
Among!trans! Ontarians,! 13%!had!been!fired! for!being!trans! (another!15% !were!fire d,!and!believed!it!m igh t!be!
because!they!were!trans).
12
!Because!they!were!trans,!18%!were ! tu r n e d ! down ! fo r ! a ! jo b;!ano ther!32 %!suspected !
this!was!why! they! were! turned! down.! Additionally,! 17%!declined!a!job! they!had! applied! for! and! were!actually!
offered,!because!of!the!lack!of!a! t ra ns \positive!and!safe!work!environment.!In!a d d itio n !to!direct!disc riminatory !
experiences,!trans!people!experience!structural!barriers!to!employm ent,!in!systems!that!are!not!designed!for!
the! possibility! of! trans!
experience.! For! example,!
28%!of!trans!Ontarians!could!
not! get! employment!
references! with!th eir! current!
name! or! pronoun,! a n d ! 58%!
could! not! get! academic!
transcripts! with! the! co rrec t!
name!or!sex!designation.!This!
places! people! in! the! difficult!
position!of!outing!themselves!
up\front! in! job! application s,!
or! being! unable! to! draw! on!
their! actual! job! h istories! to!
strengthen!their!applications.!!
!
Discrimination in
medical care
&
One! in ! ten! trans! peo p le! w h o! had! accessed! a n! emergency! roo m ! p rese ntin g! in ! th eir! fe lt! ge nd er! had! been!
refused! ca re! or! had! care! terminated! prematurely,! because! they! were! trans.
13!
One\quarter! rep orte d! being!
belittled! or! ridiculed! by! an! emergency! care! provider! for! being! trans.! Among! those! with! a! family! physician,!
approximately! 40%! had! experienced! discriminatory! behaviour! from! a! family! doctor! at! least! once.! These!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
11
!Marcellin!RL,!Bauer!GR,!Scheim!AI.!Intersecting!impacts!of!transphobia!and!racism!on!HIV!risk!among!trans!persons!of!colour!
in!Ontario,!Can a d a.!F0<$.5.0=)#$()6$'I:#-.0.'%).$)9'#-0<)#$()4+5.#-)2#"')2013;6(4):97107.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\09\2013\0017!
12
!Bauer!G,!Nussbaum!N,!Travers!R,!et!al.!We’ve!got!work!to!do:!workplace!discrimination!and!employment!challenges!for!trans!
people!in!Ontario.!!"#$%)*JK4F)*"+L'50)FMG:--'0.$!2011;!2(1).!Available!in!English!and!French!at!
http://transpulseproject.ca/research/workplace\discrimination\and\employment\challenges\for\tra ns\people\in\ontario/!
!
•••!!!4!!!••!
experiences!included!refusal!of!c are!or!refusal!to!examine!specific!body!parts,!being!ridiculed,!an d!the!u se!of!
demeaning!language.
13
!!
!
A!participant!in!the!first! qualitative! phase! of! Trans!PULSE! described!their!experience! seeking!hea lth! care!as!
follows
14(p.355)
:!
!
6)&+ 0)0+-()D=)+$' )+7)0<+%')0<"'' )(+50+"%)0<#0)6)%<+ :-( ),"+D#D -=)%''O)<'#-0<)5#"')' -%'P <' "'Q )D'5#: %'1)7+")
%+8')"'#%+$1)<')(.()$ +0)O$+P)R0<#0)6)P#%)0"#$%S).$)#(B#$5'1)D '5#:%')0<#0)P#%$>0)P <#0)6)P #%)%''.$&)<.8)
7+"1)# $( )P<'$ )<')7+:$( )+:01)<'),"'00=)8:5< )%#.()P+"( )7+")P+"(1)TT*-'#%')&+)%+8',-#5')'-%'1>>)%+)0<#0)<')
P+:-($>0)<#B')0+)('#-)P.0<).0U)V+P1)0<#$O7:--=1)0<.%)&:=>%)-'#B.$&)0+P$).$)#D+:0)#)P''O1)%+)6)P+:-($>0)
5#"'Q)D:0).0)D+0<'"%)8').88'$%'-=)0<#0)P'>"')%0.--)0"'#0'()0<#0)P#=)D=),'+,-')P<+)%<+:-()O$+P)D'00'"U)
!
Violence
!
Trans!people!are!the! targets!of!specifically!directed!violence;!20%!had!been!physically!or!sexually!assaulted!for!
being! trans,!and! another! 34%! had! been! verbally! threatened! or! harassed! but! not! assaulted.
15
!Many!did!not!
report!these!assa ults!to!th e!police;!in!fact,!24%!reported!having!been!harassed!by!police.
16
!Trans!people!also!
face! vio len ce!in!institutio na l!settings!suc h!as!prison s;!6% !of!Trans!PU LSE !particip an ts!had !been !in!prison!or!jail,!
and!one\third!of!them!re po rted !experiencing!viole nce !due!to!their!gender!(above!and!beyond !violence!they!
may!have!encountered!for!other!reasons).
17
!Impo rt antly,!b e in g ! incarcera te d ! in!a! facility!a p p ro priate! to!the ir!
gender!identity!was!not!sufficient!to!protect!them!from!transphobic!violence.!!
!
Identity documents
!
Trans!people!face!issues!w ith!both!federal!and!provincial!identification!docum ents!that!have!sex!designations!
(i.e.! have ! a! visible! “M”! o r! “F”! on! the! d oc ument! to! ind icate ! sex).! These! include! passports,! driver’s! licenses ,!
Indian! Status!cards,!military!IDs,!perman en t! resident!cards,! and!health!cards.! As!of!20 09\ 2010 ,!among! trans!
Ontarians!who!had!socially!transitioned!to!live!full\time !as!men!or!wom en ,!and!wh o!had!changed!their!legal!
names!to!reflect!this,!many!did!not!have!concordant!ID.!Only!30%!had!changed!the!sex!designation!on!all!of!
their! federal! an d! provincial! id e n tity ! docum en t s;! 31%! h a d ! not! changed! the ! se x! designation! o n! any! id e n tit y!
document.
18
!!
!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
13
!Bauer!GR,!Zong!X,!Scheim!AI,!Hammond!R,!Thind!A.!Factors!impacting!transgender!patients’!discom fort!with!their!family!
physicians:!a!respondent\driven!sampling!survey.!Manuscript!in!preparation.!
14
!Bauer!GR,!Hammond!R,!Travers!R,!et!al.!“I!don't!think!this!is!theoretical;!th is!is!o u r!lives ”:!h ow!erasure!impac ts!h ea lth !ca re!fo r!
transgender!people .!N+:"$ #-)+7)0< ')C% %+5 .#0.+$ )+7)V : "%'%).$)C 6@4 )2# "' !2009;20(5):348361.!Available!at!
http://www.nursesinaidscarejournal.org/article/S1055\3290(09)00107\1/abstract!!!!
15
!Bauer!GR,!Pyne!J,!Francino!MC,!Hammond!R.!La!suicidabilité!parmi!les!personn es !tra ns !en !O n ta rio :!Im p lic at ion s !en !tra va il!
social!et!en!justice!sociale!/!Suicidality!among!trans!people!in!Ontario:!implications!for!social!work!and!social!justice.!;'B:')
4'"B.5')4+5.#-!2013;59(1):3562.!Available!at!http://www.erudit.org/revue/ss/2013/v59/n1/1017478ar.html?vue=resume!
16
!Marcellin!RL,!Bauer!GR,!Scheim!AI.!Intersecting!impacts!of!transphobia!and!racism!on!HIV!risk!among!trans!persons!of!colour!
in!Ontario,!Can a d a.!F0<$.5.0=)#$()6$'I:#-.0.'%).$)9'#-0<)#$()4+5.#-)2#"')2013;6(4):97107.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\09\2013\0017!
17
!Scheim!A,!Cherian!M,!Bauer!G,!Zong!X.!Joint!effort:!prison!experiences!of!Trans!PULSE!participants!and!recommendations!for!
change.!!"#$%)*JK4F)FMG:--'0.$)2013;!3(3).!Available!in!English!and!French!at!http://transpulseproject.ca/research/prison\
experiences\of\trans\pulse\participants/!
18
!Bauer!G,!for!the!Trans!PULSE!Project.!!"#$%)/$0#".#$%>)4'?)@'%.&$#0.+$%)+$)A'('"#-)#$()*"+B.$5.#-)6('$0.0=)@+5:8'$0%3)C)
;',+"0)*"',#"'()7+")0<')2#$#(.#$)9:8#$);.&<0%)2+88.%%.+$.!15!November!2012 .!Av a ilab le!a t:!http://transpulseproject.ca/wp\
content/uploads/2012/11/Trans\PULSE\ Sex\Designations\on\IDs\Report\for\CHRC\2012.pdf!
!
•••!!!5!!!••!
Impacts of Discrimination and Violence on Social Participation and Health
!
Our!research!results!show!that!experiences!of!discrimination!and!violence!can!result!in!exclusion!from!social!
spaces,! unemploym ent,! avoidan ce! of! health! care,! and! poo r! men tal! health.! It! is! likely! that! similar!processes!
play!out!in!systems! that!we!have!not!studied! in!detail,! such!as!education! and!social!services.!Moreover,!trans\
specific! discrimination! may! not! be! the! only! form! of! discrimination! ex perienced .! For! example,! we! have!
documented! experiences! of! racial! discrimination! experienced! by! trans! persons! of! colour,! and! shown ! that!
racism!and !tran sp ho bia !can!interact!synergistically!to!put!trans!persons!of!colour!who!experience!high!levels!of!
both!at!particularly!high!risk!for!HIV.
19
!
!
Avoidance of public spaces and exclusion from communities
&
Approximately! two\thirds! of! trans! people! in! Ontario! had! avoided! public! spaces! or! situations! because! they!
feared!harassment,!being!perceived!as!trans,!or!being!“outed”!as!trans.
20
!Among!those!who!had! begun!to! live!
in!their!felt!g e n d er !full!or!part\time,!this!proportion!was!higher!(83%).!The!majority!(57%)!of!trans!Ontarians!
had! avoided!public!washrooms!due!to! these!safety! fears.!Gyms,!travel! abroad,! malls,!schools,! and! restaurants!
were! also! commonly! avoided.! Avoidance! of! public!
spaces! may! reflect! the! d etrimen tal! effects! of! past!
experiences! of! transphobic! violence.! Of! those! who!
had!experienced!physical!and/or!sexual! violence!due!
to! be ing!tran s,!9 7 %!report!avo iding !at!least!o ne!type!
of!public!space,!and!one\third! had! avoided! most! of!
the! spaces! we! inquired ! abou t.! In! addition,!
discrimination!may!force!trans!people!to!leave!their!
communities! and! neighbourhoods! of! origin;! 32%! of!
trans! Ontarians! had! to! move! away! because! they!
were! trans,! either! for! their! safety! or! to! access!
services.
19!
&
Avoidance of health care
&
Past! experiences! of! discrimination! in! health! care!
settings!or!the!fear!of!such!discrimination,!as! w ell! as!
a! lack! of! identification! that! reflects! o ne’s! lived!
gender,!may!lead!trans!people!to!avoid!encounters!w ith!the!health!care!system.!That!21%!have!avoided!the!
emergency!department!w hen!they!needed!it,!spec if ic a lly !due!to!being!trans,
21
!demonstrates!the!potential! for!
discrimination!to!have!life\and\death!consequences!for!trans!people.&
&
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
19
!Marcellin!RL,!Bauer!GR,!Scheim!AI.!Intersecting!impacts!of!transphobia!and!racism!on!HIV!risk!among!trans!persons!of!colour!
in!Ontario,!Can a d a.!F0<$.5.0=)#$()6$'I:#-.0.'%).$)9'#-0<)#$()4+5.#-)2#"')2013;6(4):97107.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\09\2013\0017!
20
!Scheim!A,!Bauer!G,!Pyne!J.!Avoidance!of!public!spaces!by!trans!Ontarians:!the!impact!of!transphobia!on!daily!life.!!"#$%)*JK4F)
FMG:--'0.$)2013;!4(1).!Available!in!English!and!French!at!http://transpulseproject.ca/research/avoidance\of\public\spaces\by\
trans\ontarians\the\impact\of\transphobia\on\daily\life/!
21
!Bauer!GR,!Scheim!AI,!Deutsch!MB,!Massarella!C.!Reported!emergency!department!avoidance,!use,!and!experiences!of!
transgender!person s!in!O nta rio,!Can ad a:!resu lts!from !a !respo n den t\driven!sampling!survey.!C$$#-%)+7)F8'"&'$5=)H'(.5.$'!
2014;63(6):713\720.!Available!at!http://www.annemergmed.com/article/S0196\0644%2813%2901453\4/pdf!
!
•••!!!6!!!••!
Economic marginalization
!
Considering! the! employmen t! challenges! described! above,! it! is! pe rha ps! not! surprising! tha t! while! trans!
Ontarians!reported!a! wide!range!of!annual!incomes,!their!median!income!was!$15,000!per!year.
22
!Given!levels!
of!education!and!experience!(44%!had!a!post\secondary!and/or!gradu ate!degree),!this!represents!significant!
underemployment.!While!some!trans!people! report!h igh!salaries,!a!sizeable!proportion!get!by!with!economic!
assistance!from!provincial!disability!pension!(ODSP),!welfare!(OW)!or!employment!insurance!(EI).&
&
Mental health and suicide
!
Trans!people! experience!extremely! high ! leve ls! of! dep re ss io n ! and ! suicid e .! Mo re ! tha n ! half! of! trans ! peo p le! in!
Ontario!have!levels!of!depressive!symptoms!consistent!with!clinical!depression,
23
!while!43%!had!a!history!of!
attempting!suicide,!including!10 %!with in !th e !past!yea r .
24
!!
!
Contrary! to! the! notion! that! depression! and !
suicidality!are!primarily!attributable!to!distress!
inheren t! to! being! t ra ns ,! we! found! evidence!
that! discrimination! and! violence! had! strong!
adverse!impacts!on!mental! health.! This!means!
that! interve ntio ns! to! improve! the! social! and!
human! rights! situation! of! trans! people! have!
the! potential! to! reduce! dep ressio n! and !
suicidality.! We! found! that! hav ing ! identity!
documents! concordant! with! lived! gender,!
reduced! exposure! to! discrimination! and!
violence,! and! access! to! m edical! transition!
treatments! (if! needed)! could! contribute! to!
reducing! the! num b er! of! trans! people! in!
Ontario!who!consider!and!attempt!suicide,!as!
illustrated ! in! th e! figures! on! the! following!
page.
25
!!
!
In!addition!to!pr o te ct io n !fro m!haras sment,!vio le n ce !an d!discrim in a tio n ,!s o cia l!support!and!fam ily!support!are!
essential!to!the!well\being!of!trans!people.!For!trans!people!of!all!ages,!social!support!and!parental!support!for!
gender!were!associated!with!lower!risk!of!attempting!suicide.!While!social!an d!family!support!are!not!direct!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
22
!Bauer!GR,!Travers!R,!Scanlon!K,!Coleman!TA.!High!heterogeneity!of!HIV\related!sexual!risk!among!transgend er!p e ople!in!
Ontario,!Canada:!a!province\wide!respondent\driven!sampling!survey.!GH2)*:D-.5)9'#-0<!2012;12:292.!Available!at!
http://www.biomedcentral.com/1471\2458/12/292!
23
!Rotondi!NK,!Bauer!GR,!Travers!R,!et!al.!Depression!in!male\to\female!transgend er!O nta rian s.!2#$#(.#$)N+:"$#-)+7)2+88:$.0=)
H'$0#-)9'#-0<!2011;30:113133.!Available!at!!http://cjcmh.metapress.com/link.asp?id=41351l3l486671x4!
Rotondi!NK,!Bauer!GR,!Scanlon!K,!et!al.!Prevalence!of!and!risk!and!protective!factors!for!depression!in!female\to\male!
transgender!Ontarian s.!2#$#(.#$)N+:"$#-)+7)2+88:$.0=)H'$0#-)9'#-0<!2011;30:135155.!Available!at!
http://cjcmh.metapress.com/link.asp?id=41351l3l486671x4!
24
!Bauer!GR,!Pyne!J,!Francino!MC,!Hammond!R.!La!suicidabilité!parmi!les!personnes!trans!en!Ontario:!Implications!en!travail!
social!et!en!justice!sociale!/!/!Suicidality!among!trans!people!in!Ontario:!implications!for!social!work!and!social!justice.!;'B:')
4'"B.5')4+5.#-!2013;59(1):3562.!Available!at!http://www.erudit.org/revue/ss/2013/v59/n1/1017478ar.html?vue=resume !
25
!Bauer!GR,!Scheim!AI,!Pyne!J,!Travers!R,!Hammond!R.!Intervenable!factors!associated!with!suicide!risk!in!transgender!persons:!
a!respondent\driven!sampling!study!in!Ontario,!Canada.!GH2)*:D-.5)9'#-0<!2015;!15:!525.!Available!at!
http://www.biomedcentral.com/1471\2458/15/525!
!
•••!!!7!!!••!
products!of!hum an!rights!protections,!it!is!plausible!that!greater! formal!recognition! of!gender!identity! and/or!
expression!would!result!in!greater!social!acceptance!and!support!for!gender.!
!
!
!
!
!
!
•••!!!8!!!••!
Greater!social!acceptance!and!support!for!
gender! identity! are! particularly! important!
for! trans! youth,! among! whom! parental!
support! is! a! key! contribu tor! to! well\
being.
26
!Among! youth! age! 16\24! who!
reported! their! parents! were! strongly!
supportive! of! their! gender! identity! or!
expression,! 4%! reported! attempting!
suicide! in! the! past! year.! W hile! this! is! still!
far! too! h igh ,! it! is! 9 3% ! lowe r! than! suicid e!
attempts! am ong! trans! youth! whose!
parents! were! not! strongly! supportive.!
Within!that!group,!57%!attempted!suicide!
in! th e! past! ye ar .! Youth! with! supportive!
parents!were! also!significantly!m o re! likely!
to! be! ade qu ate ly! h ou sed ,! to! not! be!
depressed,! to! have! high! self\esteem,! and!
to!report!being!sa tisfied!w ith!the ir!lives.!
!
!
Moving Forward
!
Additional!results!from! Trans! PULSE!may!be!found!in!the! publications!referenced,!for! which!we!have!provided!
links! where ve r! pos sib le .! We ! recog n iz e! tha t! our! one ! proje c t! will! not! hav e ! prod u ce d ! all! inform a tio n ! that ! is!
desired! for! discussions! regarding! protected! grounds! as! well! as! human! rights! policies! for! government!
commissions! (e.g.! On tario
27
),! business es ,! and ! non\government! organizations.! Given! the! unique! data! set! we!
have,!and!in!recognition!of!the!public! funds!provided! for!the! conduct!of!our!study,! we!hope!this!summary!will!
be!useful!both!in!Canada!and!abroad.!!!
!
!
!
!
!
& &
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
26
!Travers!R,!Bauer!G,!Pyne!J,!et!al.!68,#50%)+7)40"+ $ & )* # "' $ 0# -)4: , , + "0 )7+ ")! "# $ %)W+:0<3)C); ' , +" 0)* "' , # "'( )7 + ")0< ' )2 < .-( "' $ >%)C .( )
4+5.'0=)+7)!+"+$0+)#$()@'-.%-')W+:0<)4'"B.5'%U2!October!2012.!!
Available!at!http://transpulseproject.ca/research/impacts\of\strong\parental\support\for\trans\youth/!
27
!Ontario!Human!Rights!Commission.!*+-.5=)+$)*"'B'$0.$&)@.%5".8.$#0.+$)D'5#:%')+7)E'$('")6('$0.0=)#$()E'$('")F?,"'%%.+$,!
2014.!Available!at!
http://www.ohrc.on.ca/sites/default/files/Policy%20 on % 20 pre ven ting % 20d iscrim ina tion % 20b ec au se% 20 of% 2 0ge nd er% 2 0ide n
tity%20and%20ge nd er% 2 0ex pre ssion .pd f!!
!
•••!!!9!!!••!
!
!
Acknowledgements
!
The!research!presented!here!was!supported!by!capacity\building!grants!from!the!Wellesley!institute!and!the!Ontario!
HIV!Treatment!Network,!and!operating!grants!from!the!Canadian!Institutes!of!Health!Research,!Institute!of!Infection!
and! Im munity! (Funding! Referenc e ! #CBR\167492)! and! Institute! of! G en de r! and! Health! (Fun din g! Reference! #MOP\
106478).! Ayden! Scheim! is! supported! by! Vanier! and! Trudeau! Foundation! Graduate! Scholarships.! Partners! in! Trans!
PULSE! included! the! Sherbourne! Health! Centre! (Toronto),! The! 519! Church! Street!Community! Centre! (Toronto),! The!
University!of! Western!O ntario!(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! Scanlo n ! (deceased),! and! Anna! Travers.! The! authors! wish! to! acknowledge! the! 16!
Community!Engagement!Team!mem bers!and!other!contributors!who!aided!survey!development,! the!85!trans!people!
and!4!allies!who!contributed!to!the!first!phase!of!the!study!that!shaped!this!survey,!and!the!433!trans!people!who!
shared!their!experiences!through!their!survey!participation.!
!
... Although not all trans people pursue hormone or surgical transition, among those who do seek help but have yet to start transitioning, up to 27% might attempt suicide. 5 This figure drops to 18% after beginning transition, and might be as low as 1% once transition is completed. 5 Access to appropriate transition care is difficult for many trans individuals, and delays in treatment might contribute to these high suicide rates. ...
... 5 This figure drops to 18% after beginning transition, and might be as low as 1% once transition is completed. 5 Access to appropriate transition care is difficult for many trans individuals, and delays in treatment might contribute to these high suicide rates. 5 While treatment for trans people was previously relegated to specialized clinics in large cities, there has been a shift in the duty of responsibility toward community physicians. ...
... 5 Access to appropriate transition care is difficult for many trans individuals, and delays in treatment might contribute to these high suicide rates. 5 While treatment for trans people was previously relegated to specialized clinics in large cities, there has been a shift in the duty of responsibility toward community physicians. Using educational tools produced by organizations like Rainbow Health Ontario, 6 family physicians have access to the resources required to initiate hormone replacement therapy (HRT) and refer patients for surgery. ...
Article
Objective: To explore past experiences and describe the expectations of members of the trans community regarding the delivery of primary care by their family physicians. Design: Qualitative phenomenologic approach. Setting: Kingston, Ont, which has a population of approximately 123 000. Participants: A convenience sample of 11 individuals older than 18 years of age who self-identified as trans was recruited through community agencies and family medicine clinics. Methods: Semistructured interviews were recorded and transcribed verbatim, and thematic analysis of transcripts was carried out by 2 independent researchers using NVivo. Main findings: Eleven interviews took place between September and November 2016; 4 individuals identified as trans men, 6 as trans women, and 1 as gender nonconforming. Themes identified included perceived physician knowledge of trans identities, patient self-advocacy, discrimination, positive spaces, and expectations of ideal care. The expected role of the family physician for trans patients includes hormone assessment and prescription and referrals for gender-affirming surgeries. Conclusion: The trans community has several physical and mental health needs that are not being met by the current health care system. Family physicians need to be empowered to provide services such as hormone initiation and gender-affirming surgery referrals. Although other specialists might have a role for some patients, most trans people expect care to be delivered by family physicians whenever possible.
... Trans populations experience high rates of physical and sexual violence, discrimination, stigma, poverty, homelessness and unemployment [58][59][60][61][62][63] and substance use may be a means to cope with these stressors [64,65]. ...
... Transgender people experience significant barriers to accessing and engaging in treatment programs [169,170]. Trans individuals may avoid healthcare and/or not disclose their gender to providers out of fear of discrimination, victimization, institutional biases and stigmatized beliefs among service providers [59,169,171,172]. Approximately half of transgender people with a substance use problem report being discouraged from seeking treatment because of expected stigma [169]. ...
Technical Report
Full-text available
There is growing evidence of the effectiveness of trauma, gender, and sex (TGS) informed approaches in all areas of the substance use field, including prevention, education, harm reduction, treatment, policy, and research. Trauma-informed practice (TIP) is an important approach to improving substance use services, programming, policy and health promotion initiatives. Equally important is the integration of sex and gender based evidence into the substance use response system. Ultimately, creating gender transformative approaches to substance use can help to reduce gender and health inequities. This toolkit provides information about these approaches to share in staff training, program planning and evaluation, and to assist in organizational development. It also includes specific tools to support practice and policy change.
Article
Full-text available
Political solidarity is often key to addressing societal injustice. Yet social and political psychology are without a common definition or comprehensive measure of this construct, complicating advancements in this burgeoning field. To address these gaps, we advance a novel understanding and measure of this construct. We conceptualized political solidarity as a construct consisting of three factors—allyship with a minority outgroup, a connection to their cause, and a commitment to working with them to achieve social change—that can emerge within and across social groups. Five studies empirically supported our conceptualization and measure; all participants were Canadian university students. In Study 1, 1,594 participants completed the initial 30-item pool. A series of exploratory factor analyses, along with indices of factor retention, supported the three-factor model. We retained three items per factor to create the 9-item Political Solidarity Measure (PSM). This three-factor model adequately fit Study 2 data (N = 275). In Study 3 (N = 268), we found evidence of the PSM’s convergent and discriminant validity. Studies 3 and 4 assessed the PSM’s retest stability in the medium-term (three to six months; Study 3) and short-term (a three-week period; Study 4; N = 126). Finally, we demonstrate the PSM’s predictive validity in Study 5 (N = 221). Controlling for modern racism, political orientation, and gender, PSM scores predicted collective action intentions and behavior benefitting the outgroup: Participants who reported higher political solidarity donated more to the outgroup’s cause and were more likely to agree to create a message of support.
Article
Full-text available
What do umbrellas have to do with leisure research? Why do they need to be troubled? Throughout the course of this manuscript, we will unpack understandings of umbrella categories – specifically, gendered umbrella categories – and why it is relevant for leisure scholars to consider these categories within their research practices. Following a discussion of the complexity involved in projects of representation, leisure scholars will find a number of guiding principles and questions that highlight the importance of doing research in ways that are simultaneously aware of but also trouble the influence of taken for granted gendered umbrellas within research processes. By thoughtfully considering the way we as leisure researchers engage in research, we can open up space within our research for the legacies that do not fit neatly into binarized identity categorisations – as well as create more opportunities for doing leisure research in increasingly socially just ways.
Article
Full-text available
This article seeks to activate a much-needed discussion about the place of transgender literary production within the field of transCanadian literature, in its multifaceted iterations. The motivation behind it sparks from the imperative to respond, while simultaneously being accountable for the narratives we produce as feminist researchers in a moment of increasing racism, transphobia, and social divisiveness in Canadian literary communities. Departing from this desire, this article turns to Kai Cheng Thom and Vivek Shraya's ethico-poetic storying and worlding through the lens of queer and trans philosophers Donna Haraway, Karen Barad, and Susan Stryker. Thom's Fierce Femmes and Notorious Liars: A Dangerous Trans Girl's Confabulous Memoir (2016) and Shraya's She of the Mountains (2014), I contend , pose a critique of the multiple modes of violence targeting racialized queer and trans communities, while simultaneously situating response-ability as an ethical compass from which to navigate, and not drown, in this global era of indifference. ¿DÓNDE ESTÁ LO TR ANSGÉNERO EN LO TR ANSCANADIENSE? LA RESPONS-HABILIDAD EN LAS FICCIONES DE KAI CHENG THOM Y VIVEK SHR AYA Resumen Este artículo busca activar una necesaria conversación sobre el lugar de la producción literaria transgénero dentro del campo de la literatura transcanadiense, en sus múltiples versiones. Mi motivación surge del imperativo de responder a, y de ser responsable de, las narrativas que producimos como investigadoras feministas en un momento de creciente racismo, transfobia y división social en las comunidades literarias canadienses. Partiendo de este deseo, este artículo se aproxima a la obra ético-poética de Kai Cheng Thom y Vivek Shraya a través de la perspectiva de la filosofía queer y trans de Donna Haraway, Karen Barad, y Susan Stryker. Propongo que las ficciones de Thom y Shraya, como ilustran los libros Fierce Femmes and Notorious Liars: A Dangerous Trans Girl's Confabulous Memoir (2016) y She of the Mountains (2014), plantean una crítica a la violencia contra comunidades racializadas queer y trans, al mismo tiempo que sitúan la respons-habilidad como brújula ética con la que navegar, y no ahogarse, en esta era global de la indiferencia.
Article
This study qualitatively explores the barriers that transgender individuals experience within healthcare settings in rural Ontario. It includes an analysis of how transgender individuals overcome these barriers, as well as the methods by which healthcare interactions can be strengthened to increase their experiences of personal agency. Twelve transgender individuals and three healthcare professionals in rural Ontario participated in open‐ended, semi‐structured interviews, which were analysed using interpretive phenomenological analysis and critical discourse analysis. Together these analyses yielded insights on themes pertaining to the breaching of human rights in healthcare interactions; rural challenges experienced by transgender patients in Ontario; the effects of non‐reciprocal relationships on trans‐patients’ experiences of personal agency, autonomy, and mental health; and factors contributing to their overall resiliency and empowerment. Potential transgender healthcare models and directions for future research are also discussed.
Article
Many nursing education programs deserve a failing grade with respect to supporting gender diversity in their interactions with their students and in terms of the curricular content directed toward engaging in the safe and supportive nursing care of transgender clients. This situation contributes to transinvisibility in the nursing profession and lays a foundation for nursing practice that does not recognize the role that gender identity plays in the health and well-being of trans-clients and trans-nurses. This article seeks to raise readers' awareness about the problems inherent to transinvisibility and to propose several curricular and structural-level interventions that may serve to gradually increase the recognition of gender diversity in the planning and delivery of nursing education and practice. Contextualized in gender and intersectionality theory, cultural safety is presented as a viable and appropriate framework for engaging in these upstream approaches to addressing gender diversity in nursing education and practice. Among the structural interventions proposed are as follows: inclusive information systems, creation of gender neutral and safe spaces, lobbying for inclusion of competencies that address care of trans-persons in accreditation standards and licensure examinations and engaging in nursing research in this area.
Article
Full-text available
Background Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada. Methods 433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via average marginal predictions, for transmasculine (n = 184) and transfeminine (n = 172) trans persons. Results Among the 83.1% (95% CI = 77.4, 88.9) of trans Ontarians who had a family physician, approximately half reported discomfort discussing trans health issues. 37.2% of transmasculine and 38.1% of transfeminine persons reported at least one trans-specific negative experience. In unadjusted analysis, sociodemographics did not predict discomfort, but those who planned to medically transition sex, but had not begun, were more likely to report discomfort (transmasculine: PRR = 2.62 (95% CI = 1.44, 4.77); transfeminine: PRR = 1.85 (95% CI = 1.08, 3.15)). Adjusted for other factors, greater perceived physician knowledge about trans issues was associated with reduced likelihood of discomfort, and previous trans-specific negative experiences with a family physician with increased discomfort. Transfeminine persons who reported three or more types of negative experiences were 2.26 times as likely, and transmasculine persons 1.61 times as likely, to report discomfort. In adjusted analyses, sociodemographic associations differed by gender, with being previously married or having higher education associated with increased risk of discomfort among transfeminine persons, but decreased risk among transmasculine persons. Conclusions Within this transgender population, discomfort in discussing trans health issues with a family physician was common, presenting a barrier to accessing primary care despite having a regular family physician and “universal” health insurance.
Article
Full-text available
Across Europe, Canada, and the United States, 22-43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact. The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks. Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10(th) versus 90(th) percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10(th) percentile. Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
Article
Full-text available
Studies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity. The Trans PULSE Project conducted a multi-mode survey using respondent-driven sampling to recruit 433 trans people in Ontario, Canada. Weighted estimates were calculated for HIV-related risk behaviours, HIV testing and self-reported HIV, including subgroup estimates for gender spectrum and ethno-racial groups. Trans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions - 25% of female-to-male (FTM) and 51% of MTF individuals - had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible. Results suggest potentially higher than baseline levels of HIV; however low testing rates were observed and self-reported prevalences likely underestimate seroprevalence. Explicit inclusion of trans people in epidemiological surveillance statistics would provide much-needed information on incidence and prevalence. Given the wide range of sexual behaviours and partner types reported, HIV prevention programs and materials should not make assumptions regarding types of behaviours trans people do or do not engage in.
Article
Full-text available
For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.
High prevalences of depression have been reported in male-to-female (MTF) transgender communities. We explored factors associated with depressive symptomatology among MTF spectrum trans people in Ontario, using data from the Trans PULSE Project Phase II respondent-driven sampling survey (n = 433 participants, including 191 MTFs with data needed for this analysis). We estimated the prevalence of depression at 61.2%. Factors associated with higher odds of depressive symptomatology included living outside of Toronto, having some college or university (vs. completed), being unemployed, and experiencing higher levels of transphobia. Increasing social support was associated with reduced odds of depressive symptomatology. Multivariable analyses suggested complex relationships between these factors, passing, and childhood abuse, which require additional study.
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.
La suicidabilité parmi les personnes trans en Ontario: Implications en travail social et en justice sociale / / Suicidality among trans people in Ontario: implications for social work and social justice
  • G R Bauer
  • J Pyne
  • M C Francino
  • R Hammond
Bauer GR, Pyne J, Francino MC, Hammond R. La suicidabilité parmi les personnes trans en Ontario: Implications en travail social et en justice sociale / / Suicidality among trans people in Ontario: implications for social work and social justice. Revue Service Social 2013;59(1):35-62. Available at http://www.erudit.org/revue/ss/2013/v59/n1/1017478ar.html?vue=resume 25
Intersecting impacts of transphobia and racism on HIV risk among trans persons of colour in Ontario
  • R L Marcellin
  • G R Bauer
  • A I Scheim
Marcellin RL, Bauer GR, Scheim AI. 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 2013;6(4):97-107. Available at http://www.emeraldinsight.com/doi/full/10.1108/EIHSC-­-09-­-2013-­-0017
Joint effort: prison experiences of Trans PULSE participants and recommendations for change
  • A Scheim
  • M Cherian
  • G Bauer
  • X Zong
Scheim A, Cherian M, Bauer G, Zong X. Joint effort: prison experiences of Trans PULSE participants and recommendations for change. Trans PULSE E-­-Bulletin 2013; 3(3). Available in English and French at http://transpulseproject.ca/research/prison-­experiences-­-of-­-trans-­-pulse-­-participants/
Trans Ontarians' Sex Designations on Federal and Provincial Identity Documents: A Report Prepared for the Canadian Human Rights Commission
  • G Bauer
  • Pulse For The Trans
  • Project
Bauer G, for the Trans PULSE Project. Trans Ontarians' Sex Designations on Federal and Provincial Identity Documents: A Report Prepared for the Canadian Human Rights Commission. 15 November 2012. Available at: http://transpulseproject.ca/wp-­content/uploads/2012/11/Trans-­-PULSE-­-Sex-­-Designations-­-on-­-IDs-­-Report-­-for-­-CHRC-­-2012.pdf