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

Abstract

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.

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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!
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Ayden&I.&Scheim,&PhD&candidate&
Vanier!Scholar,!Trudeau!Scholar!
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Epidemiology!&!Biostatistics!
Schulich!School!of!Medicine!&!Dentistry!
The!University!of!Western!Ontario!
London,!Ontario,!Canada!

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17!October!2014!
Updated!1!June!2015!
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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 .!!
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Trans!PULSE!was!funded!by:!
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Purpose of this Report
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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,
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!and!are!heavily!cited!in!the!Ontario!
Human! Rights! Commission’s! 2014! policy! on! gender! identit y! and! discrim i n a tio n,
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!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
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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.!
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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).!
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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!driver’s!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,
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!and!a!successful!Ontario!Human!Rights!case!regarding!sex!designation!change.
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!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.%%.+$.!15!November!2012.!Available!at:!http://transpulseproject.ca/wp\
content/uploads/2012/11/Trans\PULSE\ Sex\Designations\on\IDs\Report\for\CHRC\2012.pdf!!
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!Ontario!Human!Rights!Commission.!*+-.5=)+$)*"'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!!
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!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!!
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!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!!!

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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?
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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.
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!They!
belong!to!all!ethno\racial!groups,!and!7%!iden tify!as!
Aboriginal.
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!Of!course,!trans!people!also!form!families:!
44%!are!in!a!committed!relationship
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!and!24%!are!
parents.
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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 .
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!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.
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!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 .
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!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 .
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!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
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!or!other!cultural!groups).!!
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!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!
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!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<)#$()4+5.#-)2#"'!2013;6(4):108–120.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\08\2013\0010!
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!Bauer!G,!Boyce!M,!Coleman!T,!et!al.!Who!are!trans!people!in!Ontario?!!"#$%)*JK4F)*"+L'50)FMG:--'0.$!2010;!1(1).!Available!in!
English!and!French!at!http://transpulseproject.ca/research/who\are\trans\people\in\ontario/!
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!Pyne!J,!Bauer!GR,!Bradley!K.!Transphobia!and!other!stressors!impacting!trans!parents!in!Ontario,!Canada.!N+:"$#-)+7)EKG!)
A#8.-=)40:(.'%!2015;11(2):107\126.!Available!at!http://www.tandfonline.com/doi/abs/10.1080/1550428X.2014.941127!!
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!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+:"$#-)
+7)4'?);'%'#"5<!2015:52(1):1\14.!Available!at!http://www.tandfonline.com/doi/full/10.1080/00224499.2014.893553!!
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!Coleman!T,!Bauer!G,!Scanlon!K,!et!al.!Challenging!the!binary:!gender!characteristics!of!trans!Ontarians.!!"#$%)*JK4F)*"+L'50)FM
G:--'0.$!2011;!2(2).!Available!in!English!and!French!at!http://transpulseproject.ca/research/gender\characteristics\of\trans\
ontarians/!

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Discrimination and Violence Experienced by Trans Persons
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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”.
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!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.!
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Employment barriers and discrimination
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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).
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!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.!!
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Discrimination in
medical care
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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.
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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!
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!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<)#$()4+5.#-)2#"')2013;6(4):97–107.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\09\2013\0017!
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!Bauer!G,!Nussbaum!N,!Travers!R,!et!al.!We’ve!got!work!to!do:!workplace!discrimination!and!employment!challenges!for!trans!
people!in!Ontario.!!"#$%)*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/!

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experiences!included!refusal!of!c are!or!refusal!to!examine!specific!body!parts,!being!ridiculed,!an d!the!u se!of!
demeaning!language.
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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)
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Violence
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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.
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!Many!did!not!
report!these!assa ults!to!th e!police;!in!fact,!24%!reported!having!been!harassed!by!police.
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!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).
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!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.!!
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Identity documents
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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.
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!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.!
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!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 : "%'%).$)C 6@4 )2# "' !2009;20(5):348–361.!Available!at!
http://www.nursesinaidscarejournal.org/article/S1055\3290(09)00107\1/abstract!!!!
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!Bauer!GR,!Pyne!J,!Francino!MC,!Hammond!R.!La!suicidabilité!parmi!les!personn es !tra ns !en !O n ta rio :!Im p lic at ion s !en !tra va il!
social!et!en!justice!sociale!/!Suicidality!among!trans!people!in!Ontario:!implications!for!social!work!and!social!justice.!;'B:')
4'"B.5')4+5.#-!2013;59(1):35–62.!Available!at!http://www.erudit.org/revue/ss/2013/v59/n1/1017478ar.html?vue=resume!
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!Marcellin!RL,!Bauer!GR,!Scheim!AI.!Intersecting!impacts!of!transphobia!and!racism!on!HIV!risk!among!trans!persons!of!colour!
in!Ontario,!Can a d a.!F0<$.5.0=)#$()6$'I:#-.0.'%).$)9'#-0<)#$()4+5.#-)2#"')2013;6(4):97–107.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\09\2013\0017!
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!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/!
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!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!

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Impacts of Discrimination and Violence on Social Participation and Health
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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.
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Avoidance of public spaces and exclusion from communities
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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<)#$()4+5.#-)2#"')2013;6(4):97–107.!Available!at!
http://www.emeraldinsight.com/doi/full/10.1108/EIHSC\09\2013\0017!
20
!Scheim!A,!Bauer!G,!Pyne!J.!Avoidance!of!public!spaces!by!trans!Ontarians:!the!impact!of!transphobia!on!daily!life.!!"#$%)*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'$0#-)9'#-0<!2011;30:113–133.!Available!at!!http://cjcmh.metapress.com/link.asp?id=41351l3l486671x4!
Rotondi!NK,!Bauer!GR,!Scanlon!K,!et!al.!Prevalence!of!and!risk!and!protective!factors!for!depression!in!female\to\male!
transgender!Ontarian s.!2#$#(.#$)N+:"$#-)+7)2+88:$.0=)H'$0#-)9'#-0<!2011;30:135–155.!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):35–62.!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.!
!