This is the first in a series of posts relaying the reflections of the 13th Philadelphia Trans-Health Conference. The conference was a gathering space for trans and gender nonconforming (GNC) people, families, researchers, activists, health practitioners, and allies.
People were there for many different reasons; ‘We’re here for our son.’, ‘I’m a nurse and didn’t get any training in trans health.’, ‘I came because this is my community.’ While the sense of community and scholarship was strong, there was also an unwavering call for action and social change. I’m offering a distillation of ideas on how to transform the systems we are a part of, undo misconceptions, re-evaluate what we think we know about LGBTQ health disparities, and identify opportunities to re-learn, unlearn, and simply learn.
Shift our language now.
Thinking about changing our language usually leads people to two issues: gender neutral pronouns and intake forms. While changing practices around these are great, gender runs much deeper in our lives and this has real complications for our health. For example, some clinics call “female” condoms “receptive” condoms since not everyone who might use a “female” condom identifies as female. This is a small but important shift in language. In another workshop hosted by the Trevor Project, we discussed other ways to talk to someone who wants to share their identity by framing “coming out” as, “Who would you like to invite in?”, positioning the process more centralized around that person.
Practitioner’s language also plays a crucial role for trans and gender non-conforming (GNC) people seeking care or services. Questions as simple as, “What do you like to go by?” or “Do you have specific names for parts of your body?” (with the intention of the provider using that language) can be a beginning step in building a more comfortable space. There are numerous resources for providers here and here. Another step is to reframe communicating risk based on behavior, not identity. For example, someone doesn’t have an increased vulnerability to HIV simply because they are trans but because of the structural factors (housing instability, work discrimination, etc.) that may give them less choices to make or place them in compromised situations.
Change our information systems and work processes.
Electronic medical records also need to be transformed to accurately and respectfully reflect information. Some institutions and organizations are beginning to change these structures and processes but many more should play close attention to how staff access and use information and prepare for clients. Often times, trans and GNC patients’ files are marked with “special notes” that never get looked at beforehand or the practitioner comes in to the visit without reading the intake form and may miss a crucial piece of information, which often needs to be retold by the client.
We also know medical providers are not the only people we interact with in health care and service settings. The first conversations with front desk staff will often make or break an experience depending on how welcoming and affirming they are. More and more organizations like Affirmations and Callen-Lorde do trainings for clinical and clerical staff, organizations, hospitals, schools, and conferences.
Focus on cultural humility processes.
There has been a push beginning in social work, to move beyond cultural competency training. How can one be truly “competent” in another’s culture? How does a single lecture, training, or workshop make you competent in an entire different experience than your own? Cultural competence trainings alone have been critiqued for a number of these reasons including the finite nature of its structure. In contrast, a cultural humility process has been proposed, or a lifelong commitment to learning and unlearning in the service of being humble, affirming, and respectful of other’s cultures. This was echoed a lot at the conference that even LGBTQ clinics were not using trans- and GNC-affirming practices. Cultural humility processes can take a number of different forms. Trans and GNC health is often tacked onto the very end of LGBTQ trainings, so separate and comprehensive trans- and GNC-specific trainings are often necessary. You can find free, comprehensive materials here.
Changing the way medical staff, social services providers, and teachers are educated is a necessary change. Some ideas that have been proposed and implemented include community-engaged medical education models, emancipatory knowing (as used in nursing practice), and critical-consciousness (Freire’s liberation pedagogy) frameworks.
One on one strategies are necessary but so are larger, structural ones. Organizations and institutions as a whole should adopt cultural humility practices. Organizations like the Task Force and AORTA provide resources and trainings on organizational change processes. Trainings cost time and money, so budgets should reflect the resources needed to fully enact a cultural humility commitment.
Rethink who your program/center/organization/research is for.
The breadth of gender identity is rarely reflected in our language and practices. Often times, the scope of our work does not encompass the diversity in identity and many people may be excluded or don’t identify with the term “transgender.” One of the most illuminating conference sessions was “A Gender Not Listed Here”, a report back on GNC respondents to the 2011 National Transgender Discrimination Survey (NTDS). With 6,450 respondents, the NTDS remains one of the richest sources of research on the oppressions trans and GNC people face. While one of the first questions, “What is your primary gender today?” might seem simple, the answers shine light on the intricacies of constructing and describing gender. When asked to describe the gender that most resonates with them, over 860 (about 13%) people chose to write in their response as opposed to checking one of the given gender categories. Of this, over 500 different descriptions of gender were shared including “questioning”, “gender fabulous”, “birl”, “otherkin”, and “gentleman femme”. This clarifies our need to more deeply reconsider our gender systems, practices of representation and inclusion, and implications for practice.
People who wrote in their gender were generally younger than the full sample, more likely to be multiracial, less likely to be white, have higher educational attainment, and more likely to live in the lowest household income category. An analysis of this data can be found here. While differences in types and amount of discrimination experienced by GNC and trans people were noted, more research is needed to more fully understand the overlapping and divergent needs of these communities. Each day, small steps are taken that ripple into larger, consequential changes. Adjusting our language, cultural humility practices, and improving information systems are just a few shifts in a sea of many more changes that are leading us to a more just future.