Some reflections on Trans Health Matters 2017

Last week I joined over a hundred other attendees at the Trans Health Matters conference in London. The event (which takes place on a mostly annual basis) was organised by cliniQ, the city’s holistic trans sexual health clinic.

For impressions of the day, you can visit the Twitter hashtag for the event here.

When I attended the first cliniQ Trans Health Matters conference in 2013, I found it to be immensely valuable and informative, but left with a feeling of deep-seated distress that persisted pretty much ever since. For at that event, I gained a better understanding of the scale of the problems that plague trans healthcare provision.

These include widespread ignorance and often also active discrimination from practitioners, plus enormous (and growing) waiting lists for gender clinics. All things I already knew about, but swapping notes with other researchers and activists helped me realise just how common and severe the issues were. My impressions from the conference were also reflected in the initial findings from my PhD fieldwork, which I was undertaking at the time.

By contrast, I left this year’s event with a greater sense of optimism and hope.

That’s not to say that trans health isn’t still a disaster area. It really is. However, I feel that since 2013, there has been a real growth in community health initiatives, and also in cis practitioners’ active engagement in the issues. This was actively reflected in the conference programme, which focused largely on what is being done and what we can do to make things better.


What is “trans health”?

Interestingly, another positive aspect of the conference for me was that gender clinics and transition processes were barely discussed at Trans Health Matters 2017.

That isn’t to say that these aren’t important things to talk about – they absolutely are – but one of my observations over the last few years has been that discussions of “trans health” focus so overwhelmingly on gender identity services that an outside observer would be forgiven for thinking that transition is the only healthcare issue that really exists for trans people.

Which, of course, would be completely wrong. Trans people face extremely high rates of discrimination, harassment, internalised stigma, poverty, physical violence and domestic abuse. These challenges can be be linked to endemic mental health problems, suicidality, substance abuse, “risky” sexual practices and disability within trans populations. Moreover, there is the matter of everyday transphobia and cisgenderism in everyday encounters with healthcare practitioners.

So it was genuinely refreshing to attend a trans health conference that focused largely on sexual health (particularly HIV prevention, reflecting cliniQ’s role as a sexual health clinic), with some additional discussion of matters such as therapy, sex work, data collection, and intersectionality. These are all deeply important issues that really deserve the attention they received on the day.

Of course, the absence of discussion on gender identity services would be a real issue if these conversations weren’t already happening elsewhere. But they are. This year alone, I’ve attended two UK trans health conferences which centred issues of transition, and I know there have been plenty of other such events that I haven’t been able to go to. This is another cause for optimism: a great increase in activist, academic and professional events looking at trans health from a range of angles, reflecting the rapid growth and increasing visibility of our communities.


Towards inclusive care

While there are a growing number of trans-specific sexual health services available in UK cities, it was really good to see a lot of discussion around how trans people can be included in services (and the promotion of these services) more generally. A great example of this was a short film that’s been made about PrEP, from which extracts were shown at the conference.

I was also really heartened to see that Trans Health Matters was a somewhat more intersectional affair this year. Two of the four speakers on the keynote panel were trans women of colour. We got to hear a particularly inspiring speech from Mexican/US activist Alexandra Rodríguez, who explained how she created a pioneering HIV prevention service for trans Latinas in California after realising there were no existing services, and reflected on the importance of providing care and support for trans migrants.

I also attended an afternoon session on barriers to access and strategies for inclusion for some of the most vulnerable trans populations in the UK: black and minority ethnic trans people, non-British trans people, and economically marginalised trans people (these are, of course, groups that frequently intersect!)

Barriers to healthcare access for BAME and/or non-British trans people.
Photos taken with permission during breakout session.

One of the most important lessons from this session was the importance of reaching out for service providers, rather than expecting that the most marginalised people will feel that a service is necessarily for them. This is particularly the case if a service is normally primarily attended by and promoted to a relatively privileged demographic.

The work of reaching out may involve an element of discomfort for white and/or middle class providers; it can involve sensitively negotiating access to new spaces (e.g. club nights and community groups run by and for people of colour and/or working class people), learning from mistakes and being open to listen and learn with humility. But it is vital to ensure that community services are truly inclusive.


Reproductive health survey

The importance of the work of inclusion really came to the fore in a plenary session where we were shown initial findings from a trans reproductive health survey undertaken by Public Health England.

The survey is still open: you can take it here.

This is the first major stastical study looking at trans people’s reproductive health and experience of services in the UK. As the survey hasn’t yet closed and the data still requires some additional processing, we were asked not to report on specific figures. However, what I can say is that (unsurprisingly) there were generally high levels of dissatisfaction with existing service providers and sexual health education, reflecting an urgent need for improvement and trans inclusion.

The aspect of the survey that inspired the most discussion and debate amongst conference attendees, however, was the lack of diversity among existing survey respondents. A majority of respondents had received a university education, and an overwhelming number were white. This reflects a wider trend in trans community responses to online surveys: it is the most privileged individuals who are more likely have access to these.

I asked the speaker if there had been a paper version of the survey produced: these can help obtain a greater number of responses from individuals less likely to access an Internet survey, including trans people of colour, working class trans people, and older trans people. He noted that unfortunately the research team (which I believe consists just of himself and a single support worker) are underfunded and are trying to do their best with the resources they have. However, other audience members noted that there were still things that could have been done to increase the response rate from underrepresented groups. For instance, the research team could have reached out to UK Black Pride and asked for help with dissemination.

To me, this conversation really brings home the importance of active inclusion, which was the main thing I have been thinking about since attending Trans Health Matters. We can’t just assume that all members of our communities will be able to access services and research: rather, we need to make the effort to ensure that they are accessible. This can involve additional work, but the real challenge is overcoming the ignorance that can arise from our own privilege, even if we are ourselves marginalised in different ways.

Of conduct and controversy: trans health activism at EPATH

Here in the UK, health is a key priority for many trans activists. While progress is sometimes painfully slow, numerous debates, protests and consultations have informed gradual change within a range of healthcare settings, and a growing number of health professionals are prepared to actively support trans peoples’ access to affirmative care. However, discussion of trans healthcare in the UK has remained focused largely on the specifics of the UK context, even as important events that influence gender identity services in particular are increasingly taking place on the world stage.

In this post, I look at recent activism at “PATH” (Professional Association for Transgender Health) conferences in Amsterdam and Los Angeles, as background to unfolding events at this week’s EPATH conference in Belgrade.


WPATH Symposium 2016

Last year I wrote briefly about international activism taking place at the World Professional Association for Transgender Health (WPATH) symposium in Amsterdam, the Netherlands. This included two unofficial fringe events: a Global Action for Trans* Equality (GATE) pre-conference, organised primarily by trans activists from the Global South, and the FreePATHH event, run by Dutch trans people living locally who couldn’t afford to attend the expensive WPATH event.

I myself experienced the WPATH symposium as exhausting, inspiring and frustrating. A myriad of positions on trans health care represented amongst the researchers, practitioners and activists present at the event, which is as it should be at any good conference. However, amongst the thought-provoking and challenging interventions, and numerous examples of progressive approaches and good practice, I also found myself overwhelmed by microaggressions from cis attendees, and thrown by the cognitive dissonance of experiences such as emerging from a session on trans-affirmative care only to find myself attempting to retain a professional demeanour whilst walking past individuas such as Kenneth Zucker. Zucker has been accused of subjecting gender questioning children to reparative therapy, and will also be known to UK readers for his participation in a recent BBC documentary (“Transgender Kids: Who Knows Best?”), to which Trans Media Watch responded with an extensively researched letter of complaint.

It was in this context that numerous interventions – both formal and informal – were organised by trans attendees at WPATH. GATE held sessions on depathologisation for trans and intersex people. FreePATHH created a range of notes with “free advice for better transgender care”, which were distributed in a social area for conference attendees to read. Someone gender-neutralised the (binary gendered) toilets with holographic signs. I also heard informally about South African trans women confronting a racist presenter on a panel.

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In this way, the WPATH symposium felt like a sometimes discouraging, sometimes productive site for real debate and contestation, both professional and political. My impression was that the the interventions that took place there would probably have a gradual impact on how trans health is understand and practised in the years of come, particularly following the creation of TPATH, a group for trans people working in trans health.  What I didn’t realise was the extent to which events would accelerate in the coming months.


USPATH Conference 2017

In February the first USPATH (United States Professional Association for Transgender Health) conference took place in Los Angeles, USA. At this event, tensions over the place of pathologising forms of care in general – and Kenneth Zucker’s ideas and practices in particular – came to a head.

In a Twitter thread written during the event, health researcher Zoé Samudzi describes how a number of academics and health practitioners, led by trans women of colour, spoke out against the inclusion of Zucker on the conference programme. One session (the first of two at which Zucker was due to speak) was briefly interrupted by an impromptu speech and later quietly picketed, after which hotel security threatened to call the police on a number of attendees.

The next day, community representatives – again led by trans women of colour – met with USPATH and WPATH organisers to read a list of demands. In the wake of this intervention, Zucker’s second talk was cancelled, and a formal apology for the initial heavy-handed response to protesters was posted to the WPATH website. This post, which also promised action to better involve trans communities in general and trans people of colour in particular in the work of WPATH, was removed from the website just two weeks later.


EPATH Conference 2017

Today (6th April) the EPATH (European Professional Association for Transgender Health) conference will begin in Belgrade, Serbia. This event is likely to be a somewhat more conservative affair than the USPATH conference due to disciplinary differences between trans health practitioners in the US and Europe: however, like the WPATH symposium, the conference programme incorporates a wide range of perspectives.

There will once again be an associated FreePATHH event on Saturday 8th/Sunday 9th, which is being organised by Serbian trans activists in collaboration with some of the Dutch individuals behind last year’s FreePATHH. It will include free talks and panels on trans and intersex issues in the former Yugoslav region, as well as arts performances and a football match. At the EPATH conference itself, TPATH will have a presence, seeking to bring together trans people working in the field.

One point of potential contention at EPATH is a code of conduct which has been drawn up for the event. In many ways, this document reflects standard conference etiquette, through (for instance) condemning individual harassment of attendees. However, there are also a number of points that appear to have been written specifically in response to recent events.

We expect all conference participants to be respectful in person and online towards other delegates, speakers, organisers, staff and volunteers.

We are committed to providing a harassment-free conference and training experience for everyone, regardless of gender, gender identity and expression, sexual orientation, disability, physical appearance, body size, race, or religion.  Harassment of participants, speakers, staff or volunteers in any form will not be tolerated.

 Harassment includes offensive verbal comments, and other forms of using disrespectful and pathologising language inconsistent with human rights standards, deliberate intimidation, stalking, following, harassing, photography or recording without explicit consent, sustained disruption of talks or other events, inappropriate physical contact, and unwelcome sexual attention. Conference participants asked to stop any harassing behaviour are expected to comply immediately.

Upon reading the code of conduct, I was immediately reminded of accounts written by trans woman who have accused controversial practitioners of inappropriately photographing them at past events. This is particularly interesting given that he’s been confirmed to speak at the conference. The reference to “pathologising language” also appears to be a nod to some of the practices at previous conferences that have distressed trans attendees.

However, the question remains about what counts as “offensive verbal comments”, “sustained disruption of talks or events”, or “recording without consent”. If a similarly filmed disruptive event occurs at EPATH as took place at USPATH, it could conceivably be framed as “harassing behaviour” within the context of the of the code of conduct, leading to protesters being ejected from the event. This is concerning because the participation of controversial clinicians such as Zucker is typically defended on the grounds of enabling “free speech” within the context of the conference: however, on these grounds, we might expect that conference attendees wishing to peaceably protest or strongly critique bad science might also be afforded freedom of speech.

I won’t be attending EPATH myself this year; like the FreePATH attendees, I simply can’t afford the expensive conference fees. However, I will be following events with great interest, and encourage other non-attendees with a personal or professional interest in trans health and/or trans activism to do the same.

Putting the “T” into Stonewall? An important opportunity

LGB rights charity Stonewall has a difficult history of engagement with trans issues. For 25 years the charity has been a powerful voice in the struggle for LGB equality, but ‘trans’ is not included in its remit within England and Wales. Stonewall has been criticised on one hand for this omission at a time when a majority of ‘LGB’ organisations have become ‘LGBT’, and accused on the other of undue interference in trans matters.

After years of misunderstandings and disagreement, Stonewall announced in June that it would be addressing these problems:

“At Stonewall we’re determined to do more to support trans communities (including those who identify as LGB) to help eradicate prejudice and achieve equality. There are lots of different views about the role Stonewall should play in achieving that. We’re holding roundtable meetings and having lots of conversations. Throughout this process we will be guided by trans people.”

I have been invited to a closed meeting that will take place as part of this process at the end of August.

I really welcome the proposal from Stonewall. In this post I’m going to explore why this dialogue is important, outline some of the proposed approaches to working with Stonewall (or not), and outline my priorities in discussing this issue with both Stonewall and other trans activists.

I also encourage readers to leave their own thoughts and feedback in the comments.


The current situation for trans people in England and Wales

I don’t feel it is an exaggeration to describe the current social and political climate as an emergency. Whilst it is true that trans people in the UK currently benefit from unprecedented civil rights, and there is talk of a “transgender tipping point” in terms of public discourse in the English-speaking world, many trans people still face very serious challenges in everyday life.

For instance, trans people are still likely to face discrimination, harassment and abuse in accessing medical services, as demonstrated in horrific detail by #transdocfail. Trans people are particularly likely to suffer from mental health problems, and this is often made worse by members of the medical profession.

For many years now there has been an exponential rise in the number of trans people accessing transition-related services; with cuts and freezes to healthcare spending from 2010, this has meant that many individuals now have to wait years for an initial appointment at at gender clinic. This problem has been compounded for trans women seeking genital surgery by the additional backlogs accompanying the recent resignation of surgeon James Bellringer.

Meanwhile, the impact of the Coalition government’s austerity agenda is being felt particularly keenly by less privileged trans people. With many continuing to face aforementioned mental health problem and discrimination from employers, benefit cuts and the increasing precariousness of employment and public demonisation of the unemployed are hitting hard amongst my contacts (some discussion of this in a wider LGBT context can be found here). Cuts to public services are also felt strongly by groups such as the disproportionate number of trans people who face domestic abuse.

Then there’s what we don’t know. For instance, research in the United States shows that young trans people are particularly likely to be homeless, and that trans women are considerably more liable to contract HIV than the general population. Both anecdotal evidence and extrapolation from international statistics and small local studies pointing to similar problems existing in the UK, but this is not enough evidence to properly address these serious issues.


Activism

I believe that trans people need a campaigning organisation that is up to the task of tackling the above problems. A campaigning organisation with the funding, resources and knowledge to lobby government, conduct research and push for social change.

Currently we rely on the energies of unpaid activists and ad-hoc organisations that are lucky to attract any kind of funding. The importance and achievements of organisations such as Press For Change and Trans Media Watch should not be underestimated, but this is not enough. Whilst Stonewall attracts millions of pounds in funding and wields an impressive range of resources, trans groups staffed largely by enthusiastic volunteers are lucky to land a few hundred pounds in donations, or a temporary project grant. You can probably count the number of trans activists employed to push for change in this country on your fingers.

Under such circumstances, stress and burnout are common amongst trans activists, even expected. Personality clashes are capable of sinking an organisation. The individuals most able to work long hours for free are typically the most privileged, meaning that there is poor representation in terms of race, disability and class.

We have to do better. We need to do better.


Solution 1: a new trans organisation

There will be those who wish to pursue the creation of a new trans organisation entirely separate from Stonewall. From this perspective, a dialogue with Stonewall offers the opportunity to discuss instances where the charity might have overstepped the mark in speaking out in relation to trans issues without this being within their remit. Beyond that, there will probably be a desire to ‘go it alone’.

For some, this will be because of Stonewall’s non-democratic structure (it is not intended to be a membership organisation), corporate links, and past disappointments such as the organisation’s initial refusal to campaign for same-sex marriage.

For others, this will be because of the view that the ‘T’ should remain independent of ‘LGB’. This position can be based upon the argument that the interests and needs of trans people differ to those of lesbian, gay and bisexual people, and/or a recognition that the trans liberation project is significantly less advanced than the LGB equivalent. From this also comes the idea that cis gay activists might not be able to properly campaign on trans issues.

There have been numerous attempts to create such an organisation over the last decade (one of which I was involved in, through Gender Spectrum UK) but none have been successful. I propose that one of the most serious barriers here is that of funding: there is so much work to be done and so many problems that individual activists are likely to face in their personal lives, that it has been extremely difficult for unpaid activists to put in the work necessary to launch such a body.

 

Solution 2: adding the ‘T’ to Stonewall

It has long been suggested that Stonewall should follow other LGBT organisations in becoming trans-inclusive. The arguments frequently centre upon an appeal to history, and the similarities of LGBT experiences.

The Pride movement emerged out of alliances forged between sexual minorities and gender variant people; this happened in part because homophobic and transphobic attitudes tend to stem from the same bigotry. Trans people have always been present in the struggle for gay and bisexual rights. Pretty much all LGBT people can talk about ‘coming out’, usually to family as well as friends, peers and/or colleagues. LGBT people often have to tackle internalised shame at some point in their lives, an inevitable outcome of growing up in a homophobic/transphobic world.

Moreover, with a great deal of organisations turning to Stonewall for LGBT equality advice and training, it has been argued that it only makes sense to explicitly incorporate trans issues, lest trans people get left behind. For instance, Stonewall does a lot of work on homophobic bullying in schools – surely it would make sense to also address transphobic bullying, particularly as the two tend to have a similar root cause?


Solution 3: a hybrid organisation

An idea I’ve heard bounced around a little ahead of August’s meeting is a kind of compromise between the two above positions. A trans charity that is linked to Stonewall in terms of sharing resources, information and funding, but remains semi-autonomous with its own leadership and trustees.

This is currently my favoured option. I feel that trans people would benefit greatly from effectively sharing some of Stonewall’s power. We’d certainly benefit from working more consistently together, instead of occasionally against one another. But we have different needs, different priorities. We might want to run our own organisation in a different way, and make somewhat different political decisions.


My priorities
in the dialogue with Stonewall

1) Representation

I was actually a little bit uncomfortable to be invited to the meeting in August. Sure, I’ve been involved in plenty of both high-profile, national campaigns, as well bits of activism in my local area and place of work. Plus, a lot of people read this blog. But ultimately, I received an invitation because I have the right connections. So many didn’t get that chance. I also strongly suspect that the majority of people present at the meeting will be white and middle-class, and that there will not be many genderqueer people present (I’m less sure about disability, because there are a lot of disabled trans people).

I’m hoping that any future meetings will be more open. If it turns out that my suspicions are correct regarding the overrepresentation of privileged groups, I hope that we can take steps to ensure that any future meetings are more representative. It’s the only way we’re going to find a way to create consensus and work on the behalf of all trans people in the long term.

If you’re not going to be at the meeting, I strongly encourage you to respond to Stonewall’s survey so your voice is heard. Also, since I’ll be there in person, I’d really like to know what you think.

2) The creation of a new trans organisation

I’ve pretty much made the argument for this already. We need national representation that can genuinely address the many problems faced by trans people today. A democratically accountable body that reflects diversity of trans lives and experiences.

I hope this is something we can work towards by working with Stonewall. Yes, there will be political differences – certainly I have ideological objections to some of the approaches taken by Stonewall – but I feel the situation is too severe and the opportunity too important to reject an offer of help.

That isn’t to say that a new organisation should overrule the work of existing organisations. I would hope that any new body works alongside existing campaign groups such as Trans Media Watch, Gendered Intelligence and Action For Trans Health without seeking to duplicate their work.

3) Starting with the essentials

I believe that the initial basis for any new trans organisation – or trans campaigns within Stonewall – should be addressing the absolute, basic needs that are not currently being met for many trans people. Housing. Health. Employment. We should be looking out for the most vulnerable, as well as addressing universal needs. This is pretty much a moral duty.

 

What do you think? Please share your thoughts and ideas in the comments!

 

This space left unintentionally blank

It’s been quite a while since I last updated!

That’s not to say that it’s been quiet in the world of trans politics – quite the opposite, in fact. In the UK alone we’ve seen #transdocfail, the furore over cissexism/transphobia from Suzanne Moore and Julie Burchill, the tragic death of Lucy Meadows, the publication of various interesting reports and the creation of various worthy campaigns…in the last few months we’ve seen pain, misery and hope.

I’d like to be writing about all of this. But, as always, the update schedule on this blog is less about what I necessarily think is interesting/important, and more about what I have the time and/or motivation to write about. In recent months I’ve been very busy, and I think I’m likely to remain busy for some time to come.

Much of my energy has been focussed on my PhD research, which looks at discourses of trans health. You can read about there here.

I’ve also been busy with playing music in bands (particularly Not Right) and organising academic events (including Spotlight on: Genderqueer and the Emergence of Trans seminar series).

I suspect there will be a time when I update this blog more regularly once again. Until then, feel free to keep checking back – I’ll be here occasionally!

Scottish Transgender Alliance seek trans and intersex artists

Cross-posted because art is cool.

Please forward to Trans* and Intersex Artists and their Allies

Are you interested in potentially submitting work (e.g. short films, visual art or pieces of writing), or performing in trans*, queer and LGBTI+ multimedia arts events in Scotland?

Scottish Transgender Alliance (http://www.scottishtrans.org) and Zorras (http://www.blissfultimes.ca/cachin.htm) are working together to create a new online resource to help event organisers link up with trans* and intersex artists and their allies.

You can be resident anywhere, as long as you are interested in receiving enquiries and invites from people and organisations who are creating trans*, queer and LGBTI+ events in Scotland (and potentially also other countries across Europe).

If you wish your information to be considered for inclusion this resource, please provide the following information in the body of an email to zorras [at] blissfultimes.ca with the subject line TRANS ONLINE RESOURCE:

1. Please tell us what kind of artist you are (list as many titles as you like). Examples: visual artist, musician, performer, dancer, writer, composer, choreographer, filmmaker, painter, photographer, punk band, other. You can also be more specific if you like (e.g. drummer/singer).

2. Where are you based?

3. Please submit a maximum 200-word artist’s bio.

4. Please submit up to 200 words highlighting any ways in which your work explores or relates to trans*, intersex, feminist, queer or intersectional equality and diversity themes.

5. Please submit a recording, photo sample, published article, or video link that best represents your work. Do not send files for this; only send links.

6. Please submit up to two additional website links (e.g. website, Facebook page).

7. Please submit a 300dpi photo that’s no larger than 8cm wide or tall. Please tell us the photographer’s name.

8. Please list the contact info you would like to make available to the public. (e.g. your phone number, email address).

NB Not all submissions are guaranteed inclusion in the online resource, depending on the relevance of your work to trans and intersex issues.

* Here we are using the term trans* in its widest and most diverse sense. We intend it to also include all those who identify as any of the following: transsexual, transgender, transvestite, cross-dresser, bi-gender, third-gender, gender variant, non-binary, genderqueer, gender nonconforming, two-spirit, androgyne and/or non-gendered.

 

This isn’t about us

Today is Transgender Day of Remembrance.

This day isn’t about our pain

This day isn’t about our struggle

This is for the dead.

It’s very easy for Transgender Day of Remembrance to become about the challenges trans people face in everyday life: fears of violence, abuse, harassment.

But we are the living, and we have a voice – however quiet – every day of the year.

This is for the dead. They have no voice.

If we don’t acknowledge their passing, it may be that no-one will. If we don’t offer respect, it may be that no-one will.

And so today is for the dead. We acknowledge their passing and offer them respect. Their lives will have had a depth and meaning that their killers could not possibly comprehend. We mourn these lives, and do not forget.

Trans Media Watch European Conference

Trans Media Watch are running a conference in London on Saturday 27th October.

They say:

This event is designed to give members of the trans and intersex communities the chance to find out more about how the media works in the UK and abroad.

Panels and discussions will run from 10am to 4pm, with guests from the world of journalism and broadcast media, including Jane Fae, Evan Harris and David Allen Green, there to discuss how their industries work and how they might better serve trans and intersex people. There will be opportunities for you to air your views and to network. This is a chance to make your voice heard and help shape the future of the UK media.

In addition, guests from Germany, Ireland, Italy and Switzerland will be there to talk about how the media treats trans and intersex people in their countries. We hope that this will be a useful learning opportunity for everyone involved.

More information can be found here.