Reversing Discrimination in Health Care

March 4, 2013

A survey of 132 medical schools in the United States and Canada, reported in the Journal of the American Medical Association on September 7, 2011, found that schools spend an average of five hours on LGBT issues.

Injustice at Every Turn found that 19 percent of sampled respondents had been refused medical care due to their being transgender or gender non-conforming, with even higher numbers among people of color. Half had to teach their medical providers about transgender care.

Jacsen Callanan, logistical coordinator for the Philadelphia-based Mazzoni Center’s annual Trans Health Conference believes the statistics on poor health-care access for trans people may be understatements.

“Over 12 years ago in Philadelphia, we became aware that there were no behavioral or medical practitioners who were experienced in providing trans-appropriate care,” says Callanan, whose organization also holds annual three-day trainings of up to 125 medical and nursing practitioners.

The center’s 2013 conference is expected to draw 3,000 participants—about 15 percent of them medical professionals. In addition to discussing basic health care for transgender people, the conference covers issues such as health insurance coverage for gender reassignment.

According to Callanan, one doctor from northeast Pennsylvania who attended the conference to learn how to provide better care to one patient is now seen as a regional expert and has more than a dozen transgender patients.

Another step forward for transgender health care was an American Psychiatric Association decision to replace the term “gender identity disorder” with “gender dysphoria” in the the Diagnostic and Statistical Manual, the central reference text for mental health diagnosis.

The fifth edition, to be published in 2013, will consider those who are transgender to have “a marked incongruence between one’s experienced/expressed gender and assigned gender.”

“Even when it moves away from pathologizing gender identity, it reintroduces and reinforces congruence as a normative ideal and maintains trans* people’s psycho-pathologization,” says Mauro Cabral, co-director of Global Action for Trans* Equality (GATE).

In 2011, Cabral, presented a report to the Geneva-based World Health Organization (WHO) calling for the reform of “gender identity disorder” in the International Classification of Diseases, the standard diagnostic tool for clinicians, epidemiologists, and health managers.

Cabral’s report focused on removing pathologizing references to this and other diagnoses involving gender-identity issues, while ensuring access for individuals to appropriate health care.  The WHO’s response is pending.

Also in 2011, Cabral spoke to representatives of Argentina’s parliament in support of the first law of its kind to allow anyone to officially change their name and gender to match their identity, without gender reassignment surgery, hormonal treatments, or a psychiatric diagnosis.

The law passed overwhelmingly in Argentina’s Lower House and decisively in the Senate in May 2012. While a similar law has passed in South Africa, its implementation has been lagging, according to Liesl Theron of Gender DynamiX, a regional organization in South Africa.

Despite gains in some countries around the world, chilling statistics on rates of violence against transgender people highlight the need for greater awareness and stronger protection measures at multiple levels.

More than 20 of 58 countries studied for a 2011 project on transphobic murders had laws that criminalize or lead to prosecution of trans people in some or all situations. The study, by Transgender Europe, also reported 816 killings of trans people in 55 countries between 2008 and 2011.

To combat this extreme violence and discrimination, a growing number of organizations —which GATE has helped to connect—have emerged to fight for trans rights and recognition in Latin America, southern Africa, the Pacific, Asia, Europe, and the United States.

One of these groups, Gender DynamiX, has built partnerships with the Uganda-based Support Initiative for People with Atypical Sex Development (SIPD) and with South Africa–based Trans-Intersex-Africa.

“Even though we’re hearing about more violence toward trans people, that doesn’t mean it didn’t happen before,” says Callanan of the Mazzoni Center. It might not have appeared in the media or identified as trans-specific. Hearing about it is a big flag that we’re moving into a major time of change.”

An August 2012 conference in Charlotte, North Carolina, bringing together trans individuals, particularly in religious communities in the U.S. South, drew 300 participants and featured an address by the mayor of Charlotte and by one of the country’s foremost gender surgeons.

“There’s a lot of work ahead both internationally and in the United States, both within the LGB community and among wider populations,” says Levasseur of Lambda Legal. “The future of trans rights work lies in our visibility. For some people, visibility means risking their life. That’s a personal decision.”

Levasseur adds that, whether individuals are standing before a judge or marching in the Trans Day of Action, visibility is the key to moving the public from ignorance to understanding: “Once people realize that [they] know someone who is transgender, it changes everything.”