2. Goal:
• To leave participants better aware of how to be trans inclusive by
increasing participants’ understanding of terms, definitions, and
issues impacting the transgendered/transsexual community.
Objectives:
• To learn new language inclusive of trans clients.
• To understand the social determinants of health for trans clients.
• To explore ways of supporting choices amongst trans clients that
minimize risks and reduce transmission of HIV .
• To develop strategies for reducing barriers for trans clients who
wish to access services.
3. Introductions
Definitions Game
Issues affecting Trans Folks
HIV and Trans Folks
Social Determinants of Health
The Process of Transitioning
Q & A
4. Name
Agency
Have you ever had a trans training before?
What are you hoping to get out of today?
5. Purpose:
To build a safe, respectful, and supportive learning environment for the
workshop.
Some of you have chosen to be here, while some of you have been
mandated to be here by your work.
We value diversity and learn from comparing and contrasting experiences.
Some participants may have a personal connection to the issues we will be
discussing and we should acknowledge this.
Everyone participates in their own way.
Risk taking and self-disclosure is encouraged and supported.
Everyone has the right to pass.
All voices are heard.
Use “I” statements.
Everyone uses their own strengths and resources.
One person speaks at a time.
Confidentiality is maintained but not guaranteed. (context of coworkers and
people you know outside of work)
Learning is a process. Open yourself to the possibilities.
Step Up, Step Back
6. Divide into teams
Remember that identities are personal
7.
8. Realizing you are trans
Sudden vs Process
Fluidity of Gender
Question gender the same you might question sexuality
For some gender can change over time, same as sexuality
Gender Binary System
Some are for it, some are against it
Some transition along gender binary, some like to
complicate
Don’t assume sexuality of a trans person
9.
10.
11.
12.
13.
14.
15. Pronouns
◦ Female to Male (FTM)/ Trans Man
Male to Female (MTF)/ Trans Woman
◦ Gender Neutral
They
Ze, Hir
◦ Ask what pronoun to use if you’re not sure
Respectful ways and not so respectful ways
◦ Changing pronouns can be challenging
◦ Dangers of using the wrong pronoun or name
Passing
◦ The importance of passing
◦ Choose when to “crossdress” (“real life test”)
16. As a medical practitioner be mindful of the
language you use to talk about people’s “bits and
pieces”
Some folks may be uncomfortable with descriptors
like “vagina” or “penis”
Ask what language they would like to use or use
gender neutral language like “genitals”
17. Bathrooms/Change Rooms
◦ Most bathrooms are gendered for men and women
◦ Trans and genderqueer folks may not feel safe using a
restroom, a basic human right
◦ Importance of unisex restrooms
◦ No need to gender single stall bathrooms
◦ Ontario Human Rights Code states that we should have
access to washrooms and change rooms in our lived
gender
Quick Tip: assume the person in the bathroom
knows which bathroom they feel the safest in
18.
19.
20. Outting
◦ Don’t out people as trans
LGB + T organizations and groups
◦ It’s more than just an acronym
21. Institutional
◦ LGB + T
◦ Gender Identity Disorder (some for being in the DSM,
some against)
Now categorized as Gender Dissassociative Disorder in
latest DSM
Interpersonal
◦ Blatant
“it”
◦ Subtle
“real man” or “real woman”
22.
23. What questions do you think are inappropriate to
ask?
Why do we want to know?
26. Can help in understanding the degree of HIV
transmission risk with certain behaviours:
High Risk:
Unprotected
vaginal or anal
intercourse;
Sharing
injection
Low Risk: equipment
Intercourse with
a condom; Oral
sex without a
condom;
Negligible Risk: Sharing
No Risk: Oral sex with a snorting/
Kissing; condom smoking
masturbation equipment
28
27. Our understanding of what makes and keeps people
healthy continues to evolve and be further refined.
A population health approach reflects the evidence that
factors outside the health care system or sector
significantly affect health.
It considers the entire range of individual and collective
factors and conditions - and their interactions - that have
been shown to be correlated with health status.
These are complex and inter-related.
Commonly referred to as the “Determinants of Health”,
these factors currently include…
29
28. Income and Social Status
Social Support Networks
Education
Employment/Working Conditions
Social Environments
Physical Environments
Personal Health Practices and Coping Skills
Healthy Child Development
Biology and Genetic Endowment
Health Services
Gender
Culture
30
29. Influences affecting
self worth/esteem:
Grief Loss Risk Behaviours:
Bereavement • Alcohol/Drug
Depression
Use
Social Exclusion Acquisition
Stigma
• Unprotected Sex
or
Discrimination • Presence of STI Transmission
Homophobia • Multiple and of HIV or STI
Transphobia Anonymous
Racism Partnering
Loss of Hope
31
30. Trans folks face social exclusion and
marginalization due to society’s hostility towards
people who don’t conform to the gender binary
categorizations
Trans folks choose medical and non-medical ways
to change their bodies or physical appearance to
make them fit more closely with their gender
identity
Trans folks identify with a range of sexual
orientations and engage in an array of sexual
behaviours with people of varying genders
31. Individual Factors:
◦ Mental health issues and impact of psycho-social stresses
including suicidal thoughts and anxiety and depression
◦ Misperceptions or a low perceived risk of HIV
◦ Low self-esteem, internalized stigma and shame
◦ Fear of rejection by prospective sexual partners and perceived
shortage of sexual partners
◦ Seeking self-affirmation and validation of gender identity
through sex with desired partners
◦ Experience of “gender dysphoria” and lack of language around
personal body parts
◦ Physiological and/or sex-drive changes associated with
hormone use and surgeries
32. Interpersonal factors:
◦ Physical and sexual abuse and violence at home
◦ Complicated gender and power dynamics in relationships
◦ Difficulties associated with disclosure of trans identity to, and
discussing their bodies and sex with, prospective sexual
partners, including the lack of language to communicate these
issues
There can be a real lack of language to describe body parts as
well: “Jokingly I say ‘glory hole’ and ‘bonus round’; but when
actually talking about my body seriously…frankly, I don’t have any
words at all. It’s just a big void in my vocabulary.”
◦ Partner’s resistance to condom use
33. Structural/Societal Factors:
◦ Narrowly constructed gender norms and societal oppression of
gender non-conformity
◦ Barriers to employment, social services, housing, legal
assistance and health and mental health care
Health care administrative procedures often do not promote
opportunities for trans people to share pertinent information about
their identities or needs; can sometimes be hostile or phobic
◦ Barriers to changing any legal documents to reflect current
lived gender identity
◦ Barriers to access to SRS, hormones, etc.
34.
35.
36.
37.
38. Some trans people report having unprotected
penetrative and oral sex
Some trans people report having sex while under
the influence
Some trans people report engaging in sex work
Some trans people report having sex with
populations with a high rate of HIV infection
(MSM)
39. Over 25% of trans people use substances and
may be sharing equipment or making sexual
decisions while under the influence
Trans people need access to new needles for
hormone or silicone injection
40.
41. Of transmen who have sex with other transmen
only 33.3% reported using a condom while having
“front hole” sex
Of transmen who have sex with other transmen
only 17.7% reported using a condom for anal sex
There may be a role for agencies to provide
education on proper use of sex toys
42.
43.
44. “One of the first guys I pick up [online]- we met. And
I’d been very explicit in my ad, but, I still wasn’t sure,
but he said ‘let’s meet’..I think I was kind of confronting
or coming face-to-face with my internalized
transphobia. ‘How can you be so excited so soon?’
So, we’re at the bar having one drink and he’s like
‘let’s go back to your place’ and I’m like ‘okay.’ Even
though I might have naturally known it was coming, I
still couldn’t believe it…”
* excerpt from Getting Primed: Informing HIV Prevention with GBQ Trans Men in Ontario
45. “So then we go and we’re lying in bed and I was
kind of like, ‘do you know what a trans guy is?’
He’s like “oh yeah, oh yeah. I know what it is. I’ve
been with them before.’ And I was scared at that
point...I was really kind of freaked out. We were
fooling around and it comes to fucking – no
condom. We fucked twice. He came in me both
times – no condom. “
* excerpt from Getting Primed: Informing HIV Prevention with GBQ Trans Men in Ontario
46. “And, the sex was alright..it was...I felt terrible
because of all the internal stuff...I was like with all
my knowledge...I have a bucket of condoms
here...all this shit..which was a great lesson to me
that you can have all the knowledge in the world,
but there are so many other things that can go
there with it. “
* excerpt from Getting Primed: Informing HIV Prevention with GBQ Trans Men in
Ontario
47. “But, I really think in hindsight that I had so much
stuff going on that it was as if I was so grateful
that this guy would sleep with me, that he could
just do what he wanted. I was very upset
afterwards and it was quite a shock to me.
Fortunately, I have...since then all the ‘fucking’ sex
has been with condoms.”
* excerpt from Getting Primed: Informing HIV Prevention with GBQ Trans Men in
Ontario
48. Policy work around trans inclusion (ie women’s only,
men’s only shelters)
Prepwork
◦ Training, education, and advocacy
◦ Stating inclusion of trans folks with ALL service users (avoids
outting certain people)
Paperwork
◦ Names
◦ Separate envelope for checks and contracts
◦ M/F on forms
Be Flexible
See Handouts
49. Housing is harm reduction – what are your local
shelters’/housing organizations’ policies around trans
clients
Need to be able to discuss risk reduction in with all
sexual risk taking behaviours
Support trans clients with getting access to proper and
adequate health care for hormones and surgeries
Make sure local harm reduction resources have
equipment for intramuscular injections
50.
51. Ask politely which pronouns to use, if you aren’t sure
Use the pronoun you’ve been asked to use
Correct others if they use the wrong pronoun
Don’t ask about surgeries or hormones unless they’ve
given you permission to
Don’t call someone by their old name, use their current
chosen name
Don’t out others as trans
Don’t use just male/female on forms
Advocate for unisex restrooms or be a “bathroom guard”
for someone using a gendered washroom
Be honest about what you do and don’t know
52. I don’t bite, feel free to ask questions
I may not know the answer to all questions but I
am willing to look it up
53. Rainbow Health Ontario
◦ http://www.rainbowhealthontario.ca
Trans Health
◦ http://www.trans-health.com
Trans Pulse Project
◦ http://transpulseproject.ca/
54. Plan A: Try using only single stall restrooms for a
day
Plan B: At least notice how many times you come
across an all gender washroom/change room
