Trans health and the risks of inappropriate curiosity

BMJ, September 9, 2019

Care providers need to be aware of the damage of inappropriate curiosity when working with people who are transgender, say Adam Shepherd, Benjamin Hanckel, and Andy Guise.

Encountering inappropriate curiosity is a common experience among people who identify as LGBT. This kind of behaviour shouldn’t happen in a healthcare facility, yet recent reports from Stonewall and the government’s Equalities Office confirm that this is a problem in healthcare and that it particularly affects people who are transgender.

What do we mean when we say that a healthcare provider is showing “inappropriate curiosity?” Researchers provided insight into what this is in a study where they describe trans participants being asked intrusive questions about their personal lives and being subjected to invasive physical examinations. Participants felt that these were irrelevant to why they had sought out medical care, and that their only purpose was to satisfy the personal interest of the healthcare practitioner. Imagine, for example, going to your GP for a chronic cough and being asked what genitals you have, or going for a foot X-ray and the radiographer making comments about your breasts.

STIs among transgender men and women attending Australian sexual health clinics

Med J Aust. 2019 Aug 29. doi: 10.5694/mja2.50322. [Epub ahead of print]

Abstract

Objectives

To estimate rates of HIV infection, chlamydia, gonorrhoea, and infectious syphilis in transgender men and women in Australia; to compare these rates with those for cisgender people.

Design

Cross‐sectional, comparative analysis of de‐identified health data.

Setting, participants

We analysed data for 1260 transgender people (404 men, 492 women, 364 unrecorded gender), 78 108 cisgender gay and bisexual men, and 309 740 cisgender heterosexual people who attended 46 sexual health clinics across Australia during 2010–2017.

Main outcome measures

First‐visit test positivity for sexually transmitted infections (STIs), stratified by patient group and year; demographic and behavioural factors associated with having STIs.

Results

14 of 233 transgender men (6.0%) and 34 of 326 transgender women (10%) tested during first clinic visits were chlamydia‐positive; nine transgender men (4%) and 28 transgender women (8.6%) were gonorrhoea‐positive. One of 210 tested transgender men (0.5%) and ten of 324 tested transgender women (3.1%) were diagnosed with infectious syphilis; 14 transgender men (3.5%) and 28 transgender women (5.7%) were HIV‐positive at their first visit. The only significant change in prevalence of an STI among transgender patients during the study period was the increased rate of gonorrhoea among transgender women (from 3.1% to 9.8%). Compared with cisgender gay and bisexual men, transgender men were less likely (adjusted odds ratio [aOR], 0.46; 95% CI, 0.29–0.71; P = 0.001) and transgender women as likely (aOR, 0.98; 95% CI, 0.73–1.32; P = 0.92) to be diagnosed with a bacterial STI; compared with heterosexual patients, transgender men were as likely (aOR, 0.72; 95% CI, 0.46–1.13; P = 0.16) and transgender women more likely (aOR, 1.56; 95% CI, 1.16–2.10; P = 0.003) to receive a first‐visit bacterial STI diagnosis.

Conclusions

The epidemiology of STIs in transgender people attending Australian sexual health clinics differs from that of cisgender patients. Gender details must be captured by health data systems to facilitate appropriate delivery of sexual health care.

Understanding the experiences of Culturally Diverse LGBTIQ+ Talent at Work

Diversity Council Australia, 2019

While many workplaces have developed LGBTIQ+ inclusion programs, they are not currently specifically addressing the cultural diversity of LGBTIQ+ people.

DCA, along with Pride in Diversity, is undertaking research to help better understand the experiences of Culturally Diverse LGBTIQ+ Talent at Work.

This project will help with understanding of the experiences of people of LGBTIQ+ people from culturally diverse backgrounds, and will assist in providing informed advice to workplaces about how to make inclusion initiatives work.

  • Are you or one of your colleagues an LGBTIQ+ person from a non-Anglo or a non-Main English speaking country cultural background?
  • Can you share your insights to help develop workplace guidance for Australian organisations wanting to better harness the skills and talents of LGBTIQ+ people from culturally diverse backgrounds?

What do I need to do?

SA drug bill risks another Stolen Gen: Aboriginal Health Council

InDaily, March 21st, 2018

The head of South Australia’s peak Aboriginal health body has warned that a State Government plan to enforce mandatory drug treatment on young people risks dispossessing Aboriginal children of their culture.

Aboriginal Health Council state branch CEO Shane Mohor has joined a growing chorus of social service and health bodies that have criticised the Controlled Substance (Youth Treatment Orders) Amendment Bill currently before state parliament.

Understanding LGBTI+ Lives in Crisis (Report)

Australian Research Centre in Sex, Health and Society, La Trobe University & Lifeline Australia, February 2019

This research report presents findings of lesbian (L), gay (G), bisexual (B), transgender (T), intersex people (I), and other sexual identity and gender diverse individuals (+) use of crisis support services (CSS) in Australia.

This is the first research of its kind in Australia that explores the needs of LGBTI+ people during a time of personal or mental health crises. It focuses on their uptake and familiarity with crisis support services in Australia, their perceptions and experiences with crisis support services, and where they might seek other professional mental health service support during a time of crisis.

This study enhances the evidence base for those working to design, resource or deliver services to meet the needs of LGBTI people in Australia during times of crisis.

Actions to support Lesbian, Gay, Bisexual, Trans and Gender Diverse, and Intersex elders

Australian Department of Health, February 2019

We know that LGBTI older people and elders are likely to have experienced violence, stigma and discrimination throughout their lives. As a result, they may be reluctant to disclose their identities or histories to aged care services and therefore remain isolated or invisible within both the aged care sector and the broader community. Combined with general stigmatisation and invisibility of LGBTI needs at large, this results in a lack of awareness of the unique needs of LGBTI elders and older people, including a lack of targeted services to support them. In addition, the fear of mistreatment or rejection from aged care providers can lead to LGBTI elders and older people delaying seeking care until their health deteriorates or a crisis occurs.

Many LGBTI elders and older people have lived through a time where identities were pathologised or criminalised, aversion therapies were encouraged, and non-consensual surgeries were routinely performed. As a result, many LGBTI older people have learned to conceal their sexual orientation, gender identity or intersex status in order to be safe, particularly when interacting with the health or social services sector. The fear and mistrust of these services in the past have led LGBTI elders and older people to be reluctant to utilise mainstream services, including aged care. Reliving past discrimination when encountering new forms of discrimination in the aged care
environment can lead to feelings of anxiety and/or depression.

The Action Plan is a resource that will assist aged care service providers to better understand how they can advocate for and support LGBTI elders and older people. By providing culturally safe and inclusive services, providers will build confidence amongst LGBTI elders and older people and their carers, families of choice (who may or may not include biological family) and allies that aged care services are available for them and they will be given the support and care they need as they age.

The Consumer Guide captures the voice of LGBTI peoples expressed through those consultations. It is intended both to help LGBTI peoples express their needs when speaking with aged care providers and as a resource to support people working in aged care to understand the perspectives of LGBTI peoples.