Uniting the Rainbow for Trans* Health

Posted by Wayves Volunteer on June 11, 2013

By Hugo Dann

"When you ain't got nothin' you got nothin' to lose. You're in visible now, you got no secrets to conceal!"

                                                             - Bob Dylan (Like a Rolling Stone)

Last week a post on facebook got my attention. It stated that an unidentified LGBT organization had received a letter from Nova Scotia’s Health Minister, David Wilson, indicating his intention not to cover sex reassignment surgeries (SRS) under the public health insurance plan, MSI. His reasons were quoted as being “due to the lack of high quality scientific evidence to support the efficacy of the long-term outcomes of these procedures and lack of a strong economic argument for their benefit.” A day or two later, the Nova Scotia Rainbow Action Project (NSRAP) revealed that the letter was genuine; that it was in direct response to their determined efforts to get SRS coverage reinstated. You can read Minister Wilson’s letter and NSRAP’s response in their “Call to Action” here.

However, at the time I saw it, the post was unsubstantiated. The quoted phrase certainly read as genuine, but it was still just a rumour. Even so, it prompted a strong response on social media, there were angry denunciations and calls for protests; my favorite being a trans* campout on the lawn of Province House. Pitching a tent for trans* rights? Count me in!

But I don’t like flying off on just a rumour (not even for a sleepover demo), so I called the Minister’s office to see what their response was. I told them I’d seen a portion of a letter purporting to be from the Minister on Facebook. I expressed my hope that it was inaccurate, and I was assured they’d look into it and get back to me as soon as they could.

A few hours later, I received a call from the Minister’s office. His Aid didn’t exactly deny the letter, but she assured me that the Minister had not made any final decision, he still wanted to consult his Cabinet Colleagues. I said I was relieved to hear that. I expressed the hope that if the Minister was indeed concerned about any of the reasons given in the letter (which of course did, in fact, come from him) —he would would let the community, and particularly members of the trans* community respond. I assured her that there was decades worth of strong scientific and clinical data, as well as good fiscal reasons, supporting the reinstatement of coverage for SRS.

It may be an amusing diversion to speculate on what lay behind this puzzling chain of events: was the Minister’s letter a feint, a test of the community’s resolve? Has he retreated from his stated intention in light of the community’s understandable anger? Was his Aide merely stalling for time when I spoke with her? Interesting questions. However, I think there is an opportunity here for the entire LGBTQ Community —one that is both more interesting and potentially much more productive than spending our time sifting through who said what to who when. In saying, ‘No,’ Minister Wilson may have inadvertently thrown open the door to real change.

For the almost 10 years that I’ve been involved in LGBTQ activism in Nova Scotia, we have had essentially one strategy with respect to trans* health: work quietly behind the scenes to persuade government to reinstate SRS coverage; don’t go public, don’t make it a political fight because the opposition will use it to demonize trans* people and we’ll inevitably lose. I’m oversimplifying somewhat for the sake of argument, and it's important to acknowledge that there have been some successes; NSRAP has secured support for SRS from Doctors Nova Scotia and the Human Rights Commission.  The recent amendment to the Human Rights Act has already proven effective in the case of high school student Jessica Durling.

A decade ago the trans* community was all but invisible, even in activist circles. We now have trans* men and women speaking publicly on mainstream media, and trans* youth challenging the status quo in high schools, even taking MSI before the Human Rights Commission.

It’s not just trans* visibility that has changed. An ongoing research project in Ontario is amassing extensive demographic and health information to paint an accurate picture of trans* realities in Canada. TransPulse is a community-based research project out of the Sherbourne Health Center in Toronto. Their data on depression among trans* people, and how exponentially their mental health improves the more they are able to access health services, is, in and of itself, a strong argument for long-term cost savings by funding inclusive trans* health care. It is exactly the kind of research project that should be undertaken in Atlantic Canada. I would encourage everyone (especially government officials and health professionals) to learn more about TransPulse.

New research and newly revised clinical practices are changing models of care to reflect different individuals’ needs. In 2011, the World Professional Association for Transgender Health (WPATH) published its 7th version of the Standards of Care (SOC). In the introduction, they explicitly recognize that trans* people are transitioning in uniquely personal ways to realize their gender identity. The Introduction states:

“[T]his version of the SOC recognizes that treatment for gender dysphoria … has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.”

This points to a trans* health care model that includes, but is not exclusively reliant upon, SRS; that is driven by the individual and their particular requirements; that serves all of the trans* community, including those who do and those who do not seek SRS. This is exactly the kind of culturally competent, patient driven, community health care model that both Minister Wilson and his predecessor, the Hon. Maureen MacDonald, have been advocating for Nova Scotians. This is exactly the model that we, as a community, should be asking for.

We’ve tried a quiet, incremental approach for years; for years the government has said, “We’ll take that under advisement and get back to you!” Now the government has politely, but clearly said, “No!” Do we respond by going back to square one? Or do we rethink our approach, incorporating the newer, more flexible standards of care? Can we use this as a teachable moment to educate ourselves, and the broader public about trans* health and trans* rights? Could this be the issue to galvanize the whole Rainbow Community in a bid for full equality?

Our community is strongest and most effective when it unites in opposition to those who say, “No, you can’t.” That’s what happened 44 years ago this June when gays and lesbians followed the lead of trans* activists, like the late Sylvia Rivera, and rioted in opposition to the police raid on the Stonewall Inn; that’s what we did here in Nova Scotia when the CBC refused to air public service announcements for gay and lesbian events, a local protest that got the attention of the national student movement and changed CBC policy; that was our fierce, unified response to government indifference during the AIDS crisis; and that’s what we did in the early years of this century to win marriage equality in Canada.

The song says, “When you ain’t got nothing, you got nothing to lose.” Well, we certainly have made some gains, but I don’t think we risk losing anything by asking for everything.

 

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