Stating the obvious

In presenting the results of the Trans Health Project, co-investigator Susan Gapka says the research team was surprised, not by what they found, but how easily they found it.

“We identified a gap in healthcare service, which was no lightening bolt,” says Gapka. “We knew that was going on.”

The study found that participants had common concerns. Surgery was important, as were counselling support services and comprehensive services.

“Not only was respectful healthcare important, but also things around employment and education… so people could have some stability in their lives,” says Gapka. “So that they could do the other things they needed to get on with their transition.”

Overall, three themes emerged: needs and recommendations for healthcare consumers, providers and services.

“You have focus groups until you hear the same thing over and over again,” says Gapka, referring to participants’ negative experiences in the healthcare system. “We found that we reached a saturation point in our second focus group. That was a real surprise.”

Presented at the 519 Community Centre on May 13 as part of Canada’s first Trans Awareness Week, the Trans Health Project was sponsored by The Public Health Alliance For Lesbian, Gay, Bisexual, Transsexual, Transgendered, Two-Sprit, Queer And Questioning Equity, a work group of the Ontario Public Health Association (OPHA).

The project began in June 2000, when the work group released a position paper on improving healthcare for gay men and lesbians. The paper “identified a need to investigate the specific needs, unique barriers and existing gaps in service for transpeople in Ontario, in terms of access and equity around healthcare.”

Gapka, a public policy student at York University who has worked on the Canadian Harm Reduction Conference, a project of Health Canada, and Rupert Raj, a psycho-therapist at the Sherbourne Health Centre with a masters degree in counselling, were hired to conduct the 14-month project. A small team of research advisors, volunteers and regional networkers provided assistance.

“When it comes to looking at healthcare as part of a trans person’s life, there’s very little work done in this field,” says Gapka. “Some of the work that’s done is problematic research…. It’s done in a traditional model where it doesn’t really empower the research subjects.”

She finds that there is some change happening. “There’s been an etiology about ‘How did you get to be this way?’ kind of a research focus…. Finding out why I’m like this or why other people are certain ways, like every third boy is homosexual or every fourth child is a transsexual woman. That doesn’t educate people, it doesn’t feed hungry people, it doesn’t house homeless people. So maybe there’s a shift in how people are looking at that and finding out more about our community.”

Gapka conducted a study of 73 people – 62 via focus groups and 11 via self-administered questionnaires. During the focus groups, participants answered general questions and shared both positive and negative experiences, mostly regarding the healthcare system. Participants were found via word of mouth, e-mail and flyers. From April through June of last year, eight focus groups were conducted, six in Toronto and one each in Ottawa and Guelph. Some of the Toronto groups focussed on specific groups including trans youth, trans seniors and participants of The 519’s Meal Trans Program.

The final report combines the results of Gapka’s focus groups and Raj’s overview of existing literature and research. His section covers issues including general health (access and equity to trans- positive healthcare and social services); physical health (such as puberty-suppressant agonists, which stop estrogen or testosterone production); mental health (like depression and anxiety); social health (including discrimination and violence); sexual health (STDs and HIV/AIDS) and spiritual health (including religious discrimination). It also looks at the lack of accessibility of sex reassignment surgery and the need for more research in areas such as the technical aspects of procedures and the physical and psychosocial outcomes of surgery, and specific trans populations such as youth, seniors and people of colour.

The paper is upfront about the data’s limitations. None of the participants reported being homeless or underhoused, only four people identified as non-white (six identified as mixed race) and less than one-third (30.2 percent) were born female.

“We only reached particular areas. There are so many other regions of Ontario that weren’t accessed. If there was a next step, that would really be it,” says Gapka, adding, “There’s a real gap. We’ve got a small sample here. There are all these other scattered samples, but there’s a huge population that we haven’t been reaching.”

At its annual general meeting in Windsor last November, the OPHA ratified the seven resolutions in the report, including further research of trans populations in Northern Ontario and rural areas, advocating for the relisting of sex reassignment surgery – left out of this month’s Ontario budget – and transition-related electrolysis, “a comprehensive facility (combined community health centre and community centre) for trans people, based in an urban setting, with satellite locations across Ontario” and “targeted hiring practices within Ontario public health units with a view towards actively recruiting trans-identified candidates for paid positions.”