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“I Don't Think This Is Theoretical; This Is Our Lives”: How Erasure Impacts Health Care for Transgender People

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For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.

Section snippets

Background and Significance

Health is a holistic state. Mental, physical, emotional, and social health are all integral to and interact toward the total experience of health (World Health Organization, 1948). A social determinants of health framework recognizes that the conditions for health are shaped by the social and political milieu in which one lives (Raphael, 2004). As an extension of this approach, risk for HIV can be viewed as a synthesis of both proximal and distal risk factors, and social determinants of health

The Trans PULSE Project

With a population of approximately 13 million, Ontario is Canada's most populous province. Trans PULSE is an Ontario-wide project that aims to broadly understand how social exclusion impacts the health of trans people. The Trans PULSE Investigators Team, with seven trans and three cissexual members, is an active partnership between community members, service providers, and academic researchers who share a desire to undertake community-based research that will help to alleviate the systemic

Results

Thematic analysis yielded the following key concerns regarding health: income instability, barriers to accessing trans-inclusive health care services, the lack of relevant and accessible information, systemic social service barriers, self-esteem and mental health issues, challenges to finding help, and relationship and sexual health concerns. These concerns were characterized by pervasive and diverse experiences of transphobia. Although community soundings covered a broad range of topics, much

Cisnormativity

Underlying the processes of erasure is cisnormativity. Cisnormativity describes the expectation that all people are cissexual, that those assigned male at birth always grow up to be men and those assigned female at birth always grow up to be women. This assumption is so pervasive that it otherwise has not yet been named. Cisnormative assumptions are so prevalent that they are difficult at first to even recognize. Cisnormativity shapes social activity such as child rearing, the policies and

Conclusion

This project was undertaken not merely to describe the challenges that trans people experience because these have been documented in previous needs assessments. Rather, the information was obtained to provide an understanding of the ways in which these challenges are brought into existence. As patterns emerged in the experiences that were shared, it was difficult to understand how social determinants of health, such as access to health care, affect the lives of trans people without

Acknowledgments

The authors acknowledge the support of grants from The Wellesley Institute and The Ontario HIV Treatment Network. The Trans PULSE Project team investigators are Greta Bauer, Michelle Boyce, Rebecca Hammond, Matthias Kaay, Yasmeen Persad, Rupert Raj, Kyle Scanlon, Sydney Tam, Anna Travers, and Robb Travers. The authors thank Scott Anderson and Melisa Dickie for assistance in organizing the community soundings and in transcription and coding, Brady Yu for his early leadership in forming this

Greta R. Bauer, PhD, MPH, is assistant professor, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.

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  • Cited by (0)

    Greta R. Bauer, PhD, MPH, is assistant professor, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.

    Rebecca Hammond, BA, is MSc candidate, Department of Community Health and Epidemiology, Faculty of Medicine, Dalhouise Medical School, Dalhousie University, Halifax, Nova Scotia, Canada.

    Robb Travers, PhD, is assistant professor, Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario.

    Matthias Kaay, MSW, MA, is a therapist, Rainbow Services Centre for Addiction and Mental Health, Toronto, Ontario.

    Karin M. Hohenadel, BA, is MSc candidate, Population Epidemiology, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario.

    Michelle Boyce is president, Diversity Training Live, Aylmer, Ontario.

    Editors' note: This article contains graphic language and content. JANAC's editorial staff is dedicated to preserving the integrity of the work of all of our authors. In qualitative research, this includes input from participants who are willing to share their experiences with the researcher and—eventually—with the reader. In this article, we have honored those individuals by leaving their words intact.

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