June 19, 2012
Transgender and gender non-conforming people face discrimination and harassment in virtually all realms of society. The stories of hate crimes against trans-identified individuals that make it into mainstream media only scratch the surface of heinous rates of violence directed toward this community. That level of trauma creates a barrier to getting through the door of a health care facility and accessing care.
Lesbian/gay/bisexual/transgender (LGBT) and women's community organizations should ideally be safe spaces for trans people who come seeking services -- and supportive spaces for the trans-identified people who work there. However, the experiences of many trans individuals and advocates show that, even within community organizations, this has historically not always been the case.
What could organizations be doing, or doing better, to create an environment that welcomes transgender community members as clients as well as potential employees? In this two-part roundtable, I spoke with three powerful transgender community health advocates to get to the bottom of these questions.
Participating in this discussion are: Devarah "Dee" Borrego, Boston-based activist, writer, speaker, and founding member of the U.S. Positive Women's Network; Danielle Castro, community mobilization specialist at the Center of Excellence for Transgender Health in San Francisco, Calif.; and Tei Okamoto, Trans* Health Clinic program manager at APICHA Community Health Center in New York City.
This is part two of a two-part discussion. Read part one of the discussion, in which we discuss barriers that transgender people face in accessing health care.
Olivia Ford: In my experience and in that of many people I've spoken to, and perhaps in your experiences as well, transgender people are more often associated with the LGBT community -- obviously, the T in LGBT -- as far as advocacy is concerned; and it would appear that the experiences and concerns of trans women are less often addressed in the context of "traditional" women's organizations. I wonder if you'd talk a little bit about your experience, Dee -- as a founding member of the U.S. Positive Women's Network (PWN), and having being involved in other ways in women-centered advocacy. Have you found these women-centered organizations to be trans inclusive? Have you found organizations to be receptive, in an explicit way, to encompassing the experiences of trans women in their work?
Devarah "Dee" Borrego
Devarah "Dee" Borrego: In general, I've found that a lot of the women-centered organizations that I've been involved with, thankfully, have been very inclusive and very welcoming. As you mentioned, I was a founding member of PWN. They have just been a fantastically welcoming organization from the get-go. They've been very proactive about recruiting and encouraging HIV-positive trans women from across the nation to be involved in their organization. They have some really amazing women and trans women. It seems like they are one of the groups out there that really get it, and understand that trans women are women. It was very firmly established when I was at PWN's convening that this is one of our core beliefs as an organization.
I also recently attended a summit that was hosted by the Center for Health and Gender Equity (CHANGE), in Washington, D.C., to address global health disparities, especially for women. I found them to be another organization that's really open to working with HIV-positive women, and HIV-positive trans women.
I know my experiences are not universal. I'm certainly aware there are organizations -- and I don't want to say "factions," but I can't think of a better word -- within women's health movements that are not as forward thinking or inclusive, in understanding that even though trans women may have had slightly different life experiences than women who have been recognized as female since birth and continue to identify as women, the overarching experiences that we have as women are the same.
I personally have been fortunate to work with organizations like PWN and CHANGE. I wish that more organizations, within the queer community and beyond, would be as open-minded.
Tei Okamoto: I think it's crucial for us to be in touch with these large entities -- national organizations, like Planned Parenthood -- to encourage them to be more trans inclusive, to get them to reexamine their policies, and to reexamine their feminism. In the activist world we throw around talk of the second wave and third wave of feminism; who's on the fifth wave?
In April the National Center for Transgender Equality just came out with a fact sheet called Transgender Sexual and Reproductive Health: Unmet Needs and Barriers to Care. That would be one resource I would recommend that organizations examine as they reevaluate their policies: What are their barriers to reaching out and meeting the needs of trans women?
Olivia Ford: Switching gears to LGBT organizations: As I mentioned earlier, people of trans experience are often associated with the LGBT community, but even our LGBT community organizations, whether they be large nationwide networks, health care providers or small community-based groups, are often lacking in their inclusion of transgender-inclusinve programming and even staffing of their organizations. Do any of you have recommendations for organizations within the LGBT community to fulfill what is, often, their implied goal of being safe places for folks of trans experience to get care and find community?
Danielle Castro: It's really difficult to be part of a non-accepting community, as part of the LGBT community. Oftentimes the T is just left off. I think that LGBT organizations tend to market themselves like they are providing trans services; but then, when you go to an agency, they have nothing for trans people. Community organizations really need to be accountable to that T.
To me, it's important for an organization to have trans representation within its advisory board, and also staff that are trans identified and can provide that face for the community. It's been a long battle. Obviously, there are LGBT organizations that are accepting of people of trans experience. I'm just talking about the ones that, historically, haven't been.
It's critical that we unite as a community. I feel like we in the trans community are part of this larger umbrella, and we're fighting a battle for equal rights.
Also, I feel that, oftentimes, the B, for bisexual, in LGBT is left off as well. I think there needs to be more equality around that.
Part of the historic struggle, from what I've seen has been that there are women involved in feminist movement, and are part of the lesbian community and identify with that community. Sometimes trans people realize that they are trans after living their lives as however else they identified. But if they're biologically born women that identified as lesbian that then realize they are, in fact, trans, and they transition from female to male, it's like there's been a betrayal. You're no longer part of the feminist movement. You're joining the other side. There's a misconception around that, I think, that perpetuates that idea of separation. I wish that there were more work being done around that.
Also, on the other hand (I'm being so binary based!): As a trans woman, I was part of the gay community, involved with gay and bisexual men a lot. Now that I identify as trans, I feel kind of a separation from that community, as well. I have different interests.
Discrimination does exist within the community. It creates a division. I think we need to work harder together to mend those gaps. When organizations like the Human Rights Campaign (HRC), make their blunders -- as HRC did back when it refused to move forward with including protection on the basis of gender identity as part of the proposed Employment Non-Discrimination Act (ENDA) -- it just feels like a slap in the face. That doesn't help. As of yet, I still haven't heard any kind of public apology.
I do have to say that I really appreciate that HRC exists, and that they are very powerful organization with a lot of resources. But it's actions like this that really help perpetuate this infighting, as it were, in the community.
Tei Okamoto: Going back to our discussion about health insurance: Often, if given the opportunity, employers will exclude trans health care from their coverage; I think it's incredibly important that LGB organizations, particularly those that are really making an effort to include the T, and people of trans experience, be made aware that sometimes they need to actually put riders within the insurance they purchase for their employees, so that when they hire trans people, trans people can have appropriate health care.
I think it's crucial that we go beyond good intentions and, if we're to move forward with the insurance conversation on a larger scale, first address the "lowest hanging fruit," which would be LGBT organizations, and ask them: How many of you are offering health insurance that provides for adequate care for trans employees? How many of you have riders within your insurance that include trans health care?
Devarah "Dee" Borrego: Danielle and Tei both really captured a lot of the important points around what I think LGB organizations really should be doing, and could be doing better, to include trans people.
Further Reading and Resources for Care Providers
Maybe this is just my own personal pet peeve, but quite frequently on forms, the kind of demographic paperwork that you fill out at organizational intakes, transgender is included in the list with sexual orientation. It seems like, in a lot of these organizations, there's no comprehension that transgenderism is not a sexual orientation. It seems like an obvious statement to me, but one that bears repeating, because people don't seem to understand it, and that's reflected in their paperwork.
And just to reiterate what Danielle said, I think it's really important that, if you're holding community events; if you have consumer advisory boards; if you have any sort of community-interactive sections within your organization, to reach out actively to members of the transgender community, and invite us to actively participate. I think sometimes trans people can be a little hesitant to stake our place at the table. Being told explicitly that we're welcome could really improve representation and understanding within an LGB organization of the importance of including the T, and not letting it just remain, silently, at the end.
Danielle Castro: Our history of being at odds with, and being left off, the service spectrum increases that level of responsibility for LGB organizations to make an effort to include us.
Having the T on your label isn't good enough. I think hiring people that represent our community, and having programs that are specific to our community, and having active outreach through the community, and letting us know that we are, in fact, welcome, is vital. That level of history and background of not being included: It's been hurtful. So it's going to take some work.
Olivia Ford: And additional healing of these rifts in the community, it seems, as well.
I think that there's a sense among many people within the LGBT community, and the HIV community, that in the past several years there has been an uptick in visibility of trans people, and with it great strides in addressing issues of concern to transgender communities. On one hand, people working in trans communities and witnessing the everyday struggles of people of trans experience might beg to differ. However, I do also hear a lot of hope from all three of you, and a good bit of optimism, and the ability to actually point to programs that are working to address a lot of the barriers to health care access that we talked about in the earlier part of this conversation.
Before we wrap up, I want to invite each of you to reflect on your many years working in the HIV community, and with folks of trans experience; looking at where we're at now as far as health advocacy, do you feel there has been progress?
Danielle Castro: It's been a long, hard road. There were many pioneers before me that have paved the road for me to be able to do the work that I do. The fact that the U.S. Centers for Disease Control (CDC) is funding trans-specific programming is, to me, phenomenal. I feel like I want to thank CDC, because this year they have also begun to adopt our recommendation for a two-step question in data collection, which asks: "What was your sex at birth?" and "How do you identify now?" They are incorporating that into all their forms, and encouraging all of the states throughout the country to use that for their HIV surveillance data. That's a phenomenal move in the right direction.
Also, there was the court case with Mia Macy that was just won, in which the U.S. Equal Employment Opportunity Commission (EEOC) ruled that it's illegal to discriminate against people in places of employment based on their gender identity or gender expression. That's a huge move that was supported by the Transgender Law Center.
The fact that we even have a Center of Excellence for Transgender Health is a really big deal. I'm so proud to be a part of it. That's a definite step in the right direction. There have been a lot of positive steps taken for trans community, and by trans community. And that's the other piece: that all of this movement involves us. A lot of us have been trying to knock down the doors, and get ourselves in the movement. But there has been a lot of collaboration on a national and international level with our allies to ensure that there are services available.
I'm not saying it's going to be work. For instance, with the two-step data collection recommendation: people aren't going to feel comfortable asking questions about gender when they haven't done so before. We'll really need to hash out what kind of capacity building assistance we should provide for people that are incorporating that system.
Tei Okamoto: Our ability to find funds for the Trans* Health Clinic at APICHA Community Health Center was a huge success, in and of itself. It means that organizations and foundations outside of APICHA -- in particular, the Paul Rapoport Foundation -- acknowledged that transgender individuals have specific health needs, and it's really important to address them. We're especially grateful for this because our grant goes beyond HIV prevention, and allows us to address broader issues through primary care, mental health, group services, targeted outreach programs, all kinds of trainings with partner organizations. It's a really courageous step for the Paul Rapoport Foundation to take a risk to fund us, and to just see the need there.
I can't say enough about all these different centers, like the Mazzoni Center in Philadelphia; their training for medical providers, and teaching proper protocols and medical procedures specifically for the trans community, is incredibly important. I was on the research team from 2003 to 2006 that eventually became Danielle's program, before it was the Center of Excellence for Transgender Health. I know we worked really, really hard there to create a center of excellence. There are a lot of wonderful people there.
I want to give a big shout out to the API Wellness Center in San Francisco, which also played a really big role in embracing the API trans community, and meeting the needs there.
Devarah "Dee" Borrego: Just taking a step back to look at the question of progress, even, in terms of culture: As a 28-year-old transwoman, I can recall my own experiences from the early '90s, and the lack of visibility of trans people in my own world. I do think the culture has shifted to begin to allow for our perspectives to start being heard. Through Chaz Bono, as a good example, being so openly public about his transgender status has, I think, really opened the minds of a lot of Americans who might otherwise not have thought about transgenderism, or have been able to be open to what that means.
The progress that's been made within the last decade or so around legal protections for transgender people, nationally, internationally, and on state levels, has been an amazing step forward. Here in Massachusetts, we passed the Transgender Protections Bill, the act relative to gender identity, in 2011, which certainly makes a lot of progress here in Massachusetts for protecting trans people. And I know that there are a number of other states and numerous localities around the world that are taking an active step to protect the rights of transgender people -- which include health care, and the right to receive the treatments and care that we deserve, and that we need.
This transcript has been edited for clarity.
This article originally appeared in TheBody.com's Pride 2012 special section.