Accessible healthcare for the trans and gender diverse community

To mark International Transgender Day of Visibility, the Division of Equity Diversity and Inclusion (EDI) spoke with UNSW staff member Eloise Brook and student Axel-Nathaniel Rose about the importance of healthcare access for the trans and gender diverse (TGD) community in light of the COVID-19 crisis. 

International Transgender Day of Visibility (ITDoV) is celebrated annually on 31 March to celebrate the stories of achievement, community and strength through adversity for trans and gender diverse (TGD) people worldwide. To acknowledge the day, EDI had the opportunity to hear Eloise and Axel’s lived experiences and their advice to fellow TGD colleagues and peers in these uncertain times. Eloise is a peer interviewer at UNSW’s Kirby Institute and a writer, academic and transgender advocate at The Gender Centre. Axel is a UNSW creative writing student, queer and disabled activist, and creative sub-editor at the UNSW student publication Tharunka. 

What does ITDoV symbolise for you and why is it important for UNSW to acknowledge? 

Eloise: I’m heavily involved in Transgender Day of Remembrance (TDoR), and ITDoV for me symbolises the opposite. Where TDoR is filled with grief, solace and strength from enduring hardship, ITDoV is a welcome balance – life, joy, strength from happiness and hope.  

Axel: Being transgender is so often associated with pain, and that’s not all that we are. ITDoV is a day for our joys, triumphs and acknowledgement of our individual and global progress. UNSW is a massive institution – it affects so many people’s lives, and the smallest acts of awareness and consideration, let alone planning, policy, and leadership make a world of difference – hopefully that’s what ITDoV can inspire. 

In the light of the pandemic we’re facing, what’s your current view on trans and gender diverse access to health care? 

Eloise: I’m a little scared about this one. The TGD community struggles to get adequate health care at the best of times so adding a global pandemic is going to make things very hard. The single most important thing we can do is to reach out and make sure that others in the community are okay. We’re all going to be processing a lot of grief, anxiety and fear. The more we can focus our energy and efforts on others, the better for everyone. While I acknowledge that I come from a position of privilege to be able to say that, I know that even a very small amount of kindness can go an extraordinarily long way. 

Axel: Generally, it’s quite poor, I’m sorry to say. The exorbitant costs of medical care; the stripping of trans people’s medical autonomy; the lack of education healthcare providers are given on trans people; denial of treatment outright; doctors enacting their bigotry with little to no accountability; most health insurance not covering transition related expenses despite it being well-proven as a wholly necessary medical treatment – the list could go on. 
 
People with trans and gender diverse experiences regularly face discrimination when seeking health care; what’s your advice to trans and gender diverse staff and students during this critical time? 

Eloise: Getting adequate health care can be very difficult. Community can help that. Firstly, TGD people have a wealth of knowledge on the best doctors to go to and the safest clinics and health care providers. Secondly, the Gender Centre is a fantastic resource to answer these questions. I should also mention that while there are some good online resources out there, nothing beats a person to person conversation. Thirdly, if in doubt you can go to a health care visit with a friend or family member who can advocate for you or give you the support you need to advocate for yourself.  

Axel: It’s hard to give any concrete advice, but please, please remember that we are not burdens. Our need for medical care, products and procedures is not superficial or less significant than anyone else’s. Many people have had various gender-affirming surgeries delayed due to a shortage of resources, and I’m so, so sorry– it’s okay to grieve and be angry and frustrated. Please stay strong and ask for support. Your body is your body and it might not fit quite right at this point, but it is yours – keep looking after it as best you can.  

What can UNSW do to help overcome health barriers for trans and gender diverse staff and students? 

Eloise: During a normal semester, TGD University staff and students frequently experience delays in processing ID documentation or getting properly recognised as their target gender. By and large this is because of bureaucracy and not overt discrimination. However, these kinds of delays frequently have a knock-on effect for accessing accommodation, Austudy or any other service that requires proof of study or work. These delays affect the ability to work and study. For some it can mean the difference between being able to study at all. 

Axel: The most preventative and positive plan for the future is simply training medical students on trans issues and healthcare, thoroughly and in consultation with transgender practitioners, policy makers and patients. Be open to hearing from us about our medical care but don’t assume you have a right to know (don’t ask us about ‘the surgery’, whatever that’s supposed to be); believe us when we say we’ve been mistreated and incorporate education on transgender issues, welfare, relationships, medicine, and legal advice into the myriad events and resources in the University. 

Finally, within the context of widespread stigma, discrimination and marginalisation in society, trans and gender diverse people experience higher rates of mental ill-health compared to their gender conforming peers. Given the social isolation measures that COVID-19 has prompted, what are the implications on the mental health of trans and gender diverse people and how can fellow staff, students and allies provide support?

Eloise: These are extraordinary and frightening times. Events are unfolding around COVID-19 so fast that all of us are feeling anxiety and under load. For a TGD person this is an added level of stress. One of the best things that fellow staff, students and allies can do (not to mention all of us) is to be inclusive. This means checking in with anyone that might be struggling or isolated and seeing what they need. It can make a world of difference to a TGD staff member or student. 

Axel: As with everyone really, it’s a matter of keeping in touch. Remember people who live in areas less accepting than Sydney, needing to go back to more conservative areas, or to countries where it’s acutely illegal and life-threatening to be transgender. People in the midst of medical transition are in a particularly vulnerable position – being alone, let alone potentially entering and exiting isolation looking very different is a confronting situation for many. Calling people by our names and saying them aloud, being affirming, positive and kind is going to be life-saving in the months ahead. 

If you want to learn more about the transgender and gender diverse community and how you can support your colleagues and peers, and the larger LGBTIQ+ community, visit the EDI website. ACON has also developed a resource on trans and gender diverse people and COVID-19 and together with Trans Pride Australia will be launching a new digital platform called TransHub on 31 March.