Student Life

Steps towards trans-affirmative health care

Concordia and McGill groups address the need for LGBTQ+ patient-physician allyship

Universal health care is a core value and a major source of pride amongst Canadians. Canada’s medical institutions are expected to meet the needs of a diverse population, yet the conversation around understanding and delivering quality care to meet trans-specific health needs is full of holes, if not entirely absent.

At the end of February, a panel of experts convened at McGill to discuss the ways public health systems perpetuate outdated practices and institutionalized discrimination against LGBTQ+ people. Healthy McGill and the Nursing Peer Mentorship Program facilitated this safe space and invited audience members to bring the potentially offensive, random, or menial questions they might otherwise be afraid to ask about queer and trans health.

Simple things like asking a patient’s pronouns and prefacing potentially sensitive questions can make a huge and lasting difference, said Wong. The willingness of health care workers to learn and use LGBTQ+ friendly language signifies allyship, which is crucial in building the trust needed to give and receive quality care.

For many of the future health care providers in the room, it was their first opportunity to address health care in an LGBTQ+ context with experts working in the field. For others, it was a chance to gain a better understanding of the barriers trans people face when seeking health care in Montreal and beyond.

In A (Not So) Short Introduction to LGBTQIA2S+ Language, bioethicist and trans activist Florence Ashley defines transgender, often shortened to “trans” as, “a person whose gender identity differs from the gender they were assigned at birth.” They point out, “being trans is independent of one’s choice to take hormones or undergo surgeries.” It is not a sexual orientation, nor is it premised on anatomical criteria.

“For health care providers there’s often the confusion between sex (assigned at birth) and gender,” said panelist Kimberly Wong, a youth sexual health educator at AIDS Community Care Montreal. “When we’re talking about sex, we’re really talking about anatomy. Gender is really a self-feeling kind of thing.”

Health care providers often conflate the two, resulting in the frustrating experience of being repeatedly misgendered, interrogated about one’s transition, or forced to bear the burden of educating the physician about transgender realities in general. A strained patient-physician relationship can inhibit one’s willingness to disclose pertinent medical information, or lead to broad assumptions premised on misinformation. “As soon as you start assuming, things go wrong really quickly. So many people end up with substandard care,” said Ashley.

Simple things like asking a patient’s pronouns and prefacing potentially sensitive questions can make a huge and lasting difference, said Wong. The willingness of health care workers to learn and use LGBTQ+ friendly language signifies allyship, which is crucial in building the trust needed to give and receive quality care.

The process of unlearning outdated terms and practices written into medical literature is still in its early stages, and in the meantime trans people have had to seek out resources and services elsewhere. “Trans people are often very good advocates for themselves because they have to be,” said Eve Finley, an equity facilitator at McGill. “That often translates into these very interesting networks of knowledge sharing that happen online and in person.”

The Centre for Gender Advocacy (CGA), based out of Concordia, is one such network for trans people in Montreal. “A lot of people reach out to us or to other trans organizations and we provide them with such important information,” said D.T., trans advocate and public educator at the CGA. “The role of the center is to provide guidance and resources to people, whether Concordia students or not.”

“Change comes from people advocating for their rights to exist,” said  D.T. “That advocacy creates the pressure that cannot be repressed, and it leads to change in policy.”

In collaboration with Concordia Health Services, the CGA reached out to experts in trans health care and organized the opportunity for health services staff to receive training in trans-affirmative care. Concordia is the only university in Quebec to have done so, said D.T, “and they also use the latest approaches to transitioning, namely the informed consent model, where we accompany the person (throughout the process) and validate and affirm their decisions regarding their own body and self.”

Despite the progress made at Concordia, the public system in Montreal is still rife with hostile spaces and ill-informed doctors unable or unwilling to provide trans-competent care. “Outside Concordia, it’s hit or miss.” said D.T. “If you don’t know who the trans-friendly doctors are, you might end up in the wrong place with someone who will not help you affirm your gender and would rather discourage you from being who you are, which is sad in 2019.” To help avoid these pitfalls, the CGA provides an interactive map of health care providers who have denied services to patients on the basis of their trans identities.

“It’s really difficult to find non-judgemental health providers,” said Wong. “There are so many situations where people will not talk to their doctors or seek care because they fear judgement.” When they do, the reported medical problems are often minimized, dismissed, or blamed on unrelated factors. D.T. called it “trans broken arm syndrome,” which refers to the tendency of health care professionals to blame medical problems that someone might have on their trans status. “It still happens a lot, and many trans people choose not to go to the hospital,” said D.T.

The syndrome is not an isolated phenomena, and it’s one with significant repercussions. A 2012 study of trans people’s medical experiences in Ontario found that over half of respondents had negative experiences in clinical settings, and 21 per cent opted not to seek emergency care due to fear of being mistreated. The Twitter hashtag #transhealthfail is an online repository for first-person accounts of such encounters, offering a glimpse at incidents ranging from careless misgendering to outright denials of service from health care providers.

With so few capable physicians in the Montreal area, even those who do manage to seek them out end up waiting weeks or months for an appointment. “We know from research and from people’s personal experiences [that] that time between discovering, affirming to yourself that you are trans and starting transitioning is the time when people go through the most distress,” added D.T. “The longer they wait, the longer they experience dysphoria.”

While the gains made at Concordia signify positive change, D.T said there is still a long way to go to reach a trans-affirmative standard of care in Montreal and beyond. “We know very well that the trans health care field evolves very quickly. There are new needs, new approaches, and so the trainings [Concordia Health Services] did should be ongoing.”

A belief in universal health care is a belief in offering accessible care to meet the unique health needs of all Canadians, and trans-affirmative care is no exception. Of all the things that can be done to improve the quality of services for trans people on a local level, D.T. said it starts with education and advocacy. “Change comes from people advocating for their rights to exist. That advocacy creates the pressure that cannot be repressed, and it leads to change in policy.”

Feature graphic by Mackenzie Lad

Article updated on Jan. 31. 2024 – One of the sources of this article has come forth and requested to be anonymous.


Concordia’s plight against HIV

This past week, students and staff were able to get tested for HIV at the Concordia Student Union (CSU) office on the seventh floor of the Hall building. A rapid HIV testing clinic was set up with the help of the CSU, the Concordia University Psychology Association (CUPA), Queer Concordia and Concordia Health Services. This is the second testing session put together by these organizations.

For this test, a certified nurse takes a prick of blood from your finger and, using a special kit, can tell you whether or not you are HIV positive or negative. The whole process, which takes around 20 minutes, includes going over your risks and sexual history, and the nurses can give you advice on how to improve or continue your safe sex practices. If the result comes back positive, the nurses would be able to put you in contact with various HIV-related resources in the city of Montreal as well as provide psychological support.

While we understand that many students might have been wary about getting tested at school, we think this issue is critical, and we applaud all four organizations that facilitated this testing clinic.

Let’s face it, students are sexually active while they’re in university and many are not properly educated when it comes to having safe sex and HIV prevention. In Canada, one in five people with HIV are unaware they’re HIV positive, according to Community AIDS Treatment Information Exchange (CATIE). Over one-quarter of all new HIV diagnoses in 2015 were in youth, according to the same source.

The Globe and Mail reported in 2014 that a person is infected with HIV every three hours in this country. In Saskatchewan the rate is nearly three times higher the national average, with 71.4 per cent of cases happening because of intravenous drug use. These figures are absolutely startling to say the least, and reveal the challenges our society has in addressing the epidemic.

One key role these rapid testing sessions fulfill is to help fight against the taboo of HIV. HIV and those who are HIV-positive face a lot of stigma, even criminalization, for having this virus. According to Sarah Schulman’s book, Conflict is Not Abuse, Canada was the country in the world to charge someone with murder for transmitting the disease. This country’s harsh criminal pursuit of HIV-positive individuals actually creates a fear around being tested. By making the testing process public and providing students accurate information about HIV, this project at Concordia helps dispel misinformation and allows the community to better understand and face HIV head-on.

Although we’ve come a long way in terms of scientific research and awareness, we need to press further and forge a discussion. We applaud the CSU, CUPA, Queer Concordia and Concordia Health Services for being progressive and open-minded about this issue and we encourage the school to hold more rapid clinics. We also encourage the student body to get tested for HIV and to properly educate themselves on safer sex practices and harm-reduction strategies like needle exchanges, which help reduce new cases of HIV. If we’re to eliminate HIV/AIDS in the near future, it’s time we start tackling this issue head on and minimize the risk of this virus being transmitted.

Contact Concordia Health Services to get tested for HIV or to speak with a medical specialist.

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Student Life

Check yourself before you wreck yourself

Concordia’s Health Services hosts a workshop on women’s common health concerns

Vaginal health, sexually-transmitted infections and breast health were some of the things addressed during Concordia’s Health Services workshop on women’s health.  The workshop, which was held in the conference room of the Health Services department on Jan. 25, addressed many common health concerns for women.

Louise Carline, a nurse at Health Services, and Gaby Szabo, a health promotion specialist, led the discussion.

During the workshop, Carline and Szabo focused largely on vaginal health. Carline stressed that Pap tests are crucial.  “[Pap tests] are important because they reduce your chances of cervical cancer by 70 per cent,” said Carline.

She described the examination process, where a doctor inserts a speculum—a plastic or metal tool used to dilate body orifices—into the vagina to evaluate the cervix.

Doctors recommend women have their first Pap test when they become sexually active, Carline said. She said the test should be done annually.

“A Pap test should be done mid-cycle, and you should avoid intercourse 24 hours before the test,” Carline said.

She also recommended that women, as well as men, get vaccinated against the human papilloma virus (HPV), which is the most common sexually transmitted infection. Concordia’s Health Services offers the Gardasil vaccine. The vaccine is covered by Concordia health insurance for Quebec residents.  However, the cost is not covered by government insurance for international students.

Szabo also stressed the importance of getting tested for sexually transmitted infections. “70 per cent of women and men will experience a sexually-transmitted infection at some point in their life,” Szabo said. “If you are sexually active, the recommendation is to get tested every six to 12 months.”

Women are also prone to getting yeast infections and urinary tract infections. Carline said it is estimated that women will have at least one yeast infection in their lifetime.

“[A yeast infection] is caused by a fungal infection brought on by antibiotics, stress, hormones or too much sugar in your diet,” said Carline. She added that, if a woman notices any symptoms, including itchiness or any vaginal discharge, she should see a nurse right away.

Urinary tract infections are also common among women, said Carline. They are caused by “bacteria that creeps up into your bladder which causes pain during urination,” she said.

A common symptom of this kind of infection is the presence of blood in urine. One important way of preventing the infection, Carline said, is to urinate after sexual intercourse. “By urination, you are eliminating that bacteria that can creep up during sexual contact,” she said.

As for menstrual cramps, Carline advised women to be active and eat healthy.

Szabo also discussed the importance of taking contraception seriously. In Canada, half of the pregnancies that occur are unplanned, she said. Intrauterine contraceptive devices (IUDs) are popular among young women, Carline said, adding that emergency contraception—Plan B—is also available for women, but is intended for emergencies only. Plan B is most effective within the first 72 hours after unprotected intercourse, Carline said.

The specialists also discussed breast health. Szabo said regular breast self-examinations are no longer recommended because, often, women only detect lumps when they are already fairly large

Concordia students can have their breasts checked at Concordia Health Services when they come in for a Pap test.

For more information, students can drop by Concordia’s the Health Services department on the second floor of the GM Building, or visit their website.

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