A Review of Transgender Health in Canada
Barre latérale de l'article
Publié-e :
nov. 2, 2015
Mots-clés :
Health, discrimination, HIV, Mental health
Contenu principal de l'article
Résumé
ABSTRACT:
Transgendered individuals are defined by having a gender identity different from their birth gender. These individuals form a prevalent distinct group within the Lesbian, Gay, Bisexual and Transsexual (LGBT) community that has specific health needs. The goal of the current work is to identify the health needs affecting transgendered individuals in order to guide potential health interventions to ameliorate their well-being. Transgendered individuals often experience elevated rates of social stigma, discrimination and prejudice, which can alienate them from other members of society including family members and health care professionals. This can have negative effects on their employment and socioeconomic status and may even render them targets of hate crimes. The combination of these factors can have significant ill effects on the physical and mental health of transgendered individuals. For example, high rates of depression and anxiety are observed within this population with a reported suicide attempt rate of over 30%. Transgendered individuals are also at high risk of being infected with HIV, with those having undergone the transition from male to female (MTF) being most affected. Although Canada is ahead of the curve in equal rights pertaining to the LGBT community compared to many countries worldwide that still have anti-homosexual legislation, there still exists a considerable amount of stigma around the transgendered community. There is a need to educate the population at large to combat social stigma in order to reduce discrimination, increase social support, improve access to health services and ultimately improve the physical and mental wellbeing of transgendered people.
RÉSUMÉ:
Les personnes transgenres sont définies comme ayant une identité de genre différente de leur sexe de naissance. Ces personnes forment un groupe distinct au sein de la communauté des lesbiennes, gais, bisexuels et transsexuels (LGBT), ayant des besoins de santé spécifiques. Le but du travail actuel est d’identifier les besoins de santé touchant les personnes transgenres afin de guider les interventions de santé potentielles pour améliorer leur bien-être. Les personnes transgenres éprouvent souvent des taux élevés de stigmatisation sociale, de discrimination et de préjugés, ce qui peut les aliéner des autres membres de la société y compris les membres de leur famille et des professionnels de soins de santé. Cela peut avoir des effets négatifs sur leur emploi et leur statut socioéconomique et peut même les rendre cibles de crimes haineux. La combinaison de ces facteurs peut avoir des effets néfastes importants sur la santé physique et mentale des personnes transgenres. Par exemple, des taux élevés de dépression et d’anxiété sont observés dans cette population avec un taux de tentative de suicide déclaré de plus de 30%. Les personnes transgenres sont également à risque élevé d’être infectées par le VIH, celles ayant subi la transition d’homme à femme (MTF) étant les plus touchés. Bien que le Canada soit en avance dans l’égalité des droits se rapportant à la communauté LGBT par rapport à de nombreux pays à travers le monde, il existe encore une quantité considérable de stigmatisation qui entoure la communauté transgenre. Il est nécessaire d’éduquer la population dans son ensemble à lutter contre la stigmatisation sociale afin de réduire la discrimination, d’accroître le soutien social, d’améliorer l’accès aux services de santé et, finalement, d’améliorer le bien-être physique et mental des personnes transgenres.
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Rubrique
Review & Clinical Practice
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28. Sharek DB, McCann E, Sheerin F, Glacken M, Higgins A. Older LGBT people’s experiences and concerns with healthcare professionals and services in Ireland. International journal of older people nursing. 2014.
29. Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. American journal of public health. 2012;102(1):118-22.
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31. Quon EC, McGrath JJ. Subjective socioeconomic status and adolescent health: a meta-analysis. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2014;33(5):433-47.
32. Hwang SW, Tolomiczenko G, Kouyoumdjian FG, Garner RE. Interventions to improve the health of the homeless: a systematic review. American journal of preventive medicine. 2005;29(4):311-9.
33. O’Campo P, Kirst M, Schaefer-McDaniel N, Firestone M, Scott A, McShane K. Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: a realist approach to synthesizing evidence. Journal of urban health : bulletin of the New York Academy of Medicine. 2009;86(6):965-89.
34. Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC public health. 2012;12:292.
35. Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. American journal of public health. 2013;103(10):1830-6.
36. Hotton AL, Garofalo R, Kuhns LM, Johnson AK. Substance use as a mediator of the relationship between life stress and sexual risk among young transgender women. AIDS education and prevention : official publication of the International Society for AIDS Education. 2013;25(1):62-71.
37. McCabe SE, West BT, Hughes TL, Boyd CJ. Sexual orientation and substance abuse treatment utilization in the United States: results from a national survey. Journal of substance abuse treatment. 2013;44(1):4-12.
38. Kecojevic A, Wong CF, Schrager SM, Silva K, Bloom JJ, Iverson E, et al. Initiation into prescription drug misuse: differences between lesbian, gay, bisexual, transgender (LGBT) and heterosexual high-risk young adults in Los Angeles and New York. Addictive behaviors. 2012;37(11):1289-93.
39. Skerrett DM, Kolves K, De Leo D. Suicides among lesbian, gay, bisexual, and transgender populations in Australia: an analysis of the Queensland Suicide Register. Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists. 2014;6(4):440-6.
40. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of homosexuality. 2006;51(3):53-69.
41. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. American journal of public health. 2001;91(6):915-21.
42. Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet Infectious diseases. 2013;13(3):214-22.
43. Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. Journal of acquired immune deficiency syndromes. 2008;48(1):97-103.
44. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS and behavior. 2008;12(1):1-17.
45. Stephens SC, Bernstein KT, Philip SS. Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS and behavior. 2011;15(3):683-6.
46. Kenagy GP, Hsieh CM. The risk less known: female-to-male transgender persons’ vulnerability to HIV infection. AIDS care. 2005;17(2):195-207.
47. Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. International journal of epidemiology. 2010;39(4):1048-63.
48. Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WLt, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341-8.
49. American Psychiatric Association Diagnostic and statistical manual of mental disorders : DSM-5 [Internet] American Psychiatric Publishing [Cited March 7, 2015]. Available from: http://dsm.psychiatryonline.org/book.aspx?bookid=556.
50. Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. American journal of public health. 2013;103(5):943-51.
51. Reisner SL, White JM, Mayer KH, Mimiaga MJ. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS care. 2014;26(7):857-64.
52. Bauer GR, Pyne J, Francino MC, Hammond R. La suicidabilité parmi les personnes trans en Ontario : Implications en travail social et en justice sociale. Review service sociale. 2013;59(1):35-62.
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54. Siksay, B. Bill C-389: An act to amend the Canadian Human Rights Act and the Criminal Code (gender identity and gender expression) 2013 [Internet] Open Parliament [cited March 11, 2015]. Available from: https://openparliament.ca/bills/40-2/C-389/.
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2. Garofalo R, Deleon J, Osmer E, Doll M, Harper GW. Overlooked, misunderstood and at-risk: exploring the lives and HIV risk of ethnic minority male-to-female transgender youth. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2006;38(3):230-6. doi: 10.1016/j.jadohealth.2005.03.023.
3. Austin SB, Conron K, Patel A, Freedner N. Making sense of sexual orientation measures: findings from a cognitive processing study with adolescents on health survey questions. Journal of LGBT health research. 2007;3(1):55-65.
4. Wilson P, Sharp C, Carr S. The prevalence of gender dysphoria in Scotland: a primary care study. The British journal of general practice : the journal of the Royal College of General Practitioners. 1999;49(449):991-2.
5. Weitze C, Osburg S. Transsexualism in Germany: empirical data on epidemiology and application of the German Transsexuals’ Act during its first ten years. Archives of sexual behavior. 1996;25(4):409-25.
6. Bakker A, van Kesteren PJ, Gooren LJ, Bezemer PD. The prevalence of transsexualism in The Netherlands. Acta psychiatrica Scandinavica. 1993;87(4):237-8.
7. Gates W. How many people are lesbian, gay, bisexual, and transgender? How many people are lesbian, gay, bisexual, and transgender? Williams Institute, UCLA School of Law. Los Angeles (CA): Williams Institute, UCLA School of Law; 2011.
8. Reisner SL, Biello K, Rosenberger JG, Austin SB, Haneuse S, Perez-Brumer A, et al. Using a two-step method to measure transgender identity in Latin America/the Caribbean, Portugal, and Spain. Archives of sexual behavior. 2014;43(8):1503-14.
9. Statistics Canada. Population and dwelling counts, for Canada, provinces and territories, 2011 and 2006 censuses 2011 [internet] Government of Canada [Updated 2014 January 1; cited March 11, 2015]. Available from: http://www12.statcan.ca/census-recensement/2011/dp-pd/hlt-fst/pd-pl/Table-Tableau.cfm?LANG=Eng&T=101&S=50&O=A.
10. Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health & social work. 2005;30(1):19-26.
11. Reisner SL, White JM, Bradford JB, Mimiaga MJ. Transgender Health Disparities: Comparing Full Cohort and Nested Matched-Pair Study Designs in a Community Health Center. LGBT health. 2014;1(3):177-84.
12. Kane MD. Social movement policy success: Decriminalizing state sodomy laws, 1969 –1998. Journal of homosexuality. 2003;8:331-4.
13. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn : A report of the National Transgender Discrimination Survey. Injustice at every turn : A report of the National Transgender Discrimination Survey. National Center for Transgender Equality, and the National Gay and Lesbian Task Force. Washington (DC): National Center for Transgender Equality, and the National Gay and Lesbian Task Force; 2011.
14. Lombardi EL, Wilchins RA, Priesing D, Malouf D. Gender violence: transgender experiences with violence and discrimination. Journal of homosexuality. 2001;42(1):89-101.
15. Factor RJ, Rothblum ED. A study of transgender adults and their non-transgender siblings on demographic characteristics, social support, and experiences of violence. Journal of LGBT health research. 2007;3(3):11-30.
16. Sugano E, Nemoto T, Operario D. The impact of exposure to transphobia on HIV risk behavior in a sample of transgendered women of color in San Francisco. AIDS and behavior. 2006;10(2):217-25.
17. Frost DM, Parsons JT, Nanin JE. Stigma, concealment and symptoms of depression as explanations for sexually transmitted infections among gay men. Journal of health psychology. 2007;12(4):636-40.
18. Davey A, Bouman WP, Arcelus J, Meyer C. Social support and psychological well-being in gender dysphoria: a comparison of patients with matched controls. The journal of sexual medicine. 2014;11(12):2976-85.
19. Fredriksen-Goldsen KI, Kim H-J, Emlet CA, Muraco A, Erosheva EA, Hoy-Ellis CP, et al. The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults: Seattle: Institute for Multigenerational Health; 2011.
20. Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, Erosheva EA, Emlet CA, Hoy-Ellis CP, et al. Physical and mental health of transgender older adults: an at-risk and underserved population. The Gerontologist. 2014;54(3):488-500.
21. Factor RJ, Rothblum ED. Exploring gender identity and community among three groups of transgender individuals in the United States: MTFs, FTMs, and genderqueers. Health Psychology Review. 2008;17:235-53.
22. Lombardi EL. Integration within a transgender social network and its effect upon members’ social and political activity. Journal of homosexuality. 1999;37(1):109-26.
23. Simons L, Schrager SM, Clark LF, Belzer M, Olson J. Parental support and mental health among transgender adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2013;53(6):791-3.
24. Wilson EC, Iverson E, Garofalo R, Belzer M. Parental support and condom use among transgender female youth. The Journal of the Association of Nurses in AIDS Care : JANAC. 2012;23(4):306-17.
25. Xavier J, Simmons R. The executive summary of the Washington Transgender Needs Assessment Survey 2012 [Internet] Gay and Lesbian Activist Alliance [cited March 7, 2015]. Available from: http://www.glaa.org/archive/2000/tgneedsassessment1112.shtml.
26. Kenagy GP, Bostwick WB. Health and Social Service Needs of Transgender People in Chicago. International Journal of Transgenderism. 2005;8(2-3):57-66.
27. Bauer GR, Scheim AI, Deutsch MB, Massarella C. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Annals of emergency medicine. 2014;63(6):713-20
28. Sharek DB, McCann E, Sheerin F, Glacken M, Higgins A. Older LGBT people’s experiences and concerns with healthcare professionals and services in Ireland. International journal of older people nursing. 2014.
29. Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. American journal of public health. 2012;102(1):118-22.
30. Adler NE, Boyce T, Chesney MA, Cohen S, Folkman S, Kahn RL, et al. Socioeconomic status and health. The challenge of the gradient. Am Psychol. 1994;49(1):15-24.
31. Quon EC, McGrath JJ. Subjective socioeconomic status and adolescent health: a meta-analysis. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2014;33(5):433-47.
32. Hwang SW, Tolomiczenko G, Kouyoumdjian FG, Garner RE. Interventions to improve the health of the homeless: a systematic review. American journal of preventive medicine. 2005;29(4):311-9.
33. O’Campo P, Kirst M, Schaefer-McDaniel N, Firestone M, Scott A, McShane K. Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: a realist approach to synthesizing evidence. Journal of urban health : bulletin of the New York Academy of Medicine. 2009;86(6):965-89.
34. Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC public health. 2012;12:292.
35. Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. American journal of public health. 2013;103(10):1830-6.
36. Hotton AL, Garofalo R, Kuhns LM, Johnson AK. Substance use as a mediator of the relationship between life stress and sexual risk among young transgender women. AIDS education and prevention : official publication of the International Society for AIDS Education. 2013;25(1):62-71.
37. McCabe SE, West BT, Hughes TL, Boyd CJ. Sexual orientation and substance abuse treatment utilization in the United States: results from a national survey. Journal of substance abuse treatment. 2013;44(1):4-12.
38. Kecojevic A, Wong CF, Schrager SM, Silva K, Bloom JJ, Iverson E, et al. Initiation into prescription drug misuse: differences between lesbian, gay, bisexual, transgender (LGBT) and heterosexual high-risk young adults in Los Angeles and New York. Addictive behaviors. 2012;37(11):1289-93.
39. Skerrett DM, Kolves K, De Leo D. Suicides among lesbian, gay, bisexual, and transgender populations in Australia: an analysis of the Queensland Suicide Register. Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists. 2014;6(4):440-6.
40. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of homosexuality. 2006;51(3):53-69.
41. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. American journal of public health. 2001;91(6):915-21.
42. Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet Infectious diseases. 2013;13(3):214-22.
43. Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. Journal of acquired immune deficiency syndromes. 2008;48(1):97-103.
44. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS and behavior. 2008;12(1):1-17.
45. Stephens SC, Bernstein KT, Philip SS. Male to female and female to male transgender persons have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS and behavior. 2011;15(3):683-6.
46. Kenagy GP, Hsieh CM. The risk less known: female-to-male transgender persons’ vulnerability to HIV infection. AIDS care. 2005;17(2):195-207.
47. Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. International journal of epidemiology. 2010;39(4):1048-63.
48. Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WLt, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341-8.
49. American Psychiatric Association Diagnostic and statistical manual of mental disorders : DSM-5 [Internet] American Psychiatric Publishing [Cited March 7, 2015]. Available from: http://dsm.psychiatryonline.org/book.aspx?bookid=556.
50. Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. American journal of public health. 2013;103(5):943-51.
51. Reisner SL, White JM, Mayer KH, Mimiaga MJ. Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center. AIDS care. 2014;26(7):857-64.
52. Bauer GR, Pyne J, Francino MC, Hammond R. La suicidabilité parmi les personnes trans en Ontario : Implications en travail social et en justice sociale. Review service sociale. 2013;59(1):35-62.
53. Garrison, R. Bill C-279: An act to amend the Canadian Human Rights Act and the Criminal Code (gender identity) 2013[Internet] Open Parliament [cited March 11, 2015]. Available from: https://openparliament.ca/bills/41-1/C-279/.
54. Siksay, B. Bill C-389: An act to amend the Canadian Human Rights Act and the Criminal Code (gender identity and gender expression) 2013 [Internet] Open Parliament [cited March 11, 2015]. Available from: https://openparliament.ca/bills/40-2/C-389/.
55. Page J. Bill C-279: Bathroom amendment may make it easier for sexual predators 2015 [Internet] Montreal Gazette [updated March 4, 2015, cited March 11, 2015]. Available from: http://montrealgazette.com/life/bill-c-279-bathroom-amendment-may-make-it-easier-for-sexual-predators.
56. de Vries AL, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. Journal of homosexuality. 2012;59(3):301-20.
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