Pauline Park, Ph.D.

On a beautifully sunny day in April 2004, I joined half a dozen members of the Gay Asian & Pacific Islander Men of New York (GAPIMNY) at the Manhattan offices of “Details,” a men’s magazine that had published an offensive feature entitled “Gay or Asian?” that mocked gay Asian men as effeminate and undesirable.  After a successful meeting with the editor and publisher, we went to the Manhattan Mall nearby on Sixth Ave. at 33rd Street for lunch; we were delighted to have gotten an apology from them and a promise that “Details” would run a formal apology in the next issue of the magazine. While my colleagues were having lunch in the food court in the basement, I went to the women’s room; when I came out, I was surrounded by security guards who stood around me in a menacing stance, demanded to know if I was a man or a woman; the five men were big and menacing; the one woman among them seemed to have some authority, and when I suggested to them that they were risking a discrimination lawsuit, she had the others return to their station behind a one-way window just down the hall from the women’s restroom. While a bit shaken, I demanded to see her supervisor, who came out a few minutes later. After reconnoitering with my colleagues in the food hall, who were curious as to why I had disappeared for such a long time, we left the Manhattan Mall. When I got home, I called my colleague, Michael Silverman, then the executive director of the Transgender Legal Defense & Education Fund (TLDEF) to enlist his support.

My experience of discrimination in the Manhattan mall on that day in April 2004 was not that different in character from countless such incidents of discrimination based on gender identity and expression that transgendered and gender-variant people have had over many decades in the United States and throughout the world; what was different was that I was a transgender activist who had led the campaign for the transgender rights law enacted only two years earlier in April 2002 and at the time of the incident in April 2004 was a member of the working group meeting at the New York City Commission on Human Rights engaged in drafting guidelines for implementation of that transgender rights law. Having written the statement of legislative findings and intent, I knew the new law as well as anyone; and given my participation in the working group at the Commission, I also knew that status of the guidelines at that moment.

The working group was actually at an impasse over the language to use to describe possible situations involving discrimination in sex-segregated facilities requiring nudity such as gyms and locker rooms. Michael Silverman represented me in legal action against Advantage Security, the private firm that provided security for the Manhattan Mall; at the same time, I filed a complaint on my own with the Commission, meeting with a staff attorney who did not know about my participation in the working group working to draft the implementation guidelines for the transgender rights law. After some discussion between TLDEF and Advantage Security, they agreed to settle, making a donation to the New York Association for Gender Rights Advocacy (NYAGRA) at my request as well as having their security guards undergo transgender sensitivity training. Ironically, the language that Michael Silverman and I worked out for the Advantage Security settlement helped us resolve the impasse within the working group and the Commission on Human Rights incorporated that language into the draft of the guidelines adopted by the Commission in December 2004.

TLDEF announced the settlement of my case as well as that of Justine Nicholas on 31 March 2005 and the  New York Times reported on our settlement, Nicholas Confessore writing,

When Pauline Park watched Mayor Michael R. Bloomberg sign an amendment toughening the city’s anti-discrimination laws two years ago, she never expected to become one of its first beneficiaries. But yesterday, a complaint filed by Ms. Park – a co-chairwoman of the New York Association for Gender Rights Advocacy, which helped lobby for the amendment to the New York City Human Rights Law – became part of the first settlement issued under it… (Nicholas Confessore, “Transgender Group Reaches Agreement on Restrooms,” New York Times, 2 April 2005).

A New York Times story tends to attract attention from both friends and foes, and so it was with this one. Among the most influential of the organizations on the religious right is the Traditional Values Coalition. TVC attacked the settlement that I reached in April 2005 in my discrimination case, not in the least bit impressed by the fact that I was the first (along with Justine Nicholas) to successfully pursue a discrimination claim under the transgender rights law enacted by the New York City Council in 2002. In response to the report by the e Traditional Values Coalition declared on April 7 of 2005,

“The New York Association of Gender Rights Advocacy has won a victory over restroom use by individuals who believe they are a member of the opposite sex… The victory involves a settlement from a security guard company that allegedly discriminated against transgender activist Pauline Park when he [sic] used a woman’s restroom in a Manhattan mall in April, 2004. Park wears women’s clothing and identifies as a woman but has not had a sex change operation. Park is still anatomically a male but calls himself [sic] a ‘male-bodied woman’… This decision means that men who think they are women and are still anatomically males can use women’s restrooms in New York City…”

The April 7 TVC news report is entitled, “Ladies Restrooms: Who is That Male-Bodied Woman In the Next Stall?” That report concludes, “In a society where rational thought still existed, Pauline Park would be institutionalized for insanity or be given intense therapy to overcome his [sic] serious gender identity disorder. Instead, he has imposed his own mental illness upon the city of New York — and Michael Bloomberg has been a willing accomplice…”

That TVC ‘news report’ (if one could call such an absurd expression of prejudice a ‘news report’) brought home to me the profound significance of the continuing pathologization of transgender identity of gender variance and transgender identity. The ‘gateway’ diagnosis required to access to hormone replacement therapy (HRT) and SRS from 1974 until 2013 was gender identity disorder (GID), introduced into the fourth edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM IV), published by the American Psychiatric Association (APA). While GID is usually thought of as the diagnosis by which adult transsexual and transgendered people gain access to HRT and SRS, the true significance of GID is much larger. First, a change of legal sex designation  the ‘gender marker’ on identification documents that assigns us to either male or female sex in most jurisdictions requires at the very least documentation of an intent to go for SRS, if not actually proof of completion of surgery (as is the case in New York City).

While there is no necessary connection between a change of legal sex designation and a change of legal name, in many if not most cases, transitioning transsexuals pursue these two changes simultaneously. The truth is that most transgendered people frequently or even consistently present in a gender that does not match their ID, which causes problems in a multitude of situations. Since 911, most large buildings in New York City require photo ID even to enter the building. And so the apparent discrepancy between ID and either ‘gender marker’ and/or gendered name and/or gender presentation in a photocan constitute a barrier to employment, housing, and public accommodations as well as to accessing health care and social services.

But if the apparent ’solution’ is to go for a change of legal sex designation as well as name, and if the former change – and in some cases, effectively, the latter – requires a diagnosis by a psychiatrist; then in effect, the ability to access health care as well as employment, housing, and public accommodations requires such a diagnosis as well. I personally find it outrageous that transgendered people in the United States and elsewhere have to have themselves declared mentally ill in order to access health care or to get or to keep a job. We must commit to finding means by which transgendered people can access forms of medical intervention such as HRT and SRS without having to subject themselves to the degradation of being declared mentally ill simply by virtue of their gender identity.

GID not only undergirds the Harry Benjamin Standards of Care (SOC) and the protocols for gender transition in this society, this diagnosis – what I call the GID ‘regime’ – constitutes the very basis for American society’s understanding of transgender. Even in relatively more sympathetic portrayals of transgendered characters such as those in “TransAmerica” and on “All My Children” and “Ugly Betty,” the discourse through which those characters are understood is a medical model of transsexuality based fundamentally on the concept of gender dysphoria. My own work as a transgender activist is informed by a feminist conception of gender and a commitment to challenging and dismantling the sex/gender binary that is at the root of our oppression as women and as men as well as transgendered men and women or for that matter, genderqueers who resist binary categorization. Our goal as a movement must therefore be nothing less than the transformation of society’s understanding of gender. And if we are committed to that goal, we must also be committed to dismantling the ‘GID regime’ that undergirds this system of gender regulation and control.

In 2013, the APA published the DSM V, which replaced ‘gender identity disorder’ with ‘gender dysphoria’ (American Psychiatric Association, “Gender Dysphoria in Adolescents and Adults,” Supplement to the Diagnostic and Statistical Manual of Mental Disorders,” fifth edition (Sept. 2016), p. 19.: DSM-5 classificaion, gender dysphoria, gender dysphoria in adolescents and adults, p. xxiv (Desk Reference, p. xxv): change F64.1 to F64.0).

I fully understand the practical implications of GID for accessing hormones and surgery, but I think we need to question the notion that we must accept the pathologizing of all gender variance as mental illness in exchange for the ostensible benefits that flow from the diagnosis. The reality is that many and perhaps even most of those who have gotten SRS paid for by private insurance in the United States in the last decade have been able to do so under the auspices of the Affordable Care Act, legislation whose future is extremely insecure given the public commitment of Barack Obama’s successor Donald Trump and the Republican majorities in both houses of Congress to repeal the ACA. One might also point out parenthetically that there was no provision in ‘Obamacare’ (as the ACA is popularly known) that explicitly prohibited discrimination in the provision of health care on the basis of gender identity or expression (or sexual orientation, for that matter), nor was there any provision that explicitly required health insurance companies from covering HRT or SRS for transitioning transsexuals. The very fact that insurance payment for HRT and SRS appear to be dependent on the fate of controversial legislation opposed by the majority party in the United States itself would seem to be a compelling argument to re-examine the very notion of retaining a pathologizing diagnosis in the DSM simply to secure continued insurance payment for those medical interventions. And it must also be pointed out that, despite the ACA, many transgendered people continue to have no health insurance at all, and those who do have either Medicaid, whose budget is more precariously perched than that of any other major federal entitlement program.

If Republicans in Congress are successful in ‘repealing and replacing’ the ACA, then the reversion to the status quo ante could well mean that those who get health insurance through health maintenance organizations (HMOs), most of which had explicit clauses written into their policies excluding coverage of any service related to gender transition, could well find themselves unable to access insurance coverage for HRT and SRS as in the era before Obamacare.

What is striking to me is the narrow parameters of the debate within the transgender community and even within the larger LGBT community over the role of the diagnosis of GID and its successor, gender dysphoria, in accessing HRT and SRS; there has been virtually no discussion in LGBT contexts of the fact that the United States is the only industrialized democracy in the world without universal health care. It seems to me that rather than fighting for private insurance coverage for medical interventions related to gender transition, we in the transgender community and the larger LGBT community should instead be demanding universal health care and statute laws that explicitly prohibit discrimination in the provision of health care based on gender identity and expression as well as sexual orientation; doing so would enable us to connect the struggle for transgender access to health care to the larger national debate over universal health care; doing so would also enable the transgender community to forge real relationships and alliances with other communities fighting for health care rather than characterizing the issue of transgender health care narrowly as a fight for HRT and SRS through a pathologizing definition of transgender identity under the rubric of disability.

It is important at this point to talk about the impact of pathologization and to recognize the fact that the pernicious effects of GID extend far beyond simply the instrumental necessity for adult transsexuals to obtain the diagnosis in order to access hormones and surgery. According to one report, three quarters of all those diagnosed with GID are diagnosed with GID in childhood and adolescence. These are for the most part gender variant children whose parents take them to a psychiatrist because Johnny is playing too often with dolls or Janie is climbing too many trees. The parents conflate homosexuality with transgender and hope that the psychiatrist can ‘cure’ or at least ‘prevent’ homosexuality in their chil dren. There may well be a significant segment of the psychiatric profession that uses the diagnosis in precisely this fashion  to try to ‘cure’ or ‘prevent’ homosexuality in children and youth – this, despite the removal of homosexuality from the DSM in 1974.

Many of these psychiatrists, such as Charles Socarides and George Rekers, are associated with the religious right and in fact advocate re introduction of homosexuality in the DSM. Rekers, who is on the faculty of the School of Medicine at the University of South Carolina, has in fact received over half a million dollars from the National Institute of Mental Health (NIMN) to study ways to ‘treat’ and ‘cure’ such ‘deviant’ behavior, including ‘at ypical gender identity,’ ‘atypical sex roles,’ and ‘pre transsexual behavior.’

One of the leading organizations advocating re introduction of homosexuality in the DSM is the National Association for Research & Therapy of Homosexuality. NARTH and their co conspirators in homophobia see removal of GID as having the potential to eliminate the ability of psychiatry and homophobic and transgenderphobic parents to police and enforce the gender boundaries that they wish to impose on their children as well as on adults to the extent possible.

I have an Asian American lesbian friend in Queens whose nephew is transgendered. When he told his parents that he felt himself to be a girl, his mother and stepfather had him institutionalized, on the basis of a diagnosis of GID. He is currently at Cinnamon Hills, which despite its charming name, is in effect a prison for youth located in the middle of the desert in southern Utah. Perhaps the most famous such case of institutionalization of a youth with GID is that of Daphne (now Dylan) Scholinski, who now identifies as a transman. At fifteen years old, Scholinski identified as a butch lesbian and was committedto a mental institution by parents who were determined to ‘cure’ her ofthe mental illness with which she was diagnosed. The Last Time I Wore A Dress is only the most famous account of a gender-variant youth subjected to behavior modification therapy for a gender identity that is no disorder and that cannot be cured.

What many people evenwithin the transgender community do not realize is that legal minors can be committed to a mental institution and subjected to behavior modification therapy up to and including electroshock therapy. In fact, even adults can be institutionalized against their will if they are diagnosed with GID, which is precisely what happened to the renowned economist Deirdre McCloskey, when family members decided that she was ‘insane’ after she told them of her intention to transition (as she writes in Crossing: a Memoir, University of Chicago Press, 1999). It seems to me that what is ‘insane’ is forcibly institutionalizing a brilliant economist simply because she has informed her family that she wishes to live her life consistent with her internal sense of gender identity. What is insane is the diagnosis of GID itself.

The pernicious effects of GID extend by implication indirectly to the intersexed as well. Intersex genital mutilation (IGM) certainly requires no diagnosis of GID, and in fact, the intersex ‘condition’ is explicitly excluded as a criterion for GID, but the rigid insistence on the sex/gender binary articulated by the GID diagnosis that is officially recognized by the psychiatric profession through its inclusion in the DSM gives implicit support to the practice of IGM.

The influence of GID also extends into the sphere of public policy as well, impeding the fight for transgender rights. We have made enormous progress as a community and as a movement over the course of the last two decades, but while 95 jurisdictions  including nine states and the District of Columbia – now have enacted legislation explicitly prohibiting discrimination based on gender identity or expression, it is a sad fact that 41 states have no such protection in their state laws. However, every state has included disability in its human rights law, and it is that rubric that litigators are using to obtain legal redress for transgendered plaintiffs across the country, and they often win on that basis. But the argument that such litigators proffer usually follows along these lines: my client is mentally ill by virtue of his/her gender identity disorder and therefore is protected under state disability law. I should make clear that I have nothing but admiration for the hard  working lawyers who represent transgendered clients – often pro bono – with limited time and resources. And in those 41 states without explicit inclusion of gender identity and expression in state human rights law, appeal to disability by way of GID may well be the only practical way of obtaining legal redress for discrimination against a transgendered client. But I think we need to recognize how sharp the horns of that dilemma may be.

As a non lawyer who works on legislation, I can tell you that the genuine happiness that I feel for the transgendered client who wins such a case is diminished by the realization that the victory for that individual undercuts the very arguments that we need to make in the legislative arena. Because it is precisely GID that gives the religious right and other opponents of transgender rights legislation their most powerful ammunition.

Consider Vermont, where activists are trying to get the state legislature to pass a transgender rights bill against the opposition of right -wing organizations such as Vermont Renewal, which describes itself as “a grassroots organization with the primary goal of promoting and defending traditional family and moral values based on the Judeo- Christian worldview that Vermont and the entire United States were founded upon” (www.vermontrenewal.org). In an op-ed in the Burlington Free Press for Vermont Renewal, Stephen Cable writes,

“Under the banner of equality, the Vermont Legislature seeks to protect transgender behavior (i.e. transvestite and transsexual) from discrimination (bills S.51 and H.228)… Despite good intent, there are major problems with this legislation. First, such behavior is associated with a treatable mental disorder. However, we question efforts which, under the pretext of equality, actually favor one mental disorder for protections to the exclusion of all others, such as depression, anorexia, kleptomania, etc. The Common Benefits Clause of the Vermont Constitution forbids such preferential treatment…”

Cable continues,

“There are, of course, serious pitfalls associated with efforts to protect behavior associated with mental disorders. Perhaps the largest would be inadvertently sending a message that such illness is healthy, or even desirable, rather than encouraging treatment and recovery – thereby trapping people within this disorder. Equally important, however, is the danger that, by affording too much protection to the sufferer, government may actually become the oppressor, creating unforeseen hardship and complexity for businesses, schools, and the common person…” Now, there are certainly many responses to Cable’s uninformed and bigoted screed, including a critique of the way in which he misconstrues disability law and how it works. And one can also respond to Cable by pointing out that there is no evidence that the GID diagnosis was intended to be used as an argument against non-discrimination legislation. But we simply cannot ignore the fact that the religious right not only in Vermont but across the country has latched onto GID as the core of its argument against transgender rights legislation at the local, state and national levels; to that extent, the removal of GID from the DSM would disable their core argument (pun intended). And any student of LGBT history would be conscious of how the removal of homosexuality from the DSM in 1974 advanced the gay and lesbian movement from that point onwards.

What I would say to the Traditional Values Coalition is this: I do not have a gender identity disorder; it is society that has a gender identitydisorder. I must admit it was a bit of a shock to be subjected to personal attack by one of the largest religious right organizations in the country, but I have taken the advice of a friend of mine who encouraged me to wear it as a badge of honor. Now that I’ve been declared a public enemy by the likes of TVC that I have ‘arrived.’

But the point I would like to make here is not so much about the TVC bull’s eye on my forehead; it is the ammunition that the discourse of mental pathology gives to opponents of transgender rights. In TVC’s report, “A Gender Identity Disorder Goes Mainstream” (also issued in April 2005), the organization declares, “These are deeply troubled individuals who need professional help, not societal approval or affirmation.”

Elsewhere in its ‘report,’ TVC describes “this mental illness and how it is being normalized in our culture.” In fact, the very title of the TVC ’special report’ is “A Gender Identity Disorder Goes Mainstream,” followed by the sub head, “Cross dressers, transvestites, and transgenders become militants in the homosexual revolution.” And TVC is not the only such organization pursuing this line of argument, however specious. The religious right is now so panicked about the growing acceptance of gay men and lesbians in this societythat they are increasingly focusing on the diagnosis of GID not only to oppose transgender rights legislation, but also non discrimination andhate crimes legislation that includes sexual orientation as well.

And that is why I say that every victory for a transgendered plaintiff whose lawyer uses disability to win a discrimination case compromises our ability to work in the legislative arena – hence my profound ambivalence about the GID-based arguments being used in such cases. A few years ago, I had a conversation with a transgender activist from another state for whom I have great respect. She insisted that the way forward for the transgender movement was the disability route. I insisted with equal vehemence that the ‘disability track’ was the wrong path to pursue. I cited the clause in the Americans with Disabilities Act that explicitly excludes ‘transvestism and transsexualism’ from coverage under the terms of the 1990 federal disability rights law, thanks to Jesse Helms. The notoriously bigoted senator from North Carolina made certain that the path to transgender rights through federal disability law would be closed, and there is little if any chance that that path will be opened anytime soon.

But the issue of federal disability law aside, the larger strategic question for our community and for our movement must be this: is our goal only litigation and legislation or are we pursuing something bigger? The whole critique of the queer left of the mainstream gay and lesbian movement is that it has for far too long focused narrowly on juridical rights. Now, I happen to believe that we should pursue non-discrimination legislation and that we must ensure that all transgendered and gender variant people – indeed, all LGBT people – gain equal rights under federal as well as state and local law in every area of activity, including marriage. But I also believe that our movement must have at its core a vision of social justice and social change. And that vision must be premised on the goal I articulated earlier. Our objective must be nothing less than the transformation of society’s understanding of gender. And so the removal of GID from the DSM must be a goal of our movement; it simply cannot be otherwise. We must discard a medical model of transsexuality that is a disease model of mental illness; we must reject any suggestion that our goal as a community and as a movement is simply to find a place within a normalizing discourse of the existing sex/gender binary, expanded ever so slightly to accommodate us – or at least those of us who can comfortably fit within a governing regime of heteronormativity. In its stead, we must embrace a vision in which all forms of transgender are seen simply as natural variants in gender identity and expression and in which all transgendered and gender variant people will be accepted as fully equal to their conventionally gendered family members, friends, colleagues, and neighbors.

It is important at this point to address the misunderstandings that have arisen when I have discussed the need for the depathologization of transgender identity and gender variance in speeches that I have given since 2007, when I called for the abolition of GID in my keynote address at the Philadelphia  Trans-Health Conference (“Transgender Health: reconceptualizing Pathology as Wellness,” 7 April 2007) and in a talk at Harvard University’s School of Public Health in Boston in 2011 (“Transgender Health, Pathology and Human Rights,” 20 April 2011). When I spoke at Harvard, one graduate student in the audience asked me if I was advocating that the transgender community disassociate itself from the disability community; this student misinterpreted my comments as suggesting that transgendered people should distance themselves from people with disabilities because of the stigmatization of people with disabilities (mental as well as physical) in American society. In fact, I think we should work to end the stigmatization of all forms of disability, whether mental or physical; and I think an alliance between transgender activists and disability rights activists would be a very good thing indeed; but that relationship cannot be based on a false pathologization of transgender and gender variance. The real basis for an effective working relationship between the transgender community and other communities, including the disability community, would be precisely the rejection of the false notion that transgender is a psychopathology, the objective of ending the stigmatization of all forms of disability.

What I would like to suggest as an alternative is to put a concept of wellness at the center of transgender health. I am arguing here for the removal of transgender identity from the DSM altogether and a comprehensive rejection of the pathologizing of transgender and gender variance. Just as homosexuality is now viewed by mainstream psychiatrists and psychologists as simply a natural variance in sexual orientation, so transgender would be viewed simply as a natural variance in gender identity and expression – no more or less natural than conventional gender identities.

The objection to such a conception coming from certain quarters no doubt would be that it would render hormone replacement therapy and sex reassignment surgery as ‘elective’ procedures, thus making it impossible to get insurance payment for HRT and SRS as ‘medically necessary.’ But I would argue that we must challenge the very notion that as transgendered people we should view ourselves as having been born with a ‘birth defect’ and instead see ourselves as being fully natural and fully human just as in fact we are.

In this conception, the various technologies that some of us use to modify our anatomy and biology would be viewed as technologies of self-determination, used to configure our bodies to conform to our internal sense of gender identity. In other words, HRT and SRS, breast reduction and breast augmentation, metoidioplasty, tracheal shaves, and other forms of plastic surgery would be technologies we can use to make ourselves feel more comfortable in our own skin – technologies that we can use to enhance our sense of well-being. In such a conception, would hormones, surgery and the like be elective? Yes, and by reconceptualizing such technologies as elective, we would reclaim our sense of self determination. The truth is that the argument for SRS as currently conceived makes no sense whatsoever. For what mental illness is surgery on a part of the body other than the brain indicated or prescribed? I know of none. The usual objection to SRS is that it involves the removal (in most cases) of perfectly healthy tissue, and that is in fact usually the case. There is nothing diseased in the sex organs of most transsexual or transgendered people who seek SRS. But surgery will enhance the well-being of those who elect it. And by reconceptualizing surgery – including and above all SRS – as elective, we reclaim our sense of agency. The notion that SRS is medically necessary cannot be advanced except by way of an argument that pathologizes our bodies and our minds – that pathologizes our very identities.

The truth is that SRS is rafely if ever medically necessary in the conventional sense of the term. Rather, SRS can be a very effective way of enhancing the well-being of those who elect it, and as such, should be readily available without any psychiatric evaluation or diagnosis to those who choose to elect it. And just as private insurance pays for hormone replacement therapy for post menopausal non transgendered women, it should pay for HRT for transgendered women and men as well as for SRS for both. The crucial point is that we as transgendered individuals have to move towards acceptance of ourselves. And we as a transgender community have to reject the idea that the body of a transgendered person is a diseased body. Even more importantly, we must reject the notion that the mind of a transgendered person is a diseased mind. The ‘problem’ of ‘gender dysphoria’ is not to be found in the mind of a transgendered person. Rather, the problem is to be found in the society that is too rigid to allow for those born male to identify as women or those born female to identify as men – or to allow those born male, female, or intersexed to identify as something other than men or women.

And so I say that what we need to do is to reconceptualize pathology as the problem and not the solution to our problems. The solution is, instead, a (w)holistic concept of wellness informed by feminist consciousness that locates the problem at the level of society and not the individual who resists the dictates of an overly gender-rigid society. As I see it, my work as a transgender activist is not about helping a small number of post-operative transsexuals to fit more easily into existing boxes but rather about helping all of us to break out of all of the boxes so that we can all be whoever and whatever we feel ourselves to be. In my view, the task facing us as a community is not to shore up regressive notions of mental pathology but rather to challenge and dismantle the GID regime and the larger sex/gender binary of which it is a part and which is the source of our oppression as transgendered and gender variant people. We must set as our objective nothing less than the transformation of society’s understanding of gender, as part of a movement for social justice for all.

Reconceptualizing the struggle for transgender health care access in progressive feminist terms is part and parcel of engaging in the struggle for universal health care, which can only be based on a ‘single-payer’ system administered by the federal government. The question of the precise form of that system of health care lies well beyond the parameters of this chapter but could certainly involve ‘Medicare for all,’ to cite just one possible option. But what is crucial is that we move from the limiting conceptualization of our work as transgender activists as being about securing access to HRT and SRS through use of the Americans with Disabilities Act (ADA) on the basis of transgender identity as a mental illness and instead recast our struggle as part of the larger struggle for universal health care with guarantees prohibiting discrimination in its provision on the basis of gender identity and expression as well as sexual orientation; by doing so, we can make common cause with other groups and communities.

I urge you to join me in that struggle. Thank you.

In 2004, I named and co-founded the Transgender Health Initiative (THINY), a joint project of the New York Association for Gender Rights Advocacy (NYAGRA) and the Transgender Legal Defense & Education Fund (TLDEF) whose mission was to enhance access to health care for transgendered and gender-variant people. When we began a series of monthly membership meetings that continued for a few years, we expected that THINY members would want to begin by working with hospitals that were part of the Health & Hospitals Corporation of the City of New York, which were and still are underfunded and desperately in need of transgender sensitivity training; we were  surprised to discover that THINY members actually wanted to address issues of transgender sensitivity — or lack thereof — at the Callen-Lorde Community Health Center; we were surprised because Callen-Lorde is the lesbian, gay, bisexual and transgender (LGBT) community health care provider in New York and may well have more transgendered clients than any other health care provider in the city.

But our transgendered members had many complaints about Callen-Lorde and their experiences there, and so we launched a project collaborating with management at Callen-Lorde to survey transgendered patients and clients on their experiences there; we designed the survey, which was made available on-line and in paper form at the front desk, and we got a significant rate of return. As a result of the very candid feedback from the survey, we were able to make recommendations to the administration, which in turn created a transgender community advisory committee as well as hiring for a new position of transgender services coordinator. Following our work with Callen-Lorde, we then began to work with senior management at HHC, though it was the inability to get a commitment to a budget for training that prevented us with moving forward on training for HHC personnel. (At the same time, Gouverneur, one of the HHC hospitals, was moving forward with a small LGBT health clinic.)

In 2009, I worked with NYAGRA’s summer intern, Kelly White, to put together the first directory of transgender-sensitive health care providers in New York City and the metropolitan area (which is now available on-line at  transgenderrights.org). Published in July of that year, this was the first directory of transgender-sensitive health care providers for New York City and the metropolitan area ever published, and to my knowledge, it was the first such directory for any city published in a print edition anywhere in the United States.

In 2006, I did a series of trainings with Michael Silverman (then executive director of TLDEF) for St. Vincent’s Hospital, which was one of the largest hospitals in New York City, and a hospital with one of the largest transgender patient populations; these were the first transgender sensitivity trainings at any major hospital in the city. Sadly enough, St. Vincent’s went bankrupt in 2010 and closed after failing to resolve a situation in which the hospital had accumulated over a billion dollars in debt. These transgender sensitivity trainings were as much of an eye opener for us as they were for the nurses, techs, and other health care professionals we trained. Participants ranged from hostile to indifferent to open-minded to genuinely supportive  in short, a microcosm of society and its attitudes towards the transgendered. Only a few of the nurses were openly hostile and even (in at least two cases) somewhat disruptive. But most of the nurses and other providers we did trainings for at the very least listened politely.

The real problem was the lack of both knowledge of the challenges facing transgendered people as they try to access health care as well as the lack of sensitivity on the part of some of these providers. With regard to the former  lack of knowledge  one of the big problems facing our community is that among those who think about transgender access to health care and there are far too few who think about this issue at all  most imagine that the main challenge we face is accessing hormones and sex reassignment surgery (SRS). While that is a challenge, the biggest challenge for transgendered people really is accessing healthcare for all of those medical issues unrelated to gender transition.

And that leads me to the central theme of this chapter. The work that I have done in New York on health care access for members of the transgender community has made very concrete the many paradoxes and dilemmas of advocating simultaneously for health care access and for human rights in the face of the pathologization

(photo courtesy Anh Ðao Kolbe)

Pauline Park is chair of the New York Association for Gender Rights Advocacy (NYAGRA), the first statewide transgender advocacy organization in New York (www.nyagra.com), which she co-founded in June 1998. She also serves as vice-president of the board of directors of the Transgender Legal Defense & Education Fund (TLDEF). Park led the campaign for the transgender rights law enacted by the New York City Council (Int. No. 24, enacted as Local Law 3 of 2002). She served on the working group that helped to draft guidelines – adopted by the Commission on Human Rights in December 2004 – for implementation of the new statute.

Park negotiated inclusion of gender identity and expression in the Dignity for All Students Act (DASA), a safe schools bill currently pending in the New York state legislature, and the first fully transgender-inclusive legislation introduced in that body. She also serves on the steering committee of the coalition that secured enactment of the Dignity in All Schools Act by the New York City Council in September 2004. Park has written widely on LGBT issues and has conducted transgender sensitivity training sessions for a wide range of social service providers and community-based organizations. She has a Ph.D. in political science from the University of Illinois at Urbana-Champaign.

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I want a president…
by Pauline Park
17 October 2016

I want a president who reflects my values, not the values of the Wall Street oligarchy as Hillary Clinton and Donald Trump do.

I want a president who stands up to Islamophobia and all forms of bigotry instead of fanning the flames of prejudice and hatred as Donald Trump and Hillary Clinton do.

I want a president who will curb the military/industrial complex instead of enabling its excesses with bloated budgets as Donald Trump and Hillary Clinton would do.

I want a president who isn’t an enormously wealthy embodiment of class privilege as Donald Trump and Hillary Clinton are, multi-milllionaires who represent the interests of the oligarchy.

I want a president who doesn’t pander to voters or condescend as Donald Trump and Hillary Clinton do but who addresses the real issues in a serious and policy-oriented manner.

I want a president who is willing to do something about global warming and climate change, unlike Donald Trump, a global warming denialist, and Hillary Clinton, whose agenda is to promote fracking, the new energy technology that’s contributing more to global warming than any other.

I want a president who really thinks #BlackLivesMatter instead of denigrating the BLM movement like Donald Trump and Hillary Clinton do.

I want a president who actually understands the corporate culture of police violence in this country like Donald Trump and Hillary Clinton and is willing to address this serious problem affecting LGBT people and people of color, especially LGBT people of color.

I want a president who tells the truth and isn’t a pathological liar like Donald Trump and Hillary Clinton.

I want a president who will challenge and downsize the National Security agency and end its illegal surveillance of US citizens and others instead of enabling the NSA like Donald Trump and Hillary Clinton.

I want a president who will end support for and subsidies to brutal dictatorships in Honduras, Egypt, Saudi Arabia, Bahrain and elsewhere instead of supporting and enabling them like Donald Trump and Hillary Clinton.

I want a president who will challenge and downsize the military/industrial complex, unlike Donald Trump and Hillary Clinton, who would further enable its excesses.

I want a president who will take the rights of lesbian, gay, bisexual and transgendered people seriously, unlike Donald Trump and Hillary Clinton.

I want a president who will stop subsidizing the illegal Israeli occupation of the West Bank and East Jerusalem as Donald Trump and Hillary Clinton do but who instead will end US subsidies to Israel’s brutal apartheid regime in illegally occupied Palestine.

I want a president who will challenge Israel’s illegal blockade of the Gaza Strip instead of supporting its policy of incremental genocide in Gaza instead as Donald Trump and Hillary Clinton do.

I want a president who knows where Aleppo is, unlike Gary Johnson.

I want a president like Jill Stein, the Green Party presidential nominee, who reflects my progressive feminist values instead of embodying anti-progressive, anti-feminist politics as Donald Trump and Hillary Clinton do.

I want a president like Jill Stein, the only feminist and the only progressive in the race~!

I want all Americans to vote for Jill Stein as president and say #NeverHillaryOrTrump; #JillNotHill~!

This is a statement read by Pauline Park (without any of the candidate references) on the High Line in Manhattan on 17 October 2016 as part of a project referencing Zoe Leonard’s poem, “I Want a President.”

Pauline Park led the campaign for the transgender rights law enacted by the New York City Council in 2002 and participated in the first US LGBTQ delegation tour of Palestine in 2012; Park did her M.Sc. in European studies at the London School of Economics & Political Science and her Ph.D. at the University of Illinois at Urbana-Champaign.

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Hillary Clinton’s anti-feminist & anti-progressive agenda will never have my support
by Pauline Park

Hillary Clinton’s supporters depict her as a courageous feminist trying to advance a daringly progressive agenda in the face of Republican opposition; the truth is actually quite the opposite: Hillary is an anti-feminist who has always pursued an anti-progressive agenda from her earliest days as a ‘Goldwater girl.’

To begin at the beginning: Hillary grew up in the lily-white upper middle class Chicago suburb of Park Ridge. It is important to point out that Barry Goldwater was not only the Republican nominee in 1964, he was the most right-wing Republican nominee of his day, part of a conservative movement that used his candidacy to take over the party and transform it into the GOP we know today, so far right-wing that Northeastern liberals like Nelson Rockefeller, Jacob Javitz and Claiborne Pell could not win nomination to run for any statewide office today, even in New York or New England. In 1964, while Bernie Sanders was on the front lines of the civil rights movement, Hillary Clinton was supporting the Republican presidential nominee who was ridiculing the Rev. Dr. Martin Luther King, Jr. and calling him a ‘communist.’

Of course, the question is not where Hillary Clinton started out but where she has ended up and where she has been along the way, and her role as First Lady of Arkansas and the United States needs to be taken into account in a comprehensive assessment of her record. Hillary supporters lash out at those who would examine that record as ‘sexist,’ but as First Lady, Hillary was not a purely decorative element in her husband’s administration in Little Rock and later in Washington, D.C.; she was a very public figure and cast herself as an active policy-maker in both administrations; and in fact, the whole rationale for her campaign for the U.S. Senate in 2000 was that she had been a key decision-maker in the Clinton administration; and so what Hillary did in Little Rock and later in Washington in her husband’s administrations are very relevant.

I would just point to her crucial role in advocating for the 1994 crime law that helped accelerate the mass incarceration of people of color — especially African American and Latino men — as well as her public advocacy for the welfare reform legislation that further impoverished millions of poor women and children, disproportionately people of color. As Michelle Alexander has pointed out, the Clinton administration

capitulated entirely to the right-wing backlash against the civil-rights movement and embraced former president Ronald Reagan’s agenda on race, crime, welfare, and taxes—ultimately doing more harm to black communities than Reagan ever did… Bill Clinton presided over the largest increase in federal and state prison inmates of any president in American history… He supported the 100-to-1 sentencing disparity for crack versus powder cocaine, which produced staggering racial injustice in sentencing and boosted funding for drug-law enforcement. Some might argue that it’s unfair to judge Hillary Clinton for the policies her husband championed years ago. But Hillary… not only campaigned for Bill; she also wielded power and significant influence once he was elected, lobbying for legislation and other measures… In her support for the 1994 crime bill, for example, she used racially coded rhetoric to cast black children as animals… Bill Clinton championed discriminatory laws against formerly incarcerated people that have kept millions of Americans locked in a cycle of poverty and desperation. If you listen closely here, you’ll notice that Hillary Clinton is still singing the same old tune in a slightly different key. I am inclined to believe that it would be easier to build a new party than to save the Democratic Party from itself. (Michelle Alexander, “Hillary Clinton Doesn’t Deserve the Black Vote,” the Nation, 2.10.16)

The support that many people of color have offered Hillary Clinton in the course of the 2016 presidential campaign is all the more curious when one considers her use of language that some would call racist, as Marc Charles wrote in April 2016,

Hillary Clinton is using terms like ‘off the reservation,’ and reassuring people that ‘We don’t need to make America great again. America never stopped being great.’ This type of behavior demonstrates she does not understand the systemic racism and blatant oppression that has been endured by people of color throughout the entire history of this nation,” writes Mark Charles, adding, “Unfortunately, the dialogue that is taking place this election cycle is not about broad-based equality or ending racism. The conversation we are having today is about the type of racism we want to settle for” (Mark Charles, “A Native Response to Hillary Clinton’s ‘Off the Reservation’ Comment,” Native News On-Line, 4.30.16)

Is it sheer ignorance of the history of race and ethnicity in the United States? Or was the ‘off the reservation’ comment a racist ‘dog whistle’ as when Hillary asserted that she had a broader base of support than then-Sen. Barack Obama, citing an Associated Press article

that found how Sen. Obama’s support among working, hard-working Americans, white Americans, is weakening again,  and how whites in both states who had not completed college were supporting me. There’s a pattern emerging here (Richard Prince, “Hard Working… White Americans,” Maynard Institute, 5.8.08)

The pattern that many people of color saw was that of a privileged white woman casting herself as the champion of white Democrats unwilling to vote for an African American. “Was Hillary channeling George Wallace? Hillary’s reckless exploitation of racial division could split the Democratic Party over race  — a tragic legacy for the  Clintons,” wrote Joe Conason (ibid).  Hillary also aggressively pushed the Republican ‘welfare reform’ bill that Bill Clinton signed into law in 1996 that plunged hundreds of thousands of families  — disproportionately African American women and children — from poverty into even deeper poverty as part of a cynical attempt to out maneuver Bob Dole and the Republicans in the lead up to the 1996 election, which Clinton won handily and most likely would have easily won even if Clinton had not signed the crime bill and welfare reform bill into law.

If Hillary supporters rail at those who criticize her policy-making role in the Clinton White House, they refuse to acknowledge the fact that she would never have been considered a credible candidate for the Senate seat of the retiring Daniel Patrick Moynihan had she not claimed to have been a key policy-maker in the Clinton administration. Neither Clinton had ever lived in New York before, and so Hillary was rightly called a ‘carpet bagger’ for moving to Chappaqua just to be eligible to run for the Senate in 2000 with the blessing of Pat Moynihan. Whether former Mayor Rudolph Giuliani could have beaten Hillary we will never know, because he withdrew from the race after being diagnosed with prostate cancer, leaving the feckless U.S. Rep. Rick Lazio from Long Island to go down to defeat in November of that year.

My own interaction with Hillary came in the form of a request that I and a group of transgender activists made to meet with her before the election and then again after she won in November; her staff refused both requests, even declining to offer a low-level staff member to meet with us to discuss transgender discrimination issues; the second time around, of course, we were not just voters, but constituents of the newly elected Senator, whose refusal to meet with us or even explain her refusal to meet with us alienated not just me but the mostly African American transwomen who were part of our group as well. The fact that Housing Works, one of New York City’s largest social service providers to people living with HIV and AIDS, was part of the group requesting the meeting, seemed to have no impact whatsoever on the willingness of Hillary’s staff to meet with us.

Just as important in creating a lasting impression with me were Hillary Clinton’s responses to questions posed by Lesbian & Gay New York (‘LGNY,’ since renamed ‘Gay City News’) to her in an interview in 2000. Paul Schindler, the newspaper’s editor, asked me if I could suggest a transgender-specific question to pose to the Senate candidate; I suggested that he ask her if she would commit to supporting full transgender inclusion in the Employment Non-Discrimination Act (ENDA) and the federal hate crimes bill. Taking my suggestion, in an interview on Oct. 4, Schindler (Paul Schindler, “Hillary Clinton Talks to Paul Schindler, 2000“) asked the Senate candidate,

“Do you think the goal of broadening the language for ENDA or broadening language in the hate crimes protection act to include gender expression and gender identity, do you think that’s a practical goal at this point politically?”

To which Hillary responds, “I think we need to try to move ENDA forward. I think ENDA is such an important legislative goal. I think it’s within reach and I think it’s a vehicle for widening the circle of rights and freedoms and responsibilities and I would really focus on trying to get that passed.”

“In other words, no effort at this point at amending?”

“I don’t see at this point that that would be in the best interest of moving the agenda forward.”

After another go around on this question, Schindler then asks, “One of the things that the transgender community points to is that, for example, on hate crimes in New York State, the entire coalition for hate crimes held out to have gays and lesbians included in it. We would have had a hate crimes bill in New York long ago if it had only been for religion and so forth. But everyone hung tough on that. But what the transgender community is saying now is, ‘Wouldn’t that approach be appropriate for them as well?’ in other words, don’t do it piecemeal, include everybody and then move forward.”

“Well no one who’s a leader in the gay and lesbian community has asked me to do that. I think there’s an understood recognition of the political reality. So for me it’s a priority to try to get ENDA passed, which is what I will work on.”

Transgendered people suffer pervasive discrimination, transgendered people of color in particular, and it was shocking to me to see Hillary dismiss transgender discrimination altogether in her comments in her October 2000 interview with LGNY; what was especially appalling was her response to the question about supporting inclusion of gender identity and expression in ENDA and the hate crimes bill: “no one who’s a leader in the gay and lesbian community has asked me to do that.” Well, it should not be up to gay and lesbian gatekeepers to decide whether transgendered people should be protected from discrimination and all the more so given that the gay and lesbian ‘leaders’ Hillary talks to are wealthy and powerful members of the gay political establishment, many of them millionaires and almost all of them white and at least upper middle class.

Even when she caught onto the increasingly common and more inclusive usage of ‘LGBT’ community, as senator and later as secretary of state, Hillary almost never addressed transgender discrimination as a stand-alone issue apart from the broader LGBT umbrella.

It is worth pointing out that Hillary not only supported the discriminatory bill that became known as ‘Don’t Ask, Don’t Tell’ that Bill Clinton signed into law in 1993 but also the Defense of Marriage Act (DOMA) that Clinton signed into law in 1996 — the only legislation specifically institutionalizing discrimination against LGBT people ever signed into law by any president in US history. And Hillary not only supported that legislation but aggressively defended it for years with language that far exceeded what was necessary to justify DOMA purely in terms of political expediency.

Hillary only came out for same-sex marriage when she began her second campaign for president and after Obama himself had come out in favor of marriage equality, and he only did some when it became clear that he would have a hard time raising money in the LGBT community for his 2012 election campaign if his administration was still supporting DOMA.

And as late as May 2016, when Hillary was almost assured of winning the Democratic presidential nomination, she refused to respond to a questionnaire from a transgender advocacy organization; as Kevin Gosztola reported on May 24,

Trans United Fund received a call from a Clinton campaign representative a full two weeks after the campaign had committed to complete the survey, explaining that the survey was ‘too long’ and the campaign did not have the appropriate resources to complete it in a timely manner. The Sanders campaign completed the questionnaire completely and on time (Kevin Gosztola, “Transgender Group ‘Perplexed’ At Why Clinton Won’t Fill OutQuestionnaire,” Shadowproof, 5.24.16).

As Gosztola put it so trenchantly, “For a ‘frontrunner’ Democratic presidential candidate, who has cast herself as the inevitable nominee, it’s hard to comprehend how the campaign could not have found time to answer some questions important to trans people.” Hillary has been at best a follower, not a leader, when it comes to LGBT rights, and for most of her career, an opponent of LGBT rights.

Of course, there are those who not only insist upon but demand that women support Hillary simply because she’s a woman, though it is difficult to see why simply being female alone should compel anyone’s support; after all, Carly Fiorina ran for the Republican presidential nomination in 2016 but got no support from Gloria Steinem, Madeleine Albright, Joan Walsh or the legion of pseudo-feminists moving in lockstep behind the Clinton machine. The truth is that most women who come to power not only in the United States but in other countries around the world do so through a masculinist discourse of power, Margaret Thatcher being a case in point; Ronald Reagan famously called her ‘the best man in England.’ I lived in London for two years during a crucial period in Thatcher’s career; I was there when she declared war on Argentina over the Falkland Islands (‘las Malvinas’), with profound consequences for the United Kingdom as well as for Argentina, and the prime minister was compared by the British and world media to Boadicea (Boudicca) and other warrior queens of yore. But Thatcher’s direction of the war was far from heroic; in fact, her order to sink the General Belgrano was arguably a war crime. Thatcher also branded Nelson Mandela a ‘terrorist,’ despite his heroic efforts to challenge South Africa’s brutal apartheid regime.

One could mention many other women who have risen to the highest office in the land, including the first female prime ministers of Israel and India; Golda Meir denied the very existence of Palestinians, including Palestinian women, and Indira Gandhi forcibly sterilized poor men and women, hardly orthodox feminism.  There is an ironic parallel between Hilary and Park Geun-hye, who served as acting First Lady of the Republic from 1974-79 when her father was president, the dictator Park Chung-hee, who was assassinated in 1979, later going on to become the first woman elected president of the Republic of Korea in 2012. A contemporary of Hillary’s, Park alienated large sections of the Korean public with her war on labor and her authoritarian style of rule, proving through her behavior and her policies that the first woman elected president of a democracy can be both anti-feminist and profoundly anti-progressive (Hankyoreh editorial, “Democracy sorely missing from Park’s inaugural address,” 2.26.13).

Closer to home, Carly Fiorina withdrew from the Republican contest after failing to et even one percent in the New Hampshire primary in January; but before her withdrawal, neither Gloria Steinem nor any other Hillary supporter suggested that women should support Fiorina’s campaign for the GOP presidential nomination despite the fact that she is just as much a woman as Hillary Clinton; Steinem’s lack of support for Fiorina speaks as much to the inconsistency and contradiction of the ‘feminists’ supporting Hillary as to the rigor of their feminism. In fact, Gloria Steinem was rebuked by feminists across the country for declaring (with no evidence whatsoever) that the only reason young women were supporting Bernie Sanders in droves was because they were looking for dates with young ‘Bernie Bros’; if Donald Trump had said that, he would have been rightly excoriating for such a deeply misogynist assertion.

The first woman elected governor of Alaska, Sarah Palin is anything but a feminist, and she became something of a national laughingstock for her bizarre pronouncements as John McCain’s Republican running mate in 2008. But Palin is a woman, and at no time has Steinem ever proposed support for Palin’s election either as vice-president or as president; it is difficult to see how either Carly Fiorina’s election as the first woman president or Sarah Palin’s would be any less ‘historic’ than Hillary Clinton’s. Nonetheless, Madeleine Albright went so far as to say that “there is a special place in hell for women who don’t support other women,” condemning women who voted for Bernie Sanders in the primaries to everlasting hellfire and damnation, a curious theology to affirm; but Albright did not support Sarah Palin for vice-president in 2008 or Carly Fiorina for president in 2016, so it is difficult to see how Albright could escape eternal torment in the flames of hell any more than any other woman who supported Bernie Sanders over Hillary Clinton in 2016.

As secretary of state, Hillary Clinton’s record on women’s issues is appalling by any standard. Hillary she supported Barack Obama’s mass deportations of Latino immigrants, deportations so enormous that La Raza dubbed him the ‘Deporter in Chief.’ Obama deported more than twice as many undocumented immigrants as George W. Bush and by some counts, more than all previous presidents combined. Hillary did not begin to distance herself from these deportations until she began her campaign for president (Betsey Woodruff, “Hillary Clinton’s Child-Deportation Flip-Flop,” Politico, 3.11.16). In a March 10 Democratic presidential debate, Hillary declared that as president she would not deport children,  prompting Betsey Woodruff to write,

Clinton struggled mightly to communicate last night that deporting children is bad… Just two months ago… Clinton defended the practice of deporting children… and less than two years before that, Clinton argued passionately that undocumented children in the United States be subject to deportation… she told Christian Amanpour that children fleeing from violence in El Salvador, Honduras, and Guatemala shouldn’t be able to stay in the U.S. (Betsey Woodruff, “Hillary Clinton’s Child-Deportation Flip-Flop,” Politico, 3.11.16).

Speaking of Honduras, as secretary of state, Hillary supported the 2009 coup d’état that overthrew the democratically elected President Manuel Zelaya. The coup that Hillary supported brought a brutal military dictatorship to power and has made Honduras one of the most violent countries on earth, and as secretary of state, Hillary continued to support the junta despite its persecution of women, feminists, artists, LGBT people, indigenous people, environmental activists and political dissidents of all kinds, and she persuaded Barack Obama to resume US aid to Honduras despite the fact that the resumption of such aid was a violation of US law as well as a breach of international law.  In March 2016, Berta Cáceres was assassinated almost certainly on the orders of the junta (“Remembering Berta Cáceres , Assassinated Honduras Indigenous & Environmental Leader,” Democracy Now, 5.4.16). A leading environmental and indigenous rights activist, Cáceres held Hillary personally responsible for the violence and repression under the junta (“Before Her Assassination, Berta Cáceres Singled Out Hillary Clinton for Backing Honduran Coup,” Democracy Now, 5.11.16).

But the coup in Honduras was not the only one that Hillary supported as secretary of state; she also supported the coup d’état in Egypt, which has proved to be a disaster for the country (Yahia Hamed, “Egypt’s coup has plunged the country into catastrophe,” Guardian, 3.16.14), plunging it into a miasma of corruption, brutal repression and despair. As in Honduras, Obama and Hillary resumed US aid to Egypt in direct contravention of US law, which prohibits continuing aid to a military junta brought to power in a coup.

It was in neighboring Libya that Hillary had her biggest impact as secretary of state, but it is not a legacy that she is eager to talk about. While Republican members of Congress have focused obsessively on Benghazi, which was so obviously a disaster for which Hillary was fully responsible as secretary of state, they have missed the forest for the trees. It was the Libya intervention as a whole that was the real catastrophe, and one which Hillary is primarily responsible, pushing Obama into the ill-fated war against his better judgment. The Gaddafi regime’s attacks on innocent civilians in eastern Libya certainly provided a rationale for a no-fly zone of some sort, but Hillary’s US/NATO intervention repeated the folly of Bush’s 2003 invasion of Iraq (which she aggressively supported), decapitating the regime and leaving a power vacuum which al-Qaeda and ISIS (‘Da’esh’) have filled.

Other than turning Libya into a failed state, it was in Bahrain that Hillary had perhaps the biggest impact. As secretary of state, Hillary approved the brutal crackdown on the popular uprising against the despotic Bahraini regime in 2011 in which the dictatorship even arrest, imprisoned, tortured and murdered doctors and nurses who tended to the wounded pro-democracy activists who participated in the uprising.

Next door, Hillary encouraged Saudi Arabia’s war crimes in Yemen in a war that continues to this day with the full support of the Obama administration, with Saudi fighter jets dropping bombs on hospitals, schools and houses and apartment buildings in Sana and elsewhere in Yemen (“As Saudis Continue Deadly Bombing of Yemen, Is Obama Trading Munitions for Riyadh’s Loyalty?,” Democracy Now, 4.21.16). An International Business Times investigation  revealed an astonishing conflict of interest on Hillary’s part:

Under Clinton’s leadership, the State Department approved $165 billion worth of commercial arms sales to 20 nations whose governments have given money to the Clinton Foundation, according to an IB Times analysis of State Department and foundation data. That figure… represented nearly double the value of American arms sales made to those countries and approved by the State Department during the same period of President George W. Bush’s second term. The Clinton-led State Department also authorized $151 billion of separate Pentagon-brokered deals for 16 of the countries that donated to the Clinton Foundation, resulting in a 143% increase in complete sales to those nations over the same time  frame during the Bush administration (David Sirota and Andrew Perez, “Clinton Foundation Donors Got Weapons Deals From Hillary Clinton’s State Department,” International Business Times, 5.26.15).

Not insignificant is the fact that these regimes are all undemocratic to say the least, including Saudi Arabia, one of the most despotic regimes on earth, whose record on human rights is appalling; Saudi women cannot vote in national elections and are not even allowed to drive; and LGBT people have been executed by the regime for same-sex relations and crossdressing, according to human rights organizations. One need also note that Saudi Arabia’s record on human rights not only did not improve during Hillary’s tenure of secretary of state but actually worsened.

Hillary Clinton’s supporters claim she is the most qualified person ever to run for president, but her support for Israeli apartheid and genocide disqualifies her entirely in my view. In a letter to fellow Methodists considering support for the boycott, divestment and sanctions (BDS) movement, Hillary denounced BDS as ‘anti-Semitic’ and declared, “We must never tire in defending Israel’s legitimacy” (Maggie Habermas, “Hillary Clinton Criticizes Group Advocating Boycott Against Israel,” New York Times, 5.10.16). Michelle Goldberg aptly called Hillary’s speech at the America Israel Public Affairs Committee (AIPAC) convention on March 21 ‘a symphony of craven, delusional pandering’ (Michelle Goldberg, “Hillary Clinton’s AIPAC Speech Was a Symphony of Craven, Delusional Pandering,” Slate, 3.21.16), in which Hillary declared, “We have to be united in fighting back against BDS,” equating BDS with ‘anti-Semitism’ (Ryan Teague Beckwith, “Read Hillary Clinton’s Speech to AIPAC,” Time, 3.21.16), this, despite the fact that the governments of Sweden, Ireland and the Netherlands have officially recognized BDS as legitimate and constitutionally protected speech (Kevin Squires, “Ireland latest EU state to defend BDS,” Electronic Intifada, 5.28.16).

While Donald Trump and Ted Cruz spoke at AIPAC and mouthed the usual Zionist machine talking points as Hillary, she alone among all the presidential candidates speaking at AIPAC specifically named the BDS movement as the enemy, and a candidate who specifically and explicitly slanders the movement for justice and human rights for all in Israel/Palestine with false allegations of anti-Semitism has fully disqualified herself as a candidate for any public office, let alone that of president of the United States (Steven Klein, “America Must Tell Israel: Annexing the West Bank Is Our Red Line” (Ha’aretz, 5.8.16). While Bernie Sanders’ pronouncements on Israel fall far short of what they could and should be, it is worth noting that he is the first major party presidential candidate to publicly criticize Israel at all in the course of a presidential contest (Jason Horowitz and Maggie Haberman, “A Split Over Israel Threatens the Democrats’ Hopes for Unity,” New York Times, 5.25.16); contrast that with Hillary’s shilling for apartheid Israel, her open support for the Israeli war of genocide in Gaa in 2014 and her declaration that destroying the BDS movement as a priority of her presidency, and there is simply no rational argument for any progressive to support Hillary over Bernie.

Even beyond Hillary Clinton’s colossal failure as secretary of state and her outrageous support for Israeli apartheid and genocide is the issue of her character, and her willingness to subvert the law and lie repeatedly about her many violations of it should be troubling to anyone who thinks that the character as well as the judgment of a president matters. Hillary is the only secretary of state ever to have set up a private server secretly in the basement of her house in order to evade clear State Department rules and then attempt to mislead the public about the subterfuge. On May 25, the Inspector General of the State Department issued a report, declaring,

At a minimum, Secretary Clinton should have surrendered all emails dealing with Department business before leaving government service and, because she did not do so, she did not comply with the Department’s policies that were implemented in accordance with the Federal Records Act (Julian Hattem, “Watchdog: Clinton, top aides did not comply on records policy,” The Hill, 5.25.16)

Destroying government documents is a serious crime and repeatedly lying about such behavior is an indictment of Hillary Clinton’s character, even if it were the case that every single one of the 32,000 e-mail messages that she destroyed was about Chelsea Clinton’s wedding planning, which is of course a completely implausible assertion.

(A.J. Vicens, “State Department Inspector General Finds Hillary Clinton Violated Recordkeeping Rules,” Mother Jones, 5.25.16).

As Amy Chozick put it so trenchantly in her May 25 news report for the New York Times, “Voters just don’t trust her,” noting that

After months of Mrs. Clinton’s saying she used a private email for convenience, and that she was willing to cooperate fully with investigations into her handling of official business at the State Department, the report, delivered to Congress on Wednesday, undermined both claims (Amy Chozick, “Emails Add to Hillary Clinton’s Central Problem: Voters Just Don’t Trust Her,” New York Times, 5.25.16)

Far from being a partisan Republican ‘witch hunt,’ the report was issued by the inspector general of the State Department, an Obama appointee and one-time subordinate to Hillary Clinton, reporting to Congress that Hillary refused to meet with him and the State Department staff conducting the review; her campaign’s statement issued after the report was widely reported on in the media was that she was waiting to be interviewed by the FBI; but that is of course absurd on its face because the FBI has never precluded her from meeting with the inspector general’s office and one would imagine would strongly support the former secretary cooperating with it.

Hillary is now viewed rightly by an overwhelming majority of Americans as dishonest and untrustworthy (Jeff Jacoby, “In Clinton, Americans Don’t Trust,” Boston Globe, 5.31.16). Part of that perception may be because of her corruption. Since leaving office as president and secretary of state, Bill and Hillary Clinton have cashed in on public office in a way absolutely unprecedented in American history. Hillary alone has received more than $22 million in speaking fees, while Bill Clinton “has earned more than $132 million in speaking fees, in addition to book royalties and other income. The Clintons’ most recent financial-disclosure forms show that he earned nearly $2.7 million in fees for speaking to audiences that included financial-industry firms, after she announced her candidacy,” writes Amy Davidson (Amy Davidson, “Bill Problems: As Donald Trump attacks both Clintons, it’s like 1992 all over again,” New Yorker, 6.6.16). Can you imagine George Washington or Abraham Lincoln raking in $132 million in speaking fees after leaving office? Or Theodore Roosevelt or Woodrow Wilson?

One of the most disturbing facts about Hillary is that she is bought and paid for by the oil and gas industry. As Charlie Cray wrote in a report for Greenpeace,

Hillary Clinton’s 2016 campaign (‘Hillary for America’) has received $147,840 in direct contributions from 65 fossil fuel lobbyists and $2,502,740 in bundled contributions by fossil fuel lobbyists. Combined, the total direct and bundled contributions from 65 oil/coal/gas lobbyists to Clinton’s campaign is at least $2,650,580 (Charlie Cray, Fossil Fuel Lobbyists’ Contributions to the Clinton Campaign, Greenpeace.org, 4.22.16).

Despite the overwhelming evidence of Hillary’s dishonesty and corruption as well as anti-progressive politics and sheer incompetence, her supporters insist that we all have an obligation to support her for the Democratic nomination and if she wins that, vote for her in the general election. And this is one of the most curious aspects of the Hillary Clinton campaign: is the binary opposition being constructed by her supporters as well as those of Donald Trump, both of whom use the other as a bogeyman with which to frighten wavering voters. But the fact is, we do not have a national election for president but rather fifty state elections (plus the District of Columbia, etc.) in which voters elect representatives to the electoral college. Of all the states, New York is one of the ‘bluest,’ reliably Democratic in every election since the Reagan landslide of 1984; so the argument in favor of Hillary, already weak, looks even weaker when one looks at the bluest and reddest of the states. While it is true that Trump’s unusual if not to say bizarre candidacy may well scramble the red/blue picture that we have been used to for the last few decades, the fact is that no one thinks that 2016 will be a 49-state blow-out like 1984 or 1972. In such circumstances, the demand by Democratic partisans that progressives support an anti-progressive candidate such as Hillary Clinton becomes even less persuasive for those living and voting in the ‘safest’ Democratic and Republican states.

Polls show Hillary beating Trump by margins of 80%-20% or even greater, so the notion that my vote for Jill Stein on the Green Party line would throw the election to Trump is simply absurd. One could point out the illogic of that logic by arguing that a vote for Jill Stein is not only not a vote for Donald Trump but is in fact a vote against Donald Trump as well as Hillary Clinton. I intend to vote for Jill Stein in November not merely as a ‘protest’ vote but as an expression of my values, and the principles of progressive politics that are at the heart of my own activism and life’s work. A vote for Hillary Clinton would be nothing less than a betrayal of progressive principles and the social justice that I have been pursuing for over twenty years now.

Pauline Park led the campaign for the transgender rights law enacted by the New York City Council in 2002 and participated in the first US LGBTQ delegation tour of Palestine in 2012; she keynoted the Queer Korea Festival preceding the Seoul Pride Parade in 2015, the largest event in the history of the LGBT community in Korea. Park did her M.Sc. in European studies at the London School of Economics & Political Science and her Ph.D. in political science at the University of Illinois at Urbana-Champaign.

The post Hillary Clinton’s anti-feminist & anti-progressive agenda will never have my support appeared first on Pauline Park.

ISSUES OF TRANSGENDERED ASIAN AMERICANS AND PACIFIC ISLANDERS
By Pauline Park, co-founder, New York Association for Gender Rights Advocacy and John Manzon-Santos, Executive Director, Asian & Pacific Islander Wellness Center

Testimony submitted to the President’s Advisory Commission on Asian Americans and Pacific Islanders

Transgendered and gender-variant people are among the most invisible and marginalized of all Asian Americans and Pacific Islanders, and it is important that our issues be addressed in any attempt to discuss the needs and concerns of the larger lesbian, gay, bisexual, and transgendered (LGBT) Asian Pacific Islander community.

What we today would call ‘homosexuality’ and ‘transgender’ have existed throughout human history, present in some form in every pre-modern society, though they have been socially constructed in very different ways across different cultures and time periods. Most often, the two phenomena have been conflated and have been constituted through notions of a ‘third sex’ or ‘third gender’ role. In fact, in pre-modern Asian and Pacific Islander cultures, individuals whom today we would identify as lesbian, gay, bisexual, transgender, or intersexual, might have identified themselves as bakla (in Tagalog), shamakhami (in Bengali), waria (in Javanese), paksu mudang (in Korean), or mahu (in Hawaiian).

Mythological narratives involving sexual transformation appear throughout the oral storytelling tradition and written literature of Asian and Pacific Islander cultures, as for example, with the Chinese story of the male deity Kuan-yin, who changed sex to become the goddess of mercy. There are many popular tales of Kuan-yin’s adventures, and traditionally, she is the most popular deity in the Taoist pantheon. It is fitting that mercy should be the province of transgendered people, because the power of the transformation teaches compassion to the transformed.

Unfortunately, European colonialism had a deleterious effect on many traditions of transgender in Asia and the Pacific. For example, the Hijra of India, male temple priestesses of the mother goddess Bahuchara Mata, were turned into social pariahs during the British occupation. And the Babain culture of transgendered priests and priestesses that was revered in traditional Filipino society was destroyed by Catholic missionaries in the nineteenth century.

In Korea, there are three distinct transgenderal traditions. Under the Silla dynasty, which unified the peninsula in the 7th century, the Hwarang warrior elite included many boys who dressed as women, wearing long gowns and make-up when they were not practicing archery or preparing for battle. In addition to the Flower Boys of Silla, there were the boy actors who played women’s roles in the Namsadang theatrical troupes that toured the villages of Korea until the end of the 19th century, often taken as lovers by the older males who played the men’s roles in those same companies. Finally, there was the tradition of the mudang, always a woman, but not always female. The paksu mudang was a male shaman who performed sacred rituals as a woman (and may have lived as a woman as well), and who was not only respected but also revered. However, the mudang culture has slowly died out, under the impact of Communism in the North (where the paksu mudang were particularly popular before World War II) and capitalism and conservative Christianity in the South. Ironically enough, the mudang tradition is in fact rooted in the Altaic origins of Korean culture having its origins in the Siberian homeland from which the Korean people migrated, and it long predates the introduction of Confucianism, Taoism, and Buddhism to the peninsula under Chinese influence after the unification of Korea under the Silla.

The term ‘transgender’ is of relatively recent origin, having come into general use only in the last ten years or so; it is an ‘umbrella’ term used to identify a diverse community of individuals who are similar only in transgressing conventional gender norms. The term is usually meant to include everyone from casual crossdressers and transvestites to post-operative transsexuals, as well as many individuals who are not consciously transgender-identified. There has been no comprehensive study of the transgender community, and so an estimate of the population is speculative at best. While Kinsey estimated the lesbian and gay proportion of the general population to be approximately ten percent, the percentage of Americans – and by extension, Asian Americans and Pacific Islanders – who are transgendered in some sense depends to a large extent on how one defines that population.

The smallest proportion of the transgender population may well be those who are transsexual-identified – both male-to-female (MTF) and female-to-male (FTM) – ‘transsexual’ traditionally being used to describe someone seeking or having undergone sex reassignment surgery (SRS). But in addition to pre-operative and post-operative transsexuals, a growing number of individuals identify as non-operative transsexuals, those who do not seek SRS; some ‘non-op’ transsexuals may undergo hormone therapy, while others do not.

A much larger category, in which would be included transsexuals, would be those whom we could term ‘transgendered,’ whether they use that term as a self-descriptor or not. This category includes transvestites and crossdressers, the former term now considered by many to be somewhat old-fashioned or overly clinical and giving way to the latter term as a self-identifier. In that category, one could also include those who identify as or who are labeled by others as drag queens and drag kings, stone butches, etc. Non-transsexual transgendered people are those who choose to spend a significant portion of their lives in the gender opposite their sex assigned at birth without SRS.

A still larger category would be the gender-variant: individuals who transgress conventional gender norms but who do not (for the most part) ‘crossdress’; this category would include feminine men (some gay, others bisexual or heterosexual-identified) and masculine women (some lesbians, others bisexual or heterosexual-identified), as well as transgendered and transsexual people. In contrast to the gender-variant are the conventionally gendered – masculine males and feminine females who at most times and in most places conform to societal standards of gender. One important point must be made here: the lesbian, gay, and bisexual (LGB) population and the transgender population are not mutually exclusive, nor are they coterminous. At some point in their lives, many transgendered people identify as LGB: e.g., an individual may ‘come out first as a gay male and then later come to identify as a transgendered woman; or a heterosexual-identified male may, as a post-operative transsexual woman, identify as a transsexual lesbian.

It is widely assumed that there are only two sexes – male and female – and that these form the basis of masculinity and femininity; this is what social theorists call the ‘sex/gender binary.’ Even many of those who recognize gender as being ‘socially constructed’ – i.e., in a very profound sense, ‘invented’ by human beings, just as we invent different styles of clothing – do not fully realize the extent to which sex is also socially constructed. Pioneering work by Dr. Anne Fausto-Sterling, a leading biologist, is leading to a re-evaluation of our notions of sex as well as of gender. The phenomenon of intersexuality represents one of the most significant challenges to the sex/gender binary. Intersexuals (traditionally known as ‘hermaphrodites’) are those whose genitalia are neither entirely male nor female. Because of the ‘ambiguity’ of their genitals at birth, intersexed people are subject to intersex genital mutilation (IGM), usually performed between birth and age six, in which their genitals are surgically altered to conform to socially sanctioned notions of maleness or femaleness. Many intersexuals suffer lifelong sexual dysfunction and physiological problems as a result of the brutal physical mutilation to which they are subjected, almost always in infancy or childhood, when they have neither the legal standing nor the cognitive maturity to give informed consent, much less to object, to IGM.

Intersexed people have existed in all societies and epochs, and were thought in many Asian and Pacific Islander cultures to have special spiritual powers. Therefore, a renewed respect for intersexuals would represent a rearticulation of traditional Asian and Pacific Islander cultural values as well as empowering those intersexed Asian Americans and Pacific Islanders who suffer so much shame and stigmatization. We therefore urge the Commission to make a public statement in support of an amendment to the recently passed federal law banning female genital mutilation (FGM) that would explicitly include intersex genital mutilation in its provisions. It is striking the extent to which Americans, outraged by the practice of FGM in the Middle East and Africa, are largely unaware of the equally disfiguring practice of IGM that the medical establishment condones here in the United States.

Ironically enough, while transsexuals often lack the means to obtain sex reassignment surgery, intersexuals have their sex involuntarily reassigned in a way that deprives them of autonomy in sexuality and gender expression. Sex reassignment surgery (SRS) can cost anywhere from $5,000-150,000, depending on whether the individual is MTF or FTM and the skill and reputation of the surgeon. Added to the cost of SRS itself is the cost of hormones (a lifetime expense, from the start of hormone replacement therapy), of psychotherapy, and related expenses. But the price that transsexuals pay for sex reassignment goes well beyond the costs of SRS and hormones: included in that price is lifelong stigmatization.

In order to obtain SRS, a transsexual woman or man must first undergo psychotherapy and obtain a diagnosis of ‘gender identity disorder’ (GID), a mental illness listed in the Diagnostic & Statistical Manual of Mental Disorders (DSM), compiled by the American Psychiatric Association (APA). The process of transsexual transition – including psychotherapy, hormone replacement therapy (HRT), and SRS is ostensibly governed by the Standards of Care (SOC) published by the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Together, the GID and the SOC constitute a regime for the regulation of gender, and one constructed and maintained largely by white, upper middle class, US-born, heterosexual-identified, and conventionally gendered men. One of the aims of the GID regime is to help transgendered women ¾ whom many such mental health professionals assume incorrectly to be mostly attracted to men ¾ become conventionally gendered heterosexual women, just the expectations are that transgendered men (who are incorrectly assumed to be mostly attracted to women) will become conventionally gendered heterosexual men. The fear of ‘transhomosexuality’ among such practitioners is high: they do not want to ‘create’ homosexuals (i.e., transsexual lesbians and transsexual gay men), but rather to ‘cure’ those they perceive to be homosexuals of their homosexuality.

The practical consequence of a diagnosis of ‘gender dysphoria’ or GID is that the transsexual man or woman so diagnosed is labeled mentally ill, even in those cases where he or she is perfectly mentally healthy. While there certainly are a number of transsexuals who have real mental illnesses (such as schizophrenia, bipolar disorder, etc.), most are no more mentally ill than non-transsexuals are. But the struggle to find or keep a job becomes a daunting one when, in order to obtain SRS, the otherwise mentally healthy transsexual has to accept a diagnosis of mental illness that could prompt discrimination based on prejudice against the mentally ill in addition to that against the transgendered. The logical solution is for the APA to remove GID entirely from the DSM. What further complicates the situation, however, is that SRS is still considered an ‘experimental’ practice (despite surgery for MTF transsexuals having been brought to a high level of sophistication), and so the diagnosis of GID is used to enable psychiatrists to ‘prescribe’ SRS as the ‘cure’ for a ‘mental illness’ that simply does not exist. It is important to realize that GID affects not only those who seek SRS: its presence in the DSM pathologizes not only transsexuals, but all transgendered people more and even more generally, all who are gender-variant. In fact, GID is diagnosed most often in gender-variant children and youth whose parents – once again, conflating homosexuality and transgender – are concerned that their children may grow up to be gay. Ironically, three quarters of the children and youth who are diagnosed with GID do in fact come to identify as LGB as adults, while only a quarter come to identify as transsexual or transgendered.

There is a growing consensus within the transgender community in favor of a ‘reform’ of GID to eliminate the designation of transsexuality as a mental illness but to retain some reference in the DSM to transsexuality as medical condition justifying HRT and SRS. We therefore call on the Commission to make a strong statement in favor of the GID reform to eliminate the designation of transsexuality as a mental illness.

The American Psychological Association has already taken a stand in favor of GID reform, stating quite clearly its belief that transgender is simply a naturally occurring variance in gender identity and expression. Just as the removal of homosexuality from the DSM 25 years ago helped significantly alter society’s view of lesbian and gay people as well as giving renewed impetus to their struggle for civil rights, so too, the removal of GID from the DSM will help remove the stigma of mental illness from transgender.

Given the profound transgenderphobia – reinforced by the GID diagnosis – it is not surprising that transgendered people constitute one of the most marginalized populations in American society, facing pervasive discrimination, harassment, abuse, and violence. The violence that is so commonplace in the lives of the transgendered was no more dramatically illustrated than in the case of Brandon Teena, a young female-bodied transman who was brutally raped and murdered in Nebraska several years ago, and whose story was told in the 1999 Academy Award-winning film, “Boys Don’t Cry.” Transgendered men and women face discrimination and violence not only in the United States, but in countries throughout the world, as documented by the International Gay & Lesbian Human Rights Commission (IGLHRC) based in San Francisco and by the Amnesty International OutFront Program based in New York. Unfortunately, many such human rights abuses take place in Asian countries.

In the face of such pervasive discrimination and violence, transgendered people, are beginning to organize its own civil rights movement, both here and abroad. Much of that political work is being done in alliance with LGB people. Hence, while there are distinct differences between homosexuality and transgender, the overlap in LGB and transgender populations and the common cause that these diverse communities have made justify the term ‘LGBT’ to describe a political community and movement.

In the last few years, the concerns of transgender communities have increasingly become integral to the lesbian, gay, and bisexual movement. Similarly, AAPI initiatives that include sexual orientation should also include the language of gender identity and expression. For example, the fear of persecution based on sexual orientation is now recognized as cause for political asylum; however, the term ‘sexual orientation’ does not necessarily include transgendered or gender-variant people. A statement from the Commission in favor of the addition of “gender identity or expression” to political asylum law would therefore help address the problem of pervasive discrimination and violence that our transgendered brothers and sisters face in many Asian and Pacific Islander countries.

It is a cruel irony indeed that transgendered people – who helped lead the Stonewall uprising that catalyzed the modern lesbian and gay movement – were marginalized in that movement after June 1969. Only in the last five years has a real transgender political movement emerged in the United States. In the 1990s, transgender political organizations formed at the local, state, and national level to press for transgender-inclusive and transgender-specific anti-discrimination and hate crimes legislation. Anti-discrimination laws that include transgender-specific language (such as gender identity and expression) have been adopted in 30 jurisdictions across the country, including one state (Minnesota), three counties, and 26 municipalities. Those cities range from the large and cosmopolitan (San Francisco, Minneapolis, Seattle, Atlanta) to the small and unexpected (Ypsilanti, Michigan; York, Pennsylvania).

A campaign is now underway in New York City to amend that city’s human rights ordinance which, if successful, would make New York City the largest jurisdiction in the country to protect transgendered people from discrimination in employment, housing, and public accommodations. The campaign is being led by a transgendered Asian woman and has elicited the support of leading Asian American organizations, such as the Asian American Legal Defense & Education Fund (AALDEF) and the Filipino Civil Rights Advocates (FilCRA). There is also a campaign to get the California state legislature to adopt similar legislation, and one of the key organizations involved in that campaign (California Alliance for Pride & Equality – CAPE) includes a number of LGB Asian Americans in its leadership. If successful, that campaign would make California – the largest state by population and one that includes a huge API community – a leader in transgender anti-discrimination law.

Little specific information exists on transgendered communities as a whole. To date there has been no community assessment of Asian American and Pacific Islander transgendered population in the U.S. From a behavioral health perspective, transgendered people are often subsumed under the larger category of gay, bisexual, and other Men who have Sex with Men (MSM). Few tracking systems allow for gender identification beyond male and female. One watershed effort was mounted in 1997 by the San Francisco Department of Public Health. The Transgender Community Health Project (TCHP) became the first study (qualitative focus groups and quantitative surveys) designed to assess HIV risk among male-to-female (MTF) and female-to-male (FTM) transgendered individuals. 505 anonymous surveys and HIV tests were administered, and risk behaviors inclusive of and beyond HIV were reported. Forty-nine, or 13%, were completed by AAPI participants.

Although TCHP data is limited in that its cohort resides in the City and County of San Francisco and its purpose was to assess HIV risk specifically, transgendered AAPIs are everywhere, often building visible communities in metropolitan areas across the U.S. More comprehensive studies on a national scope are urgently needed for transgendered people across races, including AAPIs. To the extent that findings from the TCHP study can be extrapolated as one example of an urban area where transgendered AAPIs live, work, and socialize, consider the alarming statistics below. Of the total sample of transgendered respondents (MTF% / FTM %):

52% / 41% had no health insurance
53% / 21% had unstable housing
65% / 29% had a history of incarceration
23% / 20% had been hospitalized for mental health
32% / 32% have attempted suicide
53% / 31% had been diagnosed with a sexually transmitted disease
35% / 2% tested HIV-positive
80% / 31% had a history of sex work
59% / 59% had a history of forced sex
91% / 57% use hormones
65% / 54% inject hormones
34% / 18% inject street drugs
63% / 91% report sharing syringes
According to the Comprehensive HIV Prevention Plan for San Francisco, transgendered respondents persons are at increased risk for HIV infection due to a combination of biological, economic, psychological, behavioral, social/situational and access-related cofactors. Primary among these are a much higher incidence of commercial sex work, substance abuse, poverty, lack of access to HIV/AIDS and medical services, and discrimination by AIDS service organizations as well as employers. In particular, commercial sex work, largely a result of employment discrimination and poverty is closely associated with: increased rates of injection drug use as well as substance abuse, increased STD rates, increased rates of rape and coerced unprotected sex, increased trauma to tissues during sex, history of child sexual abuse and abusive relationships, as well as dramatically increased numbers of sexual encounters and numbers of sexual partners of higher risk.

The Plan also suggests that a transgendered sex worker’s risk for HIV infection may be different from other groups. One study reports that transgendered sex workers are more likely to have receptive anal sex with their paying partners than their primary partners, a behavior with direct consequences for HIV and STD infection if protection is foregone. Preoperative transgendered sex workers who are trying to earn money for gender confirmation surgery or sexual reassignment may perceive a monetary incentive for unprotected sex as beneficial in the moment, despite the associated health risks. Feminization through hormone therapy, hair removal, plastic surgery, breast implants, and sexual reassignment surgery, although costly, is often a transgendered individual’s first priority.

Sharing unsterilized needles and syringes during injection drug use or hormone use is also common within the MTF transgendered community. Injection drug use, and in particular injected speed or crystal methamphetamine use in combination with commercial sex work is a common practice. Injection hormone therapy is seen as a positive component of the gender confirmation process, and therefore safe, though it poses many of the same HIV transmission risks as injection drug use.

Rejection and isolation are integral aspects of a transgendered sex worker’s life. Transgendered individuals are often marginalized from the mainstream gay and lesbian communities and many are ostracized by their families of origin. As a result, they have low self-esteem, neglect their own health, and are fatalistic about the future. Discrimination creates significant barriers for transgendered persons who want to maintain or seek regular employment. Eliminating discrimination during access to services is particularly important for disenfranchised groups such as transgendered individuals and sex workers. The provider of services is seen initially as a representative of a larger social system which is perceived as antagonistic to their well being. Based upon direct experience, many transgendered people distrust service providers, feel misunderstood by them, and believe that providers regard them as expendable, which further prevents access of services.

From the TCHP study, some AAPI-specific data can be gleaned. Consistent with a high HIV-seroprevalence among transgendered AAPI participants (27%), they reported high levels of HIV risk behavior, including unprotected anal intercourse and other sexual activities, as well as other co-factors such as sharing needles for the injection of hormones and street drugs. Among transgendered AAPI sex workers, the drugs of choice are injected and non-injected speed, such as crystal methamphetamine, which helps them to work late into the night. These individuals are often isolated from traditional support networks available in AAPI families and communities while language and cultural differences often limit access to health and human services. Finally, transgendered AAPIs engage in high-risk behavior but their perception of susceptibility is low, a reality consistent with gay, bisexual, and other MSM AAPIs. The transgendered AAPI population in San Francisco is estimated to number 2,500, or 40% of the local transgender population, and tend to be immigrants and refugees from Asian countries such as the Philippines, Thailand, Laos, Vietnam, and China where transgendered individuals have a distinct social role.

Some nonprofit organizations report anecdotal evidence that confirm the TCHP findings. Specifically, highest among the needs of transgendered AAPIs are immigrant and refugee-competent, multi-lingual programs that broker housing, employment, and health care.

Given the complex factors which place transgendered AAPIs at high risk of disease and discrimination, targeted programs and interventions should address the following barriers:

Linguistic and cultural barriers: Asian immigrants and refugees face linguistic and cultural barriers to accessing services. Since most outreach is conducted in English, limited English individuals are not reached through mainstream channels of outreach and promotion. In addition, when health services are located, limited English proficient individuals often are unable to describe their health problems to primarily English-speaking service providers. Furthermore, providers are often unaware and even insensitive to the nuances of AAPI cultures and the needs of these individuals. For example, AAPI cultures discourage the open discussion of life-threatening illnesses for fear of inviting the disease into one’s life; thus, the superstition and fatalism attached to disease undercuts the value AAPI peoples place on prevention. The fear of stigmatization is particularly important in AAPI communities. There is fear “that any disclosure will result in community-wide disclosure of a person’s most intimate, personal life. Hence many AAPIs will not disclose outwardly nor acknowledge internally behaviors that put them at risk. Out of denial, many high-risk individuals will neither acknowledge that they are at risk nor identify with a service which targets risk behavior; consequently utilization of education prevention services is low and perpetuation of risk behavior remains high.”

Lack of health providers trained in cross-cultural delivery of services: Health care systems lack culturally responsive and linguistically appropriate services. Given the diversity of AAPIs, the health service system is simply unable to reach out to many populations, especially as AAPI populations continue to grow exponentially. In addition, effective partnerships between mainstream health organizations and community-based agencies working with limited English proficient individuals are lacking. Few AAPI language interpreters are competent in sensitive issues related to work in the sex industry, gender identity among transgendered individuals, and HIV/STD services. Many lack self-advocacy skills to effectively access health services on their own.

Socioeconomic conditions which impede access to health care system: Transgendered AAPIs who engage in sex work and exchange sex for money or drugs face immediate needs which are prioritized over seeking health services. Many sex workers are immigrants and are fearful of arrest and prostitution convictions, which could hurt their chances for naturalization. Many of the transgendered MTF AAPI sex workers, being born male, often send money home to provide for their parents in fulfillment of their filial duties.

The pervasive discrimination, harassment, abuse, and violence that transgendered people face has led to the marginalization of transgendered people, and have led transgendered AAPIs in particular into sex work and other dangerous occupations.

A strong statement from the Commission on the need to accept and appreciate the fullness of the diversity of AAPI communities would do much to help ameliorate the marginalization and the stigmatization of transgendered and gender-variant AAPIs. We would also appreciate a strong statement in favor of fully inclusive hate crimes and anti-discrimination laws at the federal, state, and local levels, as well as a statement in favor of the reform of GID. And we would view as a special priority a statement from the Commission in favor of the addition of the phrase ‘gender identity or expression’ to federal asylum law and administrative guidelines.

Transgendered, intersexual, and gender-variant people were respected and even revered in many Asian and Pacific Island cultures, from the hijra in India to the paksu mudang in Korea to the mahu in Hawai’i. Contemporary AAPIs of transgender experience have much to contribute to their AAPI communities of origin, if given the chance.

By Pauline Park & John Manzon-Santos, October 2000

Additional References / Sources
Clements, Kristen, et al; HIV Prevention & Health Service Needs of the Transgender Community in San Francisco: Results from Eleven Focus Groups; San Francisco Department of Public Health; 1997.
Clements, Kristen, et al; The Transgender Community Health Project: Descriptive Results; San Francisco Department of Public Health; 1999.
Consensus Report; San Francisco Department of Public Health; 1997.

http://www.apiwellness.org/article_tg_issues.html

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“Disappointed liberals, conservative critics and ordinary citizens who remember the candidate of 2008 have asked that question about Obama’s presidency. What has he been willing to fight for?,” Dan Balz writes of the famous reply that Lyndon Baines Johnson made to an adviser who suggested that Johnson avoid pushing civil rights legislation (Dan Balz, “Obama and LBJ: Measuring the current president against the past one’s legacy,” the Washington Post, 13 April 2014). “Well, what the hell’s the presidency for?” was LBJ’s response. Barack Obama quoted that reply in his speech at the LBJ Library on April 10 at a three-day conclave marking the 50th anniversary of the Civil Rights Act of 1964. I have great respect for Dan Balz, but there are 2 points that he’s missing here. First, the Affordable Care Act (ACA) is not Medicare; it’s health insurance reform that falls far short of true health care reform, which would entail truly universal health care. And second, it’s not simply the fact that Obama has no other legislative successes other than the ACA; it’s the fact that he hasn’t even tried to push a progressive policy agenda.

“For better or worse, Johnson represented the high-water mark for American presidents pushing through sweeping legislation — not just the Civil Rights Act, but the Voting Rights Act, Medicare, Medicaid, the Fair Housing Act and major measures on immigration, education, gun control and clean air and water. No president since has approached that level of legislative success,” writes Peter Baker (“For Obama Presidency, Johnson Looms Large,” New York Times, 8 April 2014), adding, “Certainly, Mr. Obama can point to landmark actions from his first term, most notably his health care program, the most significant expansion of the social safety net since the Johnson era.”

But the ACA is based on a Republican plan from the Nixon administration & is closer to a big corporate give-away than it is to true universal health care. In the absence of any other significant achievement, what will Obama’s legacy be?

At best, it will be largely symbolic: the election & re-election of the first African American president. But I think the real legacy will be the continuation of Bush administration policies, including immigrant deportations, drone strikes and mass NSA surveillance. Obama’s legacy will also include the criminalization of investigative journalism & the war on whistleblowers.

Ironically enough, the one real comparison with LBJ is the way in which Obama’s right-wing foreign policy & expansion of the national security state — rather like Johnson’s Vietnam War — has overwhelmed Obama’s extremely limited domestic policy agenda and undermined his attempts to claim a legacy of progressive policy-making.

But most damning of all, in my view, Obama’s legacy will be 8 years of missed opportunities to address the biggest threat to the planet, that of global warming; if it continues to accelerate as it looks to, then perhaps none of this will matter, because Obama will have allowed processes to continue that will lead to making the planet uninhabitable for human life, in which case, there will be eventually be no human beings to assess his legacy at all…

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Transgender Health Care: What Hospital-Based Providers Need to Know
Pauline Park, Ph.D.
Chair, New York Association for Gender Rights Advocacy (NYAGRA)

St. Barnabas Hospital
Embrace Healthcare Equality: Introducing Our LGBTQ Initiative
11 October 2013

I’m honored by the invitation to speak here at St. Barnabas Hospital and I’m especially honored to keynote the Embrace Healthcare Equality: Introducing Our LGBTQ Initiative event today. I would like to thank the LGBT diversity subcommittee for the invitation and I would especially like to thank Dr. Rory Sweeny McGovern, who was instrumental in introducing me to this hospital. Rory and I worked together as part of a transgender health care task force at St. Vincent’s Hospital for several years and I think we and our colleagues did great things together, including organizing the first transgender sensitivity training sessions for any major hospital in this city.

Let me begin by commending you for your commitment to ensuring full access to health care here at St. Barnabas for all members of our community. But let me also add that doing so will require a very significant commitment of resources — both time and financial — to attain that objective. Since founding Queens Pride House — the only LGBT community center in the borough of Queens in 1997 and the New York Association for Gender Rights Advocacy (NYAGRA) in 1998, I have been involved with work on access to health care for members of the LGBT community in a variety of capacities; one of the most important of these has been the Transgender Health Initiative of New York, a community organizing project established to ensure that transgendered and gender non-conforming people can access health care in a safe, respectful and non-discriminatory manner.

The transgender sensitivity trainings that we did at St. Vincent’s was an important expression of that commitment, and they helped create a model for what can be done at any hospital in this city or this country. Another important part of that work was the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area and the first directory of transgender-sensitive health care providers published in print format anywhere in the United States. I continue to update that directory on nyagra.com.

Transgendered and gender-variant people face pervasive discrimination in attempting to access health care in the United States. Some of the impediments to accessing quality health care are obvious and some are not. In order to understand those impediments and how to address them, it is first necessary to understand the community that we are discussing — hence the NYAGRA ‘circles diagram’ that I created way back in 1999 when we began the campaign for the the transgender rights law bill that was ultimately enacted into law by the New York City Council in 2002. I have used this diagram to illustrate in as simple a way as possible a diverse and complex community.

Briefly, the three circles include transsexuals — those who seek or have obtained sex reassignment surgery (SRS); those whom I will call ‘the transgendered’ — those who present fully in a gender not associated with their sex assigned at birth at least part of the time; and the gender-variant — including relatively feminine males who may still identify as men and boys and relatively masculine females who may still identify as women and girls. It is important to note here that this is a map of the gender universe and does not directly refer to sexual orientation; there are those in each of these circles who may identify as lesbian, gay or bisexual as well as those who may identify as heterosexual. In contrast to those in these three circles, the majority in any society are conventionally gendered — a majority of whom are undoubtedly heterosexual, but a significant minority of whom may be lesbian, gay or bisexual.

While addressing the conflation of sexual orientation with gender identity and gender expression is an important and indeed crucial part of the process of educating health care providers and the general public on transgender issues, it is also true that addressing discrimination based on gender identity and gender expression will go a long way towards addressing discrimination against LGB people because so much of that is based on the gender expression of gender-variant LGB people.

So how can we ensure full access to health care access for all members of the LGBT community here at St. Barnabas? Based on my own experience as an activist, advocate and consumer of health care, here are ten simple rules that I would like to suggest that we consider:

Rule #1: Effective health care provision requires the construction of a relationship of trust and confidence between the provider and the patient/client/’consumer.’ It is the responsibility of providers to educate themselves on issues of gender identity and gender expression in order to serve their patients, clients, and consumers sensitively and effectively. Conversely, it is also the responsibility of transgendered and gender-variant people to do what they can to educate and empower themselves and work with health care providers in order to obtain the best health care that they can.

Rule #2: Effective health care provision requires that providers take into account the diversity of the transgender community, which is extraordinarily diverse — in terms of gender identity and expression as well as race, ethnicity, religion, dis/ability, and sexual orientation. There are as many ways of being transgendered as there are transgendered people.

Rule #3: Health care providers need to understand that sex reassignment surgery (SRS) is not the end point for most gender transitions.  Most transgendered people do not want SRS and most who do never get it. There are as many ways of transitioning as there are transgendered people.

Rule #4: Transgendered and gender-variant people are denied care in many areas not directly or even indirectly related to their gender identity; any attempt to address health care provision for members of the community must address those areas not related to gender transition as well as those areas that are transition-related. Some transgendered people are denied coverage for treatments or procedures that relate to their anatomical or biological sex assigned at birth, such as prostate cancer for transgendered women or cervical or ovarian cancer for transmen. Only in a relationship of mutual trust and respect can physicians and other health care providers be sensitive and informed enough to provide effective care in such areas.

Rule #5: The impediments to health care access are both medical and non-medical and effective health care provision requires that providers take into account and address both sets of impediments. Transgender sensitivity training should focus primarily on the psychosocial aspects of the interaction between providers and consumers, and that training should extend to physicians and nurses as well as everyone in a health care facility.

Rule #6: Health care providers need to avoid pathologizing transgendered people through the false diagnosis of gender identity disorder (GID) while at the same time understanding that such diagnoses are used by some transgendered people to access hormone replacement therapy (HRT), sex reassignment surgery (SRS) and other desired medical interventions.

Rule #7: Transgender sensitivity training needs to be mandatory for all staff in hospitals and health care-providing facilities, including technical people, security guards, and intake staff as well as medical and mental health professionals; physicians should undergo psychosocial sensitivity training, regardless of participation in ‘grand rounds’ and other cognate medical trainings and discussions. Transgender sensitivity trainings should be no less than two hours in duration and ideally should be four hours long. Real training involves an intensive interaction between the trainer and the trained. Webinars and handouts may be used to supplement such trainings but can be no substitute for trainings themselves. Trainings should be conducted by those who have specific expertise in transgender issues, not merely those who do general ‘diversity’ trainings or even those who do LGBT trainings but who lack expertise on transgender issues specifically. Given staff turnover, trainings must be conducted at regular intervals.

Rule #8: All health care providers and health care-providing facilities should adopt policies and protocols that specifically prohibit discrimination based on gender identity and gender expression in the provision of health care, and such policies and protocols should be regularly and effectively communicated to all relevant constituencies.

Rule #9: Health care providers should participate in larger efforts to achieve legal and public policy change in order to provide effective and universal health care for all, including all transgendered and gender-variant people; providers need to understand that the denial of health care to transgendered and gender-variant people is part of a larger denial of health care access to and insurance coverage and payment for health care to LGBT people, low-income people, poor people, and people with disabilities in the United States.

Rule #10: There are no rules, only ‘best practices’ — or at least, better practices and worse practices; and such practices must be informed by the lived experiences of transgendered and gender-variant people.

Now, every hospital is different and every set of health care providers is unique; but these ten rules, it would seem to me, can be applied anywhere, including here at St. Barnabas. By coming here to this auditorium, you have taken the first step in  helping make this real. But as I have said, it is training that is arguably the most important and indeed crucial element in making it real and attaining an objective that I believe we all share. I congratulate you all and I especially commend the LGBT diversity subcommittee for organizing the launch of the LGBTQ Initiative today and I look forward to working with you all in helping make St. Barnabas the fully welcoming and inclusive hospital that I know it can be. That goal is within our grasp and we simply need to seize the opportunity to make it real. Carpe diem. Thank you.

Pauline Park is chair of the New York Association for Gender Rights Advocacy (NYAGRA), which she co-founded in 1998, and president of the board of directors as well as acting executive director of Queens Pride House (the LGBT community center in the borough of Queens), which she co-founded in 1997. Dr. Park led the campaign for passage of the transgender rights law enacted by the New York City Council in 2002. She served on the working group that helped to draft guidelines — adopted by the Commission on Human Rights in December 2004 — for implementation of the new statute. Park negotiated inclusion of gender identity and expression in the Dignity for All Students Act, a safe schools law enacted by the New York state legislature in 2010, and the first fully transgender-inclusive legislation enacted by that body, and she is a member of the statewide task force created to implement the statute. She also served on the steering committee of the coalition that secured enactment of the Dignity in All Schools Act by the New York City Council in September 2004. In 2004, Dr. Park named and helped create the Transgender Health Initiative of New York, a community organizing project established to ensure that transgendered and gender non-conforming people can access health care in a safe, respectful and non-discriminatory manner. And as executive editor, she oversaw the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area and the first directory of transgender-sensitive health care providers published in print format anywhere in the United States. Dr. Park did her B.A. in philosophy at the University of Wisconsin-Madison, her M.Sc. in European Studies at the London School of Economics and her Ph.D. in political science at the University of Illinois at Urbana-Champaign. She has written widely on LGBT issues and has conducted transgender sensitivity training sessions for a wide range of organizations, including the New York State Affirmative Action Advisory Council (AAAC), the Association of Vocational Rehabilitation in Alcoholism and Substance Abuse (AVRASA), the Latino Commission on AIDS, the Park Slope Safe Homes Project, and the Queer Health Task Force at Columbia University Medical School. In addition to presenting at the HIV Grand Rounds lecture series of the Bureau of HIV/AIDS Prevention and Control of the New York City Department of Health and Mental Hygiene, Dr. Park co-facilitated the first transgender sensitivity training sessions for any major hospital in New York City at St. Vincent’s Hospital Manhattan. In 2005, Dr. Park became the first openly transgendered grand marshal of the New York City Pride March. She was the subject of “Envisioning Justice: The Journey of a Transgendered Woman,” a 32-minute documentary about her life and work by documentarian Larry Tung that premiered at the New York LGBT Film Festival (NewFest) in 2008. In 2009, Dr. Park was designated ‘a leading advocate for transgender rights in New York’ on Idealist.org’s ‘New York 40’ list. In October 2012, Dr. Park was one of 54 individuals named to a list of ‘The Most Influential LGBT Asian Icons’  by the Huffington Post. In November 2012, she was named to a list of ’50 Transgender Icons’ for the Transgender Day of Remembrance 2012.

The post Transgender Health Care: What Hospital-Based Providers Need to Know (St. Barnabas, 10.11.13) appeared first on Pauline Park.

Securing Health Care for Our Community: Activism, Advocacy, Policy, Politics & Practicalities

Translating Identity Conference
University of Vermont
Burlington
13 October 2012

keynote speech
Pauline Park, Ph.D.
Chair, New York Association for Gender Rights Advocacy (NYAGRA)
and President of the Board of Directors & Acting Executive Director, Queens Pride House

I’m honored to have the opportunity to give the keynote speech at the Translating Identity Conference here at University of Vermont. This is my first time visiting this campus, my first time in Burlington and my first time in the Green Mountain State. I’d like to begin by thanking the hard-working TIC 2012 committee that organized this year’s conference, including Asher, James, Jen, Kat, Katherine, Morgan, Samuel, Shannon and especially Eliza, who was instrumental in arranging my appearance here.

And I’m delighted to see that UVM is moving forward on a number of transgender-inclusive policies, including gender-neutral restrooms, inclusive on-campus housing options, and preferred name and pronoun information on various lists on campus. Given that transgendered and gender-variant people face pervasive discrimination in attempting to access health care in the United States, I’m especially pleased to see that UVM’s insurance plan now includes gender transition-related treatments and procedures such as sex reassignment surgery (SRS), or as some call it, gender reassignment surgery (GRS).  When I address the topic of transgender community access to health care, the topic of surgery inevitably comes up. But of course, SRS is only one aspect of transgender health care, and most transgendered people I know don’t want it; surgery should be included in every health care plan, but it is going to be the end point for only a relatively small number of trans people, and the question of accessing health care for members of our community should not be focused primarily on SRS, much less limited to it. Because the reality is that it is those thousand and one aspects of health care that do not have any direct relation to gender transition that need to be addressed at least as urgently as those that do.

To state the obvious, individuals in this country access health care — or are denied access to health care — in many different contexts and circumstances. Some of the impediments to accessing quality health care are obvious and some are not. Based on my own experience as an activist, advocate and consumer of health care, I’d like to offer ten simple rules that health care providers who are committed to full transgender inclusion in the provision of health care may wish to consider:

Rule #1: Effective health care provision requires the construction of a relationship of trust and confidence between the provider and the patient/client/’consumer.’ It is the responsibility of providers to educate themselves on issues of gender identity and gender expression in order to serve their patients, clients, and consumers sensitively and effectively. Conversely, it is also the responsibility of transgendered and gender-variant people to do what they can to educate and empower themselves and work with health care providers in order to obtain the best health care that they can.

Rule #2: Effective health care provision requires that providers take into account the diversity of the transgender community, which is extraordinarily diverse — in terms of gender identity and expression as well as race, ethnicity, religion, dis/ability, and sexual orientation. There are as many ways of being transgendered as there are transgendered people.

Rule #3: Health care providers need to understand that sex reassignment surgery (SRS) is not the end point for most gender transitions.  Most transgendered people do not want SRS and most who do never get it. There are as many ways of transitioning as there are transgendered people.

Rule #4: Transgendered and gender-variant people are denied care in many areas not directly or even indirectly related to their gender identity; any attempt to address health care provision for members of the community must address those areas not related to gender transition as well as those areas that are transition-related. Some transgendered people are denied coverage for treatments or procedures that relate to their anatomical or biological sex assigned at birth, such as prostate cancer for transgendered women or cervical or ovarian cancer for transmen. Only in a relationship of mutual trust and respect can physicians and other health care providers be sensitive and informed enough to provide effective care in such areas.

Rule #5: The impediments to health care access are both medical and non-medical and effective health care provision requires that providers take into account and address both sets of impediments. Transgender sensitivity training should focus primarily on the psychosocial aspects of the interaction between providers and consumers, and that training should extend to physicians and nurses as well as everyone in a health care facility.

Rule #6: Health care providers need to avoid pathologizing transgendered people through the false diagnosis of gender identity disorder (GID) while at the same time understanding that such diagnoses are used by some transgendered people to access hormone replacement therapy (HRT), sex reassignment surgery (SRS) and other desired medical interventions.

Rule #7: Transgender sensitivity training needs to be mandatory for all staff in hospitals and health care-providing facilities, including technical people, security guards, and intake staff as well as medical and mental health professionals; physicians should undergo psychosocial sensitivity training, regardless of participation in ‘grand rounds’ and other cognate medical trainings and discussions. Transgender sensitivity trainings should be no less than two hours in duration and ideally should be four hours long. Real training involves an intensive interaction between the trainer and the trained. Webinars and handouts may be used to supplement such trainings but can be no substitute for trainings themselves. Trainings should be conducted by those who have specific expertise in transgender issues, not merely those who do general ‘diversity’ trainings or even those who do LGBT trainings but who lack expertise on transgender issues specifically. Given staff turnover, trainings must be conducted at regular intervals.

Rule #8: All health care providers and health care-providing facilities should adopt policies and protocols that specifically prohibit discrimination based on gender identity and gender expression in the provision of health care, and such policies and protocols should be regularly and effectively communicated to all relevant constituencies.

Rule #9: Health care providers should participate in larger efforts to achieve legal and public policy change in order to provide effective and universal health care for all, including all transgendered and gender-variant people; providers need to understand that the denial of health care to transgendered and gender-variant people is part of a larger denial of health care access to and insurance coverage and payment for health care to LGBT people, low-income people, poor people, and people with disabilities in the United States.

Rule #10: There are no rules, only ‘best practices’ — or at least, better practices and worse practices; and such practices must be informed by the lived experiences of transgendered and gender-variant people.

Having laid out these 10 simple rules for health care providers, how can we bring every locality and state in this country up to the highest standard in the provision of health care for members of our community?  I’d like to suggest three broad avenues that can lead us to that goal. First, legal and policy change; second, activism and advocacy; and third, social change through the transformation of understandings of gender.

With regard to the first — legal and policy change — one of the challenges in the United States is the relatively decentralized and diffuse structure of policy-making; as a transgender community and movement, therefore, we must be active at the federal, state and local level in order to shape law and policy at all levels; and we must move laterally across different arena in order to help shape rule-making by a large number of federal, state and local government agencies; it is not only the Department of Health & Human Services, for example, that has authority over health care provision at the federal, but scores of other federal agencies. Change in this area must include not only rules and regulations as well as agency policies, in some cases, it might even require the enactment of statute law by city councils, county and state legislatures and Congress. And in addition to legislation by legislatures and regulation and rule-making by executive agencies, legal change will need to be advanced by litigation and judicial decision-making as well.

And when it comes to legal and policy change, it is vitally important that that change not focus on only one element of the community. All too often, the focus in so many of these discussions has been on the medical interventions that are the most obvious element of gender transition; but as important as it is to secure coverage of and payment for hormone replacement therapy (HRT) and sex reassignment surgery (SRS) in insurance policies and health plans, ‘transgender inclusion’ must mean inclusion of everyone in our community, including non-transsexual transgendered and gender-variant people as well. Policy must not be based on what I call the ‘classic transsexual transition’ narrative to the exclusion of those who follow other paths to the actualization of their gender identity.

Rather than pursuing a narrow approach of seeking only to eliminate clauses excluding medical interventions associated with gender transition — important as that task may be — the approach that I would suggest would be to think broadly about how we as transgendered and gender-variant people should have unimpeded access to the health care system as a whole. And so I would urge us to commit to the goal of universal health care in the United States. The most efficient system is one in which there is a single payer, and as improbable as a so-called ‘single-payer’ system may seem at this particular juncture in our political history, I think it would be even more unlikely that half measures and partial reforms will get us to the goal of truly universal health care.

It is ironic indeed that the Affordable Care Act (ACA) has been labeled ‘socialist,’ since what has become known as ‘Obamacare’ has its origins in the policy discussions of the Nixon administration and was championed by Republicans such as Bob Dole and later Mitt Romney, who as governor of Massachusetts made the ‘individual mandate’ the core of the health care reform law that has since become known as ‘Romneycare.’ While the ACA includes some very significant advances such as the provision prohibiting denial of health insurance to those with pre-existing conditions, the new law does not get us to where we need to go. One significant lacuna is the lack of a provision explicitly prohibiting discrimination in the provision of health care based on sexual orientation and gender defined to include gender identity and expression; I would like to suggest that LGBT organizations make a priority the enactment of an amendment that bans such discrimination.

Such an approach would have the advantage of moving public discourse away from a discussion of specific surgeries and procedures and toward a discussion of how our health care system fosters institutionalized homophobia and especially transgenderphobia. Achieving enactment of such legislation would not be easy, but the tangible benefits to members of our community would be vastly more significant than merely ending exclusion of coverage of and payment for HRT and SRS from health insurance policies. And a campaign for such broad-based legal and policy change would enable members of our community to form coalitions and alliances with other communities and groups seeking social and economic justice in the area of health care.

There may be those who would view such an approach as ‘political,’ or at least more political than many currently take, which is to focus on securing access to HRT and SRS on the grounds that they are medically necessary. And there are those in our community who like to approach it as some sort of technical mechanical exercise. But it seems to me that legal and policy change  is inevitably political; that point may seem obvious to me but it is not to some in our community. The pursuit of legal and policy change is by its very nature political in that it must be pursued in the highly politicized environment of policy-making at the federal, state and local levels in this country. A technocratic approach to policy-making can only serve to obscure the important issues, which are all questions of value. The truth is that there simply is no such thing as value-free policy-making and there is no such thing as a non-political policy-making context or arena. And it is not just legislatures that are political; executive agencies are thoroughly political, as are courts.

I’ve been a part of three successive coalitions that have attempted to change the policy of the City of New York so that transgendered people can obtain amended birth certificates without SRS — an important advance if we were to achieve it, given that most trans people I know in New York do not want SRS and that the birth certificate has become the governing personal identification document in the post-911 universe. The first coalition, which neither I nor my organization was invited to join, preceded the three subsequent coalitions and was formed in 2002, shortly after enactment of the transgender rights law by the New York City Council in 2002; that very first birth certificate coalition was able to negotiate a new draft regulation with the top staff in the Department of Health & Mental Hygiene (NYC DOH); and that new regulation, if adopted, would have eliminated the requirement of surgery for amended birth certificates, with enormous positive implications for access to health care as well as employment for transgendered New Yorkers.

What members of that very first coalition should have realized but did not was that an informal agreement without the assent of the mayor’s office was simply not sufficient in the highly politicized environment of New York City policy-making. Even with the sign-off of the commissioner (himself a political appointee) as well as the key deputy and assistant commissioners (both career civil servants), staff in the office of the Mayor Michael R. Bloomberg had not seen the draft regulation before it went to the Board of Health for a vote. For purely political reasons that had nothing to do with the merits of the regulation itself, the mayor’s office effectively vetoed the new draft regulation, ordering the Board of Health to vote down the proposed regulation and setting back the cause of birth certificate policy change in New York City for more than a decade.

So neither the merits of the argument nor sincerity and commitment are sufficient, even if they are a necessary part of the mix that is needed to bring about legal and policy change; political savvy and sophistication are also important as is the ability to organize and mobilize constituencies and allies. And that leads us to a discussion of activism and advocacy, which is how we can bring about important legal and policy change. And here it cannot be emphasized enough that ‘activism’ isn’t just what big-name activists do, it’s what we all do — at least, what we all can do, if we put our minds to it. There are more the more obvious forms that activism and advocacy can take, such as lobbying legislatures, for example, and testifying at public hearings, not to mention that old standby, organizing a demonstration; but there are hundreds if not thousands of ways in which each of us can influence government policy — everything from writing a letter to the editor of the local newspaper to blogging to organizing a poetry reading or an art exhibition. And as mentioned above, training is a crucial aspect of educating health care providers on gender identity and expression, so either engaging in training or pressing the powers that be (whoever and wherever they may be) to mandate training — is very important activism and advocacy work. Certainly, on a campus like this, there are countless opportunities for activism; at one university I spoke at some years, ago, for example, there’s one day of the year when students take chalk to the sidewalks of the quadrangle and do ‘chalking’ about whatever issues are important to them. With a constantly changing student population, transgender sensitivity training and education on a college or university campus will never be finished.

Last but not least, we as a community and a movement must engage a process of real and transformative social change; our goal must be not only to gain certain discrete health care benefits for members of our community — as important as those are — but to transform society’s understanding of gender. And that is why we must advance the day when we no longer have to rely upon the diagnosis of gender identity disorder (GID) to gain access to hormones and surgery. As I like to say, I do not have a gender identity disorder; it is society that has a gender identity disorder. And so we must all work together to de-pathologize transgender; we must move this society from a deviance model to a model that recognizes transgender simply as the manifestation of naturally occurring gender variance.

Of course, not all the members of our community seek such transformative social change; but it seems to me that we have a tremendous opportunity before us to actualize the transformative potential of the transgender movement by challenging and dismantling the sex/gender binary that is at the root of our oppression. And I would like to suggest that we do so as part of a larger movement for social justice that links with the struggles of people of color, immigrants (including the undocumented), the poor, people living with disabilities, people living with HIV/AIDS, and all those facing marginalization in this society. As the Mahatma Gandhi would say, we must be the change we wish to see in the world.

The task before us — to make health care accessible to all members of our community — is an enormous one, but lest you be daunted by the challenge, I would simply point out that the campaign for the transgender rights law enacted by the New York City Council in 2002, while involving hundreds of people, was led by a small group of just half a dozen people. As the celebrated anthropologist Margaret Mead put it so well, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Thank you.

* * * * *

Pauline Park, Ph.D. (paulinepark.com) is chair of the New York Association for Gender Rights Advocacy (NYAGRA) (nyagra.com), president of the board of directors and acting executive director of Queens Pride House (queenspridehouse.org). Park named and helped create the Transgender Health Initiative of New York (THINY) and oversaw the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area. She led the campaign for passage of the transgender rights law enacted by the New York City Council in 2002 and served on the working group that helped to draft guidelines for implementation of the statute.

The post Translating Identity Conference speech on transgender health care (10.13.12) appeared first on Pauline Park.

On behalf of the board of directors and staff of Queens Pride House, I would like to welcome you to the celebration of our 15th anniversary. Queens Pride House  is the only lesbian, gay, bisexual and transgender (LGBT) community center in the borough, and we do our best with limited resources to serve the community in its full diversity. Queens Pride House serves thousands of clients a year and conducts health support, education and referral programs, youth training, and cultural and social programming. We have a youth group and a transgender support group and we host a support group for translatinas; we have both an English-speaking and a Spanish-speaking men’s group, and the Grupo Espanol is here in force~! And we provide space for many outside groups to meet as well.

We decided to use our 15th anniversary as an opportunity to honor Selena Blake, Ross Levi, the Rev. Charles McCarron, Daniel Cano and Voces Latinas for their contributions to the LGBT community. Selena Blake is a documentarian who directed the film “Taboo Yardies,” about homophobia in Jamaica. As executive director of the Empire State Pride Agenda, Ross Levi led the organization’s successful campaigns for the Dignity for All Students Act and the state marriage equality law, and he has since joined Governor Andrew Cuomo’s team as vice-president for marketing initiatives in the business marketing division at Empire State Development (ESD), New York’s chief economic development agency. Rev. McCarron was the first executive director of Queens Pride House, serving as an unpaid volunteer in that capacity in 1997-98. Since 2004, he has been executive director of Episcopal Community Services of Long Island. Daniel Cano interned at Pride House and then stayed after his internship to conduct a series of workshops on positive psychology; he just finished his associate’s degree at La Guardia Community College and is now starting his first year at Hunter College of the City University of New York (CUNY). Voces Latinas will be honored for their work with immigrant Latinas in Queens living with HIV/AIDS and those at high risk for HIV/AIDS.

And we’re delighted to have Raphael Miranda as the master of ceremonies for our anniversary benefit. An openly gay man who lives with his husband and two cats in New Jersey, Miranda is the weekend meteorologist and weather producer for NBC New York; he can also be seen on the digital channel New York Nonstop.

This event would not have been possible without the generous support of all of you as well as our sponsors and advertisers, including: the Ali Forney Center, APICHA community health center, Armondo’s Italian Restaurant, Connie Idavoy and Bum Bum Bar, the Callen-Lorde Community Health Center, Chayya, Dignity-New York, the Episcopal Diocese of Long Island, Harlem United, the Lambda Literary Foundation, the Latino Commission on AIDS, the New Immigrant Coalition for Empowerment (NICE), the Rev. Joseph Pae, Eddie Valentin, SAGE (Senior Aging in a GLBT Environment), Sullivan Street Press, the Transgender Legal Defense & Education Fund (TLDEF). And our individual donors, including: Mercedes Cano, Fernando Gomez, Winston Lin, Otton Nielsen, Lilian Nieves of PRIDE, Charles Ober, Bryan Pu-Folkes, Alfonso Quiroz & Jeff Simmons, Mark Sullivan Roy, Itala Rutter & Toni Olivera, and Richard Wandel. And I’d like to thank the Out Hotel for generously donating a gift certificate.

I would also like to thank our board and staff. Our board members include Audie Edwards (vice-president), Sara Gillen (secretary), Itala Rutter (chair of our development & fundraising committee), and Kleber Jalon (chair of our audit committee). And our hard-working staff, including Michelle Abdus-Shakur (our program coordinator & office manager), Carlos Cubas (our outreach coordinator), Juan Almonte (our fiscal assistant), Rene Vazquez del Valle (our director of clinical programs), and our four new social work interns.

A few people I would especially like to thank are our new fundraising assistant, Monica Lewis; our chief financial officer and board treasurer Charles Ober, who is the only member of the board in continuous service since our founding in 1997; and who, along with me, is the only original co-founding member of the organization still directly involved in its operations. And Jonathan Acevedo, our volunteer designer, who designed most of the ads in the program journal.

If you find it in your heart — and wallet — to offer an additional donation, please do so. You can also buy copies of my CD of piano music (“Barricades Mysterieuses) for $20 each; all proceeds go to supporting the work of Queens Pride House.

And if you haven’t already done so, please sign our mailing list so we can keep you abreast of our many activities. The next opportunity you’ll have to support our work will be our holiday party, which will be held at Queens Pride House on Dec. 6. Between now and then, we will have a Halloween party at the end of October (date to be determined). Please ‘like’ us on Facebook and ‘follow’ us on Twitter. Thank you all again for your support~!

The post Queens Pride House 15th anniversary speech (9.27.12) appeared first on Pauline Park.

About-Face at Health Department
By Paul Schindler
Gay City News
12.07.2006

In a move that occasioned the city health commissioner, Dr. Thomas R. Frieden,
to acknowledge “we were at fault,” the Board of Health Tuesday abruptly pulled
back from a proposal that would have allowed New York City-born transgendered
individuals who have not undergone sex-reassignment surgery but nonetheless
provide significant medical certification of their transition to change the
gender designation on their birth certificate.

Instead, the board adopted a far narrower measure that will allow those who do
undergo such surgery to change their designation from M to F or vice versa.
Until now, they could merely remove their original gender marker but not
substitute the other, leaving the category blank on the revised birth
certificate.

In an interview with Gay City News, Frieden declined to comment on whether the
change in course reflected any input from the police department, city
corrections officials, or the federal Department of Homeland Security regarding
the tightening of official standards for personal identification in the wake of
the 9/11 attacks.

The climate of increased security concerns, however, makes the birth certificate
issue even more critical for individuals who have completed a gender transition
and need to receive basic personal identification such as a driver’s license or
a passport.

The original proposal put forward by the Department of Health and Mental Hygiene
was the result of a lengthy task force process that included city officials,
medical practitioners, and transgender advocates, and received overwhelmingly
positive response during a public comment period that concluded with a hearing
on October 30. In 139 pages of input published on the health department Web
site, all but seven pages endorsed the approach, often in significant detail,
even though many urged that even greater flexibility be incorporated into the
regulation change.

The negative comments on the Web site were largely brief e-mail correspondences,
most with harshly transphobic comments. “Are you guys losing all sense of moral
values?” read one. “Modern day Sodom and Gomorra-May God forgive you.”

“If I wish to call myself a dog, I suppose you people would allow that too?” was
the comment from another correspondent. “I am befuddled and wonder if the
inmates are now running the asylum,” read a third.

In explaining its reversal in direction, Frieden’s department, in a written
release, said, “After reviewing that plan and input received during the public
comments period, the health department concluded that the proposal would have
broader societal ramifications than anticipated. Besides being a key element of
identity, gender has important implications for many societal institutions that
need to segregate people by sex. These include hospitals, schools, and jails, as
well as some workplaces.”

Citing those issues-which have been central to the debate over transgender
rights for years-raised more questions than it answered.

First, it left largely unexplained how the department could have put forward a
proposal, received nearly unanimous public comment essentially saying it
reflected a good start but that more needed to be done, and then settled on a
final plan well short of what it originally put on the table.

“Citing unspecified ‘ramifications’ of the proposed policy, the Board
of Health has missed an opportunity to help transgender people move from the
margins to the mainstream,” said Michael Silverman, executive director of the
Transgender Legal Defense & Education Fund, in a written statement. “For many
transgender people, sex-reassignment surgery is a financial impossibility. For
others, it’s medically inappropriate. And still others choose not to undergo
surgery for a variety of personal reasons.”

“I’m extremely disappointed that the Board rejected the widely supported
recommendations in such a cursory manner,” said Paisley Currah, director of the
Transgender Law & Policy Institute. “The recommendations were the work product
of a dedicated advisory committee and were proposed after two years research and
consideration. It’s simply indefensible that nonsensical reasons blamed on
identity security were cited as the key reason for rejecting the
recommendations.”

“I’m surprised and very disappointed,” said Bonnie Scott Jones, a
staff attorney at Lambda Legal, who had offered a detailed response, urging
greater flexibility regarding medical and mental health certification of a
gender transition, during the public comment period.

Asked whether transgender advocates were justified in feeling as though the
ground rules for public comment and negotiation of a solution had been changed
on them, Frieden said, “That’s a perception that could well be out there.” He
insisted, however, that the Board of Health was in fact considering two
proposals – one to allow for a switch in gender designation on the birth
certificate and the other
to modify the criteria for what constituted a gender change. The proposal
considered at the October 30 hearing would have modified the requirement that
sex reassignment be completed to a less prescriptive formula that relied on a
medical doctor and a mental health professional certifying that unspecified
medical and psychotherapeutic
treatments have been undergone as part of a gender transition.

While acknowledging the clear preferences uncovered in the public hearing
process and lauding the work of those who advised the department in developing
the original proposal, Frieden said, “We were at fault” for not consulting with
other parties such as law enforcement, hospital administrators, and schools that
have
requirements for sex-segregated facilities, including cells, patient wards and
rooms, and showers.

“The advisors we had we were wonderful but we received input from a fairly
narrow range of interests,” he said. Asked why the health department – regarding
the sensitive sex-segregation issues that concerned it – could not look to the
guidelines established by the city’s Human Rights Commission when it adopted a
code for enforcing the 2002 amendment to city law outlawing gender identity or
expression-based discrimination, Frieden said, “A certificate and human rights
law are very different and should not be conflated.”

Pressed to clarify what that meant, the commissioner said, “In the city law,
whatever gender you consider yourself to be you are.” He did not specifically
address how the lack of a changed birth certificate might limit the ability of
transgendered individuals to access the protections guaranteed under the 2002
law, except to say that their rights are not defined by their birth
documentation.

The concerns about sex-segregated facilities – bathrooms and showers in
particular – have consistantly percolated at the surface of the debate, both
about trans rights and the effort by then-President Bill Clinton to allow open
service by gays and lesbian soldiers prior to falling back on the Don’t Ask,
Don’t Tell policy. In a number of recent controversies, trans people have been
arrested for using public
bathrooms, including those at Grand Central Terminal, intended for persons of
their post-transition gender.

Yet, Frieden could not explain why the health department came to this concern so
late in the game, after several years of discussion.

“Hindsight is always easier,” he said.

In addition to the concerns cited over sex segregation, the department’s press
release also alluded to “forthcoming federal regulations which are anticipated
in 2007 and which are anticipated to include provisions on birth-certificate
security, death-birth matching, and verification of driver’s license
applications with
birth certificates.” An internal health department memorandum, provided to Gay
City News by the city, made specific mention of draft regulations due under the
Real ID Act of 2005, and the importance of birth certificates to the federal
government signaled by the Intelligence Reform and Terrorism Prevention Act of
2004.

Asked whether the health department had received input on the earlier proposal
after the October 30 hearing from the NYPD, city corrections officials, or the
U.S. Homeland Security Department (but which had not been entered into the
public record), Frieden momentarily conferred with aides with him at the time of
the telephone interview and then said, “No comment.”

Despite the reversal this week, trans activists vowed to keep pressing for
change and voiced optimism about eventually prevailing.

“We are certainly not giving up,” said Z Gabriel Arkles, a staff attorney at the
Sylvia Rivera Law Project, which does advocacy work on behalf of the transgender
community. “We believe the department is taking us seriously and it’s possible
to get a victory in this area.”

Pauline Park, chair of the New York Association for Gender Rights Advocacy,
said, “NYAGRA is more eager than ever to meet with the department of health.”

In fact, Park and Transgender Legal Defense’s Silverman were at best lukewarm
about the proposal considered in October, feeling that it embodied a medicalized
perspective of gender variance that assumes that it is a pathology and was at
odds with the gender self-definition and expression assumptions of the 2002
transgender rights law. Silverman, in his release this week, said that the
proposal that had been rejected included “race and class disparities,” a reflection of his view that many would be unable to access the medical certification required.

“On balance, adoption of the policy as written was not a significant advance for
the community,” Park said, suggesting that if advocates are able to reopen
discussion of the issue with health officials, she for one will be pushing for
far more than the city ever contemplated. City Council Speaker Christine sent
the Board of Health a statement supporting the proposal originally put forward,
with provision for some greater flexibility.

In a written reply to a Gay City News query, Quinn said, “I am very disappointed
at the Board of Health’s decision to withdraw its transgender proposal, and have
begun conversations with the Department of Health and Mental Hygiene to better
understand their rationale.” She added she hoped “to move this issue forward.”

This article originally appeared in Gay City News on 7 December 2006.

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Trans-Form the Occupation

Pauline Park

at

Occupy Wall Street

13 November 2011

Thank you for the opportunity to speak here. I’m Pauline Park, chair of NYAGRA, the New York Association for Gender Rights Advocacy, and president of the board of directors of Queens Pride House, an LGBT community center in the borough of Queens.

I’m honored by the invitation to speak here at Occupy Wall Street, which I think is one of the most exciting recent developments in American politics. People are finally standing up to corporate greed and the powers that be. And that includes transgendered people. I’m a transgendered woman who was born in Korea. I’ve lived in New York since 1995 and I’d like to talk about the people who make up my community.

1) The diversity of the transgender community.

We need to recognize the full diversity of the transgender community. There are as many different ways of being transgendered as there are transgendered people. Do not assume that sex reassignment is the end point for every transgender transition; most transgendered people do not want sex reassignment surgery, and most people who do never get it.

2) ‘Transgender’ as an umbrella term.

There are literally hundreds of descriptors and self-descriptors that people use to identify or self-identify. But don’t confuse the label with the person. ‘Transgender’ is an ‘umbrella’ term that is widely used to bring together a wide variety of different subgroups within the community, including transsexuals, crossdressers and genderqueers. The term ‘transgender’ can be used in three different ways: as a term of self-identification, as an analytic term, or as a political term. There are many people who don’t identify with the term ‘transgender,’ including a lot of immigrants and transgendered people of color.

3) Sexual orientation vs. gender identity.

It’s important to understand the difference between sexual orientation and gender identity. Sexual orientation refers to who you’re attracted to; gender identity refers to how you identify and express your gender. Sexual orientation has nothing to do with gender identity per se. There are transgendered people who identify as heterosexual as well as those who identify as lesbian, gay and bisexual. Don’t assume someone’s sexual orientation from their gender identity or presentation. What do you know about someone’s sexual orientation if you know that they’re transgendered? Nothing~!

4) Discrimination.

In this society, transgendered and gender-variant people face pervasive discrimination, harassment, abuse & violence. Even with a transgender rights law in place since 2002, transgendered people regularly report discrimination in this city. Fortunately, the transgender rights law enacted by the New York City Council in 2002 prohibits discrimination based on gender identity and expression in employment, housing, public accommodations, education and credit. If you experience discrimination, contact NYAGRA through nyagra.com or the Transgender Legal Defense & Education Fund through the TLDEF website at transgenderlegal.org.

5) Bullying, harassment & violence.

Transgendered and gender-variant youth face pervasive bullying and bias-based harassment in our public schools; and the rate of teen suicide among trans and genderqueer youth is astronomically high. Many trans and genderqueer youth drop out of school because of such bullying; and without even a high school diploma, the chances of finding a well-paying job are very slim. Last year, the New York state legislature enacted the Dignity for All Students Act (DASA), which prohibits bullying and bias-based harassment in public schools throughout the state.

6) Housing & homelessness; health care.

Many transgendered people find themselves homeless because of discrimination and abuse, including domestic and intimate partner violence. Many are forced into sex work, with heightened risk of HIV infection, police brutality, and street violence. Many transgendered people lack health insurance and even access to basic health care.

7) GID.

Many transgendered people access hormones and surgery through the diagnosis of gender identity disorder (GID). But the GID diagnosis pathologizes everyone who is gender-variant as a gender deviant. As I like to say, I do not have a gender identity disorder; it is society that has a gender identity disorder. We need to eliminate the pathologizing of transgender and gender variance.

We need to create a society in which no one is denied employment or housing or health care because of their gender identity or expression. We need to recognize the multiple oppressions that face transgendered people of color, including immigrants of color. We need to recognize that the root of our oppression as transgendered and gender-variant people is the sex/gender binary — the policing of rigid gender norms by the police and public authorities, corporations and other employers, and conventionally gendered people in our society. We need to bring feminist consciousness to the project of challenging, deconstructing and dismantling the sex/gender binary.

We need to create a society characterized by social and economic justice, not governed by rigid gender norms and corporate profits. And as a step towards that goal, we need to make sure that this space is safe for everyone, including our transgendered brothers and sisters. As the Mahatma Gandhi said, we need to be the change that we want to see in the world.

Thank you.

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Pauline Park, Ph.D.
Chair
New York Association for Gender Rights Advocacy
(NYAGRA)

Transgendered and gender-variant people face pervasive discrimination in attempting to access health care in the United States. Some of the impediments to accessing quality health care are obvious and some are not.

Based on my own experience as an activist, advocate and consumer of health care, here are a few simple rules that health care providers who are committed to full transgender inclusion in the provision of health care may wish to consider:

Rule #1: Effective health care provision requires the construction of a relationship of trust and confidence between the provider and the patient/client/’consumer.’ It is the responsibility of providers to educate themselves on issues of gender identity and gender expression in order to serve their patients, clients, and consumers sensitively and effectively. Conversely, it is also the responsibility of transgendered and gender-variant people to do what they can to educate and empower themselves and work with health care providers in order to obtain the best health care that they can.

Rule #2: Effective health care provision requires that providers take into account the diversity of the transgender community, which is extraordinarily diverse — in terms of gender identity and expression as well as race, ethnicity, religion, dis/ability, and sexual orientation. There are as many ways of being transgendered as there are transgendered people.

Rule #3: Health care providers need to understand that sex reassignment surgery (SRS) is not the end point for most gender transitions.  Most transgendered people do not want SRS and most who do never get it. There are as many ways of transitioning as there are transgendered people.

Rule #4: Transgendered and gender-variant people are denied care in many areas not directly or even indirectly related to their gender identity; any attempt to address health care provision for members of the community must address those areas not related to gender transition as well as those areas that are transition-related. Some transgendered people are denied coverage for treatments or procedures that relate to their anatomical or biological sex assigned at birth, such as prostate cancer for transgendered women or cervical or ovarian cancer for transmen. Only in a relationship of mutual trust and respect can physicians and other health care providers be sensitive and informed enough to provide effective care in such areas.

Rule #5: The impediments to health care access are both medical and non-medical and effective health care provision requires that providers take into account and address both sets of impediments. Transgender sensitivity training should focus primarily on the psychosocial aspects of the interaction between providers and consumers, and that training should extend to physicians and nurses as well as everyone in a health care facility.

Rule #6: Health care providers need to avoid pathologizing transgendered people through the false diagnosis of gender identity disorder (GID) while at the same time understanding that such diagnoses are used by some transgendered people to access hormone replacement therapy (HRT), sex reassignment surgery (SRS) and other desired medical interventions.

Rule #7: Transgender sensitivity training needs to be mandatory for all staff in hospitals and health care-providing facilities, including technical people, security guards, and intake staff as well as medical and mental health professionals; physicians should undergo psychosocial sensitivity training, regardless of participation in ‘grand rounds’ and other cognate medical trainings and discussions. Transgender sensitivity trainings should be no less than two hours in duration and ideally should be four hours long. Real training involves an intensive interaction between the trainer and the trained. Webinars and handouts may be used to supplement such trainings but can be no substitute for trainings themselves. Trainings should be conducted by those who have specific expertise in transgender issues, not merely those who do general ‘diversity’ trainings or even those who do LGBT trainings but who lack expertise on transgender issues specifically. Given staff turnover, trainings must be conducted at regular intervals.

Rule #8: All health care providers and health care-providing facilities should adopt policies and protocols that specifically prohibit discrimination based on gender identity and gender expression in the provision of health care, and such policies and protocols should be regularly and effectively communicated to all relevant constituencies.

Rule #9: Health care providers should participate in larger efforts to achieve legal and public policy change in order to provide effective and universal health care for all, including all transgendered and gender-variant people; providers need to understand that the denial of health care to transgendered and gender-variant people is part of a larger denial of health care access to and insurance coverage and payment for health care to LGBT people, low-income people, poor people, and people with disabilities in the United States.

Rule #10: There are no rules, only ‘best practices’ — or at least, better practices and worse practices; and such practices must be informed by the lived experiences of transgendered and gender-variant people.

* * * * *

Pauline Park, Ph.D. (paulinepark.com) is chair of the New York Association for Gender Rights Advocacy (NYAGRA) (nyagra.com), president of the board of directors of Queens Pride House (queenspridehouse.org), and vice-president of the board of directors of the Transgender Legal Defense & Education Fund (transgenderlegal.org). Park named and helped create the Transgender Health Initiative of New York (THINY) and oversaw the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area. She led the campaign for passage of the transgender rights law enacted by the New York City Council in 2002 and served on the working group that helped to draft guidelines for implementation of the statute.

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Moving Beyond Shock on Transgender Health

By Paul Schindler

Even for those with some knowledge of the economic, social, and health disparities facing the transgender community, an August New York Times Magazine story, “The High Price of Looking Like a Woman,”likely shocked the conscience.

The story explored an underground and little known practice by which so-called “pumpers” inject silicone into the breasts, buttocks, hips, and faces of transgender women aiming to feminize their appearance. The practice exists outside the medical care industry and without its safeguards –– or, usually, even anesthesia.

Among many medical risks associated with the practice is the customary use of loose silicone rather than enclosed implants, a procedure that can lead to the migration of silicone throughout the body and, in turn, disfigurement and scarring. The Times story, in gruesome detail, spelled out a host of other negative outcomes, including chronic infection, blood system poisoning, respiratory impairment, autoimmune reactions, pulmonary embolisms, and death.

The story cites a conclusion by the New York City health department that just over one-fifth of the estimated 12,500 transgender people in the city have undergone silicone injections. Given the high proportion of that population that is uninsured and the widespread exclusion of gender transition procedures in both private and public health care plans, it is likely that the vast majority of those silicone procedures were carried out in the unsafe underground pumping economy.

It’s all too easy to come away from the Times’ account with nothing more constructive than the view that these pumpers must be stopped. Although the story quotes a practitioner identified only as S. saying, “I try to help the girls because they want to look feminine,” advocates for the transgender community familiar with the phenomenon make clear that pumpers are culpable for the significant harm they cause.

Jillian Weiss, a legal scholar who teaches at New Jersey’s Ramapo College and works with corporations on transgender workplace diversity issues, told Gay City News, “The people who are doing this have to know the risks and are not informing those who come to them.”

Pauline Park, who heads up the New York Association for Gender Rights Advocacy (NYAGRA), said, “Pumpers prey on naïve trans people.”

Weiss and Park agree that pumpers should face criminal prosecution, but neither is under any illusion that going after the “supply” side will curb the unmet demand the transgender community has for procedures and hormone therapies needed to facilitate their gender transition.

Mara Keisling, the executive director of the National Center for Transgender Equality, emphasized that it is simplistic and demeaning to suggest that efforts by transgender women to feminize their appearance are all about cosmetics. In her view, feminizing is, above all else, about “passing” –– and not getting killed.

“It’s about survival in getting a job, about not getting beat up on the subway, or maybe about finding a guy who will let them have a bed for the night,” she said.

Weiss and Park emphasized that true liberation for transgender people likely involves self-acceptance on matters including appearance. But, to get from one day to the next usually forces other considerations. “I don’t feel that passing should be necessary for a transgender identity,” Weiss said, “but in the real world, it is.”

The goal, then, must be to expand private and public health insurance access to the full range of services transgender people need to lead full and productive lives –– including mental health counseling, hormone treatments, and surgical interventions, ranging from genital reconstruction to breast augmentation to facial feminization.

In most health insurance programs, that is a steep climb. Gender reassignment surgery, in particular, is widely disallowed.

Prohibitions and limitations on covering treatment related to gender transition –– even those that might be viewed as primarily “cosmetic” –– are based in prejudice. Breast augmentation is now viewed by society as a legitimate medical expense following a mastectomy, yet vital services are denied transgender people, despite the fact, as Keisling put it, that “science has rendered its judgment –– these are medically necessary.”

According to the Human Rights Campaign (HRC), Medicare does not cover gender reassignment surgery, though “there is no exclusion under the federal Medicaid statute.” As a result, the National Center for Lesbian Rights reports, “Almost every court that has ever considered the issue has concluded that states cannot categorically exclude sex reassignment surgeries for Medicaid coverage.”

Last month, for example, a three-judge federal court panel threw out a Wisconsin law banning hormone therapy or sex reassignment surgery for transsexual prison inmates. Cutting three transgender patients off from hormone treatment, the court found, amounted to “cruel and unusual punishment,” banned by the 8th Amendment to the US Constitution.

The 2005 Wisconsin statute that gave rise to the case, however, illustrates the political realities cutting against the posture federal courts have taken. When prison officials in the state first authorized hormone treatment for the three plaintiffs, a spate of news stories about taxpayer-funded “sex changes” led the Legislature to rush through a prohibition.

According to Park, NYAGRA, the Empire State Pride Agenda, and other groups have been working toward ending policies put in place during the Pataki administration that placed hurdles in the way of Medicaid funding for gender transition.

At the federal level, Park, Weiss, and Keisling all pointed to opportunities under the new health care law –– both in terms of banning discrimination based on gender identity/ expression in providing services and in defining the benefits available under expanded Medicaid eligibility and the health care exchanges the law establishes.

Discussions of these issues between advocates and staff at the Department of Health and Human Services have begun, but have not reached any definitive results. Keisling is upbeat about the possibilities: “The good thing about this administration is not that they do everything everyone wants, but that they are reasonable. We can go in, and if we show problems that can be fixed, I think we can get things done.”

Significant progress has made on comprehensive transgender health care at the nation’s largest corporate employees, due in good measure to pressure put on them by HRC through its Corporate Equality Index. According to the group, 25 percent of Fortune 100 and fully 40 percent of Fortune 1000 companies now offer transgender-inclusive health insurance. Speaking at the World Diversity Leadership Summit in Manhattan last week, Deena Fidas, deputy director of HRC’s Workplace Project, said corporate employees have found that such benefits do not materially increase their healthcare costs.

Many transgender Americans, of course, do not work for the nation’s largest employers. Some work at jobs where they get no health care benefits; others scrape by in the underground economy, including sex work. This situation is largely the legacy of pervasive discrimination. Only determined efforts at education and advocacy will change this picture.

As Keisling pointed out, “Young trans folks are often mentored. If a mentor says, ‘Go get silicone,” many will follow that advice.” Outreach to transgender youth, many of them invisible or living on the streets, is required.

But the bigger education challenge involves the broader society, and that demands that the larger gay and lesbian community join with our trans brothers and sisters in tearing down stereotypes about gender and demanding equal employment and healthcare access. As the LGBT community fights high profile battles like marriage equality, it cannot –– in good conscience –– forsake this critical responsibility.

This editorial first appeared on Gay City News.com on 14 September 2011.

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