Amid the firestorm North Carolina ignited March 23 with its bathroom laws and a Virginia court case that will determine which restroom a Gloucester teen can use, a daylong transgender symposium to provide education for health care providers will take place in Charlottesville April 27.
“It’s the first event of its kind in Virginia that I’m aware of,” says Ted Heck, who works for the Virginia Department of Health in HIV prevention and who helped organize the symposium. “Its real focus is providers,” he says, “and it was organized by community members.”
One of those is Karen Barker. She is with the Transgender Health Alliance of Central Virginia and she’s the parent of a transgender teen. She says her son’s primary care physician had no experience with that, and she was surprised to learn UVA did not have a transgender teen clinic. UVA opened a Transgender Health Clinic in March 2015.
“Access to care was really critical for me,” she says. “First for my son, but it’s an issue for a lot of people.”
“It’s a really new field,” says Heck. “There’s very little training in medical schools, and very little medical literature. Even people with expertise don’t have a lot of data to back them up.”
Regardless of socio-economic status, transgender people face significant health care disparities, according to a 2011 National Center for Transgender Equality and National Gay and Lesbian Task Force survey of 6,450 people. Nineteen percent reported being refused medical care, a number that’s even higher for people of color.
Survey participants reported four times the national average for HIV infection, and much higher rates of suicide attempts, smoking and drug and alcohol use than the general population.
Whether trying to get care for transitioning or HIV or even basic health care, “It’s all pretty challenging for trans folks,” says Heck.
Heck knows. He moved to Virginia in 1999 and knew he was going to be transitioning. He was unable to find an endocrinologist in the Richmond area willing to prescribe hormones, and finally found a provider in the Washington area who worked with his primary care physician.
Sometimes the information a provider has is outdated. “Before, they used to require that you live in that [gender] role for a year before you can access hormones,” says Heck. “That can be incredibly challenging, especially if you live in a rural area.”
At one time, UVA was a pioneer in sexual assignment surgery. Dr. Milton Edgerton joined the faculty in 1970 from Johns Hopkins, the first academic institution in the United States to perform such surgery. Neither UVA nor Johns Hopkins does so now.
Gender transitioning worked under a different model then, says Heck. “It was very patronizing and people had to jump through a lot of hoops.”
In some ways, Virginia is ahead of the curve as far as services available to transgender people, says Heck. His work in HIV prevention is funded by the Centers for Disease Control and Prevention. “They’re more progressive in making sure the needs of at-risk people are met,” he says. “Because it’s federally funded, it can’t really be restricted as it could be if state funded.”
Virginia’s General Assembly held off on moving on its own bathroom bill restricting transgender students to using the facilities of their biological gender in anticipation of the 4th U.S. Court of Appeals decision in the case of Gavin Grimm, whose Gloucester School Board ruled he had to use the girls or a unisex restroom. A decision in that case is expected any day now.
North Carolina not only legislated which public bathrooms its citizens may use, it also rebuked Charlotte for prohibiting discrimination based on sexuality. The state now faces a lawsuit, the NBA is reconsidering its 2017 all-star game in Charlotte and its attorney general says he won’t defend the law.
Heck felt a combination of anger, frustration and disappointment over the Tar Heel state’s decision. “I wasn’t surprised, unfortunately,” he says.
That sort of legislation creates a “hostile environment, particularly for young folks,” he says. “When they have to hide who they are, their behavior becomes riskier. There’s a high level of stigma. Any time people’s opportunities are limited because they can’t get a job or find housing, that certainly could have an impact.”
So far 95 people have signed up for the April 27 symposium. “Response has been better than we thought,” says Barker.
Celebrities like Caitlyn Jenner and Laverne Cox have drawn a lot of attention to transgender issues, says Heck, but their visibility also brings a backlash in much the same way that the legalization of same-sex marriage brought religious freedom bills.
“These bathroom bills are part of the backlash,” says Heck.