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Ruth Pearce @NotRightRuth
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Good morning! I'm back at #wpath2018, where 9(!) parallel sessions are now taking place.

I'm at "The Argentinian experience in public transgender health after the implentation of the Gender Identity Law".
First we're hearing from a speaker from the Argentinean Transvestite, Transgender and Transsexual Association (I missed her name, sorry about this). #wpath2018
The organisation was founded 25 years ago by trans women who wanted to fight state persecution, which included being regularly detained by the police. #wpath2018
The average life expectancy for trans women in Latin America is between 35 and 40 years. #wpath2018
We're hearing about the findings of a survey of trans people undertaken *before* the Gender Identity Law was passed:

89% had lack of social health insurance.
55% describe themselves as unemployed
84% sex workers
43% in unstable housing
79% arrested at least once
Other issues noted in survey prior to the passage of Argentina's 2012 Gender Identity Law included:

- high rates of STI infection (34% with HIV, 97% with HPV)
- unsupervised hormone therapy
- mental health problems
- long-term issues with silicon implants
Trans women who initially acquired a gender-congruent identity card following the passage of Argentina's 2012 Gender Identity Law were

- more likely to have access to trans-affirming healthcare
- likely to be been discriminated against
- less likely to be sex workers
There was an *enormous* drop in recorded state police and detention by police following the passage of Argentina's Gender Identity Law. However, while violence is nowhere near pre-2012 levels, it has increased somewhere since this initial drop. #wpath2018
What's new about Argentina's 2012 Gender Identity Law?

- gender identity understood as internal/individual matter
- no proof of medical treatment or judicial approval required for legal gender change
- all persons older than 18 able to access comprehensive healthcare
We heard a bit about Casa Trans, a new health centre in Buenos Aires which provides education and healthcare services specifically for the trans population - the first centre of its kind in Latin America. #wpath2018…
Next steps for activism:
- comprehensive sex education
- quota for employment of trans people
- comprehensive healthcare in all areas of Argentina, including rural areas
- research on hate crimes and causes of death
- countering the anti-"gender ideology" movement
You can read an English translation of Argentina's groundbreaking Gender Identity Law here #wpath2018…
Next we're hearing about the Program for the Implentation of Gender and Sexual Diversity Health Policies in Buenos Aires province. A new initiative established in 2016 with an aim to guarantee comprehensive healthcare for LGBT people from human rights perspective. #wpath2018
The Program kicked off with research (interviews and focus groups). Issues identified included:

- lack of LGBT-sensitive health providers
- lack of training for health personnel
- lack of supplies for hormone therapy
- lack of gender-affirming services (esp surgery)
Wow - the Program brought about huge increase in service provision. Increases from Jan 2016 and Aug 2018:

- LGBT-sensitive health providers from 4 to 39 providers
- hormone providers from 2 to 29
- surgical providers from 2 to 4
- hormones for adolescents from 0 to 5
Prior to 2016 every trans person had to ask to hormones in person in just 2 centres, and (I think) it could cost. Following scale-up in provision hormones are now available for free from 29 providers across Buenos Aires province. #wpath2018
In Argentina is that access to gender-affirming care is guaranteed through the law - but responsibility for implementing the law falls to provincial + local authorities.

Context: at present still 29/175 muniplicities in Buenos Aires have direct hormone provision. #wpath2018
Huge growth also in training on trans health for health personnel in Buenos Aires. e.g. training of health teams rose from 18 teams in 2016, to 34 in 2017, to 103 in 2018. Shows importance of investment - enables wider access to knowledge and competency. #wpath2018
Since 2017 the Buenos Aires Program has also started providing education for healthcare providers specifically on hormone provision (which was not available before this time). This has substantially increased access to free hormones. #wpath2018
Argentina's Gender Identity Law makes legal gender change easy, but also provides a legal right to access gender-affirming care such as hormone treatment regardless of whether or not someone has changed their legal gender. #wpath2018
Who is accessing hormone therapy through formal healthcare providers in Buenos Aires? According to a recent survey:

- 35.8% trans men or men
- 55.6% women, trans women or transvestites
- 8.6% other gender category

Rise in anti-trans/anti-woman discourse from conservative movement opposed to "gender ideology" means that Argentinian providers have to spend more time justifying work.

Economic issues and decrease in investment in healthcare have also caused difficulties. #wpath2018
Now in this session we're going to hear from Cecilia E Calvar, of the Endocrine Unit of the Hospital Fernandez. #wpath2018
Calvar: Growth in trans people accessing services in 2012. Rates of trans men and women remain broadly even, but there has been a slow growth in non-binary people accessing services in the last three years. #wpath2018
Calvar: Trans men at Hospital Fernandez likely to access services at a younger age on average (24.7) than trans women (29.5). Interesting to me how these figures reflect similar situation in UK.

Trans men also more likely to have higher level of education. #wpath2018
Calvar: 76.5% of trans women previously took unmonitored hormones compared to 26% of trans men. #wpath2018
Based on a range of further differences in access, needs and background, Calvar argues that trans men and trans women should recieve tailored care rather than necessarily treated the same. #wpath2018
Calvar explains assessment procedure for hormones at Hospital Fernandez. No psychiatric exam. Patients recieve physical assessment (e.g. blood test for hormone, lipid levels etc. Trans men have ultrasound sonograph. Trans women who have self-medicated have a mammogram. #wpath2018
Calvar: in 2nd appointment patients asked sensitive questions about bullying, abuse, suicide ideation etc to find out if they require additional mental health support.

"Our patients are not afraid because they know it's not an assessment [of whether they are trans]". #wpath2018
Audience question about availability of mammoplasty. Calvar: unfortunately this isn't available for free in Buenos Aires at present due to lack of surgeons prepared to provide this service. Only available through private insurance. #wpath2018
Audience question about appearance of non-binary patients from 2013 - what happened?

Calvar: changing language and wider cultural change. Less non-binary people presenting in Argentinian services than in other countries, but this is expected to change. #wpath2018
Finally in this session (I think) we're hearing a talk on access to HIV testing for trans people in Buenos Aires. #wpath2018
Importance of sexual health testing that is sensitive to trans people's specific needs. A session for trans people had no attendees - so the service hired a trans caseworker and started travelling to where trans women lived to provide services. #wpath2018
That was a super interesting panel - thank you to everyone who spoke, I'm grateful to have heard about your knowledge and experience. #wpath2018
(The panel hasn't quite finished as it is overrunning a little, but I have to go to charge my laptop during the break)
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