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Sex Ed, Broken Hearts & Mental Health

Sexual health is about more than our body parts. The youth I work with understand this inherently.

In my role as Sexuality and Reproductive Health Facilitator at Sexuality Education Resource Centre Manitoba, I work on a number of different projects, one of which is focused exclusively on newcomer youth in Winnipeg. It is called the Our Families Can Talk About Anything project, which brings together parents and youth from newcomer families to talk about sexuality and sexual health and work to build bridges of communication between parents and their teens about these topics.

During these newcomer youth workshops, we spend as much time exploring topics of broken hearts, relationships with parents and consent as much as vaginas, condoms and STIs. Sexuality is a complex and dynamic aspect of our humanity and includes physical, emotional, mental and spiritual components, all interconnected.

I really believe that I have the best job in the province. I get to host sexual health workshops and discussions with newcomer youth who are navigating the challenges of being young in Winnipeg in 2018, learning about themselves as they transition to adulthood and struggling with their roles as children of parents who maybe just don’t understand. Add to this the pressures and stresses of puberty, social media and hallway crushes. There is so much to navigate.

With these pieces put together, it becomes clear how mental health plays an integral part of the story. Our hearts, minds and bodies are all connected.

In our sessions, the youth talk about relationships with parents and their struggle to be independent. We explore LGBT2SQ* identities, respect for diversity and how these intersect with religious beliefs. We share about consent, cat-calling and abusive relationships. We explore body image, self-image, valuing ourselves. We dissect the intricacies of decision-making, how to trust ourselves, when to trust in others. We talk about what respect means, how we respect our own bodies and how we respect the bodies of others. We discuss racism, cultural adaptation, bullying and community. We talk about birth control choices, STIs and the science of how bodies work.

We also talk about broken hearts. If there were one thing I would love to communicate fully to you it would be these amazing conversations about broken hearts. Youth understand how mental health connects to physical health. Hearts and feelings directly affect thoughts and actions. They speak with great articulation on feeling the grief of broken relationships and their need to devise strategies to get out of bed on mornings when they are so sad they can barely breathe. They know and experience the pain of breakups and the cloud that hovers above them for months, sometimes years afterwards. They know that hearts and minds are connected; they are working so hard to find a way through this.

We cannot afford to ignore the mental, emotional and spiritual aspects of sexual health. Talking about bodies as if they are separate from our relationships, separate from our thoughts and feelings would be missing most of the story.

The 16-year-old woman who is asking for condoms because she feels pressured into sex by her boyfriend, the boyfriend she cannot tell her parents about because they do not want her dating until she is 18, is facing immense pressure from many sides of her life. We let her know that contraceptives are available to her, and with those we also provide information on her sexual rights, on her inherent value as a person, on her agency to use her body the way that she thinks best, on what healthy relationships look and feel like. Providing birth control options is important but not the only part of sexual health that needs attention; all of these are connected.

Sexual health is about more than our body parts. It is about how our mental, physical, emotional and spiritual selves interact in terms of our sexuality and our understanding of ourselves. It is about mental health, reproductive rights, birth control access, consent, bodies, healthy relationships, body image, smashing the patriarchy, social justice and all of the things that affect our bodies and relationships.

We cannot separate the physical from the mental or the spiritual; it just would not make sense. Effective sexual health education encompasses all of these aspects of our sexuality, while we assist youth in the skills they need to effectively Mind Their “Business”.

The Importance of Queer and Trans-Affirming Mental Health and Substance Use Support

Historically, LGBTQ people have not been made to feel comfortable to talk about their lives and experiences while accessing support in health care and social service settings. To this day, many people suffer from abuse, bullying, harassment and discrimination because they are LGBTQ-identified. This certainly also happens in health care settings. Existing services are not designed with LGBTQ people in mind and health care providers are not receiving the proper training to meet the needs of this population. In response, Faith and Tim started Pieces to Pathways (P2P), a peer-based harm reduction program for queer and trans folks.

P2P started as a conversation between Faith and Tim, two friends who met in recovery. The two got sober with the support of 12-Step programs,[1] and this lived experience as sober queer and trans people combined with their histories of grassroots community development inspired the development of the program.

Faith and Tim, who are vocal about their own experiences with addiction and recovery, would regularly get friends or mutual acquaintances sent their way when they struggled with substance use. They would meet with these individuals, often in coffee shops, to discuss their stories and share what had worked for them to get sober and stay sober. When it came time to make a referral to social or health services that were queer and trans affirming, Faith and Tim discovered that there were very few places they felt comfortable referring people to.

In the summer of 2014, Faith and Tim started P2P and in December 2014, they were successful in securing government funding from the Toronto Central LHIN (Local Health Integration Network) to conduct a community based needs assessment. By the end of March 2015, a full literature review analyzing 115 peer-reviewed articles was conducted, 28 different social service providers were interviewed, 640 LGBTQ youth were surveyed, and 5 focus groups were facilitated with 48 participants. The findings, compiled into a final report, echoed Faith and Tim’s experiences:

  • 65% of survey respondents said that provider and/or client orientation towards their LGBTQ identity negatively impacted their service use experiences.
  • Past year substance use prevalence rates among queer/trans youth in Toronto ranged from 1.19 to 57.2 times higher than those of the general Canadian population.
  • 37% of survey respondents would like to or were actively trying to reduce or eliminate their alcohol use.
  • 44% of survey respondents would like to or were actively trying to reduce or eliminate their drug use.

Many queer and trans youth use alcohol and drugs to cope with the daily oppression they face in their lives and many use substances just to survive. When this population thinks they might have a problem with their use, they are unsure if existing services will be able to meet their needs as an LGBTQ person. When this population actually goes to get help and access services, 2 out of 3 have a negative experience because of their queer and trans identity. Survey respondents reported not feeling safe disclosing their identity, not being accepted for their identity, and being actively mistreated by health care providers. This results in an unfortunate situation where queer and trans folks must either access services that may be harmful to them, or completely disengage with services altogether.

To respond to these realities, P2P was envisioned as a peer based program – with all frontline staff being queer and trans identified and having their own lived experiences with substance use and recovery, however defined by each individual. In this model, lived experience is used both as an intervention strategy and as a tool to build community for people that are facing similar struggles. The program is currently housed at Breakaway Addiction Services[2] and, as a harm reduction program, offers 1-to-1 support through case management, hosts 3 community drop-in nights and co-facilitates dialectical behavioural therapy (DBT) groups.[3]

Throughout P2P’s work, the access needs for gender variant individuals in health care settings have been made clear.

Top three needs

All-gender bathrooms, inclusive in-take forms, and respect for an individual’s pronouns.

When these needs are not met, patients/clients report feeling like they are not respected or understood for who they are, which can result in them discontinuing treatment or not accessing health care in the future.

10 Tips for Engaging and Supporting LGBTQ Youth

  1. If you don’t know or understand a particular concept, “Google It” or ask a colleague.
  2. Avoid making assumptions about peoples’ gender, sex and sexual orientation.
  3. If you’re unsure about a person’s pronouns, ask them.
  4. If facilitating a group environment, incorporate a “pronoun go-around” and also ask if participants have any access needs.
  5. If you make a mistake, it’s okay. Apologize and make it right next time.
  6. Show that you support the LGBTQ community.
  7. Know your limitations in supporting someone and if necessary, refer to a colleague or another organization.
  8. Stay up to date and keep yourself informed about historical and contemporary LGBTQ issues. If you have learned something, share it with others.
  9. Ask the person what they want, what they need and how they want their experiences defined.
  10. Understand that not all queer and trans youth have the same experiences.

 

[1] 12-Step programs are community based supports where individuals who identify as addicts and alcoholics meet to mutually support one another.

[2] Located in the Parkdale area of Toronto

[3] The drop-in spaces include an abstinence night on Monday, a harm reduction space for racialized youth on Tuesdays and a harm reduction night on Thursdays. P2P regularly works with many addiction, harm reduction and mental health service providers in Toronto by providing LGBTQ and harm reduction advocacy, education and training. Once a month, P2P hosts a community harm reduction kit making event that is open to everyone, where participants can make safer use kits for crack use, injection drug use, crystal use and partying, as well as kits for injecting hormones and safer sex practices. P2P regularly attends drop-ins of partnering organizations and parties to do harm reduction outreach and to hand out kits.

 

More than Pronouns and Good Intentions: 5 Ways toward decent and affirming trans healthcare

In the past few years, trans rights and social policies that take trans lives into account have seen exponential growth. This is largely due to the decades-long work of trans people, especially those organizing for their safety and survival. Critical progress has been made under the leadership of trans women of colour, trans people doing sex work, and trans parents; however, these contributions are so often devalued and minimized. Thanks to the hard work of trans communities before us, we now have increased protections, more visibility, and service providers who are scrambling to meet our needs. This sense of urgency to engage with us is even more pronounced with sexual and reproductive wellness—an area of health where vulnerable parts of our bodies and selves come under scrutiny by cis (non-trans) society and where cis providers have much to learn about sexual and gender diversity.

There is a great deal of variation in how providers deliver trans healthcare. Thus, instead of looking at specific actions that providers can take (which can vary depending on context), here are 5 values-based perspectives to consider as a provider.

These perspectives can contribute to dignified and affirming healthcare experiences, whether it be primary or specialist care, sexual and reproductive health, or mental health services. Above all though, we hope anyone involved in trans health is looking to their own local community for meaningful engagement[1] and up-to-date information on health care needs.

Depathologize gender and sexuality

As of 2012, Gender Identity Disorder (GID) has been replaced by Gender Dysphoria in the DSM-V[2]. However, transgender people continue to be pathologized in a variety of ways. Depending on where we live, psychological assessments and psychotherapy are often prerequisites to hormones, surgeries, and identification papers. Sometimes we must also adhere to prescriptive gender presentations, report specific sexual orientations or hide sex practices to meet a provider’s requirements. These pathologizing practices and other negative experiences with providers are communicated from peer to peer and have an impact on how, when, and if we use available services. As a provider, being mindful of how underlying biases and choices can affect our anxiety and avoidance is critical to quality care.

Respect self-determination and bodily autonomy

We have the right to make our own health decisions. This right to choice includes which interventions, treatments, and medications we want to access. We also have the right to label our own bodies and functions based on what feels comfortable or least problematic to us. To this end, follow our lead when it comes to terminology. Also, in order to avoid assumptions, check-in with us about what words we like to use, what parts we have (or don’t), and how we use those parts. Only ask intimate questions when relevant to our care. Communication about physical examination is also essential. Consent is important before touching another person, and some trans people prefer not to have a health practitioner touch certain parts of them. Reminding trans people they have the right to refuse treatments or ask for a second opinion are some ways to encourage our autonomy.

Cultivate safety and trust

Have practices and policies that explicitly show that you value trans people’s privacy and confidentiality. Very rarely are trans people encouraged to establish boundaries based on what feels right to us. Our privacy requirements should be addressed, and early on. For example, in Ontario, physicians are entitled to assume they have their client’s implied consent to share personal health information with other providers in the client’s circle of care. Assuming implied consent in this situation could cause harm and damage trust. The ethics of sharing personal information about our transitions and how these stories are told needs to be discussed.

Having clear policies that are made available to everyone will help trans people navigate services better and decide if the limits of confidentiality are acceptable to them. Knowing who has access to our files, what information goes on record, and how these records are stored helps us build confidence in our providers. Included in this type of explanation would be any mention of our histories of “gendered” health care (e.g. pap smears, menstrual cycles, testicular discomfort), and, importantly, which names are on file and which names get called out in the waiting room. We have the right to receive accommodations and to be addressed by our actual names regardless of whether or not these names are also on our identification documents. Taking these steps can go a long way in creating a safe environment.

See the unique person in front of you

Recognize that trans people are a diverse, complex, and often contradictory population—like all communities. This includes the people who wrote this article, who most definitely were not elected to represent the whole trans population! Trans people, like all people, come with different life baggage, worldviews, bodies, spiritualities, class backgrounds, and relationship networks. We also have our own intra-community conflicts, challenges, and strengths. Keep this in mind and do your best to show flexibility when collaborating with trans people. There is no “right way” or “wrong way” to be trans, nor is there any test to prove or disprove one’s trans-ness. Each individual comes to trans-ness through a unique life path, with different struggles and successes along the way.

Support trans knowledge, leadership and empowerment

Recognize that trans people have historically been, and continue to be, over-studied, under-consulted, and dismissed for their trans-ness. There are many papers about experiences of discrimination, risk-taking, mental illness, suicidality[3], and oppression of trans people, but very few concerning sexual and reproductive wellness. There are even fewer by trans researchers and/or in collaboration with trans communities.

Trans people are the experts on their own health, and on trans health broadly speaking. We have been doing comparative analyses of surgeons, medications, side-effects, therapeutic approaches and aftercare for as long as we have been accessing these services. Given the huge number of obstacles we have faced, we have been creative and efficient in navigating complex, often hostile health services to attain our wellness goals and support each other. To only credit cis (non-trans) people for advances in trans health is to ignore a whole wealth of knowledge and best practices based on years of community development and information gathering. Encouraging trans leadership and trans knowledge development is not only ethically better, it is also a more efficient use of resources.

We are indebted to trans people who came before us, those who will come after us, and everyone else who contributes to the collective work of trans liberation. To everyone making efforts to encourage meaningful involvement of trans people in reproductive and other forms of health: thank you and keep going! The conversation is just getting started.


 

[1] Much of what we know about meaningful engagement comes from principles which emerged from the HIV movement. Please visit the Canadian Positive People Network (CPPN) for more information on movements led by and for HIV positive people, and their contribution to many spheres of health advocacy.

[2] For a global resource on trans health and information on history, check out “Trans Bodies, Trans Selves”, a book developed by and for trans people: http://transbodies.com/, which includes a fantastic chapter on sexual and reproductive health.

[3] Check out TransPulse research findings on access to health care in Ontario: http://transpulseproject.ca/research/

SRH Week 2017 is just around the corner!

This year, Sexual and Reproductive Health Awareness Week (SRH Week) will take place from February 12-18 with the theme: Ready for some pillow talk?

The 2017 campaign will build on last year’s “What’s Your Relationship Status” campaign by asking health care providers and clients/patients to “start the conversation” for the best possible care.

Open communication between health care providers and clients/patients is crucial to sexual and reproductive health.

On February 12th, we’ll be launching a quick reference book for health care providers and a blog series spotlighting health care providers making a real difference. We’ll be on Facebook and Twitter too! Find us @srhweek or download our social media kit (coming soon!).

The new campaign and material will be available on www.srhweek.ca as of February 12. Can’t wait until then? Check out campaign material from last year!
Of course, any campaign needs strong voices to really make a difference. Help promote sexual and reproductive health this SRH Week by displaying the posters, following @SRHweek on Twitter and Facebook, visiting www.srhweek.ca and helping to spread the word!

Want posters? No problem! If you would like to order copies of the poster, click here and fill out the poster order form. We’ll be happy to send you posters at no charge. For campaign graphics, social media tools, PDF copies of the poster and much more keep visiting www.srhweek.ca!

Now let’s start the conversation!