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Local Journalism Initiative

COVID-19 has slowed surgeries across Ontario. For some trans people that is particularly painful

When Niko Stratis transitioned, she was living in the Yukon and despite  having no medical background, she had to help direct her treatment plan. “My doctor didn’t know what being trans was,” she said. “So, I had to do a  bunch of research and then bring documents into him.” Stratis, a freelance writer, created a resource website for the territory with  the help of a government grant, to help walk others through the experience of  transitioning. But now, Stratis has less control over what’s stalling her next step. While gender-affirming surgeries and other elective surgeries are happening  in Ontario, they are happening at a slower pace. As COVID-19 cases rise and  there is increasing demand for ICU care, experts  expect further delay for non-urgent surgeries.  While Stratis understands the impact of the pandemic, she also says she  doesn’t think of gender-affirming surgery as elective. The uncertainty and long postponement, Stratis says, has had a negative  impact on her mental health and the gender dysphoria she deals with. “These are  things I kind of am relying on to keep my mental health in check. That’s a  really difficult thing for me to manage,” she said. “I’m probably waiting upwards of three more years for things that will  benefit me physically and mentally,” she said. Alex Abramovich, a scientist at CAMH’s Institute for Mental Health Policy  Research, agrees the access to gender-affirming procedures “have a major impact  on the mental health and well-being of trans people,” noting that there has been  research that links a lack of access to increased suicide risk. “Those are things that I would describe as really life-saving therapies,”  Abramovich said. “And now with COVID, I think it’s much harder to access those  things,” including support groups and the ability to lean on community when  things take a mental toll.  Abramovich was lead author on a study this year that assessed the “Health  Conditions and Health Service Use Among Transgender Patients in Canada.”  While data for the study was collected from 2012 to 2016, the findings are  relevant to what we have come to know about COVID-19.  After months of contending with COVID-19, the risk factors the trans  community faces during the pandemic have scarcely been considered. Yet, there is overlap with Abramovich’s findings and those factors that can  raise the risk of contracting COVID-19 and also lead to worse outcomes. The  study found that trans people are more likely to live in lower-income  neighbourhoods, are more likely to experience chronic health conditions and have  significantly higher rates of mental health issues.  Another takeaway from the study was a need for health-care administrators to  update categories for sex and gender, which often don’t reliably identify  transgender patients. Updating categories would help to more easily identify  health trends like these. With regard to COVID-19, data is more widely collected on race, income and  location but does not capture trans identity. While the pandemic has limited access to gender-affirming surgery and  highlighted other health impacts, in general, Ravyn Wngz says, access to health  care has always been a challenge for trans people. “There’s so many people asking me for the first time about health care ‘How  has COVID changed health care for trans people?’ It hasn’t. It was difficult for  us to access health care before (and) it’s difficult for us to access it now,”  said Wngz, who is a steering member of Black Lives Matter Toronto, storyteller  and two-spirit trans woman. “Even in a country like Canada, where it’s called ‘free health care,’ it’s  still difficult for us to be respected,” Wngz said. “A lot of trans people don’t  actually go to the hospital when we’re sick. We go to our community centres, we  go to our local prevention sites.”  Devan Nambiar is the program manager of Rainbow Health Ontario at Sherbourne  Health which works to help health-care systems better serve the LGBTQ community.  Rainbow Health runs 40 to 50 training sessions a year with various  organizations, and provides resources and guidebooks on how to provide more  inclusive care. Nambiar identified numerous barriers faced by the LGBTQ community including  implicit bias and intake forms that don’t allow people to identify their gender  beyond the sexes male and female. If someone has “experienced transphobia and challenges to basic care, it  becomes very daunting to actually go see a health-care provider,” Nambiar said.  But he has seen slow change and more inquiries about how to improve care in  Ontario. “It is slowly building, but of course, it’s not perfect, because things take  … time to build up to the capacity to serve everyone’s needs,” Nambiar said. Myles, a 20-year-old content creator and make up artist, started her  transition in February, and for her, fortunately the pandemic has not halted the  progress she was hoping to make with her hormone therapy, and she recognizes the  privilege she has. “I’m still able to have that be a peace of mind,” she  said. She said the process has been smoother thanks to the doctor she found through  a LGBTQ resource centre. “It keeps me very secure in how I feel about what I’m  going through medically,” she said.  “It’s very important to have LGBT friendly doctors and trans-friendly doctors  because we need the health-care system to be a safe space for trans people,” she  said.  If you are thinking of suicide or know someone who is, there is help.  Resources are available online at www.crisisservicescanada.ca or you can connect  to the national suicide prevention helpline at 1-833-456-4566, or the Kids Help  Phone at 1-800-668-6868.  Angelyn Francis is a Toronto-based reporter for the Star covering equity and  inequality. Her reporting is funded by the Canadian government through its Local  Journalism Initiative. Reach her via email: afrancis@thestar.caAngelyn Francis, Local Journalism Initiative Reporter, Toronto Star

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