Health care agencies need to respect a person’s pronouns and recognize that gender identity goes beyond a checkbox of male or female. (Photo Credit: The Gender Spectrum Collection)

In June of 2013 the world watched and held their breath as George Zimmerman went to trial, charged with shooting and killing Trayvon Martin, a Black teen who lost his life at Zimmerman’s hand on February 26, 2012, in Sanford, Florida. 

 Zimmerman was found not guilty — he insisted it was self-defense — and many took to the internet to express their grief, anger and disbelief. 

One of those people was Alica Garza, a Black queer woman, activist and author. Lots of folks responded to Garza’s Facebook post. One of the respondents (a queer activist and LGBTQ rights advocate) was Patrisse Cullors. Cullors ended her response to Garza’s post with a hashtag, #BlackLivesMatter. 

Shortly after, and joined by human rights advocate and strategist, Opal Tometi, the three women organized a Black-centered political project that became the Black Lives Matter movement, aka BLM. The movement went national about a year later in 2017 after the deaths of Michael Brown in Missouri and Eric Garner in New York. 

Prior to 2013, the letters BLM were just that, three letters. Although there probably were some environmentally conscious folks who might have recognized the letters as an acronym for the U.S. Department of Interior’s “Bureau of Land Management,” what is most commonly thought of today is the social justice movement these three women spearheaded. 

Not as well-known, however, is their statement on inclusion: 

We affirm the lives of Black queer and trans folks, disabled folks, undocumented folks, folks with records, women and all Black lives along the gender spectrum. 

Prior to BLM gaining the recognition that made them a household name and powerhouse political force, another closely related acronym existed that was not as widely recognized: DEI (Diversity, Equity and Inclusion). That has since changed.

The Centers for Disease Control (CDC), a leader in DEI practices, defines Diversity as an appreciation and respect for the many differences and similarities in the workplace. This includes varied perspectives, approaches and competencies of coworkers and populations we serve. 

To uncover the defining explanation for Equity, we look to YW Boston (YWB), a social justice organization (and offshoot of the YWCA) that has been at the helm of equality advancement and empowerment for women since 1866. From YWB’s website: “Equity is the fair treatment, access, opportunity and advancement for all people, while at the same time striving to identify and eliminate barriers that have prevented the full participation of some groups.”

The CDC goes a step further to offer the definition of Inclusion as a set of behaviors that encourages employees [and others] to feel valued for their unique qualities that result in a sense of belonging. 

In the not-so-distant past, DEI was a phrase primarily echoed in Human Resources Departments. Post-BLM, however, more organizations and individuals are realizing what an important role DEI plays in the workforce, social settings and the world at large. 

That said, companies who want to show their social consciousness (particularly in the wake of massive social justice unrest) have jumped to hire DEI Administrators and now offer their staff DEI training (virtually and in person) while promoting and marketing their efforts to clients and customers. The healthcare industry, which has largely evolved into a for-profit business in the United States,  isn’t much different, but one does wonder, particularly during this era of political correctness and so-called “cancel culture,” just how good of a job is being done, and is needed change actually taking place?

In seeking answers to those questions, qnotes took a look at how DEI in the LGBTQ community is being handled in healthcare. More simply, we looked at how the power of words (and actions) finds its way onto medical forms and in the interactions and care received by LGBTQ community members. 

Most people know that slurs and negative connotations cause pain, but many don’t think or realize how that same pain can occur when people have their very existence erased. For instance, if a nonbinary (not identifying as male or female) or gender non-conforming person wanted to apply for health insurance through Blue Cross Blue Shield NC, the largest health insurance organization in the state, they would immediately notice they are required to check one of only two boxes for gender. 

The same can be said for many intake and assessment forms required for service by countless health care providers. Gender is frequently limited to male and female, and most often there’s nothing that allows a transgender-identified individual representation. Once a person gets past that, they then have to interact with staff and practitioners who may have missed the DEI class or simply do not realize that their language is hurtful and/or non-affirming. 

Microaggressions like mis-gendering folks (referring to people by the wrong pronoun) has been linked with increased suicide rates among transgender individuals. Microaggressions are subtle statements, incidents or actions which are often unintentional, yet discriminatory toward a marginalized group. A 2018 study published in the Journal of Adolescent Health surveyed 129 transgender and gender nonconforming youth from three U.S. cities. It looked at the microaggression of mis-gendering and not using a person’s chosen name. Their findings echoed what many already know about the power of words that affirm or wound.

In assessing the use of chosen names and examining the association with depression, suicidal ideation and suicidal behavior, the study revealed that after making the adjustment of using a trans youth’s chosen name in more contexts (home, school, work or with friends) those young people had lower rates of depression, suicidal ideation and suicidal behavior. The same could also be said for LGBTQ adults who regularly deal with health care professionals and others who routinely do not affirm their identities with the language they use and the treatment they deliver. 

Avilyn Grace Jac’El (aka Avi Grace) is a 30-year-old transgender woman and former lead processing clerk for a major hospital in the Carolinas. In recalling experiences surrounding the care of trans patients, Jac’El reflected upon an incident she “discovered almost by accident.” 

 “While collecting paperwork one day, there were nurses speaking about a transgender woman. They misgendered her, insisted on using Mister — right to her face and behind her back. They blatantly made fun of the patient — compromising the integrity of their care. I knew the patient and relayed the information to the person’s partner who said, “it was nothing new and that the treatment was infuriating.” 

At the time, Jac’El was too afraid of personal reprisal to make a formal complaint against any of the involved hospital staff. “I said nothing because they were RNs and supervisors. With one call they could have had me fired. If I had to do it all over again, I’d speak up. I should have made a formal complaint. I spoke with one of the nurses later [and] nothing happened. That’s when I realized, trans people aren’t safe in health care.”

In recounting her own experiences with health care professionals, Jac’El said she’s been pretty fortunate. “Personally, having just come out [as trans] six months ago; for the most part everyone has been kind. There is a lot of ignorance and a lot of speculation but the two primary care physicians I’ve seen in the last 14 months have embraced my womanhood.”  

Jac’El explained that individuals in the trans community talk about these things and support each other. “We know where to go, I don’t want to say the name, but everyone knows the hospital … where they treat us with dignity.”

Some health care professionals are already doing just that. They’re taking employer provided DEI training seriously and to heart. During a recent HIV testing event at Charlotte Black Pride’s Expo, qnotes spoke with a young trans man who confirmed that the person who tested him was very polite and affirming by beginning the assessment process with two questions, “What is your current gender?” and “What are your pronouns?” The client was pleased with the interaction, and noted how something seemingly so small can go a long way. 

In a statement about the importance of Diversity in the workplace, the CDC responded with this press release: “To be a truly effective public health agency, our workforce must continue to reflect the populations we serve. Diversity and inclusion drive innovation, creativity and improve performance. These improvements strengthen our work in public health promotion by eliminating health care disparities in underserved and minority communities and enhancing our work in disease prevention and control.”  

It would seem there is plenty of validity to the CDC’s claims about diversity. The trans man who had a good experience received it from a community-based organization with a very diverse staff that includes Black and brown LGBTQ community members and allies that consistently aim to practice DEI with the empathy and respect all people deserve. 

Jac’El is adamant that ensuring more positive health care interactions for the LGBTQ community still remains desperately needed.

 “The education that’s needed is more than a two-hour seminar once a year,” she explains, “I know that’s a lot to ask, but a lot is needed. They [health care workers] are good with mental health referrals, but I think an overall understanding of the transgender story [is] understanding that every person is unique. Our lives and pain is real, you [should] care enough to educate yourself on your own time.”

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