|In the second research review intended to assist LGBT submissions in support for SOP 432 and the addition of gender identity to the Human Rights Act, I will focus on Roberta Perkins' Transgender Lifestyle and HIV Risk (1994).
It is true that this paper is now over twenty years old, but along with collective action from transgender rights and LGBT organisations across Australia, it has had decidedly positive effects. At the time when Perkins (herself a transwoman) originally wrote her research paper for the Australian Federation of AIDS Organisations (AFAO), only two jurisdictions, South Australia (1984) and the Australian Capital Territory (1991) had included gender identity within their antidiscrimination legislation. After she did so, the pace of change accelerated dramatically across Australia. New South Wales (1996), Victoria and Western Australia (2000), Queensland (2002) and Tasmania (2013) have all followed suit, as has Australian federal antidiscrimination law. Today, the Northern Territory is now the only Australian jurisdiction that has not added gender identity to its antidiscrimination legislation- and it has fewer inhabitants than Dunedin on our side of the Tasman (at one hundred thousand people).
Perkins' study was funded by AFAO and the Commonwealth Department of Health and surveyed 146 transwomen across the continent. The report was carried out under the auspices of the Department of Sociology at the University of New South Wales. As Perkins noted in her introduction, the report had several objectives- it set out to estimate the total transgender (transsexual) population within Australia. It also assessed their levels of education and existing occupational skills, as well as their current sources of income, health outcomes, HIV risk and prevention concerns, legal, housing and other issues. Both transwomen and transmen participated, although one limitation of the study is that it predominantly focuses on the concerns of white transwomen and transmen, not Koori/Murrie ('aboriginal') 'sistergirls' and 'brotherboys'. Perkins had earlier surveyed the Sydney based transgender community (1983), but this occurred before even the earliest trans-inclusive state antidiscrimination legislation, passed in South Australia shortly afterward. Accordingly, sex work, illegal drug use and an incarceration history all figure in her earlier, anecdotal accounts of transwomen from that period. In 1991, Perkins conducted survey research of the users of Sydney's Tiresias House. In educational terms, two thirds had school certificate baseline school leaver qualifications, eleven percent were certified tradespeople and had relevant trade qualifications, and four percent had tertiary qualifications. However, of this sample, eighty percent were unemployed due to their gender identity.
After an introductory section on transgender and transsexual identification, she then provides brief contextual descriptions of transgender social networks in several Australian cities. Sydney is a major transgender centre within Australia, especially for those fleeing transphobic or dysfunctional families and/or communities of origin. It is a multicultural city, affecting the issue of diversity when it comes to health promotion and HIV/STI prevention material. It has the most accessible facilities for reconstructive surgery. Its transgender community is highly diverse, including academics, business entrepreneurs, factory workers, sex workers, the unemployed and university students. It also had numerous transgender rights and health organisations in the mid-nineties- the Transgender Liberation Coalition focused on antidiscrimination reform, the Trans Anti-Violence Project dealt with transphobic violence prevention and Trans Outreach Coffs Harbour (TOUCH) dealt with Northern NSW transgender community members. By the time that Perkins wrote, Tiresias House had 'transitioned' into the Gender Centre, a Sydney transgender community health and social services centre. Sex work was a primary occupation for many Sydney transwomen, although like Auckland and Christchurch today, street sex work occurred and carried risks from anti-sexworker or transphobic clients or moralist vigilantes. Unlike New Zealand, however, some transgender sex workers operated from brothels.
In Brisbane, the Queensland transgender community appeared centred on the Fortitude Valley and New Farm inner city districts, which were prone to interpersonal violence due to the presence of street gangs, drug abusers and organised crime. Brisbane's primary transgender support organisation was the Australian Transgenderist Support Association (ATSA). ATSA ran a phone advisory line and produced advisory materials about gender identity for Queensland transwomen and transmen. Outreach and remote area support were important ATSA activities, but limited by lack of funding from the Queensland state and Australian federal governments.
Melbourne tended to have a history of interpersonal strife within its community organisations, which rendered them ephemeral and unstable. The most durable facility seemed to be the Gender Identity Clinic at Monash University. LGBT intercommunity relationships were cooler than those within New South Wales or Queensland. Although South Australia had the earliest 'trans-inclusive' antidiscrimination laws within Australia, Perkins noted that this legislation was flawed, given that those covered had to have been born in South Australia and have had reassignment surgery there (which was not available in South Australia at the time). However, LGBT intercommunity relationships were cordial and warm. Western Australia and Tasmania had marginal trans communities at the time that Perkins wrote her report. Given Sydney's greater LGBT and transgender community development, it provided most of the survey respondents.
Proximity, openness, transparency and multicultural diversity, as well as population scale were all presented as reasons for possible overrepresentation of Sydney survey responses. Perkins cites figures that suggest that about eight percent of Sydney's two million adult male inhabitants experience gender identity conflict at some point during their lives, so the total 'transgender' population might be anywhere from 40,000 to 80,000 potential transwomen, with a smaller proportion of transmen. Only a small proportion of that total (13%) are undergoing the continuum of transitioning, from hormone treatment to chest surgery to full reassignment surgery.
In housing terms, almost one-third lived in rental property. One sixth owned their own property freehold, while a similar proportion lived with others. One twelfth lived in either a Housing Commission property or in a refuge. None of the sample reported homelessness.
When it came to occupational discrimination, all of the pre-reassignment occupational categories showed decline when the individual began and completed transitioning, especially in the cases of sales work, office work, factory work, small business ownership and skilled manual work. Given that study was carried out before the advent of trans-inclusive anti-discrimination laws elsewhere than in South Australia, these figures may have been redistributed since. While sex work and adult erotic entertainment employment was an inclusive if restrictive employment option, theatre, social work, domestic work and nursing also represented more 'liberal' occupational categories and represented smaller declines after reassignment.
Perkins commented that transphobic discrimination resulted in wasteage of training and occupational expertise, as well as prior academic qualifications. Many of the respondents had a university degree, university entrance school leavers qualification, school certificate or skilled trade qualification. Few lacked any educational qualification altogether. However, in terms of ethnicity, most of the respondents were white Australians, British migrants and New Zealand migrants. Although most of the respondents parents had come from working class origins, their own pre-reassignment work history was usually within the clerical sector.
In terms of current sexual identity, one-quarter of those surveyed identified as straight, while a similar proportion identified as lesbian or gay. Roughly one-eighth identified as either bisexual or asexual before their reassignment. After reassignment, one third identified as straight, while one-fifth identified as bisexual. While forty percent were not in a current relationship, thirty percent were. Almost a quarter of those sampled were within a de facto relationship with their partner. When it came to sex, most reported oral sex, while two-thirds reported anal sex and half of those sampled reported vaginal sex. Of the transwomen sampled, seventy percent reported using condoms, but less than half reported using them all the time. When it came to sexual violation, one third had experienced individual rape, while one tenth had experienced gang rape and another tenth had experienced incest. Most of the above had occurred during adolescence. This may explain recent data that suggests that transwomen have higher levels of HIV exposure than ciswomen, although given greater transwomen's access to more inclusive rape and incest crisis services, it may not now necessarily mean more resort to sex work in contemporary Australia or New Zealand.
While forty percent of transpeople sampled had never had an STI, a quarter had had public lice, seventeen percent had had thrush, while fifteen percent had had gonorrhea, twelve percent had had Hepatitis B and eleven percent had had non-specific urethritis. Given that these figures matched equivalent cis sex worker statistics, this may primarily be an occupational concern and ungeneralisable to transwomen and transmen outside the sex industry. As for drugs, there is some evidence that although high, alcohol, cigarette, cocaine, heroin and other drug usage has diminished within the transgender community over time. Again, though, this may be artefactual and more reflective of cis and transgender sex workers alike, and therefore ungeneralisable to transwomen and transmen outside the sex industry.
Unsurprisingly, given the medical intricacies of hormone treatment and reassignment surgery, transwomen (and transmen) were heavy users of medical services. Over ninety percent saw their general practitioner regularly, while forty percent saw an endocrinologist, thirty seven percent saw a psychiatrist, nearly twenty percent attended a sexual health clinic and thirteen percent saw a psychiatrist. As might be guessed, hormone treatment and reassignment surgery (seventy one percent and thirty eight percent respectively) were primary reasons for medical visits, while forty one percent visited their GPs for prescription drug use, and thirty one percent saw psychiatrists and general counsellors for mental health aspects of transitioning in this context. Over one quarter of those sampled saw their medical practitioner every two to six months, while twenty percent saw them every fortnight and eleven percent saw their doctors fortnightly or once every six months. As with many other patient groups, the respondents particularly wanted more transgender employment within health services and inclusive medical practice (seventy three and sixty four percent respectively), more outreach services (forty two percent) and flexible access hours (twenty eight percent), greater condom availability (twenty eight percent) and greater efficiency conducting medical visits (twenty five percent). Most were satisfied with standards of care from their general practitioners, but fewer respondents replied that endocrinologists or psychiatrists provided best practice care in their context.
Half obtained their information about HIV/AIDS from medical practitioners, while forty percent did so from media sources, forty percent did so from health pamphlets, and twenty percent or so from the sex industry, friends and relatives, community health services or LGBT community health services apiece. The sample seemed quite knowledgeable. However, younger transwomen and those in transient housing circumstances were likelier to have lower levels of knowledge about HIV prevention, as well as those in isolated personal circumstances such as rural communities.
Insofar as experiences of transphobic discrimination themselves were concerned, Perkins noted that her respondents reported unsatisfactory professional practise from police (thirty four percent), lawyers and public servants (twenty nine percent apiece), one quarter of potential employers (twenty four percent), co-workers and shopkeepers (twenty three percent). As for discrimination from members of the lesbian and gay male community, nearly forty percent reported transphobic interactions with gay men, while only fourteen percent reported such adverse relationships with lesbians and slightly more was the case with ciswomen in general.
Understandably, over eighty percent of respondents felt that antidiscrimination, equal opportunity, legal recognition legislation and cisgender public education about transgender concerns was highly relevant to transgender community members. Sixty seven percent supported greater vocational training for transwomen, while sixty three percent wanted more research about transgender issues and fifty eight percent wanted better access to education, while a similar proportion of the sample wanted more funding for transgender community welfare groups. Almost eighty percent of the sample reported reliance on government income support, primarily unemployment or sickness benefits. Twenty percent were not.
Perkins closed her report by recommending antidiscrimination law inclusion for the transgender community (happily now accomplished almost everywhere in Australia), addressing transphobic violence and its prevention, police sensitivity training over transgender concerns, legal assistance programmes, decriminalisation of sex work across Australia, HIV and STI education for transgender sex workers, outreach to geographically isolated transgender community members, targeted counselling and substance abuse prevention services, government subsidisation of transitioning needs, affirmative action and vocational training programmes for transgender community members.
Twenty years later, what has changed? In an article for HIV Australia in 2013, Abigail Groves noted that this had been a one-off research project, however detailed and comprehensive it was, but that given the effectiveness of sex workers rights organisations in HIV/AIDS education and low HIV exposure levels in contemporary Australia, HIV exposure levels might not be as high as in other countries. However, community scale uncertainty and documentation anomalies are problems in establishing the scale of HIV contact and prevention efforts within Australian transgender communities.
Recommended: Roberta Perkins et al: Transgender Lifestyles and HIV Risk: Sydney: Australian Federation of AIDS Organisations/Sociology Department of University of New South Wales: 1994: http://www.afao.org.au/_data/assets/pdf_file/0020/4655/Transgender_Lifestyles_and_HIV-AIDS_Risk.pdf
Abigail Groves: "Transgender Women and HIV" HIV Australia: 9:4: February 2013: http://www.afao.org.au/library/hiv-australia/volume-9/number-4/transgender-women-and-hiv#.U3fysfm1b9U Politics and religion commentator Craig Young - 20th May 2014