(HEA5a) Turning the Tide Towards Queer Health I: Honouring Lived Experiences

In 2023, we witnessed increased attacks against 2S/LGBTQIA+ communities, such as the obstruction of Policy 713 in New Brunswick, the passing of Bill 137 in Saskatchewan, and a nationwide social movement targeting Queer-inclusive education. In the face of what Marci Ien, the Minister for Women and Gender Equality and Youth, calls the “rising tide” of anti-2S/LGBTQIA+ rhetoric and policy, Queer vitality is at risk. These sessions offer insights into how we can honour lived experiences in supporting the well-being of Queer communities, and opportunities to “queer” health interventions that transcend reductionist notions of tolerance. Tags: Equality and Inequality, Gender, Health and Care, Sexuality

Organizers: Hannah Crouse, Dalhousie University, Joseph Lahey, Dalhousie University; Chairs: Hannah Crouse, Dalhousie University, Joseph Lahey, Dalhousie University

Presentations

Kai Jacobsen, Caleton University

"How dare they think that they know us more than we know ourselves?" Trans autistic experiences of epistemic injustice in gender-affirming health care

Transgender people are much more likely to be autistic than the general population, with approximately 14% of trans and nonbinary people in Canada identifying as autistic (Trans PULSE Canada, 2020). Research indicates that autistic trans people experience significant barriers to accessing healthcare, especially gender-affirming health care such as hormones and surgeries. While research into autism and gender diversity is increasing, most is conducted from a pathologizing medical framework that fails to incorporate the voices or lived experiences of trans autistic people themselves. My research addressed this by asking: What are trans autistic people’s positive and negative experiences with accessing gender-affirming health care? What are the impacts of these experiences on trans autistic people’s lives? How can gender-affirming health care providers better support trans autistic people? To answer these questions, I conducted qualitative semi-structured interviews with 12 autistic adults who had accessed gender-affirming care in Ontario in the past five years while an adult. Interviews were conducted over Zoom or in writing over Microsoft Teams chat, based on participant’s preferences. Participants were recruited from trans and autistic social media groups and community organizations. I analyzed these interviews using reflexive thematic analysis. Participants described numerous instances of being unfairly discredited, not believed, not taken seriously, or invalidated by health care providers. I frame these experiences as examples of epistemic injustice—harm done to individuals in their capacity as knowledge-holders. Many health care providers have not received sufficient education in trans health care, and trans people often know much more about gender-affirming care than their providers. However, providers sometimes perceive their client’s claims to knowledge as a threat to their medical and epistemic authority. Consequently, participants described how some providers use their expert status and specialized training to assert dominance and authority over their clients. Participants felt that ableist attitudes ingrained in society led providers to underestimate and discredit autistic people’s capacity to understand themselves and make decisions. Consequently, many participants did not trust the health care system and avoided disclosing their autism, masked their autistic traits to appear neurotypical, or avoided care altogether. Some participants felt pressured to say the “right” answers and confirm to a restrictive narrative of transness in order to access care. Despite these significant harms, participants also described positive experiences in which health care providers acknowledged the limits of their clinical knowledge, listened deeply to their client, and worked together to support a decision-making process that centred the patient’s autonomy and embodied knowledge. These contrasting experiences highlight the centrality of epistemic (in)justice to trans autistic people’s positive and negative healthcare encounters. This presentation will highlight epistemic injustice as an undertheorized aspect of trans health care experiences. I argue that the medicalization of both autism and transness devalues trans autistic individual’s self-knowledge and creates the conditions for epistemic injustice in healthcare. Improving health care for all trans people—but particularly trans autistic people—requires developing epistemic humility and willingness to listen to and learn from clients as key clinical skills for gender-affirming health care providers. Based on participants’ experiences and suggestions, I will identify recommendations for policy and practice changes to improve gender-affirming health care.

Nic Kuzmochka, Dalhousie University

Aggressor, Victim, Agent, or "Horny Meth Gay"?: Narratives of Party and Play and their Impact on Conceptions of Health

Party and Play (PnP), also commonly referred to as Chemsex, is a practice most commmon among men who have sex with men (MSM) where individuals engaging in sex use drugs with the intention of enhancing their sexual experiences. The substances most involved include crystal methamphetamine (crystal meth), gamma-hydroxybutyrate (GHB), and ketamine, with crystal meth being by far the most common (Bourne et al., 2014). Studies of PnP have been primarily characterized by analysis of it as a risky sex behaviour, especially considering increased rates of HIV/AIDS transmission among PnPing men (Prestage et al., 2015 Sewell et al., 2017; Souleymanov et alk., 2019; Tomkins et al., 2019), with some focusing on how PnP facilitates the growth of social networks and connections among MSM and interacts with broader facets of queer culture (Power et al., 2018; Race, 2011; 2015). What has remained relatively unexamined, however, is exactly how queer men both within and outside the scene talk about and conceptualize PnP as a cultural behaviour. This approach, which centres Weber’s (1978) interpretive frame, allows for an understanding of how PnP fits into a broader range of queer behaviours and attitudes in the current cultural landscape. I chose to explore this question using two publicly accessible sources of data. The first data set includes five reddit threads containing more than 600 comments posted in queer-centered groups that included significant discussion of PnP as a behaviour and included comments in support of, decrying, and relaying experiences with PnP. The second is a collection of eleven short interviews with men who currently or have previously engaged in PnP discussing their experiences published by the Men’s Sexual Health Alliance (GMSH). While these interviews do center a harm reduction approach, they include a range of current users and those who have left use behind, considering it harmful, and a variety of perspectives to those who see significant benefits to those who regret their participation. Through this review I find that PnP is a site of considerable conflict among queer men, with conversations of the practice dominated by condemnation not just of it as a risky behaviour but of individuals who choose to engage with it. Three common narratives of PnPers emerged from this data: aggressor, agent, and victim. Narratives from non-PnPers generally considered them to be of poor moral character and potentially dangerous to other queer men or considered them to be victims of a totalizing addiction stemming from the substances themselves and a culture of promiscuity and risky behaviour. This is contrasted by narratives from PnPers themselves that centered agency, personal responsibility, and characterized harm as often stemming from stigma surrounding their behaviour. As such, I argue that, among gay men, narratives of health are being weaponized against PnPers, considering their risky behaviour to be endemic of poor character, obscuring cultural processes of PnP, and potentially enhancing the risks of PnP itself. This work is deeply reflective of how narratives that are generally positive such as ‘take care of your body’ and ‘don’t engage in risky behaviours’ can become weaponized into forces of exclusion that may do as much or more harm than practices themselves. This is especially important within communities of queer men, where the spectre of the HIV/AIDS epidemic colours conceptions of health and risk and establishes strict links between community belonging and health. In order to combat hate, health narratives must rely instead on discussions of agency and choice and decenter narratives of health based stigma.

Hannah Crouse, Dalhousie University

Life Before Death: Exploring Long-Term Care Institutions and Life-Affirming Care for LGBT & Queer Seniors

Traditional theories of aging are being re-examined as we strive to create social policies, and care models, that can support increased demand for long-term care. Given that our care institutions are fundamentally shaped by heteronormativity, LGBT and queer older adults are systematically excluded from supports that could facilitate their transition and inclusion in long-term care (Sussman et al., 2018). As the baby boomer generation – and LGBT and queer members of this cohort, whom Ramirez Valles (2016) playfully calls gay by boomers – move into long-term care, it is important to consider their unique historical location, as they came of age during the gay liberation movement, creating the first cohort of openly lesbian, gay, bisexual, and transgender (LGBT) people. Therefore, our care systems must adopt inclusive policies and models of care, that recognize the cultural context of gayby boomers as they begin to move into long-term care. While there is ample literature on aging, demonstrating its complex, cultural, social, and temporal nature, there is limited social science literature concerning aging LGBT adults. Some social scientists propose that this gap in the literature is a product of “rhetorical silencing, whether intentional or as a by-product of discourse, that renders elders invisible in queer theory and queerness invisible in aging or gerontological theory” (brown, 2009, p. 66). Further, LGBT communities are historically less intergenerational, as we “nearly lost an entire generation” due to the hiv/aids crisis, severely reducing the number of LGBT elders (Bitterman and Hess, 2020; Weststrate et al., 2023). The survivors of this crisis have been largely invisible due to the pervasive stigma that has kept them “safely” in their closets and hidden away from younger people (Fredriksen-Goldsen, 2016, as cited in Weststrate et al., 2023). This loss of nearly an entire generation, alongside pervasive stigma that invisibilizes survivors of the crisis, has made LGBT intergenerational relationships rare, which may amplify their exclusion from queer and aging theories (brown, 2009). As a result, research on LGBT aging has only significantly advanced in the last couple of decades. The unique dual silencing, first of age in queer theory, and, second a silencing of queerness in theories of aging, has left LGBT older adults “physically and socially isolated from both the LGBT and older-adult communities, as well as the care organizations serving those communities” (brown, 2009, p. 66; Twigg, 2004). Historically, “senior services” in north America have denied openly lesbian and gay seniors, stating that they would “not be welcome at senior centres in their area” (Cahill and south, 2002, p. 50). Further, LGBT older adults have experienced bias from medical professionals, such as being subject to anti-LGBT rhetoric or limiting their access to health coverage from a partner’s work benefits (Cahill and South, 2002). Given these care organizations include healthcare, they, by extension, include long-term care (ltc). Ergo, older LGBT adults confront fears and experiences of queerphobia upon moving into ltc, making them subject to potential dehumanization in their final years. This paper will present findings from my qualitative ma thesis. Through employing participant observation and conducting interviews with LGBT residents of a large long-term care home in Atlantic Canada, my project is designed to answer the following research questions: first, how do older LGBT adults describe their experience living in long-term care; and how, specifically, do they describe their sexual identity as influencing these experiences? Second, how can long-term care homes better support LGBT and queer residents? In answering these questions, my project aims to fill a gap in LGBT aging research and to draw attention to the lived experiences of older LGBT adults residing in long-term care.