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of SexualMinorities A Reporf on the Experiences Svstems and Social-Services in Ontario's Health-Care
Abstract gaymen,bisexuals, andtransgendered lesbians, systems, andsocial-services In the health-care professionals who are fund and by tax dollars services their given by the people shortstrift both are paidby them. prejudice. andindividual in two mainforms:systemic comes Discrimination heterosexuality; formsthat assume intake service include: discrimination Instances of systemic in which partners; work environments same-sex policies that fail to recognize next-of-kin service-provider to the authorities; to be acceptable homophobia appears openlyexpressed gay,bisexual, contexts. or transgendered omitslesbian, thatroutinely training and professionals who feelfreeto makeprejudiced include: Instances of individualprejudice a finding out that on service/treatment of their the standard or who reduce hostilecomments gay,bisexual, or transgendered. is lesbian, client/patient people who belongto otherminoritygroups gaymen, andtransgendered bisexuals, For lesbians, are regions, all theseissues or by living in under-resourced by sexism also,or who aredisadvantaged compounded. treatment by the people equitable areguaranteed gaymerL andtransgendered bisexuals, Lesbians, the CanadianHuman Rights Act, and the Ontario Canadian Charter of Rights and Freedom,s, is illegal. HumanRightsCode. Discrimination gaymen,bisexuals, andtransgendered to saythisin1997but lesbians, a littleoddto need It seems with dignityandrespect. be treated andshould to society who contribute beings people arehuman of service-users. on the shoulders to leavethe onusfor bringingaboutchange It is inappropriate professional is in place. Employers, fromthetop down. Legislation musthappen change ln all cases, enforce non-discrimination implement, and must establish, and servicemanagers associations, for education possible by providingappropriate policies. They must makethe implementation service-providers. andmakes of the problems the dimensions survey, thisreportindicates Based on anOntario-wide for change. recommendations in this report are thoseof the authorsand T'heviewsexpressed representthe fficial policy of Health Canada. do not necessarily

SvstemsFailure - Exeadive

1997 iectAffirmation.

Afirmation'staskwasto identifyandaddress the health-care andsocial-service needs Project of in Ontario.(Theterm"sexual minorities" wasused to encompass lesbians, gays, minorities sexual people.)A three-year projectcertainly couldnot identifytheseneeds, andtransgendered bisexuals, needed publicise aswell ascarryout the processes to bringaboutchange.Therefore andeducate, hasproduced to bebuilt on by thosewho Project Affirmation the followingreportasa foundation out socialchange to achieve equitable in learning, researching, educating, andcarrying areinterested gays, people. provision for lesbians, bisexuals, andtransgendered service andfocusgroupsshowsystemic received ProjectAffirmation's survey The responses through insensitivity, from unbelievable ignorance, andhostilitydown to ranging failure. Therearestories population failed The has this by failingto andincompetence. system institutional stone-walling gaymen,bisexuals, must andtransgenderists Theresult is that lesbians, provide appropriate service. of theirlives;if theydo, theyrisk meeting whether to disclose thecircumstances make thedecision they obtainmay not and social-services assistance if theydo not, the health-care with prejudice; Their needed health care and social services. avoid even to theirneeds.Manysimply correspond is compromised. services careandsocial to health access Gay Men, and Bisexuals i Lesbians, pointthatlesbians, gaymerL area disenfranchised andbisexuals asa starting It mustberecognized gaymerL deviant, or deeplytroubled andbisexuals asdysfunctional, population. Notions of lesbians, permeate all levelsof society,andthe healthHomophobia andheterosexism arestill wide-spread. peopleturn to gay, andbisexual are no exception.Whenlesbian, systems careand social-service relationship the ensuing to prejudice; theyarevulnerable or support for help,assistance, these systems position. places in a morepowerfi.rl the service-provider gaymen,andbisexuals in Ontarioarewell awareof this thatlesbians, Theproject's survey shows services they receive.It is worth noting careandsocial ofthe health critical theyareclearly situation; (openly gay, "out" lesbian, or bisexual).It is by no means tend be to reached by thesurvey thatthose gay,andbisexual population.Givenwhat of thelesbiaq who areout arethemajority clearthatthose giveus pause. felt by the restshould to be silent have to say,theneed theout members and Transgenderists ii Transsexuals facedby transgendered and transsexual andacceptance acknowledgment, Thelackof recognitiorq peopleare not only invisibleand andtranssexual peopleis evenmore profound. Transgendered within systems that operate to health-care andsocial-service they areincomprehensible unwanted; Forthenq of beingheardandunderstood theprocess rigid,gender-role boundaries. overlysimplistic, just giventhe absence is amazing of haveto survive Theabilitythese communities is at a beginning. provided them. to support on contractby a transgendered of this reportwasprovided The transgender/transsexual section felt it was communities and transsexual researchconsultantsinceparts of the transgendered Failure - Executive
a J

Affi rmation-I 997 CLGRO/Proiect

gay,andbisexual to be carrying out this work. Indeed,CLGRO for a lesbian, coalition inappropriate position raised in thissection of the reportandhastakenno ofificial on hasnot discussed theissues develop an understanding of that it is clearlycrucialandurgentthat service-providers therq except people. and transsexual needs oftransgendered to the andsensitivity communities only as they of transgendered allowedus to studythe needs Projectlimitations providers, andsocial-service furtherstudyin the areaof health-care reported them,we recommend withregard to thispopulation. associations andprofessional institutions educational and Homophobia Heterosexism, iii Sexism, in Ontario. careandsocial services of health constituency areclearly thetargeted Heterosexuals themselves, or whentheir needs invisible. Theyarenoticedonly whentheyassert aremainly Others (asin thecase of gaymenandAIDS). Then,what be overlooked thattheycannot areso dramatic just or inappropriate. inadequate aslikelyto be but it is maybe well intended, is offered they will be that, if peopleare not heterosexual, anticipate At the very least,theseservices do not fall For example, thosewhoserelationships andlifestyle. in bothappearance heterosexualJike or Silvl are not leather, drag, as of suchcommunities modelor members into the nuclear-family themselves but the services of theirexistence, areoftenaware service-providers Individual accepted. them. to receive arenot prepared professions with the medical andsocial-welfare relationship hada troubled have'always Women - and havebeenseen "tranquillization" gynecological to unnecessary surgery from unnecessary human, that is, a man. from the modelof a healthy as deviating historically by theseprofessions impetus of the women's the havenot beendealtwith at lengthin this report,since Issues of sexism We focushereon the issues andacademic. bothgrassroots many resources, hasprovided movement in writing on or work haveoftenbeenoverlooked since these orientation, sexual raised by women's donewith women. peoplehavealwaysbeenawareof the and transsexual transgendered, Lesbian,gay, bisexual, health-care and social-service of fear,anxiety,and angerthat arisewithin the mainstream feelings is to helpthem whosemandate andinstitutions for service. Organizations theycontact organizations go not helped. They awayfearful, and definitely places misunderstood, wheretheyare unsafe become unreachable, and themas non-compliant, that hasinterpreted of a system angry,and mistrustful resistant. iv Service-Providers gays,bisexuals, to workingwith lesbians, generally thattheywereopen reported Service-providers providedwere adequate and not necessarily people and that the services and transgendered point quick out the lack of funds to Theywouldbeopen to furthertrainingbut were discriminatory. lesbian, and the to those of in contrast were stark Their responses so. to do Edy,bisexual, part neglect on the of servicedatapointto serious Affirmation users.Project service transgendered heterosexism homophobia and degree of systemic indicates the clearly providers. This discrepancy that exists.

Affirmation, 1997 ms Failure - ExecutiveSummary. CLGRO/Proiect 4

It is not acceptable to simplyprofessan openattitudetowardsthe lesbian,gty, bisexual, and communities.Proactive mustbe demonstrated transgendered commitment throughthe sensitive, provision for all patients informed, andequitable service required andclients. Certainly, homophobia provision, areinsidious, but sub-standard service whether andheterosexism or not it is intentional, in termsof service-delivery is irresponsible If intentional, it constitutes standards. unethical and providers behaviour.If unintentional, havelost touchwith their responsibility discriminatory to be professionals, attuned andinformed to the needs andcircumstances aware,sensitive, of thoseto whomtheyprovide services. gay, bisexual, Future study shouldalso focuson the viewsand experiences of lesbian, and withinthehealth-care service-providers andsocial-service systems. transgendered Educational Institutions v Post-Secondary institutions was also surveyed, since they train educational A sampleof post-secondary contentthat is positive professionals careandsocial services. Curriculum entering thefieldsof health peopleis only minimally gays,bisexuals, in existence and transgendered and towards lesbians, placement Their depends is of related opportunities. existence on this also true arbitraryat best; professors professors. for individual It is possible andwholefaculties to avoid entirelythe individual gay,bisexual, intolerance communities. andtransgendered Systemic issues andneeds of thelesbian, lackthe opportunity issues andthat students cannot whowishto address these maymean thatthose fieldplacement. In someinstitutions, studentrequest content or relevant request inclusive curriculum risky for the students. whichis hardlyinvitingandpotentially is the only yay to raisetheseissues, lesbian-, reported institutions that,thoughtheywereopento developing Manyeducational Edy-, of cuniculum,theywerenot cunentlywilling to do so because andtransgender-positive bisexual-, arealready available a lackof commitment, sincemanymaterials lackoffunding.Thisdemonstrates are means canbe utilizedat little cost. Students of addingto the curriculum for useandcreative gay,bisexual, projects andtransgendered communities research andthe lesbian, willingto undertake resources. canprovide Associations vi Professional had"sexual in their codesof ethics. It studied orientation" Most of theprofessional associations of professional associations that patients andclientswill be is generallyexpected of the members irrespective orientation. of their sexual andequitably treatedsensitively in a codewill not achieve listingof theterm"sexual orientation" the desired However, thesimple indicatethat its result. The experiences described by Project Affirmation surveyrespondents guidelines, policies, associations must develop clear influenceis, at best,limited. Professional mechanisms, to backup their codes of ethics. Theyshouldalsoprovide andenforcement education, knowledge, aregiventheopportunity to develop the necessary training sothatprofessionals ongoing andsensitivity. understanding, vii Financial and HumanCosts gays,bisexuals, For lesbians, andthosein the transgender communities, the very systems that
Affirmation.1997 Failure - F)xecutive Summarv. CLGRO/Proiect Svstems 5

needs of discrimination andresult health andsocial-service canbe sources profess to carefor people's thatledthemto seek assistance. of the situations in a worsening personal, in the system resultin increased costs:financial, andin Thesegapsandinadequacies include of individuals who are The human coststo society thousands resources. termsof human productive to become members their opportunity in their self-esteem; anddamaged highly stressed, is diminished. of society procedures, medical or unnecessary botched In financial terms,we seethe cost of repeating to seekpreventive or follow-up patients havebeen too discouraged intervention because emergency private (OHIP), government ministries, insurance and Plan care. The OntarioHealthInsurance service. We seethe cost of carrierspay out when peopleneedto shoparoundfor unbiased because inadequate, and that is protracted of counselling health assistance, mental inappropriate is unabated. whose distress to those services continuing viii Conclusion training to dealappropriately fieldsreceive adequate in these that professionals It is imperative gtY, of the lesbian, services to members whenproviding with carryingout their responsibilities the health-care that support andinstitutions Thestructures communities. andtransgender bisexual, institutions) must professional educational (government, associations, systems and social-services to work for themandwith them. andbegin communities these to ignore cease role canplayan important associations institutions andprofessional educational Post-secondary and sensitivity.Higherlevelsof professional knowledge, expertise, the necessary in'developing By makingtheseachievements carewouldbe achieved. levels of quality andthushigher expectation fieldswill beginto and social-service within the health-care andhomophobia heterosexism systemig diversityin or not, needto respect in government diminish. Thosewho setsocialpolicy,whether socialsupportstructures. andimplementing whendesigning orientation sexual gay, bisexual, and facedby the lesbian, circumstances We hopethat this reportof the appalling andsocial-service systems of health-care will leadto the transformation communities, transgender humanright. as a fundamental service-provision to equitable affirm access until they proactively gaps inadequacies in the and past rectified, current neglectcanbe change, Through responsible for a healthier, implemented services andequitable developed, new approaches systemremedied, Ontario. stronger gay, bisexual, and transgendered, The work of ProjectAffirmationconfirmswhat the lesbian, for which they pay knownfor a long time:theydo not get the service have communities transsexual to society, but not to benefitfrom to contribute andto whichtheyhavea right. Theyareexpected for health-care and social-service systems It is time needed changes. it. This reportcallsfor much of fair andjust treatment for everyone. the principles to beginto respect Lesbian and at the Canadian Afrrmation'sdatahavebeenstoredandcanbe accessed Project #201,TorontoM5W lGz; (16)777-2755. Street 56 Temperance Gayfuchives,

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Table of Contents
Tableof FactSheets andCharts About CLGROandProjectAffirmation Abstract Preface I 2 3 4 5 6 7 8 9 1l Guideto theReport HealthCareandSocialServices: Survev Overview Regions... Francophones.. Bisexuals.. . Transsexuals andTransgenderists Race, Ethnicity, andCulture First-Nations Peoples Youth Fa mi l i e sl R e l a ti o n sh i ps ......24 3l 36 56 . . 6l ....67 .,.... 76 89 ..,,.94 l0l 105 . 123 126 139 l4l . 143 147 149 ..8l . . xiii ...xiv I ...... 6 . . . . . ix

.xuals 1 0 O l d e r l e s b i a n s , G a y M e n , a n d B i s.e lllness 12 Disability andChronic 13 HIViAIDS 14 Violence Delivery 15 Health-Care andSocial-Service 16 Systemic Links 17 Recommendations Ap p e n d i xl R : e fe re n ce s... Appendix II: Terminology . Reading AppendixIII: Suggested AppendixIV: CLGROPublications .. AppendixV: CLGROMembership

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respondents 0f 1233 prac'tices you need tobeimproved that heahhcre Do think services and people? gay, Yes: 1139(96%) and bisexual meet the needs of lesbian, tobetter people gay, you health+ae for lesbian, and bisexual service Do think that provided: were would following be improved ifthe inOntario .sarne+ex spousal benelits Yes: 1142 (92.6%)

'same-sex provided health+are benefits byemployers Yes: 1140(92.5%) extended .education and bisexualissues for doctors ongay, lesbian, .education providers about lorolher health+are gay, issues and bbexual lesbian, .intake people for as foms allowing toidenlity gay, bbexual lesbian, and .intake people have hatthey forms allow toldentify lhat partners same-sex .gay-, images indoctois lesbian-, and bisexualpositive health+are settings offices and olher .equal patlners lor recognition sametex .more lorgay-, and refenallists lesbian-, information providers healthcre and bisexualpositive Yes: 1127 {91,4%) Yes: 1123(91.1%)

Yes: 904 (73.3%)

Yes: 960 (77.90/"1

Yes: ee8 (80.e%) Yes: 11s1(s3.3%)

Yes: 1095 (88.8%)

Faifure- Exeailive




Tatal surueysample:1,233 Breakdownof surveyrespondents by percentage: Women Men Aged 2&54 years Employed Eamed$20,000+ Eamedlessthan$20,000 On social assistance education Post+econdary Sexuallyactivein previousyear relationship ln a same-sex . Women . Men Parnts 45o/" 54Yo 80% 70"/" 64% 36%

Reglonalproflle of respondents
OntarioUrban MetroToronto OntarioNorth OntarioRural 5O/" 33A
1O"/" 5o/"

Age proflleof respondents

Over 54 2664 years Under26

8O/" 15%

Educationprofile of respondents
Graduate degrees degrees or Undergraduate community college Highschoolor less 21"4 31% 28"h

72o/" 95"/" 66% 75"/" 58% 18o/"

Incomeproflle of respondents
Over $49,000 $20-49,000 Under$20,0o0 2O"/" Mo/" 36%

26o/o Wornenwfth chlldren ol these,childlen liw with them 61%

- all respondents findings Significant

. 23%reportedbeing physlcally assaultcd becauseof thelr sexualorientation . 71%reportedbelngverbally harassed . 52%believethair sexualorientation will be vlewed negatlvely by health.caraprovldors . 74lohavedisclosed thelr sexual orlentatlon to thelr physlclans . 24/" olwomen and 39% of men said their doctors asked aboul lhelr sexual orlentatlon . 89%of respondents statedthat mental health prolesslonals (soclal workers, psychologlsts, psychlatrlsts, etc) need lralnlng to better deal wlth lesblans, gays and blsexuals.


21% ol these,chlldren llvewfththem 31%

Dlsabledor had chronic lllness of morethan6 monthsIn duration 21% . almostevenlysplit between men and wom6n . 50%of the men HIV positiveor livingwith AIDS Seltidentifiedas bisexual as Self-identified . FirstNatlon . EastAslan,South Asian,Middle Eastern, Black,Hispanic,or Jewish . Francophones . Yottth gay,bisexual Not out as lesbian, 5% 4o/o 9o/" 3o/o 15/o 11o/o

Not saleto be out in theircommunities . Men 35% . Women 42%

Affirmation, 1997 s Foilure - Exeattive Summary. CLGRO/Proiect 9

Psychiatrists Psychologists SocialWorkers MedlcalDoctors Religious Leaders

Seen /easf

Psychiatrists ReligiousLeaders Psychologists SocialWorkers MedlcalDoctors

Failure'Exeailive Si




. . . 147o reponed their families of origin were not supportive of their relationship 34e/oreported their families of origin were supportive 19/" of those acknowledged by hospital staff as being in same-sex relationships reported that their partner was not welcomed as thelr support - 8o/osaid inappropriate comments were made by staff because their partner was present - 34"/" reported that their partner was not kept informed about medical treatment of respondents overall recefued supplementary 586/o health-care beneflts through an mployer but only 417" of these reported that coverag was extended to same-aex partnrs of those who repoded havlng extended health-care plans through thefr places of employment, nearly 1O"/"dld not dlsclose a samesex partner because they dld not feel safe comlng out at work


. 18/o of respondents overall were parents - &"/" of these were women - 53o/o had some or all children living with them 87o/o of all parents were parents of their biological child(ren) and 15ol.were parenting a partner's biological child(ren) 6/o of all parents had adopted child(ren) 8;96/o of parents reported having had to hide the fact they are parenting with a same-sex partner 14"/"of all parents had not disclosed their sexualorientation to thelr child(ren)

. . . .

s Failure -.Executive tl

ion 1997

. 65 respondents, 5% of the total sample . on average, younger than respondents overall and more are students . A4Y. had been in counselling or therapy; 53a/o of these believed their lives were neither understood nor respected by the Person they saw . 42o/ohad come out to thelr doctors comparod wlth 74/" of survey rspondents overall

Mosf commonly used

-ffi,@. -ffi-

Generlc counselllng and therapy Speclallzed lesblan, gay, and blacxual gervlces Publlc*realth nurses Sulclde/crlsle llnes Addlctlon servlces
Least commona used $E:E'*F lEffiwr

Sulcldo/crlsle llnes Addlctlon sctwlcec Generlc counselllng and therapy Publlc-health nurses Speclallzed lesblan, gay, and blsexual serwlces
Least problematicl nagative

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iectAffirmation. 1997



. . getting access to hormones was extremely difflcult means of acquiring hormones were: - illegally, ofi the street - through a doctor - through the Gender ldentity Clinic of tho Clarke Institute of Psychiatry linding a doctor who is transgnder-positive and willing to prescribe hormonos was very difficult; somo transsexuals resorled to going to doctors who had "questionable'repulations or were known as "plllpushers" transgender people often had to educate their doctors about hormone treatment or other medlcal lssues

GENDER IDENTIW CLINICS AND HOSPITALS . . GenderldentttyCllnlcbpollcy of requlrlnga personto crossdressfor one year beforereceMng the Clarke's and stresslul to be arbltrary hormonetreatmentwas determlned was characterlzed as belng "absolutecontempt,"ranglng people by hospttals the treatmentof transgendered pronouns use of Inapproprlate from ridiculeand dlsdainto Insistent

SERVICES FOR HOMELESS PEOPLE . who werehomeless and transgenderlsts for lranscexuals therowerefow resouroes - youth sheltrs youth - were generallyunsympathetlc to transgendered people - were hostileand unsafeplacesfor transgendered peopleor told them howto dress and act, - had staffmemberswho refusedaccossto transgendered subjectedthem to unfairtreatmentand blamedthem for the violenceor hostileattitudesof other shelter-users - womenrs shelters - generallyhad one ol the followlngpollcles,all problematlc - refusalto admlt - accepianceof postoperatlvemale-to-female only transsexuals - acceptancetf the Indfuldual a gendertransltlon of undergolng could proude documentatlon - In some situatlons, transsexuals In motelrooms housedmale-to-{emale ALCOHOL, DRUG, AND SUBSTANCE ABUSE . . peoplecometo termswlth thelr gender ldenttty the long and difffcultprocessthroughwhlchtransgendered to escapeconluslon,paln and sufferlng can lead them to alcohol-and drug-abuse for peopledeallngwfth substance forms of supportavallable reportedthat tradftional surveyrespondents they could only "dealwith"thelr abuseproblemslf they hld the abusewere not welcomlngof transsexuals; transgender lssueswhich were part of them

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Chapter l7: Recommendations ProjectAffirmation was only a beginning. Its findingsare a call to action by: - federaland provincialgovernments (recommendations 2-9); - Ontariogovernment (10-25); - local and regionalgovernments (26-28); - boardsof education(29-31); - health-care providers(32-67); and social-service - professional (68-74); and post-secondary educationalinstitutions associations - employers and the private sector(75-76); - lesbian, gay, bisexual,and transgender communitygroups(77-78).

GENERAL RECOMMENDATION l7.l policiesand in all sectors mustdevelop and service-providers Policy-makers, educators, piocedures to: peopleas consumers gay,bisexual, of (a) address andtransgendered of lesbian, the needs health-care andsocialservices; gay,bisexual, lesbian, violence against and (b) eradicate any supportfor verbalor physical people or their communities; transgendered forms of (c) recognize as systemic heterosexism, biphobia, andtransphobia homophobia, that mustbe dealtwith proactively; oppression gay,bisexual, taking (d) atrrm thediversity andtransgendered communities, of the lesbian, age,ability, race,ethnicity,culture,relationship into accountsuchfactorsas gender, to whichpeopleareable aswell asthe degree income, language, andeducation, status, orientation. theirsexual to disclose safely FEDERAL AND PROVINCIAL GOVERNMENTS Peoples First Nations/Two-Spirited provincialgovernments mustwork in concert to ensure that health-care benefits 17.2 Federaland Plan (OHIP) are available to oFreserve not coveredby the Ontario Health Insurance gay, people. lesbian, bisexual, and two-spirited transgendered, Youth provincialgovernments mustprovidestable, long-term fundingfor peer-support 17.3 Federaland gay, youth. groupsandservices for lesbian, bisexual, andtransgendered
s Failure - Execative Summarv- CLGRO/Proiect Affirmation- 1997


Older Lesbians, Gays, Bisexuals,and TransgenderedPeople 17.4 Federaland provincialagencies must beginto plannow for futuregenerationsof older lesbian, gay, bisexual,and transgendered people; health-careand social-service policy for the aging must acknowledge them, research demographics, and considertheir needs.

Famil ies/Rela t ionsh i ps 17.5 Federaland provincialgovernments must introduceand passlegislationamendingthe full rangeof statutes containingdiscriminatory definitions of "spouse," "marital status," "family," and similarterms so that they includesame-sex relationships.

governments 17.6 Federal andprovincial mustprovide adequate funding to: (a) continueHIV/AIDs research; specifically, the federalgovernment shouldintroducean improved national AIDS strategy; (b) maintain and improve community-based providing education, AIDS organizations counselling, andsupport. Violence governments mustconduct 17.7 Federal andprovincial continuing research into violenceagainst gay,bisexual, people lesbiaq in orderto identifystrategies andtransgendered for education andprevention. Delivery Health-Care and Social-Service bodies in theareaof health-care 17.8 Federal andprovincial thatprovidefunding and social-service gay,bisexual, mustestablish standards of equitable distribution that includelesbian, delivery individuals andgroups. andtransgendered departments, andtheirprovincial-government must 17.9 HealthCanad4otherfederal counterparts, provision funding ensure of to: (a) carry out furtherresearch gay, into the health-care needs andsocial-service of lesbian, people generally; andtransgendered and bisexual, (b) promotegreaterawareness gay, andsocial-service issues of the health-care of lesbian, Francophones, members of racial, ethnic and cultural bisexual,and transgendered people. minorities, andFirst-Nations ONTARIO GOVERNMENT Transsexuals and Transgenderists pilot projecton addictions 17.10 The Ministry of Healthmust fund a research-based and the communities to document thesituation(includingthe extentto which transsexuaUtransgender recoveryservices) mainstream agencies offer transgender-positive and ascertain what is needed that situation. to the address

Foilure - Executive 15




surgery through The Ministry of Healthmust continueto fund the costs of sex-reassignment Plan (OHIP). the Ontario Health Insurance

health-carecentre, 17.12 The Ministry of Health mustprovidefundingfor a transsexuaVtransgender to hormones andoperatefrom the philosophy that which would provideinformed,safeaccess individualscan take an active role in their own health care. andtransgendered all transsexual Youth Educationand Training,and Health must of Communityand SocialServices, 17.13 The Ministries issues related to lesbian,gay, bisexual, and materials on bias-free educational develop guidance communityworkers, and counsellors, youth for useby high-school transgendered youth. provide to services otherswho counselor ips Famil ies/Relationsh so that the in line with recentprovincialcourt precedents 17.14 Ontario laws must be amended gay men, lesbians, and bisexuals heterosexuals, equally to is available children adoptionof living singly or in couples;in the caseof couples,both partnersmust have equal adoptive status. HIV/AIDS 17.15 The Ministry of Health must improvethe Trillium Drug Planby reducingthe deductiblefor the working poor and improving the coverageof complementary,experimental,and new therapies. Health-Care and Social-ServiceDelivera 17.16 Ontario Health InsurancePlan (OHIP) coveragefor psychotherapymust be extended to and socialworkers. include psychologists,psychotherapists, 17.17 The Ontario governmentmust ensurethat legislationdoesnot prohibit or restrict the ability of individualsto seekout the servicesof more than one doctor within OHIP. 17.18 The Minister of Health must halt plansto close Ontario hospitalsthat have implemented lesbians,gays, servicesand programs to meet the specialneedsof women, Francophones,

instead, peoplgor members the of otherminoritycommunities; andtransgendered bisenrals, and encourage othersto offer similar must supportsuchhospitals Ontario government services. Links Systemic act that includes an employment-equity mustintroduce andpass 17.19 The Ontariogovernment in CLGRO'sl99l brie{, with therecommendations gays, in accordance andbisexuals lesbians, WeCount. mustamend theOntarioHumanRightsCodeto 17.20 The Ontariogovernment andguarantee the recognition of sameof "spouse" (a) remove definition thediscriminatory relationships; sex grounds in the harassment sections of the (b) add"sexualorientation" to thelist ofprohibited Code: Failure - Exeailive Svstems l6

(c) permitthird-party complaints; (d) significantly by boardsof inquiryfor damages increase the amountthat canbe awarded psychologicaVemotional or suffering. arisingfrom lossof dignity/worth with sufficient govemment Human RightsCommission mustprovide theOntario 17.21 TheOntario to: andotherresources funding (a) conduct province-wide aboutthe OntarioHumanRightsCode,payingspecial education andservice-providers; to institutions attention aswell the othergrounds orientation, of (b) ensure on issues of sexual theyareproactive prohibited discrimination. government must 17.22 TheOntario including thosebased on sexual (a) provide training on allformsof discrimination mandatory and human-rights appointees, boardof inquiry/tribunal for all arbitrators, orientation commissioners: healthcare,and social with employment, (b) ensurethat all government bodiesdealing gay,and/or representatives; bisexual lesbian, have openly services gay,bisexual, groups for lesbian, andtransgendered government mustprovide 17.23 TheOntario people with fundsto: in the provision homophobia andheterosexism against (a) conduct campaign u prouin."-wide at large; housing andthe community employment, andsocialservices, of health-care health programs careandsocialservices; (b) develop of specialized providers. andsocial-service (c) providesensitivity trainingto health-care groups, the Ministry of Education gay,bisexual, andtransgender with lesbiarL 17.24 In consultation policies, to help guidelines, directives, and,asapplicable, andissue mustdevelop andTraining of thosecommunities needs of members the specific accommodate colleges anduniversities andsocialentering the health-care students for usein training inclusive curricula andprovide fields. service groups, the Ministry of 17.25 In consultationwith lesbian,gay, bisexual,and transgender andthe andSocialServices, theMnistry of Community andRecreation" Culture, Citizenship, policies, guidelines, so that: and directives implement and Ministry of Healthmustdevelop underthe professionals of their requirement (a) health-care areinformed andsocial-service g&ys, for lesbians, bisexuals, provide equitable services OntarioHumanRightsCodeto people; andtransgendered fieldswill explicitlyinclude (b) professionalassociations in thehealth-care andsocial-service gays,bisexuals, to lesbians, requirement services the that conduct in theircodes of ethical people be providedequitably. andtransgendered

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Affi rmation.I 997 CLGRO/Proiect



Health-Care and Social-ServiceDelivery must implementpoliciesand procedures 17.26 Local and regionalgovernments similar to those recommended for the Ontariogovemmentin order to educatethose within their jurisdictions needs of the lesbian,gay, bisexual,and transgendered aboutthe health-care and social-service currentserviceinequities. communities and to beginredressing standards of equitabledistribution that 17.27 Local and regionalfunding bodiesmust establish gay, bisexual, individualsand groups. includelesbian, and transgendered 17.28 Community programsfor youth, older people, people with disabilities,and others must gay, bisexual, people. and transgendered welcomeand servelesbian,

Youth policies andprocedures that: mustintroduce andenforce 17.29 Boards of education youthandprotectthemfrom harassment (a) affirmlesbian, gay,bisexual, andtransgendered andviolence; people gay,bisexual, andtransgendered (b) fostera positiveenvironment in whichlesbian, teachers, andadministrators arefreeto comeout in safety; who arestudents, (c) encourageguidanceand career counsellorsto help lesbian,gay, bisexual, and professions. andsocial-service enterthe health-care transgendered students principals standards opposing discrimination mustrequire to adoptandenforce 17.30 Schoolboards gay,bisexual, parents andof parents andtransgendered theroleof lesbian, andmustsupport gay,bisexual, andtransgendered children. who advocate on behalfof their lesbian,

resource increase materials on HIV/AIDS for must and update educational 17.31Boards ofeducation introduce intoschools andensure schools, them there areadequate and secondary elementary theiruse. resources to facilitate
HEALTH.CARE AND SOCIALSERVICE PROVIDERS Francophones mustbemade in thehealth-care andsocial-service systems to accommodate 17.32 Structural change gay, bisexual, lesbian, and transgendered the linguisticand other needsof Francophone people.

Affirmation. 1997 ms Failure - ExecutiveSummarv- CLGRO/Proiect l8

Bisexuals mustprovide andsocial-service agencies adequate bisexual-specific sexeducation 17.33 Health-care that: that recognize andotherservices (a) bisexuality is not anaspect of homosexuality; (b) thereareimportantdifferences heterosexuality between bisexuality, andhomosexuality providing when services; must be understood and acknowledged that (c) biphobia is different from homophobia. Transsexuals and Transgenderists personnel and other hospital staff must receive awareness training 17.34 All emergency-room general prefened-pronoun health-care issues) (including to enable useandspecific sensitivity, clients; be provide to transsexual/transgender this could arranged equitable service themto professional associations and schools. work with medical andnursing through collaborative abouthormone therapyand providesuchtherapyto themselves 17.35 Doctors must educate transgenderi stsandtranssexuals. Institute must: of Psychiatry ldentityClinic(GIC) of the Clarke 17.36 TheGender (a) establish whatservices areneeded by transsexual commiffee to determine anindependent people; of GIC representatives and mustbecomposed thiscommittee andtransgendered and clientsreflectiveof the diversityof the transsexual transsexual and transgender communities; transgender preferably under(a) above,of the policy (b) conduct established by the committee a review, be prescribed. year's before hormones can cross-dressing insisting on one for transsexuals andtransgenderists, shelter established specifically of shelters 17.37 In theabsence in Ontarioshould reviewcurrentpractices andpoliciesto shelters associations andhomeless people. and transgendered needs meetthe oftranssexual must: 17.38 Shelters (a) assume clientssafefrom for keeping transsexual andtransgendered the responsibility residents; at thehands of othershelter andharassment violence, discrimination, (b) provide a list specifyingwhich shelterswill and will not accept transsexualor people; transgendered (c) educate issues, the needfor bias-free andtransgender stressing their staffin transsexual to provideequitable services. of the agency andthe responsibility treatment must provide bias-free services to transsexuals and services 17.39 AlcohoUdrug-rehabilitation andmakingclearto andservice-providers trainingfacilitators this involves transgenderists; groups is not acceptable. that prejudice

Failure - Executive l9



Race, Ethnicityand Culture and social-service agencies mustprovideanti-oppression trainingto service17.40 Health-care providers; mustbesensitive thistraining to theseparate dynamics of homophobi4 sexism, and impact(s) racismas well asthe additional of double or multiple oppression experienced by who belong to morethanonegroup. those First-Nations People needed to develop the cultural sensitivity to provide must begiven training 17.41 Service-providers gay, lesbian, to bisexual, two-spirited, and transgendered and equitable service sensitive people of theFirstNations. gay,bisexual, twotowardslesbian, mustprovidesupportandunderstanding 17.42 Nativehealers people moresensitivity in their communities; theymustacquire spirited,andtransgendered issues. orientation aboutsexual to andknowledge Youth musttraintheirstaffto: organizations 17.43 Health-care andsocial-service youthasclients; gay,bisexual, (a) expectlesbian, andtransgendered youth in which gay, bisexual, (b) createa climateof trust for lesbian, andtransgendered is respected; identification or sexual is ensured andtheir gender confidentiality youth andmakethem gay,bisexual, (c) meet andtransgendered needs of lesbiarU thespecial rolemodels. aware of positive Gays,and Bisexuals Older Lesbians, andaffirmsolderlesbia[ gay, that welcomes mustoffer an environment 17.44 Service-providers g&y,bisexual, people; and that olderlesbian, theymustrecognize andtransgendered bisexual, relationships. peoplemayhavesexual/loving same-sex transgendered Families/Relationships privacyneeds for thosein same-sex 17.45 Institutionsmustprovidevisitingrightsand respect in opposite-sex ones. relationships astheydo for those parents mustbeprepared to include: andtheirchildren serving 17.46 Programs parents (a) lesbian, gay,andbisexual ofsuch parents; andthe children parents; gay,andbisexual (b) positivereferences to lesbian, upon marital (c) psychological of parenting that are not based criteriafor the assessment orientation. status or sexual gay,andbisexual people musthaveaccess to the full rangeof optionsandservices 17.47 Lesbiaru procedures, pregnancy, and childbirth;policies, and protocolsfor conception, concerning partner no male women with and/orwith insemination must eliminate bias against alternative partner. a female

Failure - Executive 20

Affirmation.I 997 CLGRO/Proiect

Disabilityand ChronicIllness with disabilities those or chronicillnesses serving organizations andsocial-service 17.48 Health-care must: (a) ensure arefully accessible; thattheirfacilities gay,bisexual or transgendered who arelesbian, (b) traintheirstaffto expect clients/patients same-sex may have sexuaVloving that their clients/patients and acknowledge relationships. research on: mustconduct organizations andsocial-service 17.49 Health-care to lesbian, of thoseprovidingservice or receptiveness (a) thedegree discomfort, of hostility, people chronic illnesses; with or disabilities gay,bisexual, andtransgendered for lesbian, illnesses or disabilities of chronic andduration (b) thevaryrng of visibility degrees mustnot forcedisclosure of people; research methods gay,bisexual andtransgendered mobility. or on stamina demands make unrealistic or orientation sexual for peoplewith disabilities materials producers of sex-andsexualitytraining funded 17.50 Publicly people people orientations. of all sexual and transgendered for/about information mustinclude must developpoliciesand procedures facilitiesfor peoplewith disabilities 17.51 Residential clients and that they have lesbian,gay, bisexual,and transgendered acknowledging needs. theirspecial accommodating

educationthat must implement service-provider agencies and social-service 17.52 Health-care in areas. and all service HIV/AIDs, for all stafflevels about information accurate conveys mustnot and,in particular, equitably livingwith HIv/AIDS musttreatpeople 17.53 Service-providers isolate which or hygienemeasures and/or medicallyunnecessary implementexcessive is beingprovided. to whomservice humiliate those Violence educationto enablethem to deal must receiveanti-homophobia 17.54 Service-providers people gay,bisexual, who arethe victimsof andtransgendered with lesbian, appropriately andgay menare victimsof that both lesbians the acknowledgement violence;this includes males. by assault sexual gays, lesbians, against proactively of violence to the issue mustrespond 17.55 Serviceagencies people by: and transgendered bisexuals, violence; for thevictims of homophobic (a) establishing services specifically gay,bisexual, communities that andtransgender (b) supporting in the lesbian, organizations andsafefacilitiesfor the victimsof programs, supportgroups,networks, offerservices, violence with the issuesinvolved in themselves must recognize and familiarize 17.56 Service-providers relationships. within same-sex violence
Failure - Executive Sl 1997


Delivery and Social-Service Health-Care agencies musthaveand enforcepoliciesstipulating that all and social-service 17.57 Health-care gathering proceed procedures fromthe assumption that clients andpersonal-history diagnostic gay,bisexual or transgendered. maybe lesbian, professionals must show that they are positivetowards and social-service 17.58 Health-care people the disclosure of a client's gays, by welcoming andtransgendered lesbians, bisexuals, gender partner, sexual and by using appropriate of a assuming the orientatioq by never sexual modelmustbe changed programs to include run on a heterosexual language; andinclusive gay,andbisexual lesbian, alternatives. identity andbehaviour; the fact that between mustappreciate thedifferences 17,59 Service-providers gay,bisexual, doesnot warrantassumptions or transgendered aslesbian, a client identifies or lifestyle. abouttheirbehaviour boards andsenior staffmust: agency andsocial-service 17.60 Health-care levelsof knowledge about staffhaveacceptable (a) establish training to ensure andmaintain people; gays, transgendered bisexuals, and to lesbians, andsensitivity gay, policies (b) assess, of lesbian, to meetthe needs maintain, andprograms andupdate people; andtransgendered bisexual, (c) establish necessary to and stafldevelopments and maintainthe program-,resource-, provideappropriate service; posters,and other imageswhich affirm (d) encourage the displayof signs,magazines, people; gays,bisexuals, andtransgendered lesbians, policieg for homophobia including (e) establish thosethat screen anti-oppression andenforce (this made must then be part whom referrals are to service-providers on the of usedby staff;; anddirectories for usein refenalprocedures documented (0 develop staffwhoarelesbian, employment equityplans to employ andimplement Bdy, First-Nations including thosewho arealsoFrancophones, andtransgendered, bisexual, people peoplgmembers with disabilities, and/or ethnicandculturalminorities, of racial, people livingwith mvlelos; gay,bisexual, (g) encourage for lesbian, andtransgendered andprovidea safeenvironment to otherstaffandclients/patients; to disclose theirorientation staffwhochoose (h) involve members gay, bisexual, within the andtransgendered communities of lesbian, geographic if necessary, in suchinitiatives. region,or beyond organization's peoplemust gay,bisexual, andtransgendered who areaffirming of lesbian, 17.61 Service-providers community, andotherdirectories. list themselves assuchin referral, gay,bisexual, who areuncomfortable with lesbian, and andotherservice-providers 17.62 Doctors must,asa people sensitized to their needs andwho arenot opento becoming transgendered andmakerefenalsto positivepractitioners. minimum, ensure absolute confidentiality musthold bodies, andotherstakeholders community advisory 17.63 Funders, sponsors, directors,
ms Failure - Executive iectAffirmation.1997


providers for the qualityof service accountable they provideto health-care andsocial-service gay,bisexual, clientele. lesbian, andtransgendered forms must use neutrallanguage intake,and other initial-contact and 17.64 Medical-history, clientsto identifutheir sexual orientation andsaywhetherthey arein a same-sex enmurage relationship. (same-sex theopportunity to designate anyone of theirchoice formsmustofferclients 17.65 Intake people, friends) next-of-kin, partners, familymembers, or as support or contacts in chosen person(s) mustbeacknowledged andaccepted as suchby thedesignated case of emergency; powersof attorneythat name mustrespect institutionalservice-providers stafi individualand partner asa decision-maker. a same-sex formsmustbe treatedwith sensitivity andotherinitial-contact supplied on intake 17.66 Information necessary required andequitable service addressing the to provide onlyto theextent andused particular health-care or other need(s)of the individuallesbian,gay, bisexual,or person is provided; it mustbetreatedconfidentially by anyone to whomservice transgendered who hasaccess to thoserecords. programming gay,bisexual, and/or transgendered with stronglesbian, 17.67 Agencies andservices must: (a) monitor community-development initiatives in their service for areaand be advocates people; gay,bisexual, andtransgendered importantto lesbian, issues gay, (b) encourage whichdo not provideadequate services to lesbian, other organizations positivepoliciesand procedures peopleto implement bisexual,and transgendered towards thosecommunities. targeted PROFESSIONALASSOCIATIONS& POST-SECONDARY EDUCATIONAL INSTITUTIONS Gays,and Bisexuals Older Lesbians, institutionsmust incorporate educational 17.68 Gerontology programsin post-secondary gay,bisexual, andtransgendered needs andcontexts of lesbian, information aboutthe specific relationships.. same-sex that theymaybe in sexual/loving recognizing seniors,

andcertifyinghealth-care associations educating institutions andprofessional 17.69 Post-secondary includingthe particular mustensure that HIV/AIDS awareness, and social-service-providers people, gay,bisexual, lesbian, andtransgendered arecomponents of pre- and issues affecting programs. post-certifi cationeducational

s Failure - Executive 23

ion. 1997

Health-Care and Social-Service Delivera associations 17.70 Professional andpost-secondary educational institutions in the health-care and fieldsmust: social-service (a) train service-providers gay, bisexual,and to meet the needsof the diverselesbian, transgendered communities of Ontario; (b) conduct or fund research into the health-care and social-service needsof these communities. 17.71 Professional must: associations (a) set out in their codes of ethics clearstandards of practice whichstate that negative or discriminatory treatment of clientsbased on their genderor sexualidentification is professional misconduct, (b) establish mechanisms for dealing enforcement with thosewho contravene suchstandards of practice; (c) provide gay,bisexual, adequate support andinformation to lesbian, andtransgendered who register complaints service-users aboutinstances of professional misconduct; (d) educate theirmembers concerning their obligation to be respectful of sexual andgender gays, identification issues in their work andto provideequitable service to lesbians, people; bisexuals, andtransgendered (e) provide opportunities gay, bisexual, for lesbian, and transgendered service-providers within their membership to contribute to increasing the levelof awareness within the profession. institutions must includein the curriculaof all programsfor 17.72 Post-secondary educational qualification, health-care andsocial-service certification or licensure: (a) anti-homophobia andanti-heterosexism training; (b) comprehensive, information unbiased aboutthe health-care andsocial-service needs of gay, people; lesbian, bisexual, andtransgendered (c) practicalstrategies and techniques for providingequitableservices to lesbian,gay, people. andtransgendered bisexual, institutions mustprovide 17.73 Post-secondary educational a positive environment in which lesbian, gay,bisexual or transgendered students, teachers, andadministrators arefreeto comeout. practicaand practical 17.74 Post-secondary institutionsmust provide appropriate educational who wishto fulfil suchrequirements experience opportunities to students with organizations providing gay,bisexual, people; services to lesbiarl andtransgendered the availability of such placements mustbe proactively communicated.

Failure - Executive Svstems




17.75 Employersmust: (a) make extendedhealth-care benefitsavailableequally to same-sexand opposite-sex couples; equallyto same-sex and (b) requirethat their insurance carriersprovide benefitspackages couples; opposite-sex relationships can apply for the coverageto (c) ensurethat employees who are in same-sex repercussions; which they are entitledwithout fear of discriminatory programs to recognizeand be sensitive (d) trainthosewho administer employee-assistance for lesbian,gay, bisexual, and and poisonedenvironments to issues of harassment people. transgendered couples. and opposite-sex equallyto same-sex must providecoverage companies 17.76 Insurance

COMMUNITY GROUPS LESBIAN, GAY, BISEXUAL, & TRANSGENDER must be proactivein communityorganizations 17.77 Lesbian,gay, bisexual,and transgender andother ageism, ahleism, anti-semitism, racism, sexism, andpersonal systemic combatting withinour communities. formsof discrimination groups must: community gay,bisexual, andtransgender 17.78 Lesbian, (suchas TheRainbowBook, which (a) create/maintain a list of positiveservice-providers publish 1995 and 1996); in helped Affirmation CLGROandProject (b) advocate of all the ProjectAffrmation recommendations; for the implementation issues, and social-service (c) through CLGRO, organizeprovinciallyaroundhealth-care perspectives they apply; as regional local or incorporating needsof our and social-service (d) seek funding for other studieson the health-care Affirmation. made by Project to builduponthebeginning communities,

Failure - Executive 25