Transphobic 'Honour'-Based Abuse: A Conceptual Tool

Power and control, resistance and survival: A systematic review and meta-synthesis of the qualitative literature on intimate partner violence against transgender individuals

Transgender (trans) individuals experience intimate partner violence (IPV) at elevated levels compared to cisgender individuals. Traditional theoretical understandings of IPV as men's patriarchal domination of women, and later, broader theories in which IPV is conceptualized as the relatively privileged partner enacting domination over the relatively oppressed partner, do not fully capture the totality of IPV experiences, including how IPV is perpetrated against trans individuals. We conducted a systematic review and qualitative meta-synthesis of the qualitative and theoretical literatures on IPV against trans individuals (N = 37 articles and books) to generate novel IPV theory inclusive of trans individuals' experiences. We identified five major themes: (1) societal context of IPV, (2) IPV tactics and types, (3) help-seeking, (4) consequences of IPV, and (5) proposed interventions for victims. Synthesizing across themes, we offer a novel theoretical model that demonstrates how abusers can leverage structural discrimination and vulnerabilities against trans victims, regardless of the abuser's own identities. We identify individual power and control tactics abusers use, including identifying a category of IPV that we term leveraging vulnerability, which involves abusers weaponizing their own vulnerabilities to avoid accountability. Reducing IPV in trans communities requires expanding current IPV theory to include trans victims, recognition of a wider range of abuse tactics, and structural interventions that promote the respectful treatment of trans individuals. Our theoretical model of IPV "centers the margins" to make trans victims' experiences, and indeed all victims whose experiences fall outside normative scripts, more legible.

"Just Because I Don't Conform to Societal Norms": A Qualitative Study of Transgender People's Experiences of Domestic Violence and Coping Methods

Background Transgender people experience violence in various forms, primarily domestic violence. The aim of this study was to examine transgender people's experiences of domestic violence and their coping methods. Materials and methods This study was conducted using the phenomenological method, one of the five basic qualitative research methods, with 20 transgender participants who applied to Ondokuz Mayıs University, Samsun, Turkey, to start the gender-affirming treatment process. The participants comprised 19 transgender men and 1 transgender woman. A semi-structured interview form was used for data collection. The average interview duration was 75.7 minutes. Audio recordings were used in the interviews, which were then transcribed. The obtained data set was subjected to content analysis. Results As a result of the content analysis, three themes emerged: being a transgender individual and the family, experiences of domestic violence, and methods of coping. According to the study results, the participants had experienced domestic violence of different dimensions, primarily psychological violence. Defined gender roles and societal expectations were determined to trigger violent behaviors. The most frequently used coping methods were giving a direct reaction, seeking instrumental-social support, and ignoring the incidents. Conclusion Our findings demonstrated that transgender people experience domestic violence at a high rate and that transphobic behaviors are triggered by societal norms. Our results are particularly noteworthy for clinicians regarding the importance of family support and accurate information for transgender people and the coping methods they use most.

Abused by the Patriarchy: Male Victims, Masculinity, "Honor"-Based Abuse and Forced Marriages

The causes and effects of what is often referred to as "honor"-based violence/abuse (HBV/A) and forced marriages on men and boys is an under-researched field of patriarchal violence. This lack of research has resulted in an imperfect understanding of how and why men become victims of HBV/A and an absence of an effective theoretical framework in which to analyze their experiences. Through an examination of 29 Case Files obtained through a gender-neutral domestic abuse refuge charity in the East Midlands, the United Kingdom, this original research will explore the ways that men, particularly younger males and those who do not conform to cultural norms of masculinity, are harmed by patriarchal structures. In doing so, this article brings to light new data and adds to the patriarchal framework for understanding HBV/A and why it is committed against men. The results of this study reveal that the ways in which HBV/A and forced marriages were presented in the Case Files present both analogies to and distinctions with the infliction of Violence Against Women and Girls (VAWG) in similar circumstances. This discovery is important for several reasons: (a) it demonstrates that men and boys are harmed by patriarchy and that patriarchal theories of violence must therefore evolve to better recognize groups of male victims; (b) it provides a typological framework to identify the different types of male victims, the types of abuse and the perpetrators involved, including the involvement of mothers as primary and secondary perpetrators; and (c) that male victims require appropriate intervention and must be taken seriously by state agencies if men are to come forward and disclose abuse.

Exploring the Domestic Abuse Narratives of Trans and Nonbinary People and the Role of Cisgenderism in Identity Abuse, Misgendering, and Pathologizing

Drawing on data from two empirical studies, this article employs cisgenderism as a conceptual tool to explore trans people’s experiences of domestic violence and abuse (DVA). Distinct modes of cisgenderism are analyzed. These are identity abuse, microaggressions, misgendering, and pathologizing practices. Qualitative data were collected via semistructured interviews (n = 24). Two inclusion criteria were used for this secondary analysis requiring participants to self-identify as trans or nonbinary and have experience of DVA. The findings illuminate the extent of cisgenderism as underpinning experiences of DVA. The article ends with a call for further theoretical and empirical research in this regard.

Debate: Why should gender-affirming health care be included in health science curricula?

BACKGROUND

Every person who seeks health care should be affirmed, respected, understood, and not judged. However, trans and gender diverse people have experienced significant marginalization and discrimination in health care settings. Health professionals are generally not adequately prepared by current curricula to provide appropriate healthcare to trans and gender diverse people. This strongly implies that health care students would benefit from curricula which facilitate learning about gender-affirming health care.

MAIN BODY

Trans and gender diverse people have been pathologized by the medical profession, through classifications of mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Disease (ICD). Although this is changing in the new ICD-11, tension remains between depathologization discourses and access to gender-affirming health care. Trans and gender diverse people experience significant health disparities and an increased burden of disease, specifically in the areas of mental health, Human Immunodeficiency Virus, violence and victimisation. Many of these health disparities originate from discrimination and systemic biases that decrease access to care, as well as from health professional ignorance. This paper will outline gaps in health science curricula that have been described in different contexts, and specific educational interventions that have attempted to improve awareness, knowledge and skills related to gender-affirming health care. The education of primary care providers is critical, as in much of the world, specialist services for gender-affirming health care are not widely available. The ethics of the gatekeeping model, where service providers decide who can access care, will be discussed and contrasted with the informed-consent model that upholds autonomy by empowering patients to make their own health care decisions.

CONCLUSION

There is an ethical imperative for health professionals to reduce health care disparities of trans and gender diverse people and practice within the health care values of social justice and cultural humility. As health science educators, we have an ethical duty to include gender-affirming health in health science curricula in order to prevent harm to the trans and gender diverse patients that our students will provide care for in the future.

BARRIERS TO TRANSGENDER HEALTH CARE IN PAKISTAN

he term “transgender” refers to a spectrum of individuals who express gender in ways that deviate from the gender binary. It includes transsexuals, crossdressers and others.1,2 In Pakistan, the state of being a transgender presents a serious challenge to the traditionally established binary systems of nature/culture, man/woman, masculinity/ femininity and sex/gender. Even transgender community were given their identity as citizens of Pakistan in year 2009.3 Whereas the transgender persons suffer significant health disparities.4,5 Real or perceived stigma and discrimination within biomedicine and the health care provision in general may impact transgender people’s desire and ability to access appropriate care. The situation of the community is worse because they are left ignored and isolated without the survival facilities, education, employment opportunities, identity crisis or even the conformity from the dominant social class.3 National health services of Pakistan should include rigorous determination in the health care system to provide adequate care for transgender in the country. There is need to know the mechanism through the knowledge and biases of medical work force across the spectrum of medical training with regard to transgender health care. With these studies we can validate and propose potential solutions to address the identified gaps. Whereas the situation in other developing countries including those belonging to African and Asian regions is not good. In developed countries the situation is found to be much better. However, reported data shows that transgender people even in developed world face various kinds of discrimination especially in health care situations. The federal government of USA does not have laws specifically for protecting transgender people from discrimination in employment, housing, healthcare, and adoption. U.S. President Barack Obama had issued an executive order prohibiting discrimination against transgender people in employment by the federal government and its contractors. While in Pakistan there was no specific law for the transgender, however, a Senate committee had approved a bill in December 2017 for full legal protection to transgender people. It will provide a relief to transgender people for their health care and other facilities. Further, National Assembly of Pakistan approved the final Bill as Act called the Transgender Person (Protection of Rights) Act, 2018 on 18 May 2018.6 There is need to assess the perceptions and knowledge of the heath care provider workforce to provide medical care to transgender. Barriers may include fear of stigma associated with providing transgender medical care. Barriers may also include bias in the structure of clinics, forms, and electronic medical record systems in addition to gaps in knowledge and bias among support staff. Identification of solutions to the gaps is needed, which are not solely a lack of knowledge. The degree to which third party payer policy impedes access needs to be determined. Determination of change needed to overcome the financial barrier to care is also required. It is necessary to evaluate other barriers including societal stigma, mental health issue among patients, and socioeconomic issues. Finally evaluation of strategies to overcome these barriers is a must to address the matter.