“MSM” Revisited: Trans Inclusion in LGBT Medical Study

[Today I added Mercedes Allen’s blog “Dented Blue Mercedes” to my blog role.  It was about time as I kept seeing people coming here from her blog in my blog traffic reports.  And when ever I have gone there (which is fairly often) I have found thoughtful and often thought provoking subjects.  I also think highly of Mercedes writing and not just because we became Facebook friends a couple of hours ago.  I liked her writing when I first encountered it on Trans-Group Blog.]

By Mercedes Allen

Crossposted on:

http://dentedbluemercedes.wordpress.com/2010/08/11/msm-revisited/

http://www.bilerico.com/2010/08/msm_revisited_trans_inclusion_in_lgbt_medical_stud.php

http://transgroupblog.blogspot.com/2010/07/trans-people-msm-and-hiv-study-and.html

August 11, 2010

Recently, I’d blogged about a term that’s increasing in usage in HIV research and outreach: “MSM,” or “men who have sex with men.”  The term was originally invented because of a need to include not just sexually active gay men but also bisexuals and men who are not gay-identified but for whatever reason have casual or incidental sex with men.  It can also include gay- or bi-identified trans males, although they’re often overlooked in the study (or sometimes even thought not to exist).  And, of course, it’s often asserted that it includes or intends to include trans women.  I’d commented:

I get it that effective terminology must be given to identify target high-risk groups for the sake of study.  I get it that the terminology needs to be both simple and encompassing.  I get it that HIV is a serious issue and relevant to the trans community, though not all trans sub-groups are high-risk.  I get it that penile-anal intercourse (PAI) risk groups can include trans women….  What I don’t and will not get is the gay community’s insistence that transsexual women are “really men” and how it’s such a bother having to state otherwise in order to be inclusive.  To be fair, there are many folks in HIV study and advocacy who don’t feel or act that way, but the prevalence of MSM-exclusive study sure reinforces this impression.

As diverse as the trans umbrella is, where MSM really fails is primarily when female-identified or dual-identified trans people (usually transsexual women) are forced into one of those “M” designations (i.e. also encompassing straight-identified men who date trans women).  This is often justified by researchers through noting other cultures where trans women sometimes do identify themselves as “really a man,” because they have not yet had the freedom to develop a language with which to self-identify, and therefore accept the language and logic that is available to and used on them.  For something that was supposed to have been devised in order to respect different male identities and transcend constructions built around terms like “gay,” people sometimes wonder why it’s such a big deal when trans women are similarly not accommodated and their identities as not men are not respected.  Especially when this is the result:

This past Spring, I’d had one such study request forwarded to me by someone who was apparently on one of the mailing lists that I forward communications to.  A few days later, he wrote me, irate that I’d not forwarded it to my trans networks.  I’d pointed out (feigning ignorance) that while a few trans men might qualify and be interested, much of what was being discussed in his email didn’t really fit FTM configuration, or at least pre-surgical.  This resulted in a missive which started off with “you know what I mean” and launched into an accusation that I’d be “guilty of the murder of” every transsexual woman who perished from HIV who might have benefited from the study.  And yet, the survey was written so thoroughly to exclude those of female gender identity, I can’t see any way that any self-respecting trans woman would be able to sit through the whole thing without becoming thoroughly incensed at the obvious refusal to dignify her as who she is.

Additionally, many trans women never have sex with men, being either lesbian-identified or not sexually active.  And for a small few of us, HRT isn’t kind, and it becomes an either-or proposition where we really do have to choose between transition and sex.  So an assumption that all trans women belong in the study is as inaccurate as the assumption that all trans men don’t.

But the solution does get fuzzy.  I’m no longer convinced that any permutation of “MSM + …” works effectively at all (and I see in my original article some failures to look outside transsexual identities to the nuances pertaining to some other flavours of trans).  Possibly some terminology along the lines of PAI practices should be considered, but it’s obvious that the status quo needs to be replaced with something more appropriate.  And if that discussion needs to happen anywhere, it needs to start in the larger LGBT sphere.

This situation is also symptomatic of a fuzzy understanding of trans realities when it comes to inclusion in LGBT medical studies in general.  Trans brings along with it a host of medical questions that are often entirely overlooked in such studies.  Which is fine if the study is presented as a general overview that is not reflecting on trans-specific care or pretending that it encompasses all the issues of the included study groups.  I also get that adding all aspects of trans to a study that is aiming to look at primarily cisgender medical issues will confuse it beyond recognition.  However, too often, these studies use the fact that there is a “transgender” checkbox in the Sex question to claim that what is presented is comprehensive and targets all the LGBT medical issues that need to be addressed — which leads researchers and medical professionals to conclude that they do not have any need to look further.

When transsexuals are factored in, there are numerous medical realities surrounding access to and cost of treatment, the fact that said treatment is part of a necessary course to righting one’s life, issues around hormone access and use, or access to surgeries or tests (i.e. obtaining a mammogram for someone with a penis, or finding a surgeon willing to perform a hysterectomy on a man).  Even outside the transsexual process, we find unique issues affecting genderqueer identification, or the existence of another DSM diagnosis intended for crossdressers (and which serves no useful purpose beyond stigmatization as well as the annexation of transsexuals): Transvestic Fetish.

Superficial inclusion can generate problems with survey questions like, “Have you ever been diagnosed with a mental illness?”   Is this supposed to include GID?  If so, isn’t that a bit like rubbing one’s nose in the fact that our little community still carries this stigma?  And if there is no means to elaborate, how are the people conducting the study ever going to know if the respondent is referring to GID (or TF), or to something else entirely?

Such surveys can often be accompanied by assumptions: the assumption that we’re sexually active; assumptions that we engage in risky sexual behaviour; sometimes assumptions that ones genitals dictate how they should be addressed; assumptions about who we’re attracted to and sexually active with; assumptions that we can see just any medical professional when we need to; assumptions that prejudice in the clinic could never take the form of being treated like we’re deluded or freakish by the doctor, medical staff and/or other staff; assumptions that we can access HRT, surgery and other forms of treatment without requiring letters of permission from someone who has psychoanalyzed us; assumptions that anyone with a trans history has to identify as trans(fill-in-the-blank), rather than as male or female.  It can also overlook issues entirely, such as that of changing one’s name on file, having it acknowledged by staff, and not having it create a crossed-wires situation were your lab tests from elsewhere don’t get where they’re supposed to.

And finally, there is an issue of relevance.  When trans-specific care isn’t in the study at all, what remains seems almost irrelevant or even foreign to trans participants.  It does seem a little humorous to me to be asked, for example, “Do you trust your medical provider enough to discuss issues with him or her that might out you as being LGBT?” when an adam’s apple (not to mention genitalia), medications, gender markers on identification or surgeries recorded on file all leave no doubt.

I don’t mean this to be entirely scathing — studies do vary, and I’m elaborating on the worst I’ve seen in order to open discussion on making them better overall.  While the MSM terminology is glaring, many other issues stem from cisgender privilege — not in the sense that cisgender people often complain about being accused of (i.e. wilful ignorance), but from the privileged standpoint of never having experienced these things, and therefore not realizing that they need to be addressed.

There is a concern that conducting separate studies can be seen as a license to not do trans population studies at all.  But because the medical situation can be significantly different for trans people, I wonder if these issues would be best handled as a trans-specific addendum?  And where language fails altogether — terms like MSM — there is a serious need for reassessment.

Readers’ thoughts on MSM and inclusion in general?

(Crossposted, and I don’t want any grief about it)

Gender… Schmender #$%@&^*

The whole ideology of gender is purely sexist bullshit.

Gender is a pure social construct, a fiction that oppresses both men and women but more women than men.

When I hear “gender assigned at birth” I want to slap someone. I wasn’t assigned a gender at birth.  The doctor looked between my legs and said, “It’s a boy.”  I was assigned male by reason of having a penis there later in life I had an operation that reassigned me to female based on that same genital appearance factor.

When I came out in 1969, I came out as a feminist.  Women in the collective gave me clothes. While the guys claimed they respected me but they also started treating me in a way that told me they expected me to adhere to the sex roles both hippie and movement women were expected to adhere to.

When other movement women saw this they introduced me to feminism.  When SDS split into Weatherman and other factions I became Weather, largely because of Bernadine Dohrn.  You see there weren’t very many strong women’s voices in SDS and the Anti-War Movement.

Bernadine Dohrn gave great rants…  Maybe months later on reflection you went WTF but at the time…  Oh how I admired her audacity and how she inspired me to act courageously.

I also learned from other radical women. Putting women and the interests of women first yet never forgetting that sexism was only one axis of oppression. Consciousness raising and analysis gave me/us an understanding of what the world expects of women.

Many of us who were dealing with having been born with transsexualism owe far more to feminism and the feminist movement than we ever did to Stonewall and the Gay Liberation Movement. We weren’t gay men even if we had male lovers.  Especially if we had male lovers… being transsexual and having a male lover meant we were straight or more accurately heterosexual since straight also had other connotations.

We weren’t some “T” so recently grafted on to what was first a Gay Liberation Movement.  We were women in transition to female having to deal with the same sexism as natal female women had to deal with.  It didn’t much matter if we were radical feminist Weather Nation women or Cosmo “Sex and the Single Girl” women.  We had to deal with sexism and pay discrimination as well as sexist assumptions based on what are now called “gender” stereotypes.

Gender was something used to keep women oppressed.  It was the idea that women are weak and stupid; fit only to be sex objects or mothers. Daddy’s little princess until given to a man only to lose her last name and become his property.* Gender became a way of telling feminists that they were not real women since they questioned the marketing of very high profit items based on pandering to a sense of insecurity in one’s own womanhood or attractiveness.

When feminism challenged those who were dealing with transsexualism part of the challenge was due to the tendency of so many of us to embrace all the marketing of gender without insight or even a sense of irony.

But gender as it is so often used today is if anything a far more sneaky and loaded with subtextual readings semiotic. Gender has now replaced sex in so much of the common discourse that we look at the construct as reality and skip over the subtextual readings of the semiotic.

Whereas once upon a time the Cockettes Troupe in San Francisco deconstructed gender and showed it as performative through the usage of exaggerated costumes and the performing of equally over the top stereotypes taken from films of the 1930s and 40s I now have some people ask if these performers were transsexual or transgender. The answer is maybe some were.  One was in the Stanford program at the same time I was, others were gay men and some were natal females.

By breaking the rules of gender through Absurdist Theater they created both campy comedy and a critique of sex roles. One of the crucial mistakes in feminist criticism of more traditional drag is the assumption that women are the target when it often seems the aim is more a matter of ridiculing roles portrayed in movies.

But Second Wave Feminism went even further in delivering a devastating critique of sex roles as defining what the proper role of women was.  When women dared step beyond the stereotypes and enter male dominated career field they were told that doing so would un-sex both women and men.  Fashion magazines and all sorts of corporate interests dished up massive loads of propaganda aimed at undermining the confidence of women seeking equality of opportunity.

One of the critiques of transsexual to female people is that we have not been socialized as women. This is an assumption that is often times contradictorily both true and false. Transsexual to female people grow up as transkids and are influenced by the same sales pitches and indoctrination as natal women yet they are told it is something they must adhere to and we are told it is something to be ashamed of.

This makes it hard for us to have a critical eye regarding this propaganda when we first come out. We may acquire it with experience but it is equally possible for us to join the masses of women who march to the beat of Sex in the City rather than to NOW and more radical feminisms.

At some point sex became gender and roles acted replaced that which was written upon the body. The ironic labeling of sex as a definer of maleness or femaleness as essentialism has resulted in many people with a poor understanding of feminist theory using it as a careless accusation.

Dividing people into classes of male and female based on the appearances of genitalia would mean that heterosexual post-SRS women and men would be able to legally marry partners of the other sex.  No more Christie Lee Littletons, no more Nikki Araguzs.

But when the misogynistic reactionary forces of both religious fundamentalism and ultra right wing politics united to defeat feminism as well as LGBT/TQ liberation and the progressive movements of the 60s and 70s they seemed to unite with corporate interests in reasserting misogyny.  Trying to sell sex roles and their importance after 15 years of serious feminist critique was more of a struggle than repackaging sex roles as gender.

The Total Woman by Marabel Morgan was supposedly a self help book for women.  In reality this 1974 publication was grounded in the rising right wing Christo-Fascist backlash that also spawned the rise of the homophobic bigotry of Anita Bryant and crew.

Along with Phyllis Schlafly these genderists put forth an ideology that could have been penned by the late transvestite activist pioneer, Virginia Prince.  The ideology was one that kept women in their places by telling them that they weren’t real women unless they filled this total woman gender role.  The same gender role feminists had critiqued under the name of “sex roles.”

Now I view “gender” as a culturally defined social construct that varies a great deal according to culture and time (see Margaret Mead’s work.  BTW her “debunker” were right wing McCarthyites).

With western modernism the naturally occurring over lapping of sex traits and abilities lead to a lessening of rigid gender roles that are more often found these days in non-western cultures.

Defining people as real men or real women based on gender is a characteristic of conservative values often based in religiously fanatical cultures which is why I find the embrace of “gender” as definer by Transgender Inc. to be more reactionary than progressive.

I read a story on Bilrico about some creep beating an infant boy to death to make him act like a man. http://www.bilerico.com/2010/08/man_kills_17-month-old_boy_for_acting_like_a_girl.php This is the problem with putting so much emphasis on gender.

In the real world an Emo boy even with nail polish and a magenta streak in his long black hair is still a boy.  The rocker girl with facial piercings, tats and black leather motor cycle boots is still a girl.

Of course without the ideology of transgender Thomas Beatie is a masculine woman who dresses and acts like a man when she isn’t having children.  But c`est la vie.  And no I wouldn’t mis-gender him like that even though I am supremely irritated by the neo-quiver full thingie.

Gender is masculinity or femininity not maleness or femaleness.  We got suckered into discussing that core identity of male or female as being gender based on Stoller’s book (Sex and Gender) way back in the 1960s.  We didn’t have a whole lot of information to operate on and lacked a vocabulary to describe what we were feeling.  We should have used “core sex identity” for that sense of being female trapped in a male body.
Little did we realize that even then introducing “gender” in to the discourse was using poisoned seeds from the fruit of a poisonous tree.  The misogynistic world according to Virginia Prince became the bullshit crop of the transgender social construct of gender.

The way Transgender Inc. uses gender is not the least bit liberating.  It can’t be as it is based on a construct that defines membership in the sex class of female or the sex class of male not based on what one commonly uses.  Male and female are generally based on whether one has a penis or vagina.

Yet the simple reality of hole or pole unites both Transgender Inc and the religious fanatic/right wingers in finding ways to tell women born transsexual that their pussies do not really make them women.

American Fascism’s Continuing Assault on ‘Useless Eaters’: Phyllis Schlafly Smears ‘Unmarried Moms’ Receiving Unemployment Benefits

From Anti-Fascist Encyclopedia: http://www.antifascistencyclopedia.com/allposts/american-fascisms-continuing-assault-on-useless-eaters-phyllis-schlafly-smears-unmarried-moms-with-unemployment-insurance

By Charlie Eisenhood
Think Progress | Jul 30th, 2010

schlafly American Fascism’s Continuing Assault on ‘Useless Eaters’: Phyllis Schlafly Smears ‘Unmarried Moms’ Receiving Unemployment Benefits

Over the past two months, many Republican pundits and members of Congress have been calling for the end of unemployment benefit extensions for the millions of Americans who can’t find work. Meanwhile, GOP Senators held the unemployment insurance (UI) extension bill hostage for weeks as 2.5 million Americans were left without the “desperately needed lifeline” of UI benefits. Even as five workers fight for every one job opening, Republicans are still calling the unemployed “spoiled” and suggesting that blocking benefits is fine because it only affects a “small amount of people.”

Last week at a fundraiser for Michigan GOP congressional candidate Rocky Raczowski, conservative pundit Phyllis Schlafly added her voice to the chorus crying out against government assistance for the poor or unemployed:

One of the things Obama’s been doing is deliberately trying to increase the percentage of our population that is dependent on government for your living. For example, do you know what was the second biggest demographic group that voted for Obama? Obviously the blacks were the biggest demographic, y’all know what was the second biggest? Unmarried women. 70% of unmarried women voted for Obama. And this is because when you kick your husband out, you’ve got to have Big Brother Government to be your provider. And they know that. They’ve admitted it. And they have all kinds of bills to continue to subsidize illegitimacy…

The Obama administration wants to continue to subsidize this group because they know they are Democratic votes.

Schlafly’s argument is specious. She talks about “subsidizing illegitimacy,” but not all single women are mothers. Less than 20 percent are mothers to young children. The rest include millions of widows, millions of young never-married women, and plenty in between — some of whom have kids, but most of whom do not.

Continue reading at:  http://www.antifascistencyclopedia.com/allposts/american-fascisms-continuing-assault-on-useless-eaters-phyllis-schlafly-smears-unmarried-moms-with-unemployment-insurance

FBI admits probing ‘radical’ historian Zinn for criticizing bureau

While many babble on about how free people are in America I have tended to question the reality of that freedom. Too often that freedom seems to mean one is free to work wages so mean and parsimonious as to give meaning to the term “wage slavery”.  Oddly that freedom doesn’t seem to extend to the rights of labor to organize, form unions and strike for better conditions, otherwise why would workers who try to exercise that freedom be fired, subjected to beatings and arrest or sometimes even murdered by those who are authorized to enforce the nations laws.

Why are people of color, women, LGBT/TQ people considered subversive and anti-American when they ask that the nation that claims to stand foursquare for freedom, justice and equality honor those claims by giving people of color, women and LGBT/TQ people those things the nation says it is most proud of.

Why are those who peacefully dissent and point out the short-comings, the bait and switch nature of these claims spied upon by secret police when our government tells us that only totalitarian governments use secret police to spy upon citizens who peacefully dissent.  Why is it okay for a nation that claims to stand for freedom of speech turns around and black lists those who have the audacity to speak out against the injustices of racism, imperialism, sexism and homophobia?  Are terminations and black listing the marks of freedom or of an authoritarian police state?

Is it more radical to petition an authoritarian state to be allowed to become part of that authoritarian state than it is to work to end the authoritarian state that oppresses so many?

The late Howard Zinn exposed the reality behind America’s image and showed us how it was so often a bright and shining lie.

For this he was investigated by the FBI and I am sure by secret police squads all over the country.  His crime being a truth teller with the courage to speak that truth to power.  I am not surprised at their attempts to have him fired and blacklisted as that is the nature of those involved in the maintaining of the authoritarian aspects of corporate freedom and the government by and for the rich.

From Raw Storyhttp://rawstory.com/rs/2010/0730/fbi-admits-probing-zinn-criticizing-bureau/

By Daniel Tencer
Friday, July 30th, 2010 — 3:22 pm

FBI files show bureau may have tried to get Zinn fired from Boston University for his political opinions

Those who knew of the dissident historian Howard Zinn would not be surprised that J. Edgar Hoover’s FBI kept tabs on him for decades during the Cold War.

But in a release of documents pertaining to Zinn, the bureau admitted that one of its investigations into the left-wing academic was prompted not by suspicion of criminal activity, but by Zinn’s criticism of the FBI’s record on civil rights investigations.

“In 1949, the FBI opened a domestic security investigation on Zinn,” the bureau states. “The Bureau noted Zinn’s activities in what were called Communist Front Groups and received informant reports that Zinn was an active member of the CPUSA; Zinn denied ever being a member when he was questioned by agents in the 1950s.

“In the 1960s, the Bureau took another look at Zinn on account of his criticism of the FBI’s civil rights investigations.”

Continue reading at: http://rawstory.com/rs/2010/0730/fbi-admits-probing-zinn-criticizing-bureau/

Posted in Abuse, History, Police Abuse, Questioning Authority, Social Justice. Comments Off on FBI admits probing ‘radical’ historian Zinn for criticizing bureau

Federal Court Strikes Down DOMA Section 3

From Glad (Gay and Lesbian Advocates and Defenders)

http://www.glad.org/current/news-detail/federal-court-strikes-down-doma-section-3/

July 08, 2010

Today, U.S. District Court Judge Joseph L. Tauro ruled that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional with respect to claims brought by seven married same-sex couples and three widowers from Massachusetts. Under the ruling, the plaintiffs are entitled to the same federal spousal benefits and protections as every other married couple.

The ruling stems from GLAD’s lawsuit Gill et al v. Office of Personnel Management et al, filed in March 2009.

“Today the Court simply affirmed that our country won’t tolerate second-class marriages,” says Mary Bonauto, GLAD’s Civil Rights Project Director, who argued the case. “I’m pleased that Judge Tauro recognized that married same-sex couples and surviving spouses have been seriously harmed by DOMA and that the plaintiffs deserve the same opportunities to care and provide for each other and for their children that other families enjoy. This ruling will make a real difference for countless families in Massachusetts.”

Read the decision.

Read GLAD’s press release.

Political Prisoners Arrested at G20 Demonstrations Segregated by Sexual Orientation

G20 security state madness

From Xtra

http://www.xtra.ca/blog/national/post/2010/06/28/G20-madness.aspx

I don’t even know where to begin on the events of this past weekend.

How about here? An account by this dude of appalling treatment by police. It’s a tale of unwarranted search and detention, segregation by sexual orientation and suspension of fundamental rights as Canadians. Welcome to Toronto, Dan. This piece brought to you by the good people at rabble.ca

I was at College and University, the southern boundary of Queen’s Park, at about 5pm on Saturday as police began to clear the so-called free-speech zone. It was appalling. I watched as a few were arrested and saw mounted police carve a group of people out of the crowd in the park and arrest them all.

Posted in Activism, Anarchism, Economic Issues, Human Rights, Police Abuse, Questioning Authority, Social Justice. Comments Off on Political Prisoners Arrested at G20 Demonstrations Segregated by Sexual Orientation

Woman caught having sex in park, charged with adultery – in New York

I swear I can’t make this shit up…

From the New York Daily News

Originally Published:Tuesday, June 8th 2010, 9:32 PM
Updated: Wednesday, June 9th 2010, 11:42 AM

By Michael Sheridan
DAILY NEWS STAFF WRITER

A woman arrested for public lewdness for allegedly having sex in a park is facing a surprising additional charge: cheating on her husband.

No, this wasn’t in a Muslim country far away, it is happening in New York.

Suzanne Corona, a 41-year-old woman from Batavia, N.Y., just east of Buffalo, was busted along with 29-year-old Justin Amend last week, police said.

The pair allegedly were having sex on a picnic table near a playground in Farrall Park just after 5 p.m. on Friday, according to WHAM 13. Police report several parents and children were nearby.

“[The police officer] asked them what they were doing, and they said, ‘Just talking,’ and obviously they weren’t just talking,” said Officer Eric Hill, of the Batavia Police Department.

The police in this country have long exhibited Nazi thug tendencies.  From the beatings and murders of union organizers to the arresting and beating of civil rights demonstrators one sees a pattern of anti-human rights abuses.

Of late the military and the police have been invaded by too many Christo-fascists who see these agents of authority positions as empowering them with the ability to enforce their twisted version of the Abrahamic desert mythology.

One expects better of places like New York…  Perhaps it is time for New Yorkers to rethink the Disneyification  of they once international famous cosmopolitan city.

Posted in Abuse, Christo-Fascism, Islamo-Fascism, Misogyny, Police Abuse, Questioning Authority, Religion, Social Justice. Comments Off on Woman caught having sex in park, charged with adultery – in New York