无家可归的跨性别者个体

主要作者: Barry Zevin, MD

概论

参与美国跨性别歧视情况调查的跨性别人群中,有五分之一表示经历过无家可归的情况。无家可归通常由以下原因造成:逃离非宽容家庭,被赶出家门,由于歧视丢掉工作,或因为歧视/自身残疾无法就业。此调查中,经历过无家可归的受调查者中,大部分尝试去无家可归者收容所的人受到过收容所员工或居住者的困扰,29%的人被直接遣离,22%的人被居住者或员工性骚扰。[1]很多跨性别个体发现医疗护理和社会服务提供者对跨性别问题和需求不甚了解。针对无家可归者的社会服务机构有必要在此领域有足够的知识水平,因为他们更易于接触到跨性别人群。[2]美国无家可归病人医护网络在该领域提供了高质量的培训。[2-4]

经常有无家可归的跨性别人群反映公共场所尤其是无家可归者收容所内的歧视和侵害。[5]虽然联邦和其他法规禁止歧视[6],很多人由于此类歧视依然难以表现他们自我认同的性别,如果收容所是性别隔离的,最好的办法也许是先以私密、非歧视的方式收集性别认同信息,然后询问住宿偏好。大部分个体倾向于根据他们生活中或自我认同的性别被安排住宿,然而在一些情形下一些人出于安全或者其他考虑,可能会希望被根据出生性别安排住宿。最好的收容所经办指南已经出台。[7-8]

功能残疾(functional disability)在无家可归跨性别人群中非常普遍。很多无家可归的跨性别个体由于此类问题无法工作。性别焦虑本身就可导致严重抑郁,焦虑和自杀倾向。[9]童年不良经历、损失和创伤可能导致创伤后应激障碍和其他持续性问题。身体侵害,酒精及药物使用也可能造成慢性身体问题。教育机会的错失和工作机会的缺失会导致学习掌握新技能的能力低下。这些问题常常导致工作能力的长期缺失。一些人可能符合社会保障中的残疾标准,这可能是他们摆脱无家可归困境的唯一途径。详细记录此类功能残疾会对这些个体有所帮助。[10]

无家可归状态与性别肯定治疗

激素疗法和跨性别手术,若患者有意愿,医疗上被认为是治疗性别焦虑所必需的。在一些案例中,无家可归的境况被作为了这些医疗服务的排除条件之一。大部分案例中需要激素疗法的个体表现高度积极,在无家可归的压力下依然可以遵从治疗和监测。为无家可归者提供医疗护理的机构已经成功地对很多患者进行了激素治疗。[3]对于那些寻求胸部,乳房,生殖器或其他性别确定手术的患者,无家可归也并非与为手术做计划相矛盾。对于这类手术,良好预后所需的居住安定程度,因手术流程和个人情况而异。医疗暂憩护理21项目(medical respite program)可帮助一些患者从某些手术静养恢复。由于往往从申请到手术需要一年或更久的等待期,这段时间就是努力稳定住房条件的时机。对于手术的愿景和承诺,对于之前流离失所的人来说往往是一个非常强的驱动力。一些患者可能会对于手术,恢复和后期护理的艰苦考验,或者他们稳定居住的可能性有不合实际的想法和认识。这些个体需要与主要护理提供者,心理健康服务提供者,护理指导员22(care navigator)等方面努力协作,从而达成术后良好预后所需的稳定性。在手术前的教育和准备过程中应注意避免患者产生这样的影响:护理者对住所稳定性的担心带有歧视意味或只是主观认为的困境。[11]

预防

对于流离失所的预防,依赖于降低在家庭,工作和其他社会环境中的歧视,并为跨性别个体提供平等的机会。帮助无法工作的人得到残疾人资格是摆脱无家可归状况的重要途径。防治无家可归的危害可以通过采用最佳的处理实践,和教育针对无家可归者的社会服务提供者达成。尽管在这一领域大量研究已经启动,仍需更多的研究,以使得最佳处理实践的发展变化被知晓,从而进一步实践这些变化。

参考文献

  1. Grant JM, Mottet LA, Tanis J, Harrison J, Herman J, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey [Internet]. National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011 [cited 2016 Mar 17]. Available from: http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf
  2. O’Sullivan A, Apodaca E, Caughlan J, Roberts LC, Hale A, Hines L, et al. Crossing to Safety: Transgender Health & Homelessness. Healing Hands (A publication of the HCH Clinicians’ Network) [Internet]. 2002 Jun [cited 2016 Mar 17];6(4). Available from: http://www.nhchc.org/wp-content/uploads/2011/09/transgendered.pdf
  3. Klein P, Wenzel C, Ammerman S, Aytch M. Practice Transformation: Improving Access to Care and Quality of Care for Unstably Housed Transgender and Gender-Nonconforming Persons [Internet]. National HCH Conference; [cited 2016 Mar 17]. Available from: http://www.nhchc.org/wp-content/uploads/2014/12/practice-transformation.pdf
  4. HCH Clinicians’ Network. “Seeing People as They See Themselves”: Health Care and Access for Transgender Individuals Experiencing Homelessness. Healing Hands[Internet]. 2015 Winter [cited 2016 Mar 17];19(1). Available from: https://[www.nhchc.org/wp-content/uploads/2015/02/hh-transgender-final-2-24-15.pdf](http://www.nhchc.org/wp-content/uploads/2015/02/hh-transgender-final-2-24-15.pdf)
  5. Mottet L, Ohle J. Transitioning Our Shelters: Making Homeless Shelters Safe for Transgender People. J Poverty. 2006 May 22;10(2):77–101.
  6. U.S. Department of Housing and Urban Development (HUD). Appropriate Placement for Transgender Persons in Single-Sex Emergency Shelters and Other Facilities [Internet]. 2015 Feb [cited 2016 Mar 17]. Available from: https://[www.hudexchange.info/resources/documents/Notice-CPD-15-02-Appropriate-Placement-for-](http://www.hudexchange.info/resources/documents/Notice-CPD-15-02-Appropriate-Placement-for-) Transgender-Persons-in-Single-Sex-Emergency-Shelters-and-Other-Facilities.pdf
  7. Massachusetts Transgender Political Coalition Policy Committee. Shelter for all genders: best practices for homeless shelters, services, and programs in Massachusetts in serving transgender adults and gender non-conforming guests [Internet]. 2013 [cited 2016 Mar 17]. Available from: http://www.masstpc.org/wp-content/uploads/2012/10/Shelter-for-all- Genders.pdf
  8. The FTM Safer Shelter Project Research Team. Invisible Men: FTMs and Homelessness in Toronto [Internet]. Wellesley Institute; 2008 Jun [cited 2016 Mar 17]. Available from: http://www.wellesleyinstitute.com/wp-content/uploads/2011/11/invisible-men.pdf
  9. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. J Homosex. 2006;51(3):53–69.
  10. O’Connell JJ, Zevin BD, Quick PD, Anderson SF, Perret YM, Dalton M, et al. Documenting Disability: Simple Strategies for Medical Providers [Internet]. Health Care for the Homeless Clinician’s Network; 2007 Sep [cited 2016 Mar 17]. Available from: http://www.nhchc.org/wp-content/uploads/2012/02/DocumentingDisability2007.pdf
  11. Deutsch MB. Gender-affirming surgeries in the era of insurance coverage: developing a framework for psychosocial support and care navigation in a perioperative period. J Health Care Poor Underserved. 2016;27:1–6.
  12. National Health Care for the Homeless Council. Gender Minority & Homelessness: Transgender Population. Focus Q Res Rev Natl HCH Counc [Internet]. 2014 Aug [cited 2016 Mar 17];3(1). Available from: http://www.nhchc.org/wp-content/uploads/2014/10/in- focus_transgender_sep2014_final.pdf
  13. Fletcher JB, Kisler KA, Reback CJ. Housing status and HIV risk behaviors among transgender women in Los Angeles. Arch Sex Behav. 2014 Nov;43(8):1651–61.
21. 译者注:一类对有健康状况的无家可归者提供短期收容疗养的项目。
22. 译者注:指在医院环境外为有需求人员选择和获取医疗服务提供指导的人员

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