Annual General Meeting for the Professional Association for Transgender Health Aotearoa (PATHA)

June 20 2020

AGENDA

1. Welcome

2. Note any apologies and appoint minute taker

3. Receiving the minutes of the previous Society Meeting

4. President’s Report

5. Financial Report

6. Executive Committee recommended motions to amend PATHA rules: 

   1. Section 4.2: Increase number of General Executive Committee Members from 3 to between 3 and 5.

   2. Section 4.5: Amend the following sentence to include “between Māori and non-Māori people” as highlighted below: 
      “The mix of Officers and Executive Committee members should demonstrate a partnership between cisgender and transgender people, and between Māori and non-Māori people, working professionally on transgender health, whether in clinical, academic, community, legal or other settings.”

   3. Section 8.1: The role of the Executive Committee. Amended to include the following highlighted sentence: “Ensure that transgender Members are represented in any decisions made.”

   4. Section 10.2: Amend this to include “and transgender members are represented in decision making” as highlighted below: 
      “No Executive Committee Meeting may be held unless more than half of the Executive Committee Members attend and transgender members are represented in decision making.”

7. Election of Executive Committee Members 
8. Close meeting

The Australian Professional Association for Trans Health (AusPATH), established in 2009 as the Australian and New Zealand Professional Association for Transgender Health, is Australia’s peak body for professionals involved in the health, rights and wellbeing of trans people, including those who are gender diverse and non-binary (TGDNB). The AusPATH membership comprises approximately 300 experienced professionals working across Australia.

The Professional Association for Transgender Health Aotearoa (PATHA) is an interdisciplinary professional organisation working to promote the health, wellbeing and rights of transgender people in Aotearoa New Zealand. PATHA's membership includes over 70 professionals who have experience working for transgender health in clinical, academic, community, legal and other settings.

AusPATH and PATHA welcome the Royal Australasian College of Physicians (RACP) advice to Minister Greg Hunt, Federal Minister for Health, regarding the care and treatment of TGDNB children and adolescents, including those seeking medical intervention. This advice is based on the available scientific evidence and the expertise of those with relevant clinical experience across sub-speciality areas of medicine and bioethics.

AusPATH and PATHA agree with the RACP that ensuring children and adolescents who are trans, including those who are gender diverse and non-binary “can access appropriate care and treatment regardless of where they live, should be a national priority”, and that “withholding or limiting access to care and treatment would be unethical and would have serious impacts on the health and wellbeing of young people.”

As stated by the RACP, clinical care needs to be “non-judgemental, supportive and welcoming for children, adolescents and their families”.

AusPATH and PATHA also support the RACP recommendation that the Australian Government provide funding for research, especially in relation to the long-term health and wellbeing outcomes for trans, including gender diverse and non-binary, young people. Increased investment in research and expansion of the knowledge base, for young people and adults, will be vital in improving the current and disturbing high rates of depression, anxiety, suicide attempts and suicide amongst this cohort.

Improving outcomes can only be achieved by reducing the stigma, discrimination, bullying and harassment that trans people, including those who are gender diverse and non-binary, are subjected to on a daily basis. Negative, hateful media campaigns aimed at invalidating the experiences and strength of this community, and those who provide care for them, is reprehensible, harmful and must stop.

There is much work for us to do to improve the lives of all trans people in Australia and Aotearoa New Zealand. Both AusPATH and PATHA look forward to assisting the clinicians, researchers, educators and advocates across our two countries to continue the provision of high quality, patient-centred, human rights-focused and comprehensive gender affirming care and treatment.

Further reading:

Royal Australasian College of Physicians’ Statement

Royal Australasian College of Physician’s Letter to Minister Hunt

Royal Children’s Hospital, Melbourne Statement

Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents 

AusPATH Position Statement on the Hormonal Management of Adult Transgender and Gender Diverse Individuals

Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa New Zealand

This statement was originally authored by AusPATH and signed on to by the PATHA Executive Committee on 11 March 2020.

PATHA asserts that the provision of gender affirming healthcare for transgender and gender diverse people is a medical necessity and that the lack of equitable access to this healthcare in Aotearoa is causing harm.[1]

PATHA notes that in He Ara Oranga (The Report of the Government Inquiry into Mental Health and Addiction) rainbow populations are recognised as being negatively impacted by “the cumulative effects of discrimination, bullying, prejudice and exclusion,” and that in addition limited access to gender affirming healthcare “has a negative effect on the mental health and wellbeing of people seeking to access them (p72).[2] 

It is the opinion of PATHA that limited and inconsistent access to essential healthcare (such as puberty blockers, fertility preservation, gender affirming hormones, mental health support and gender affirming surgeries including chest reconstruction, hysterectomy and orchiectomy) is itself an aspect of discrimination. 

PATHA recognises the right of transgender and gender diverse people to be able to make informed choices for themselves regarding gender affirming healthcare and that as a minimum, District Health Boards (DHBs) should provide timely access to the following services: puberty blockers, fertility preservation, gender affirming hormones, mental health support and gender affirming surgeries including chest reconstruction, hysterectomy and orchiectomy.

Currently, there are large variations in the provision of gender affirming healthcare services across the 20 DHBs in Aotearoa, New Zealand.[3] PATHA strongly recommends that all DHBs provide clear information about pathways to access gender affirming healthcare services delivered by DHBs and primary health care. PATHA recognises that these healthcare services should involve transgender people, including Māori transgender people, in the development and provision of services.[4] 

PATHA affirms that all health services in New Zealand must provide equitable and accessible gender affirming healthcare services that are evidence based and align with international standards and community feedback. To that end, PATHA recommends that DHBs enable flexible and responsive pathways that are based on informed consent and self-determination.[4]

References

[1] For a list of medication organisations who affirm the medical necessity of gender affirming care see: https://transcendlegal.org/medical-organization-statements. For more information about the health of transgender people in New Zealand and the negative impact of inconsistent access to gender affirming healthcare see Veale J, Byrne J, Tan K, Guy S, Yee A, Nopera T & Bentham R (2019) Counting Ourselves: The health and wellbeing of trans and non-binary people in Aotearoa New Zealand. Transgender Health Research Lab, University of Waikato: Hamilton NZ. https://countingourselves.nz/index.php/community-report/.

[2] See the full report here: https://www.mentalhealth.inquiry.govt.nz/inquiry-report/he-ara-oranga/

[3] For more details on the lack of consistent gender affirming services across New Zealand see: https://patha.nz/news/is-the-provision-of-gender-affirming-health-care-equitable-across-the-district-health-boards-in-aotearoa-new-zealand

[4] Oliphant J, Veale J, Macdonald J, Carroll R, Johnson R, Harte M, Stephenson C, Bullock J. Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato, 2018, p8-9. https://researchcommons.waikato.ac.nz/handle/10289/12160

The Professional Association for Transgender Health Aotearoa (PATHA) committee would like to express collegial and professional support for those working professionally for transgender health in Australia during a time where there are media attacks against the provision of gender-affirming care in that country.

PATHA supports the increasing focus in both countries on informed consent models of gender-affirming care in position statements, standards, and guidelines developed and endorsed by both the Australian Professional Association for Trans Health (AusPATH) and PATHA. These are based on local and international research, and user feedback in this rapidly-developing area of medical care.

PATHA supports AusPATH in their work to improve the quality of and access to gender-affirming care, for those who need it. Leading medical organisations have stated the medical necessity of gender-affirming care, including the American Academy of Pediatrics, American Medical Association, World Medical Association, and the World Professional Association for Transgender Health. Lack of services, withholding care, and so-called reparative therapies are harmful and contravene international human rights standards that apply to both Australia and Aotearoa New Zealand.

There is a very close working relationship between those working professionally for trans health in Australia and Aotearoa New Zealand, whether through formal bodies (such as ANZPATH until recently and various Australasian Colleges) or through online and face-to-face collaborations. This level of collaboration was always envisaged when PATHA was established and we intend for continuing and strengthening collaboration between PATHA and AusPATH.

The inaugural Aotearoa Trans Health Symposium was held in Hamilton in May 2019. The symposium attracted almost 200 delegates, including health professionals and community members. As part of the event, a panel discussion was held to outline what gender affirming health care was being provided by District Health Boards (DHBs) around the country. Panelists involved in the provision of trans health from 13 DHBs spoke about the services available in their DHB.

Prior to the symposium, Dr Jeannie Oliphant conducted a survey of clinicians from around New Zealand. Information was sought from clinicians providing gender affirming healthcare in all of the 20 DHBs in New Zealand with the exception of West Coast DHB for which no appropriate clinician could be identified. No response, unfortunately, could be elicited from the clinicians approached in the Southern DHB but survey responses were received from clinicians representing the 18 remaining DHBs. In some regions, multiple DHBs share services and resources, such as the Auckland region which is made up of three DHBs; Waitemata, Auckland and Counties Manukau and the Wellington region which also has three DHBs; Capital and Coast, Hutt and Wairarapa.

The 2018 Guidelines for Gender Affirming Healthcare for Gender Diverse Children, Young People and Adults in Aotearoa, New Zealand has made a series of recommendations for the provision of gender affirming healthcare in this country.1 One of the key recommendations in the guidelines is that DHBs provide clear information on pathways to access gender affirming healthcare services and that DHBs have clear and timely referral pathways for young people and their whānau to access information and trans health care.

There is good evidence that provision of puberty blockers and gender affirming healthcare for trans young people significantly improves mental health and wellbeing outcomes.2,3 It is well recognised that young people who are trans and gender diverse report high rates of distress, with a national survey of secondary students showing that significant depressive symptoms and suicide attempts in the past 12 months were reported by 41% and 20% of trans students, respectively, compared to 12% and 4% of their non-trans peers.4

Of the 18 DHBs, 9 (50%) have some information available to clinicians regarding referral pathways for gender affirming healthcare in their region but only the three Auckland region DHBs (17%) provide information to the public on the healthcare available and how to access this. The simple act of providing publically-available information would relieve a huge amount of distress and frustration for those people trying to access support for themselves or their whānau.

Another key recommendation in the guidelines is that DHBs provide equitable and accessible gender affirming healthcare services that align with international standards, evidence-based literature and community feedback. While detailed information about the health services were not obtained, it was reassuring that puberty blockers and hormonal therapies could be accessed through all 18 of the DHBs, although some smaller DHBs reported difficulty in providing this care.

The guidelines recommend that health services enable the involvement of trans and gender diverse people, including Māori trans and gender diverse people, in decisions that affect them with regard to the development and provision of services.1 The importance of involving consumers in the development and oversight of clinical services is well understood in the health sector. However only nine DHBs (Auckland region x 3, Waikato, Wellington region x 3 and Canterbury region x 2) have some form of clinical and consumer advisory group providing input into service development. The guidelines also recommend that DHBs provide clear pathways for timely access to gender affirming healthcare, including puberty blockers, hormonal therapies, fertility preservation, voice therapy, counselling and mental health support, and gender affirming surgeries. Not all trans and gender diverse people will want to access all of these interventions, but for some this is immensely important.

Counselling support was available in seven of the DHBs, with nine DHBs only having limited access and two DHBs not providing any counseling support. The table below highlights the postcode lottery nature of obtaining gender affirming healthcare in New Zealand at present.

District Health Board	Fertility (sperm freezing)	Voice therapy	Chest surgery	Hysterectomy	Orchiectomy
Northland	Yes	Yes	No	Yes	Yes
Waitematā Auckland Counties Manukau	Yes Yes Yes	No No Yes	Yes Yes Yes	Yes Yes Yes	Yes Yes Yes
Waikato	Yes	Yes	No	Limited access	Limited access
Lakes	No	No	No	Unclear	Unclear
Bay of Plenty	Yes	Yes	Some access	No	No
Tairāwhiti	No	No	Yes	Yes	Yes
Hawkes Bay	No	No	No	No	No
Taranaki	Yes	Yes	No	No	No
Whanganui	Yes	No	No	Unclear	Unclear
MidCentral	Yes	No	No	Yes	Unclear
Capital & Coast Hutt Wairarapa	Yes Yes Yes	Yes Yes Yes	No No No	Yes Yes Yes	Yes Yes Yes
Nelson/Marlborough	No	Yes	No	Limited access	No
West Coast	Not contacted
Canterbury/Sth Canterbury	Yes	Yes	In progress	In progress	In progress
Southern	No response

It is clear from the above table that there is a need for a conversation between the Ministry of Health and DHBs regarding the minimum standard of gender affirming healthcare that should be provided. This would be beneficial for trans and gender diverse people in all regions of New Zealand. In addition, there are some very simple and low-cost initiatives that would make a huge difference for trans and gender diverse people and their whānau around New Zealand, such as DHBs providing publicly-available information on the pathways to access services.

References:

1.      Oliphant J, Veale J, Macdonald J, Carroll R, Johnson R, Harte M, Stephenson C, Bullock J. Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato, 2018.

2.      de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134:696- 704.

3.      Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental health of transgender children who are supported in their identities. Pediatrics. 2016;137(3):e20153223.

4.      Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, et al. The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth ’12). J Adolesc Health 2014 Jul;55:93-99.

The Professional Association for Transgender Health (PATHA) welcomes the news this week that Statistics New Zealand will move beyond a binary (male or female only) gender question in the Household Economic Survey. The organisation also supports Statistics New Zealand’s decision to include a question about sex assigned at birth, to be able to count the transgender population.

“This is long overdue”, said Dr Jaimie Veale, PATHA President and Senior Lecturer in Psychology at the University of Waikato. “Transgender people have been telling Statistics New Zealand for a long time that they need to see themselves represented in our population data. These questions reflect international standards for best practice, and the data we collect using these questions will be crucial for us to understand the size of the transgender population, demand for services, as well as the health social inequities that transgender people face. Accurate data is necessary for us to inform policy and law changes”, she said.

“My understanding is Stats NZ is still working out what might be the best and most effective ways of collecting information about rainbow populations, including population measures for intersex and transgender people, and we welcome their progress towards robust data about and for our communities”, said Joey Macdonald, PATHA Secretary.

PATHA was formed at a meeting of over 70 health professionals and people working to promote transgender people’s health at the Aotearoa New Zealand Trans Health Symposium on May 4th 2019, to provide networking, education, and advocacy for this group.

On the 9th May 2019, the New Zealand Companies Office accepted our application to register the Professional Association for Transgender Health Aotearoa Incorporated.

The societies number is 2735252.

As per the rules of the society, the first AGM of the organisation will be held between the 1st April and 30th June 2020. In the interim, the inaugural Executive Committee, selected at the 4th May 2019 meeting, will govern the organisation. The inaugural Executive Committee includes:

• Dr Jaimie Veale (President)

• Dr Jeannie Oliphant (Vice President)

• Joey Macdonald (Secretary)

• Duncan Matthews (Treasurer)

• Jesse Porter

• Dr Rachel Johnson

• Jemima Bullock

CSPdoc_3199901_3.pdf

Delegates at the country’s first ever Trans Health Symposium voted unanimously to create the Professional Association for Transgender Health Aotearoa.

The inaugural President of PATHA is Dr Jaimie Veale, who is a Senior Lecturer in Psychology at the University of Waikato.

Over 200 hundred health professionals and members of transgender communities attended the event at the University of Waikato. The level of interest in the Symposium went far beyond organisers’ expectations, requiring them to move it to a larger venue in the weeks before registrations closed.

The event included overviews of two large University of Waikato research projects: the Honour Project Aotearoa and the Counting Ourselves survey. Other presentations focused on ways to address barriers to gender affirming care and mental health support around the Aotearoa, including through Māori and Pasifika community-led health initiatives (FINE and Gender Minorities Aotearoa), and by working with children, youth and their whānau.

Invited speakers included Dr Ruth Pearce from the UK, who presented research on pregnancy among transgender people and Dr Rita Yang who discussed surgical pathways in New Zealand.

Publication of a new transgender health guideline for New Zealand was celebrated. “This guideline provides clear recommendations to District Health Boards about the gender affirming healthcare services that should be provided locally for transgender people”, said lead author, Dr Jeannie Oliphant.

A panel discussion involving clinicians representing 13 different District Health Boards  revealed a concerning lack of equity in the healthcare services available across New Zealand. “Currently only the Auckland DHBs provide publicly available information regarding local service provision”, noted Dr Oliphant, “there is an urgent need for other DHBs to provide clear pathways for consumers wanting to access gender affirming healthcare regionally”.

Over 70 delegates voting to establish the new Professional Association for Transgender Health Aotearoa (PATHA). “This organisation was formed to provide education, networking, and collaboration for everyone working professionally to advance the health of transgender people in Aotearoa”, said inaugural PATHA President, Dr Jaimie Veale.