The 2021 PATHA Annual General Meeting will be held via online video call from 1-3pm on Saturday the 19th of June, 2021. At this meeting, we will be electing members to the positions of President, Vice-President, Secretary and up to four general Executive Committee members. We are seeking nominations for these positions. All of these positions are voluntary and unpaid.

Background

PATHA is an interdisciplinary professional organisation that works to promote the health, wellbeing, and rights of transgender people. We are a group of people working professionally on transgender health in clinical, academic, community, legal, and other settings. We envision an Aotearoa New Zealand where all transgender people have full access to appropriate healthcare, and that all healthcare providers have access to information and resources which enable them to provide appropriate healthcare. You can read PATHA’s full vision and purposes here.

At present, PATHA is run entirely by volunteers and governed by an Executive Committee. Some of PATHA’s work is undertaken by committees - the Policy and Advocacy Committee and Education Committee - that have active participation by non-Executive Committee members. 

The PATHA Executive Committee has a friendly and collaborative atmosphere and is made up of a diverse group of transgender and cisgender people with a shared passion for transgender health. We have a range of professional and volunteer affiliations and experience working in relevant fields. We aim to have an Executive Committee that is ethnically, geographically, and professionally diverse. PATHA strives to uphold the principles of the Treaty of Waitangi. 

Responsibilities

PATHA Executive Committee members are expected to:

• participate in Executive Committee meetings;
• actively contribute to working towards of PATHA’s vision and purposes;
• complete action items between meetings; and
• be able to commit to an average of two to three hours of work per week.

During meetings, each Executive Committee member is expected to:

• be prepared and have read background information sent to Executive Committee members about the issues being discussed;
• actively participate in the meeting;
• interact with fellow Executive Committee members in a respectful and constructive manner; and
• take responsibility for completing specific action items.

In addition, the President, Vice-President and Secretary have the following responsibilities:

President
The President is responsible for: overseeing PATHA’s operation and ensuring its Rules are followed, convening and chairing meetings including the Annual General Meeting, and providing a report on PATHA’s operations at each Annual General Meeting.

Vice-President
The Vice-President is responsible for: assisting the President with their responsibilities, including stepping into the role of the President and chairing meetings in the event of the President being absent or unable to fulfil their duties.

Secretary
The Secretary is responsible for: recording the minutes of meetings; overseeing the register of members; maintaining PATHA’s records and documents; and receiving and replying to correspondence.

Commitment

The PATHA Executive Committee holds monthly meetings via videoconference. These meetings typically last 90 minutes and are held on weekday evenings. Executive Committee members are expected to attend meetings regularly. Executive Committee members are also expected to actively contribute to the achievement of PATHA’s vision and purposes by completing specific activities in their own time.

Eligibility

You must be a PATHA member to apply for these positions.

We encourage people with the following skills and experiences to stand for these positions:

• Have a demonstrated commitment to, and knowledge of, transgender health and healthcare
• Have knowledge of Māori and Pasifika models of transgender health
• Possess a collaborative, collegial working style
• Have strong communication skills
• Be well connected with with transgender communities and/or health providers working with transgender communities
• Have a strong understanding of the breadth of factors that influence transgender people’s health and well-being, and of diversity within transgender communities

A range of skills are necessary to ensure a smoothly functioning Executive Committee. These include: legal skills, accounting / finance skills, fundraising, media relations and communications strategy, and knowledge of regulations governing incorporated societies.

PATHA’s rules require that the mix of Officers and Executive Committee members should demonstrate a partnership between cisgender and transgender people, and between Māori and non-Māori, working professionally on transgender health, whether in clinical, academic, community, legal or other settings. We aim to have an Executive Committee that is ethnically, geographically, and professionally diverse. As part of our desire for geographical diversity, we are particularly interested in nominations from people living in the South Island, and as part of our desire for professional diversity, we are particularly interested in nominations from people with primary care experience.

Term

Executive Committee term lengths are two years. 

How to Apply

To nominate yourself for one or more of these positions, please fill out the online form here by 5pm, Monday June 14th.

Below is the briefing that PATHA sent to the incoming (2020) Minister of Health on the topic of transgender health. We have made this public as they might be useful for anybody advocating to advance transgender people's health.

We thank the PATHA Policy and Advocacy Committee their expertise and work that they did to create these.

You can also use these links to download the cover letter and briefing document.

We are pleased to announce that this symposium will be held at Tautoru TSB Space, Tūranga Central Library, Ōtautahi Christchurch on 25-26 September 2021. Click here for more information about this symposium.

A new article about providing gender affirming healthcare was published in Rata Aotearoa / New Zealand Doctor in August 2020. It has an accompanying elearning activity with CME credits.

We would like to thank Dr Cathy Stephenson, Alex Ker, and Dr Rachel Johnson for this work.

You can read the article and find out more about the elearning activity here.

WPATH, EPATH, USPATH, AsiaPATH, CPATH, AusPATH, and PATHA Response to Bell v. Tavistock Judgment

[Update 5/4/2021: This statement has been developed into a paper that was published in the International Journal of Transgender Health. It is available on the WPATH website here. The authors note “the current paper is an extended version of that statement including the scientific evidence and references which the necessary brevity of such policy statements precludes”.]

[Update 1/1/2021: AusPATH have also released their own statement about this ruling which is available here.]

Statement Regarding Medical Affirming Treatment, Including Puberty Blockers for Transgender Adolescents

The Boards of Directors of the World Professional Association for Transgender Health (WPATH), the European Association for Transgender Health (EPATH), the United States Professional Association for Transgender health (USPATH), the Asia Professional Association for Transgender Health (AsiaPATH), the Canadian Association for Transgender Health (CPATH), the Australian Professional Association for Trans Health (AusPATH), and the Professional Association for Transgender Health Aotearoa (PATHA) all strongly disagree with the recent judgement of the London High Court in Bell v. Tavistock. We believe this decision will result in significant harm to the affected children and their families. We oppose this ruling and urge that this ruling be appealed and overturned.

Click here for the full statement.

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.