Discovering Davao City
“He likes you,” Arvin Y. whispered, pointing with his lips to a guy not far from us.
“No, he doesn’t,” I whisper back, eyeing the guy who was, indeed, looking. “He’s just curious or something.”
And then the guy smiled, seeing me looking at him.
“He does like you; he does!” Arvin Y. said again, this time no longer whispering, as he added: “Go talk to him or something!”
I did – and without beating around the bush, the day (and the night, actually) ended with the guy (“Clint’s the name,” he said, “and anything’s the game”) hanging with us. A definite plus for Arvin who, because I wouldn’t, ended up sleeping with him, “enjoying for real the Davaoeño’s brand of hospitality,” Arvin Y. said.
This, normally, wouldn’t merit special attention, but we were at this small Internet café right beside Dunkin Donuts, not too far from the entrance of Gaisano Center along Jacinto Street in Davao City – a relatively busy heterosexual place; and Clint wasn’t a boy for-hire, too, but a “straight-acting, straight-looking gay guy just looking for (others with the same persuasion) to hang out with,” he said.
And while Arvin Y., in his 30s, said Clint is a rarity, Clint, in his early 20s, said he isn’t. “There’s many of us, actually. ‘Out’ out there, looking for fun,” he said.
“Then I may have been hiding all these times,” Arvin Y. said, “and I missed out the changing of Davao City.”
“Perhaps you were,” Clint said. “Perhaps you were…”
And indeed, perhaps we – not just Arvin Y. – missed out on the changing of Davao City, which has developed to be the rightful Queen City of the Real South of the Philippines (not Cebu City, which is in Central Philippines, even if it is south of Metro Manila, thus the moniker that is in every way representative of how imperialist Metro Manila is).
DAKBAYAN SA DABAW
Occupying 2,444 square kilometers of land, the city of Davao on the Mindanao group of islands in southern Philippines is the largest city in the country (and once, of the whole world). Ranked by Asiaweek Magazine among the 20 Most Livable Cities in Asia, it is one of only three recognized Metro areas in the Philippines, the others being Metro Manila and Metro Cebu, which Metro Davao outranked as the number one most livable city in the country. Also ranked as the 10th Asian City of the Future by the Foreign Direct Investment Magazine, Metro Davao is composed of the cities Davao, Tagum, Panabo, Island Garden City of Samal, and Digos, and the municipalities of Carmen and Sta. Cruz.
The bigger question is why go to Davao City, if at all.
Well, for one, there are its attractions. Davao is home to “kings and queens of nature,” e.g. Waling-Waling, the Queen of Philippine Orchids; Philippine Eagle, King of Philippine Skies; Durian, King of Exotic Fruits; and Mt. Apo, King of Philippine Mountains. “Try being here in February, when we annually celebrate our foundation day; or in August, when we celebrate the annual Kadayawan Festival, the big fiesta to celebrate while giving thanks to God for the bounties that the province continues to get,” Arvin Y. said.
Among the major attractions include (to cover the kings and queens), Mt. Apo, which, at 10,311 feet is the tallest mountain in the Philippines, ideal for mountaineers or simply naturalist adventurers; the Philippine Eagle Natural Center, home to almost 20 Philippine Eagles, and where they are bred in captivity to grow their number (there are buses from Aldevinco Mall to take visitors to the center); and various orchid and fruit plantations, e.g. Waling-Waling Orchid (Vanda Sanderiana), Yuhico Orchid Gardens in Greenhils, Derling Worldwide Orchid Corporations in Dumoy, Malagos Gardens Resort in Calinan, and the Puentespina Orchid Gardens along Cabaguio Avenue.
Then there are the San Pedro Cathedral, whose structure was laid in 1847, making it one of the oldest churches in Mindanao, honoring St. Peter, the city’s patron saint; and Dabaw Museum, located inside the Davao Insular Village, showcasing the province’s heritage.
Secondly, as an emerging business hub, Davao should be in every businessman’s must-visit lists in the Philippines – it sure has been for the likes of the Ayalas and Gokongweis (among Metro Manila’s biggest business families), not to mention that the Sys (of SM) already made a home there. In fact, particularly for ICT businesses, a recently concluded XMG Global Offshoring Leadership Study reveals that Davao will be a viable alternative ICT site three years from now, considering that competition in Cebu City is nearing saturation as the talent ramp-up continues. Among others, the study highlights the population of Davao City as considerably higher than other Tier-2 offshoring cities globally. In the Philippine context, Davao City’s population is 71% higher than Cebu City, 499% larger than Olongapo-Subic City, 333% higher than Angeles-Clark City, and 340% larger than Baguio City. The city’s estimated workforce is twice of Cebu, nine times of Subic, seven times of Clark, and six times of Baguio. This has not even taken to account the manpower pool at the nearby cities and provinces of Davao. Also according to the study, Davao has various educational institutions annually yielding a higher number of IT and BPO qualified graduates than Subic, Clark and Baguio by 689%, 278% and 40%, respectively.
Thirdly, there are the traditional attractions, e.g Samal Island in Davao del Norte, which has white sanded beaches as beauteous (well, so-so) as Bohol’s, or at least of Puerto Galera in Mindoro Oriental, less the number of people flocking there; and Talomo Beach, which has sunken World war II warships, just 200 meters from the shore.
And then, of course, there are the boys.
BOYS, BOYS, BOYS…
There was a time when cruising in Davao was largely AYOR (at your own risk), with open secret cruising areas including Victoria Plaza Mall (J.P. Laurel, Bajada), Gaisano Mall of Davao (J.P. Laurel Avenue), Gaisano South City Mall (Illustre St.), the Boulevard Strip, Ilustre Avenue, and the Lawaan Theater. Cruising-wise, though, the other malls may actually be included – e.g. Aldevinco Shopping Center, Chimes Mall, City Triangle, DAMOSA Market Basket, Davao Central Warehouse Club, Felcris Department Stores, NCCC Mall of Davao (McArthur Highway corner MA-A), NCCC Mall (Main), and SM City Davao (Quimpo Boulevard). “As is typical in the Philippines, you can basically pick up any man anywhere,” Arvin Y. said, commented by Clint with: “The difference is, here, you pick up men who wouldn’t expect to be paid – they’re the same as you, looking to have fun.”
Of course both admit that “care should be taken.” “This isn’t a city that’s one big buffet of men, after all,” Arvin Y. said. “Just that progress as far as gay (or bisexual, as straight-acting, straight-looking gay Davaoeño’s self-identify) expression is concerned.” Generally speaking, similar to other places all over the Philippines, male Davaoeños can be “persuaded” to have same-sex sexual relations, though this often involves payment of some kind (by the out homosexual to the self-identified heterosexual), so care really is needed, especially for those not into this scene.
Fortunately, there already are gay-specific venues, e.g. Tahun Bar and Jefz Café, though, generally, “most every place is just gay friendly,” e.g. Philosophy Spa (near Apo View Hotel), Bahia Spa, Holiday Gym and Spa (both in Torres), and Firm Spa, where the expression of gay identity is more akin to Western expressions, i.e. gay to gay (or, locally, bi to bi, even if the use of term is questionable), so that no monetary exchanges are needed.
Arvin Y. promised to catch up with Clint a few days later – I’d already be back in Makati City in Metro Manila then, so I would be out of the picture. But “do come back,” he said, “having seen how Davao has blossomed into the city it is now.”
And perhaps I will – in this city that’s the real queen of the south.
HOW TO GET THERE
Philippine Airlines, Cebu Pacific, and Air Philippines flights are available daily from Metro Manila, with the approximate flying time of one hour and 35 minutes; though there are also flights from Cebu City, Cagayan de oro City, and Zamboanga City, taking approximately 55 minutes.
There are also international flights from Hong Kong and Palau, among others.
Davao City is, however, accessible through the Pan Philippine Highway from Metro Manila; as well as by ship/ferry, with major passenger ships docking in the city to and from other ports around the country.
Three crucial steps for a thriving business
If your business is surviving, but not thriving, take these three crucial steps to get the most out of your company.
If you’re a business owner, you may think that simply surviving the COVID-19 crisis, and the financial impacts it has had, is enough. Think again.
If your business is surviving, but not thriving, take these three crucial steps to get the most out of your company.
Provide excellent customer service
While you likely set out to solve a problem that a customer was facing or provide a product that someone was in search of, it may have been lost somewhere along the road. It’s time to remember that. So, instead of just offering middling service at best, make sure your customer service is optimal.
Go the extra mile when you can; if a customer has a question that you don’t have the direct answer to, point them to an expert that might. Is your customer asking for an upgrade, a product, or something that you don’t offer yet but might? Don’t forget to reach out directly to them as soon as you do have it available, whether that means salted chocolate chip cookies if you own a bakery, or a new way to track receipts if you offer a SaaS solution to finances.
Offer the type of customer service that you want when you frequent a business. Each customer you interact with has their own unique customer experience, so remember that when providing them your solution or product.
Do not cut prices even during a crisis
Don’t underestimate your company’s worth. Many start-up businesses under value their product, solution, or service. When this happens, they don’t charge enough. And do you know what happens? People don’t think they’re getting a great deal when they work with you. They just expect that you are providing them the price that you see necessary to charge them. Investigate your pricing strategy and make sure it aligns with your product.
There is evidence that shows when two identical services are offered at different prices, people will often go with the higher price. Why? They simply assume it’s better. If your product is good, do not cut prices, offer coupons, or boast that you’re the cheapest in the area. Not only are you attracting the wrong customers by doing this, but you’re also likely to lose customers when you raise prices that weer previously unsustainable.
Stop overpromising and under-delivering
If a car mechanic tells you that they can fix your car by that evening, you expect it to be finished by the end of the day, right? When you go to pick it up, only to find that it actually won’t be done for three more days, you’re probably more than a little miffed. What would happen though if the mechanic initially told you they’d let you know a timeframe, but expected it to be finished in about three days, and actually had it done in two? You’d think, “Wow, that was fast!”
Instead of overpromising and under-delivering, be honest with your customers. If you are planning to have an update for your app by the end of the month, be realistic. Don’t promise them more than you can actually deliver on in the allotted amount of time, and your customers will learn to trust you.
Growing your business takes work
Growing a business isn’t all rainbows and cupcakes. It takes years of hard work and dedication, but if you want your company to thrive, not just survive, it’s time to kick it up a notch.
Surviving COVID-19: 5 Strategies hotels should implement ASAP
Even when the pandemic ends, the practice of social distancing, fear of large crowds, and quarantining may continue to linger for months or even years. This means that business owners need to keep up with this drastic shift in consumer behavior.
The coronavirus outbreak that started in Wuhan, China has spread like wildfire throughout the world. With the world on hold, global travel has been put to a stop, causing a huge blow to the hospitality industry, particularly hotels. Travel bans mean less tourists, and less tourists mean lesser hotel guests.
Even when it ends, the practice of social distancing, fear of large crowds, and quarantining may continue to linger for months or even years. This means that business owners need to keep up with this drastic shift in consumer behavior. Keep in mind that many of your potential guests may develop a lasting stigma against crowded places, including hotel lobbies, busy restaurants, schools, offices, and more.
According to the STR and Tourism Economics, the hotel industry is projected to suffer a 50.6% decline in revenue per available room (RevPAR) in 2020 due to COVID-19. In another research from CBRE, since the outbreak began in January 2020, it will take approximately 6-10 months for hotel demand to increase and 12 to 16 months for average daily rate (ADR) and RevPAR to gain footing.
With that said, hoteliers need to take proactive measures to prepare for recovery once this dies down. Here are five strategies hotels should implement to survive the effects of COVID-19.
1. Inform Your Customers of Critical COVID-19 Information
Be sure your customers know of the changes in hotel operations due to COVID-19. Inform them whether your hotel is open, as well as cancellation policies for reservations made before the outbreak. Also, don’t forget to let them know that you have a prevention plan in place.
You can connect with your customers via website, social media, emails, and local listings. Your website and social media platforms should contain the following necessary information in which to put your customers at ease:
- Cancellation Policy – the best route is to waive cancellation fees or allow guests to rebook.
- Address Frequently Asked Questions About COVID-19
- Comprehensive Prevention Plan
- How Your Hotel is Helping the Community
- Contact Information
2. Recognize the Efforts of Front liners
Doctors, nurses, hospital staff, security guards, cashiers, garbage collectors, medical technicians – these are just some of the people who work in the frontlines to fight the war against COVID-19. Recognizing their efforts is the least we can do to repay their service.
For hoteliers, you might consider offering discounted rates for front-liners and first responders. Some hotels are now offering complimentary rooms for healthcare professionals with the help of the American Hotel & Lodging Association’s Hospitality for Hope.
If you want to give a little something to the first responders, you can donate food from your restaurant to local hospitals, offer more affordable rates, offer complimentary rooms, or donate to relief and recovery funds.
3. Connect with Existing and Potential Guests on Social Media
Since everyone is quarantining, the use of social media has drastically increased over the past few weeks. It’s a great opportunity for business owners, especially hoteliers, to stay connected with your guests and engage with them through posting travel and destination content.
You can ask previous hotel guests to share a picture from their past stay, share photos of your hotels, post pictures of your area, share virtual tours of tourist spots, or ask your clients to share their favorite touristy activity in your city.
If your hotel has a gym, you can post at-home workout videos. You can create videos or instructional guides to keep your guests fit while they’re confined to their home. These are just some of the ways to stay connected amid a global pandemic.
4. Try Upselling
As travel and dine-in demands are being put on hold, every hotelier’s strategy should include looking for strategies to build additional revenue. For it to be effective, you need to figure out what your customers need and want.
You can encourage guests to book in advance by offering them premium rooms at a discount. You can also offer longer stays for a lower price. For example, book a four-night stay and get the fifth at 50% off.
This inspires business travelers to extend their stay and encourages potential guests to enjoy a relaxing stay post-pandemic. If your hotel has a dining area or a wellness spa, you can maximize your revenue by offering gift cards. For your restaurant, you can offer delivery or pickup orders.
5. Personalize Your Marketing Campaigns
Pandemic or no pandemic, personalizing your marketing campaigns is vital to your success. By doing this, your customers will feel important. Whether you want to reach out to business travelers or encourage advance bookings, it always helps to send personalized messages to potential guests.
With so much on your plate, it can be tempting to generate an automated marketing message. However, you can use this time to get to know your audience and connect with them. You can also try using campaign management software to schedule posts in advance, which will keep your messages aligned.
Combat the Effects of COVID-19 with These Hotel Financing Options
The effects of COVID-19 in the hotel industry are inevitable. However, as the saying goes: “Those who fail to plan – plan to fail.”
If you need financial assistance, there are different hotel financing options you can choose from. Taking out a loan may seem counterintuitive, but fortunately there are lending companies that offer flexible repayment terms.
Know thy history; revisit the first 10 years of San Francisco’s Pride
Even Pride gatherings are getting confused nowadays – e.g. Is it still to protest, or (even if the organizers claim it’s a “protest”) is it really just one big party? A revisit to Pride’s history – at least of San Francisco’s, in the US – has opened to help every-all see how everything was in the early days.
Even Pride gatherings are getting confused nowadays – e.g. Is it still to protest, or (even if the organizers claim it’s a “protest”) is it really just one big party? Should events highlight the not-that-pretty/sexy yet still ongoing struggles, or just focus on the glamour (and while at it, earn organizers big bucks)? And part of this confusion stems from the lack of awareness, if not appreciation of Pride’s history.
A revisit to Pride’s history – at least of San Francisco’s, in the US – has opened to help every-all see how everything was in the early days.
Organized by the GLBT Historical Society, with the support of San Francisco Pride, “Labor of Love: The Birth of San Francisco Pride, 1970–1980” showcases how San Francisco’s LGBTQIA community in the 1970s forged the annual celebration that would come to be known as the San Francisco Lesbian, Gay, Bisexual and Transgender Pride Parade.
On June 27, 1970, a small group marched down Polk Street, and the following day staged a “gay-in” picnic in Golden Gate Park. Over the course of the decade, Pride became an annual San Francisco event, growing by leaps and bounds. Initially referred to as Christopher Street West — to commemorate the 1969 Stonewall Riot on that street in New York City — and then as Gay Freedom Day, Pride drew some 250,000 participants and spectators in 1980.
“Labor of Love” revisits the first 10 years of San Francisco Pride using historic photographs, ephemera, artifacts, and film and sound recordings from the archives of the GLBT Historical Society and from community members. The exhibition explores the goals, the controversies, the hard work, the desires and the sometimes-competing spirits of struggle and celebration that laid the foundation for one of the city’s best-known public festivals.
The exhibition is co-curated by Gerard Koskovich, a public historian and rare book dealer; Don Romesburg, professor of gender and women’s studies at Sonoma State University; and Amy Sueyoshi, dean of the College of Ethnic Studies at San Francisco State University. They emphasize that Pride has traditionally deployed both frivolity and protest to promote a positive cultural shift in how society views LGBTQ people.
The exhibition is organized around four themes.
“Why Pride?” considers how organizers and community members explained the purpose of the annual gathering.
“The Work of Pride” explores the ever-increasing commitment to planning, fundraising, volunteer support and governance that the event required.
“Pride Fights” grapples with the debates over what Pride should be, who should be included, who should make the decisions and how they should be made.
Finally, “Big Gay Family” highlights how the creation of San Francisco Pride brought diverse people into a collective, yet often contested kinship.
The interactive final section of the show, “Pride: From Past to Future,” invites visitors to reflect on the history, then look ahead by submitting their responses to two questions: “How will the future of Pride be shaped? How should it be shaped?” The answers will be posted in the online gallery to spark an ongoing dialog about the heritage of Pride.
“Labor of Love” will also be installed as a physical exhibition at the GLBT Historical Society Museum at 4127 18th Street in San Francisco’s Castro district at a future date.
For more information, visit the GLBT Historical Society website at www.glbthistory.org.
Skin pigmentations: Types and treatment options
You should seek medical advice from experts to manage hyperpigmentation conditions. It is advisable to seek skin protective measures for a healthy and happy lifestyle.
Skin pigmentation is a health disorder that affects the normal appearance of your skin. It is easily noticeable because of the change in color in the area with the disorder. The melanin gives your skin its color. Hyperpigmentation occurs when the color pigment cells of the melanin get damaged or when the cells are unhealthy.
In this article, we take a quick review of some of the hyperpigmentation conditions, treatment options, among other related issues.
Types of skin pigmentation
Some skin pigmentation like birthmarks act as beauty spots for some people, while for others it affects their self-esteem or poses health risks.
Birthmarks are abnormal skin colorations that appear at birth or a few days after birth. Most of the birthmarks are normal while others are cancerous and may pose serious health risks for individuals.
Nevus of Ota
They are gray or blue discolorations on the skin which appear on the face or in the eyes. They result from excessive production of melanin on the skin causing discoloration. Many people with the disorder are prone to conditions of skin cancer such as melanoma cancer of the eye, cancer of the central nervous system, and others. They may also cause glaucoma on the individuals.
You can use prescribed bleaching agents for this kind of discoloration, such as laser, hydroquinone, and others.
They are birthmarks that appear as growths on the face, arms, trunk, and legs. They are a bunch of tiny blood vessels concentrated on one spot. Some hemangiomas are easily visible on the skin, while others appear bluish since they are deep in the body. The level of severity of this condition depends on if it reduces as your child grows up. Treatment is recommendable to avoid consequential health issues such as bleeding, ulcers, and others.
Use of corticosteroid medication, laser treatment, surgery, use of topical or oral beta-blocker medications. You should first consult an expert on the treatment required to avoid various serious side effects of these treatment methods.
Other pigmented birthmarks include Macular stains, Port-wine stains, and others.
Skin pigmentation disorders
Albinism results from a lack of melanin in the skin, hair, or eyes. The condition is inheritable because of the presence of a gene that prevents the production of the pigment melanin.
The condition has no cure. The people with the condition should use sunscreen to prevent them from skin cancer. A visit to an ophthalmologist is recommendable to avoid eye problems.
Vitiligo is a condition caused by pigment loss. The body’s immune system attacks color pigment cells which cause white patches on the skin. It can cause other health issues such as anemia, diabetes, and others.
There is no cure, but you can get treatments such as the use of topical steroid preparations, topical immunomodulators, excimer laser, and others.
Other pigmentation disorders include; Post-inflammatory hyperpigmentation, Ashy dermatosis, Melasma, Lentigo Solaris, among others.
You should seek medical advice from experts to manage hyperpigmentation conditions. It is advisable to seek skin protective measures for a healthy and happy lifestyle. Hyperpigmentation may bring about other health issues, hence it is crucial to ensure that your condition gets checked by a health expert.
Covid-19 affects adolescent and young adults sexual and reproductive health
LGBTQ youth have also been impacted. And for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.
Social distancing and limited access to contraceptive and abortion care during the COVID-19 pandemic is affecting the sexual and reproductive health of adolescents and young adults, according to a new study by researchers at Columbia University Mailman School of Public Health and Rutgers University. The researchers address how these challenges, as well as peer and romantic relationships, are being navigated.
The finding are published in the journal Perspectives on Sexual and Reproductive Health.
Huge changes for adolescents and young adults, include school closures, potentially much more time with family, the interruption of the normal trajectory toward increased independence and, for many, very limited or no physical proximity to sexual and romantic partners.
Even though the pandemic may lead to less opportunities for sex for some young people, disruptions in access to contraception and abortion can be extremely problematic for adolescents and young adults who are still able to be physically close to their partners during the pandemic, note the authors. “The good news is that some services, including obtaining many forms of contraception and receiving testing and treatment for sexually transmitted diseases can be handled through telemedicine,” said Leslie Kantor, a professor and chair of the Rutgers Department of Urban Global Public Health. “If telemedicine remains as widely available as it has been during the coronavirus pandemic, access to sexual and reproductive health care may actually improve for young people.” However, Kantor and colleagues say that lack of privacy and confidentiality, which many adolescents and young adults are experiencing while living at home with family, can also hinder the ability to get necessary sexual and reproductive healthcare.
In terms of testing for sexually transmitted infections or seeking abortion care, there is not a lot of data specifically on young people. But many states have tried to restrict abortion access by arguing it is not an essential service despite the fact that abortion clearly is essential and needs to be timely. There also have been very concerning declines in vaccinations for all children older than age 2 and the use of the HPV vaccine, which prevents cancer-causing infections and pre-cancers, has plummeted.
LGBTQ youth have also been impacted, although fortunately, many LGBTQ centers quickly moved support groups and other services online. And for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.
While social disruption resulting from the pandemic affects young adults’ sense of health and well-being, one positive aspect is that young adults are digital natives familiar with online platforms and social media. “Young people are supposed to be gaining independence at this time in life, so for those who have had to return home after a period of being away, maintaining relationships with friends and romantic partners at a distance may be particularly challenging. Our view that their constant digital connection was negative is now a positive for them at this time,” said David Bell, MD, MPH, Columbia Mailman School of Public Health associate professor of Population and Family Health and Pediatrics.
Study finds gender-affirming health care good on paper; still lacking in practice
Fact: Many trans women, especially those in rural areas, couldn’t find a doctor trained to provide those hormones, and the doctors they could access did not know where to refer them for more specialized care.
Good in reports; shitty in actual practice.
This is the state of gender-affirming policies and health care for transgender women, with many of pro-LGBTQIA polices actually still not fully realized in practice, according to a study from Oregon State University found.
In the US, the Supreme Court recently barred employment discrimination against LGBTQIA people, which brings national law more in line with laws that have been in place in various states for several years.
Oregon, for instance, has the Oregon Equality Act of 2008 that protects trans people against employment and housing discrimination, while the expansion of Medicaid in 2015 expanded health coverage to include gender-affirming care like hormone-replacement therapy and transition surgery.
However – and this is worth stressing – those legal protections are not enough to address social determinants of health such as financial status and access to housing, or the everyday discrimination still felt by many trans women in Oregon, said Jonathan Garcia, a researcher ins the OSU College of Public Health and Human Sciences said. The cumulative effect of those subtler forms of discrimination takes a significant toll on trans women.
“In spite of ranking so highly in terms of Oregon’s support for gender-affirming care, the impact of social discrimination is so great that it challenges policy implementation and the lived experience of people,” Garcia said. “This is how discrimination sort of gets in between the cracks – it plays out in more complicated and indirect ways so that you can’t really weed it out.”
Garcia’s study, published in the Transgender Health journal, gathered detailed interviews with 25 trans women in Oregon, ages 18 to 39. Of those 25, six had been homeless at some point in the 12 months prior and only 20% had full-time employment, though all had some form of health insurance.
According to the study’s findings, one of the biggest challenges facing trans women is navigating the health care system. At least in Oregon, though the law requires insurance to cover hormone-replacement therapy, many trans women, especially those in rural areas, couldn’t find a doctor trained to provide those hormones, and the doctors they could access did not know where to refer them for more specialized care.
In other cases, trans women had to undergo a psychological evaluation to obtain a diagnosis of gender dysphoria – the distress people feel when the sex they’re assigned at birth doesn’t match the gender with which they identify – before they could begin to access hormone replacement therapy. This route is much more time-consuming and cost-prohibitive than the “informed consent model,” wherein trans patients can attest that they understand the risks and benefits of pursuing gender-affirming medical treatment, without first having to prove psychological distress. For some study participants, the idea of gender dysphoria made them feel like they had a medical problem and invalidated their lived experience.
“All of that is really, really confusing,” Garcia said. “It requires them to become experts in their rights, in the law, in the availability of these services and where they are offered.”
Most trans women who were able to navigate that system credit their success to their social support network of other trans people. In addition to this informal network, Garcia said, the system needs to have trained and properly compensated health workers in place who can act as navigators, and they need to understand not just health care but the intersections with housing and the legal system that affect people’s access to care.
“We need help with navigating these systems and establishing trust, so that people are actually able to claim and enjoy the rights that they have, so that the rights don’t remain on paper,” he said.
The study was limited in that 21 of 25 participants were white women. Despite numerous efforts to recruit Black and Latinx trans women, Garcia said, they were unable to reach them through participant referrals and community center contacts. He attributed this to their extreme marginalization in queer spaces in Oregon.
“But we can tell that whatever this set of women is experiencing, I expect the experience of trans women of color to be far more challenging,” Garcia said. “Specifically because of structural racism and disenfranchisement from queer networks, which were a critical resource for the women who were able to navigate these systems.”
Garcia’s co-author was Richard Crosby at the University of Kentucky.
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No less human
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