Back in April, we reached out to Dr. Meredithe McNamara to talk about the Day of Silence, gender affirming care, and how we can continue the conversation. Here are her responses below:
What is the Day of Silence and why is it important?
The Day of Silence is an annual observance on the second Friday in April. This is a student-led movement that is internationally recognized as a day to raise awareness about harassment and discrimination faced by lesbian, gay, bisexual, transgender and queer people, particularly adolescents and young adults. Those who participate take a vow of silence to symbolize the silencing effect of discrimination on LGBTQ+ individuals and their allies. The Day of Silence encourages students to take action to promote inclusivity, understanding, and acceptance.
How does this discrimination connect to global health?
The past few years, an escalating series of legislative attacks have been launched against LGBTQ people in the United States that are rooted in disinformation about transgender identity and gender-affirming care. US evangelical leaders who push an anti-transgender agenda at home have long exported this hatred to other parts of the world. Disinformation has been equally potent in targeting LGBTQ people abroad.
There is a direct relationship between countries that were once under colonial rule and those that criminalize LGBTQ identity. Of the 64 nations that currently issue harsh punishments for diverse expressions of gender and sexuality, 30 are in Africa. Nations such as Jamaica, Uganda, Kenya, Nigeria, and others were brutally colonized during the 1800s and subject to a host of Victorian-era laws targeting LGBTQ people. Prior to colonization, diversity in sexual orientation and gender identity were normal aspects of life in indigenous cultures throughout the African continent and beyond When colonialism ended, these laws remained in place.
What is gender affirming care?
Gender-affirming care is a wide range of medical, psychological, and social interventions that support individuals in expressing and affirming their gender identity, which may be different from the sex they were assigned at birth. Gender dysphoria refers to a clinically significant distress from the discordance between their sex assigned at birth and gender identity. Gender affirming care can lifesaving to people with gender dysphoria. Gender-diverse people at all stages of live can benefit from gender-affirming care. For children, this may include adopting hairstyles, clothing, a chosen name, and pronouns that align with their gender identity, along with the support of adults in their lives. Adolescents who have entered puberty may further benefit from medications that temporarily block pubertal change and hormones that align their appearance with their gender identity.
What evidence is there of the benefits of this care?
Over 18 studies demonstrate the benefits of gender-affirming care in transgender youth and many more demonstrate the benefits in adults. Benefits of gender-affirming care include improved mental health and body satisfaction, and reduced risk of eating disorders, non-suicidal self-harm, and suicide. The World Professional Association of Transgender Health has issued the 8th edition of the Standards of Care, which was developed using National Academy of Medicine standards for guideline development.
Legislation that targets LGBTQ peoples’ health and human rights have a profoundly negative impact on us all. Anti-gay legislation (1) perpetuates stigma and disrupts access to healthcare, thus hindering efforts to prevent and treat HIV, (2) leads to social and economic marginalization, including loss of employment, housing, and family support, (3) gives tacit approval for violence and harassment, (4) worsens mental health, and (5) fuels persecution. A threat to the human rights of anyone is a threat to the human rights of all.
How do we continue the conversation and make an impact?
While it is distressing to hear of escalating anti-LGBTQ legislation in Uganda and elsewhere, we must conduct a thorough inventory of the reasons why such a hostile climate exists. Reactive calls to limit aid and condemn anti-LGBTQ actions elsewhere are inherently hypocritical. Cisgender, heterosexual and white privilege have played profound roles in the victimization of LGBTQ people throughout history. And as we make strides to protect members of the LGBTQ community within the US, we must remember that our efforts are wasted if we do not excavate the true source that harms this community. We must challenge religious extremism where it infringes up on basic human rights. UN FOGI/ ICC
Successful legal challenges of anti-LGBTQ legislation in the United States may create an expanding climate of safety for LGBTQ people everywhere. On this Day of Silence, I encourage us all to reflect on the legacy of LGBTQ leaders where discrimination and hatred is especially harsh and celebrate their strengths.
Dr. Frank Mugisha, Director of Sexual Minorities Uganda on WNYC’s The Takeaway. Call Me Kuchu, a 2012 documentary about LGBTQ pride in Uganda and the legacy activist David Kato who was murdered in 2011.