Trans Day of Visibility Clinic Inclusion Recommendations

For Transgender Day of Visibility, TWIRI has been working on an initiative to encourage clinics across Canada to improve the trans inclusivity of their websites.

Recently, we conducted interviews with trans and gender diverse people in Ontario about their experiences seeking gender affirming and sexual health care. Many participants reported the same thing: that visible inclusion on websites can be a deciding factor as to whether they feel safe contacting a clinic for any healthcare-related need.

In advance of Trans Day of Visibility on March 31st, we’ve reached out to clinics across Ontario who provide sexual health care services but have limited signs of trans inclusion on their website to invite them to consider taking a few small but meaningful steps to help trans clients feel more comfortable reaching out and using your services. We have made a few possible suggestions of how to improve trans inclusivity on your website, and wanted to offer some specific examples below!

Here are some ideas for you to consider:

Include pronouns in staff bios

Including pronouns in your staffs biographies on your clinic's website makes it clear that you and your staff understand that everybody has pronouns, regardless as to whether they are cis or trans, and that you cannot assume someones pronouns based on their appearance or legal sex on their healthcard.

Sharing pronouns is a meaningful form of allyship because it decreases the burden on trans and gender nonconforming people to be the only ones to share their pronouns, which can be othering.

Here are some examples from the TWIRI website of how to format this seamlessly:

Include trans pride flags or trans colours on your site

Visual indicators of inclusion can be both welcoming and eyepopping!

Pride flags are one of the most simple, eyecatching, and impactful indicators of inclusion you can have on your website. In speaking with trans and gender diverse community members, many stated that a pride flag being included on a clinic's website is one of the first signs they look for to see if they feel safe accessing care there. Pride flags that are specifically trans-inclusive are particularly impactful.

Some suggestions to consider adding to your website:

1. Transgender pride colours, or a photo of the trans pride flag

   
   

   

   
   

2. progress pride flag, which indicates 2SLGBTQ+ inclusion with an emphasis on the experiences of trans and racialized community members

   
   

   

3. use royalty free images that reflect the diversity of your clients. We recommend this resource bank for royalty free images!

Use gender neutral language to describe clinic offerings

Instead of using gendered language that does not describe the experiences of all people who may need to access those services, using descriptive and body-forward language can decrease barriers to care for trans folks.

The way that we frame care is not neutral. For example, people of all genders have a need for many services that are grouped under the umbrella of 'women's health', such as trans men and transmasculine people with their natal anatomy that might need pap smears or birth control. Similarly, many women, transfeminine or cisgender, may not need certain kinds of gynecological care and may feel othered from their womenhood from this implicit exclusion on the basis of reproductive capacity.

Choosing to define certain health procedures and services in a non-gendered way, by stating the type of service and the anatomy required for such screenings and procedures, can make a big difference.

Some examples of how to use gender neutral and body forward language include:

1. Instead of women's health, describe the specific services you offer

   1. reproductive care, or birth control, or describe the type of contraceptive offered

   2. pap smears

   3. fertility counseling

   4. or make it evident that not only women may need to access these services

2. Include gender neutral descriptions of body parts when describing services

   1. breast/chest exams

   2. vagina/front hole

   3. using neutral terms such as 'genitals', or internal/external anatomy

3. Let patients set the tone for how they like to refer to their body parts, and follow their lead

In Memory, In Solidarity: Honoring Trans Lives on Transgender Day of Remembrance

November 20^th is Transgender Day of Remembrance (TDOR), a day to honor the memory of transgender (trans) people who have been lost to anti-trans violence. TDOR was founded in 1999 by a group of trans activists in Boston, Massachusetts, following the murders of Rita Hester and Monique Thomas in 1998, and Chanelle Pickett in 1995. Trans people experience higher rates of violence than cisgender (cis) people, and one's likelihood of experiencing violence is greatly increased if you are a person of colour or work in sex work. We must always consider the intersecting systems of power and oppression that bring about these inequitable experiences, and fight for justice and equity to protect trans people and address systemic inequalities which lead to greater risks of death.  

For Transgender Day of Remembrance, the Trans Women and Gender Diverse People HIV/Sexually Transmitted and Blood-Borne Infections (STBBI) and Health Research Initiative (TWIRI) spoke with Asya Gunduz. An activist and community leader, she is the Lead of Transgender and Diverse People HIV Prevention and Health Promotion at the Ontario HIV Treatment Network (OHTN), as well as the co-lead of TWIRI. She founded LubunTO, a newcomers organsiation for LGBTQ+ Turkish, Kurdish, and West Asian people in the Greater Toronto Area. Together, we discussed TDOR, pressing issues faced by trans communities in Canada, and what advocacy efforts can do to address complex and intersecting forms of stigma facing our communities.

TWIRI: Thank you so much for taking the time to do this with me today. I'll start with our first question. What does Trans Day of Remembrance mean to you, and why is it important for the community?

Asya: Trans Day of Remembrance was created by Black trans communities [following the murder of] Rita Hester. So, it is very important, first, because Black and Brown and BIPOC [Black, Indigenous, and Other People of Colour] trans people have been discriminated against in the systems at every segment of society. It's also an important day to remember and memorialize the trans lives that were lost because of the rising trans hate. And [to commemorate] all the trans lives, all the trans survivors, and elder survivors that [are with us] today as well. So, it is important to both highlight the validity of Black trans folks and their work and visibility, but also, to remember the ones that we lost, not exclusive to HIV, but also other health conditions, suicide, and hate crimes as well.

TWIRI: Absolutely, yeah. Considering also the global rise in anti-trans hatred and violence against our communities, what are some of the most urgent psychosocial issues that are facing the trans community today?

Asya: I think some of the issues that we're facing are very connected to each other, and it boils down to social class that we're in right now [as transgender people]. I think, realizing that you're trans and opting for gender-affirming care and being out and about while being trans, which is not a choice for most of us, attracts physical, social, and health barriers. So that creates a status in society that has more stigma and that attracts more stereotypes towards you. This is reflected in our mental health, you know, in our HIV status. When you look at the numbers of HIV transmission in Canada and in the United States as well, the transmission rates are sometimes double [for trans people]. You know, some research shows it as 7 times more than compared to cis people. Trans communities are also affected by HIV in other segments of life, because since, sometimes our communities cannot find jobs. Sex work communities and trans communities have always, you know, worked [closely] together. All of these psychosocial issues that we face in different segments of society and systems, including education and health, affect our relation to HIV epidemic, affect our relation to access and prevention, affect our ability to survive, especially considering now, the anti-trans hate rising from USA and in Canada, considering the hate groups in [collaboration with] McMaster University and considering the bills that are trying to be passed by the Alberta government,. None of these things are random, and I think people do not realize or choose not to make connections.

TWIRI: And so, given how varied and complex all these different forms of oppression are, and how they impact trans people in mental health, interpersonally, but also in accessing medical care as well, how can advocacy efforts better support healing and well-being for trans people, especially when faced with a fairly dismal political climate on top of the pre-existing barriers that we've always faced in various forms?

Asya: I think, well, getting over barriers as a community takes a toll on the community itself and community members. And without sharing the struggle of it with other communities without doing solidarity, doing reparations with other communities, we cannot take off from under this rubble. Not only transphobia, but also HIV stigma, other access barriers that we have, and anti-immigration sentiments. We have to remind ourselves that we have complex backgrounds that were coming from, experiences, contacts, complex intersections that we are trying to survive in this life, and I think it's important to support, fund, and advocate for the initiatives that make a difference. And so, the Trans Women and Gender Diverse People's HIV/STBBI and Health Research Initiative (TWIRI) is a good precedent of how research initiatives can be made by and for trans people and in connection with policyholders and interest holders. The partnership between TWIRI and the OHTN is a great example of how the research and policy spaces can uplift the very needed areas of knowledge dissemination and creation in our sector. I think those are some of the success stories and ways that our programs have made a difference in improving lives and well-being of trans people. And there are many other ways of advocating for us as well.

TWIRI: That answer ties into my following question. I feel like we’ve covered some of the success stories or programs that have made a difference in improving the lives and well-being of trans people. But would you like to expand more on those programs or expand on what advocacy looks like in our current context as well?

Asya: In our current context, especially in the research context, advocacy is such a complicated term, because, first, most research organizations do not have that in their mandate. They do not feel accountable to respond to any happenings that are anti-trans, or that are happening in USA, or elsewhere, in some way or other. The institutional research imperative is not very responsive to trans issues. But what I'm observing is that these things are changing. For example, I know that under TWIRI, we started to engage more folks in the community, and we have expanded our portfolio of trans researchers in the teams that we're doing the work with and doing the research with. We have done an internal review process, while trying to expand our national and regional outreach to other communities. We are highlighting some of the work, again, by and for trans people on our pages, in our research. We are organizing  the TWIRI Research Conference in 2026. We have a community advisory board run by Chelsea Davis and me, with close to 20 trans and gender diverse people across Ontario and some from out of province as well. So, those are some of the steps we can take. None of those things include, like, going out to the streets, which I think researchers can also do. But there are steps that, in your capacity, you can do as a researcher, as a policy maker, to explore other dynamic ways to support as allies, and as community members as well, right? But, especially if you're an ally. So, we should be aware of that sentiment and necessity as researchers, as policy makers, as policy reviewers, and even as people from the community.

TWIRI: Absolutely, yeah, and thinking about what that engagement is like as a researcher, especially for myself as a researcher who's also a community member, it's always quite… it can feel quite complicated to wear that many hats as well, and I think calling on, researchers, especially who are allies, to even consider going out in the streets with us is pretty important too, you know? I appreciate your perspective on that as well. Now thinking about remembrance and what it means to be put in a position to be caring for and holding the legacy of those who have been doing this work before us, and thinking about how, this day is, by and large, dedicated to the people who we have lost. As a fairly young trans person who is oftentimes in leadership and mentorship roles in your communities, what is it that you wish that younger trans people would remember, and how can young trans people help to carry memory forward?

Asya: It's a very humbling experience to be in that role, and it's also teaching me a lot from the other generation, from Gen Z, that there have been a lot of disconnect between our generations. There are other aspects of it, a trans immigrant adult has a different zonal knowledge and experiences than a trans person in high school coming from a white background in toronto, right? And the first time that I realized this I was at a community event teaching sexual health to middle school and high school kids, ranging from 13 to 17 years old, which is something really complicated, since the regional government is trying to take away or trying to curb the update of sexual health curriculum, because they're still being taught a curriculum from the 1990s. So, it was a teaching moment for me. Some of the youth are already aware of a lot of things. They were aware of PrEP; they were aware of how to wear a condom. But some of the things that I found was difficult for them to understand was that sometimes they thought the fight against HIV stigma was over. But then I shared with them, and they were really surprised that HIV criminalization was still a thing in Canada, and they were really surprised about some of the self-disclosure regulations. What I'm seeing is there is this kind of disconnect. We need to continue sharing these legacies but also share current impediments that people living with HIV in Ontario face, and how they're affected by the current types of stigma and current types of government and regulatory [discrimination]. Again, I have a lot to learn from elders as well, which I am doing. By reading, by meeting them, by, withdrawal and reflecting on how I can do things better for the next generations, and in a meaningful and respectful way for the people who came before us. And I respect our elders who survived the many incidents and many eras of transphobia and HIV stigma, and who are still here, still fighting, still trying to teach us.  I also find it's an unlearning process as well, about yourself. It's important to also note that the HIV demographics are changing as well. That we may need to really include youth in our consideration of programming.

TWIRI: Absolutely, yeah. And so my last question is, do you have any words for cis allies on Trans Day of Remembrance?

Asya:  I mean first of all, let us [trans people] lead work and give us opportunities to lead work that focuses on our communities. What I want from cis allies? Well, they're already allies, right? They're already, you know, respecting pronouns and trying to not say terrible things to our face. But what I'm interested in is what happens behind closed doors. I know from passing trans men, friends who are not open as trans, that [sometimes they are saying] not very good things. I also know from my experience with cishet men as partners, or with men in general as partners, that they still have a lot of things to unlearn and learn about us. So what I'm curious about is that if a cis ally has a trans friend, meaning really knowing a trans person, giving efforts to meaningfully and respectfully be in spaces where they can support trans people and meet us. And I'm not saying like, “Hey, meet us and explore”, no. But that you have stigma and misinformation if you don’t know things, right? And oftentimes when I ask allies: “Hey, do you have a close friend who is trans?” Most of the time, the answer is still no. So, really getting to know us also means you need to get out of your comfort zone and question things that you [benefit] from in a system that upholds your privileged status and upholds heteronormativity. As trans people, we can expect more things than we are taught to expect from cis allies, I think. And that is definitely more than just respect and pronouns. It requires a transformation of certain behavior practices, transformation of how we address others, transformation of power dynamics, and giving us spaces. For Trans Day of Rememberance, specifically, going back to that, just remember: what is important for [trans people] on this day? It's not only about us coming together, commemorating, but also, it can be an opportunity to find yourself reflected in another's story, even cishet people. So, allies should try to be there, try to understand our pain as well, know our legacy and the things we want to memorialize. How can you, as an ally, contribute to it? This is really important.

There is a lot of information about TDOR online. For more information, check out the Human Rights Campaign website. Click the hyperlinks to learn more about our work at TWIRI or the OHTN.

To all those who have been taken from us due to transphobic violence, we honor your life and continue to push for justice and change in your memory. To imagine what a truly equitable world could look like requires meaningful engaged allyship and coalition-building across community groups. Violence experienced by trans people, especially trans women of colour and sex work communities, should not be tokenised or used to further a culture of fear, and the varying forms of stigma and discrimination behind such acts of violence must be meaningfully considered. To reflect critically on TDOR, I encourage you to read the perspectives of Black trans women and transfeminine sex workers, such as this piece by L’lerrét Jazelle Ailith.