Ayden is researching how marginalization impacts transgender people’s health in order to find strategies for intervention at the social and policy levels.
Impacts of Social Exclusion on the Health of Transgender Ontarians: Identifying Strategies To Increase Health Equity
Despite increasing acceptance and human rights protections in Canada, transgender populations continue to experience profound social exclusion and discrimination. They also bear a disproportionate burden of health conditions, including HIV, depression, suicidality, and problematic substance use, which evidence suggests may be interdependent and the result of social exclusion. Yet these problems have traditionally been addressed through individual-level, disease-specific interventions. In part, this may be due to the perceived difficulty of identifying the impacts of social processes on health and of intervening to reduce social exclusion.
Ayden Scheim’s doctoral project aims to remedy these methodological and substantive challenges by developing and testing quantitative methods for exploratory analyses that better account for social determinants of health. He intends to apply these methods in order to identify modifiable processes of social exclusion that contribute to poor health outcomes, and their co-occurrence, among transgender Ontarians.
Q & A
Tell us about your research project and its central idea.
My research project asks how social marginalization and discrimination impact the health of transgender people, and in particular, how they drive the co-occurring and synergistic health problems documented in some transgender populations. These include HIV, depression, suicidality, and problematic substance use. The primary aim of my research is to identify potential strategies for interventions at the social and policy levels, recognizing that individualistic solutions are inadequate to remedy socially produced health problems.
What led you to choose this research project in particular?
I have been working on issues of gender and sexual minority health and human rights for over a decade, as a service provider, researcher, and activist. In that work, I saw first-hand how marginalization and discrimination affect the well-being of people in my communities, and particularly transgender people. At the same time, study after study described the multiple, co-occurring mental, physical, and sexual health problems in trans communities. While documenting inequities is hugely important, it is only the first step towards finding solutions. In addition to describing problems, our roles as epidemiologists include uncovering the causes of health and disease at the population level. While community members know that marginalization negatively impacts the health of trans populations, researchers are only beginning to examine these relationships. Having the opportunity to do my doctoral research as part of the Trans PULSE community-based study allows me to translate this experiential knowledge into research questions that can be addressed with sophisticated methods capable of generating rigorous and impactful evidence.
What is new or surprising about your research?
My research is the first of its kind to be conducted in Canada, which is arguably among the best places in the world to be trans, in terms of formal human rights. Yet, we see great health disparities—for instance, 43% of trans Ontarians have attempted suicide. The situation for trans people in Canada can be seen as representing the impacts of social exclusion even in a “best case scenario,” highlighting the needs for social, as well as legal, change. It may be surprising to some that my research is within the field of epidemiology. I hope that through conducting this research, which includes work on methods for epidemiological research that are informed by social theories, I will help make it less surprising for an epidemiologist to ask such questions!
In your opinion, who will most benefit from your findings?
My research has contributed to efforts to promote trans human rights; two of my publications were included in the new Ontario Human Rights Commission policy on discrimination based on gender identity and expression. I hope that trans communities in Canada will continue to benefit from my findings, but I particularly think and hope that trans communities internationally will benefit. This is an incredibly exciting and challenging time to be conducting trans-related research, as the ground continues shifting beneath our feet. Since our data were collected in 2009-2010, gender identity and expression have been added as protected grounds to the Ontario Human Rights code, and legal and policy changes have made it easier for trans people to change the gender marker on identification and access medical transition care. While this presents a limitation in extrapolating findings in Ontario in 2014, it is of benefit in jurisdictions where trans people continue to fight for these rights and my findings may have potential as an advocacy tool.
Within the next three to five years, what impact could your research have on the Canadian public policy debate?
I hope that my research will underscore the need for explicit human rights protections for trans people at the national and international levels and also spark debate about the means by which public policy can help to realize improved health and life chances for trans people, through and beyond enforcement of such protections. More broadly, I want my research to contribute to revitalizing public policy debates about intervening on the social determinants of health.
Ayden Scheim is a PhD student and a Vanier Canada Graduate Scholar in epidemiology and biostatistics at Western University, where his research applies social-epidemiological theory and methods to understanding how social exclusion affects the health of transgender people. Ayden’s doctoral research builds on more than a decade of experience as a community-based researcher, activist, service provider, and health promoter in sexual and gender minority communities. Ayden is currently an investigator for four studies on the social contexts of HIV vulnerability and resilience, ethics in participatory research with people who use drugs, and quantitative methods to bridge social theory and population health research.
Ayden holds a BA in sociology from the University of Toronto, which he completed as a proud graduate of the Transitional Year Program. He co-founded and currently chairs a working group that produced the first comprehensive sexual health resource for gay and bisexual transgender men, a tool that has been translated into seven languages. Ayden has co-authored reports, case studies, and fact sheets for organizations including the University of California San Francisco Center of Excellence for Transgender Health and the Open Society Foundation. He collaborates and consults on transgender social inclusion and health for national and international organizations, and he is both a member of the Global Forum on Men Who Have Sex with Men and the HIV Research Group, and a contributor to implementation guidelines for the World Health Organization’s Guidance on Prevention and Treatment of HIV and Other Sexually Transmitted Infections Among Men Who Have Sex with Men and Transgender People in Low- and Middle-Income Countries.
Outside of his studies, Ayden volunteers with the local needle exchange program. He is a volunteer facilitator for the London Area Network of Substance Users and he helps organize the London Prisoners’ Justice Film Festival.