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
Mr. Scheim has been a leader in the transgender health field for almost 15 years, which ultimately led him to pursue doctoral research in social epidemiology. His dissertation examines the health impacts of social exclusion and discrimination in the transgender population, and strategies for better measuring these complex phenomena. At the same time, he is an active co-investigator on mixed-methods projects related to supervised injection and other health care services for marginalized people who use drugs; measurement of sex and gender in population health surveys; and transgender sexual health.
It is well-documented that stigma and discrimination have detrimental effects on the health of marginalized populations. However, measuring discrimination is far from simple. It is a multidimensional concept that can include anticipation of unfair treatment, experiences of subtle interpersonal slights, and acts of discrimination that are legally actionable under human rights legislation. Moreover, intersectionality theory suggests that individuals who occupy multiple marginalized social identities or positions may be unable to disentangle the bases on which they experience discrimination, as surveys often require them to. Therefore, the first aim of Ayden’s doctoral research project is to develop and validate a multidimensional and intersectional measure of discrimination for use in population health surveys. The second aim of Ayden’s project focuses on the specific manifestations and impacts of discrimination within Ontario’s transgender population. Despite increasing acceptance and human rights protections, transgender Canadians continue to experience profound social exclusion and discrimination. Related to this, they are vulnerable to poorer health outcomes than their non-transgender counterparts, such as HIV and problematic substance use. Drawing on rich survey data from the Trans PULSE Project, Ayden aims to identify modifiable processes of social exclusion that may contribute to these outcomes, in order to inform strategies for social- and policy-level intervention.
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 candidate, 2014 Trudeau Scholar, and Vanier Canada Graduate Scholar in epidemiology and biostatistics at Western University. His research applies social-epidemiological theory and methods to understanding the health impacts of social exclusion and discrimination. Ayden’s doctoral research builds on almost 15 years of experience as a community-based researcher, activist, service provider, and health promoter in sexual and gender minority communities. In addition to his doctoral project, Ayden is an active investigator on studies exploring social contexts of HIV vulnerability and resilience, access to health care for transgender people, and quantitative methods to bridge social theory and population health research. Alongside researchers from the Ontario HIV Treatment Network and the BC Centre for Excellence in HIV/AIDS, he is leading research examining the feasibility of supervised injection services as part of the response to reduce drug-related harms in London, Ontario.
Ayden emphasizes integrated and accessible knowledge translation, working with knowledge users to develop his research projects and to disseminate findings. He has published widely in scientific journals and has authored reports, case studies, and fact sheets for organizations including the International Reference Group on Transgender People and HIV, the Global Forum on MSM and HIV, the University of California San Francisco Center of Excellence for Transgender Health, and Open Society Foundations. His research findings and consultation have informed policies and programs developed by the Ontario and Canadian Human Rights Commissions, the Canadian Centre for Ethics in Sport, Toronto Public Health, and provincial ministries of health. Ayden co-founded and chaired 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.