Read in English

Nixtiequ nindirizzaw xi kummenti riċenti dwar servizzi tas-saħħa għal persuni trans (servizzi t’affermazzjoni tal-ġeneru) li għamel il-Ministru Prof. Jo Etienne Abela waqt l-intervisti tiegħu ma’ LovinMalta u Times of Malta.

Nixtiequ nibdew billi nindirizzaw is-suġġeriment li l-kura tas-saħħa speċjalizzata għan-nies trans hija “kumplessa”. Il-kumplessità mhijiex ġustifikazzjoni għall-ineżistenza jew ir-rifjut tal-kura. Kull qasam tas-saħħa, minn trattamenti kontra l-kanċer sa servizzi ta’ saħħa mentali, jiġu bl-isfidi u l-kumplessitajiet tagħhom. Propju għalhekk, il-professjonisti f’dawn l-oqsma huma mistennija li jkunu kompetenti, imħarrġa tajjeb u speċjalizzati. Minkejja l-isfidi u d-dewmien f’oqsma oħra tas-sistema tas-saħħa tagħna, inklużi dawk imsemmija qabel, ħadd ma jistenna li l-istat joqgħod lura milli jipprovdi l-kura f’dawn l-oqsma jew li jlaqqamhom kontroversjali. Il-kura tal-affermazzjoni tal-ġeneru teħtieġ biss li nersqu lejha bl-istess dedikazzjoni, bi prattiċi bbażati fuq l-evidenza, b’kompassjoni, u b’approċċ iffukat fuq il-pazjent; approċċ li nemmnu kien qed jiġi implimentat b’suċċess f’Malta.

Nixtiequ wkoll nindirizzaw it-tħassib li ntwera rigward l-għeluq tal-Klinika tal-Ġeneru Tavistock u l-isfidi mediċi-legali fir-Renju Unit. Huwa essenzjali li nikkontestwalizzaw avvenimenti barranin, hekk kif ġew interpretati ħażin minn xi wħud, biex jipprotestaw kontra l-aċċess għal kura tal-affermazzjoni tal-ġeneru għaż-żgħażagħ trans, u b’hekk qed jiġi miċħud jew differit it-trattament għall-adulti trans ukoll. L-għeluq tal-Klinika tal-Ġeneru Tavistock kien riżultat tar-rakkomandazzjonijiet tar-Rapport ta’ Hilary Cass, rapport li suppost talab għal approċċ aktar reġjonalizzat u olistiku għall-kura tal-affermazzjoni tal-ġeneru għaż-żgħażagħ fir-Renju Unit.

Madankollu, ħafna kliniċisti, attivisti u akkademiċi kkritikaw ir-reviżjoni ta’ Cass. Riċentement, grupp ta’ esperti kitbu lis-Segretarju għas-Saħħa tar-Renju Unit, u ħeġġu biex iwaqqaf l-implimentazzjoni tar-rakkomandazzjonijiet tar-Rapport ta’ Cass. L-ittra tagħhom tiddeskrivi r-reviżjoni bħala “spettaklu assurd” li tagħmel rakkomandazzjonijiet li “jdgħajfu l-kura għan-nies trans billi jbeżżgħu bl-għadd ta’ żgħażagħ li jfittxu li jużawha”. Barra minn hekk, is-servizzi pprovduti fil-Klinika tal-Ġeneru huma bbażati fuq mudell ta’ kunsens infurmat, iggwidati mill-Istandards tal-Kura tal-WPATH (Assoċjazzjoni Dinjija għall-Kura tas-Saħħa tat-Transġeneri). WPATH innifisha kkritikat ir-Reviżjoni Cass għal diversi kwistjonijiet, inkluża l-metodoloġija u l-esklużjoni ta’ esperti fil-qasam tal-kura tal-affermazzjoni tal-ġeneru.

Huwa importanti wkoll li nenfasizzaw li l-kura tal-affermazzjoni tal-ġeneru mhijiex biss numru ta’ interventi mediċi bħat-terapija ta’ sostituzzjoni tal-ormoni u l-kirurġiji tar-riallokazzjoni tal-ġeneru, imma tinkludi firxa ta’ interventi soċjali, psikoloġiċi, u ta’ mġiba, bħal pariri, psikoterapija u speech therapy. In-nies trans ta’ etajiet differenti, inkluż iż-żgħażagħ, li għadhom qed jistennew biex jiksbu appuntament fil-klinika, qed jiġu mfixkla milli jaċċessaw xi wħud minn dawn is-servizzi. Studji numerużi u l-Istandards tal-Kura mill-WPATH, li huma bbażati fuq reviżjonijiet sistematiċi tar-riċerka, huma ċari; l-aċċess għal kura tal-affermazzjoni tal-ġeneru, inkluża għal żgħażagħ, iwassal għal riżultati aħjar ta’ saħħa mentali, tnaqqis fl-ansjetà, livelli aktar baxxi ta’ dipressjoni, u kwalità ta’ ħajja aħjar. Il-kura tal-affermazzjoni tal-ġeneru ssalva l-ħajjiet, speċjalment għaż-żgħażagħ li huma aktar vulnerabbli għal sentimenti ta’ iżolament, diskriminazzjoni, u disperazzjoni meta jiġu miċħuda l-kura li jeħtieġu.

Il-Ministru semma wkoll li s-sistema tas-saħħa ta’ Malta ta’ spiss timmudella lilha nnifisha fuq dik tal-NHS tar-Renju Unit. Malta ilha indipendenti mir-Renju Unit għal 60 sena, u wasal iż-żmien li nibdew nikkontestaw din il-mentalità kolonjali li r-Renju Unit għandu jkun il-benchmark tagħna f’kull aspett. Madankollu, kieku verament insegwu l-mudell sħiħ tal-NHS tar-Renju Unit, kieku għandna sexual health policy, u l-NHS Malti jkun qed joffri aċċess komprensiv għall-mediċini tal-prevenzjoni tal-HIV bħall-PEP u l-PrEP, li huma disponibbli faċilment taħt l-NHS tar-Renju Unit iżda għadhom mhux disponibbli fis-sistema tas-saħħa f’Malta u għal bosta nies huwa diffiċli biex jaċċessawhom.

Ir-realtà kurrenti tagħna hija li n-nies trans ta’ kull età qed jitħallew f’limbu, jistennew għal appuntamenti li drastikament jistgħu itejbu s-saħħa mentali u fiżika tagħhom. Malta għandha l-opportunità li tkun ta’ eżempju fil-qasam tal-kura għan-nies trans, kif għamilna bil-liġi GIGESC tagħna li ddepatoloġizzat l-identitajiet trans, iżda biex nagħmlu dan, ma nistgħux naqgħu fin-nassa tar-riċerka preġudikata, il-propaganda transfobika, u mudelli antikwati jew applikati nofs leħja minn sistemi ta’ kura f’pajjiżi oħra.

Parti integrali mill-progress leġiżlattiv li għamlet Malta għall-komunità LGBTIQ kienet, parzjalment, grazzi għas-smigħ u l-konsultazzjoni mal-komunità, attivisti u partijiet oħra interessati li jaħdmu mal-komunità LGBTIQ. L-MGRM ikkuntattjat lill-Ministru erba’ darbiet fl-aħħar sena, u talbet laqgħa biex jiġu diskussi u indirizzati l-kwistjonijiet fil-Klinika tal-Ġeneru, u għadna qed nistennew risposta. Jekk il-Ministru u l-professjonisti għandhom tħassib, allura s-sejba ta’ soluzzjoni mal-komunità LGBTIQ u professjonisti msemmija għandha titqies bħala t-triq ‘il quddiem.

Il-benesseri tal-pazjenti għandu dejjem ikun fuq quddiem nett tat-titjib fil-provvediment tal-kura tas-saħħa; jekk dan ma jkunx minnu f’kull każ, tkun trasgressjoni tal-kura u tar-responsabbiltà li jkun żgurat li l-membri kollha tas-soċjetà jkollhom aċċess ugwali għall-kura tas-saħħa. Nittamaw li l-Ministru għas-Saħħa jikkunsidra dan bis-serjetà, u jikkunsidra t-talba tagħna għal laqgħa ta’ konsultazzjoni.

Studji u Riżorsi

– Green, A. E., et al. (2022). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. JAMA Network Open, 5(3), e220978.

– van der Loos, M. A., Hellinga, I., Bouman, M.-B., & van der Sluis, W. B. (2022). Gender-affirming hormone therapy in adolescents and adults: A systematic review on mental health outcomes. European Psychiatry, 64(1), e18.

– Välimäki, M., & Söderström, I. (2021). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 12, 101-109.

– The Trevor Project. (2021). National Survey on LGBTQ Youth Mental Health 2021.

– van der Miesen, A. I. R., Steensma, T. D., de Vries, A. L. C., & Bos, H. M. W. (2020). Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers. Journal of Adolescent Health, 66(6), 699-704.

– Turban, J. L., et al. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725

– Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 116-123.e2.

Aqra bil-Malti

We would like to address the recent comments on trans healthcare (gender-affirming care) made by Minister Prof. Jo Etienne Abela during his interviews with LovinMalta and Times of Malta. In particular, we wish to address the suggestion that trans healthcare is “complex”. 

Complexity is not a justification for inaction or denial of care. All areas of healthcare, from cancer treatment to mental health services, come with their own intricacies and challenges. That is precisely why professionals working in these fields are expected to be competent, well-trained and specialised. Despite the challenges and delays in other parts of our healthcare system, including the aforementioned ones, no one expects the state to shy away from providing care in these areas or to label them controversial. Gender-affirming care simply requires that we approach it with the same dedication, evidence-based practices, compassion, and a patient-centred approach; an approach we believed was being implemented successfully in Malta.

We would also like to address the concerns raised regarding the medico-legal challenges in the UK and the closure of the Tavistock Gender Clinic. It is essential to contextualise foreign events, as they have been misinterpreted by some to argue against access to gender-affirming healthcare for trans youth, which in turn is denying or delaying care for trans adults too. The closure of the Tavistock Gender Clinic was an outcome of the recommendations of the Hilary Cass Review, a report that supposedly called for a more regionalised and holistic approach to gender-affirming care for youths in the UK. 

However, many clinicians, activists and academics have criticised the review. Recently, a group of experts wrote to the UK Secretary for Health, urging them to halt implementation of the Cass Review’s recommendations. Their letter describes the review as an “absurd spectacle” which makes recommendations that “undermine trans people’s care by fear-mongering about the number of young people who seek to use it”. Moreover, the services provided at the Gender Wellbeing Clinic are based on an informed consent model of care guided by the WPATH (World Professional Association for Transgender Health) Standards of Care. WPATH itself has criticised the Cass review for various issues, including its methodology and exclusion of experts in the field of gender-affirming care. 

It is also important to highlight that gender-affirming care is not just medical interventions like hormone replacement therapy and gender reassignment surgeries; it encompasses a range of social, psychological, behavioural interventions, such as counselling, psychotherapy and speech therapy. Trans people of various ages, not just youths, who are still waiting to get an appointment at the clinic are being hindered from accessing any of these other services. Numerous studies and the Standards of Care by WPATH which are grounded in systematic reviews of research are clear; access to gender-affirming healthcare, including for youth, leads to better mental health outcomes, reduced anxiety, lower levels of depression, and a higher quality of life. Gender-affirming healthcare is life-saving, especially for younger people who are more vulnerable to feelings of isolation, discrimination, and despair when denied access to the care they need.

The Minister also mentioned that Malta’s healthcare system often models itself after the UK’s NHS. Malta has been independent from the UK for 60 years, and it is about time that we start challenging this colonial mindset that the UK must be our benchmark in every aspect. That being said, if we were truly committed to following the UK NHS model in its entirety, we would have a sexual health policy, and the Maltese NHS would be offering comprehensive access to HIV prevention drugs such as PEP and PrEP, which are readily available under the UK NHS but are still out of reach for many in Malta.

Our current reality is that trans people of all ages are being left in limbo, waiting for appointments that could drastically improve their mental and physical wellbeing. Malta has the opportunity to lead by example when it comes to trans healthcare, just as we did with our GIGESC law that depathologised trans identities, but in order to do so, we cannot afford to fall into the trap of biassed research, transphobic propaganda, and outdated or incomplete models of care from abroad. 

An integral part of the legislative strides Malta has made for the LGBTIQ community, were in part thanks to listening to and consultation with the community, activists and other stakeholders working with the LGBTIQ community. MGRM has reached out to the Minister four times in the past year, requesting a meeting to discuss and address the issues at the Gender Wellbeing Clinic, and we are still waiting for a response. If the Minister and professionals have concerns, then should not finding a solution with the LGBTIQ community and said professionals be considered a way forward?  

The welfare of the patient must always be at the centre of improving provision of healthcare; anything otherwise, is a dereliction of care and responsibility to ensuring all members of society have equal access to healthcare. We hope the Minister of Health has this at heart, and considers our request to meet. 

Studies and Resources

– Green, A. E., et al. (2022). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. JAMA Network Open, 5(3), e220978.

– van der Loos, M. A., Hellinga, I., Bouman, M.-B., & van der Sluis, W. B. (2022). Gender-affirming hormone therapy in adolescents and adults: A systematic review on mental health outcomes. European Psychiatry, 64(1), e18.

– Välimäki, M., & Söderström, I. (2021). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 12, 101-109.

– The Trevor Project. (2021). National Survey on LGBTQ Youth Mental Health 2021.

– van der Miesen, A. I. R., Steensma, T. D., de Vries, A. L. C., & Bos, H. M. W. (2020). Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers. Journal of Adolescent Health, 66(6), 699-704.

– Turban, J. L., et al. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725

– Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 116-123.e2.

Overview
The Rainbow Families Network (RFN) is a joint collaboration between MGRM and the Malta Foundation for the Wellbeing of Society. This initiative is dedicated to providing a space for LGBTI Families and their children through discussion meetings, informational talks, and informal activities.

The Rainbow Families network is seeking passionate and dedicated Early Childhood Educators to provide their services for children aged 1-5 years during RFN events and activities, usually happening once a month.

Key Responsibilities

1. Childcare Provision
– Provide safe, nurturing, and engaging childcare during events.
– Ensure the physical and emotional wellbeing of all children in their care.

2. Planning
– Collaborate with MGRM and MGFWS to understand event requirements, schedules, and child-
specific needs.
– Assist in planning and implementing age-appropriate activities for children.

3. Communication
– Maintain open and effective communication with MGRM and MFWS Officials
– Work collaboratively with the other educators and volunteers to ensure cohesive care and
support for children.

4. Safety and Compliance
– Adhere to all policies of the network including the safeguarding and GDPR policies.
– Ensure a safe environment for children.
– Always maintain confidentiality of sensitive information.

Qualifications and Requirements

Applicants for this position must:
(i) be able to communicate in both Maltese and English to the benefit of the service user.
(ii) be in possession of a recognised qualification in Early Childhood Education, Child Care, or a related field.
(iii) be able to work independently and as part of a team.

(iv) Be able to work during evenings and weekends.
Experience working with children with learning difficulties and disabilities will be considered an asset.

Application Process

Interested candidates are invited to submit their CV, covering letter, relevant certifications and police conduct by sending an email on mgrm@maltagayrights.org by not later than Friday 19th July.

Note
The ratios of children per educator will be smaller than classroom ratios to ensure a more personalised care. This position is on a casual basis; successful applicants will be responsible for paying their own taxes.

Hello queers & friends!

International Pride month incoming, so we’re doubling the fun with twice the amount of events. We’re kicking things off with a thrift event that promises hidden gems, followed by another round of our beloved karaoke. Get ready for Refugee Week Malta, an essential celebration of solidarity and inclusion. Sharpen your wits for our Trivia night, where knowledge meets queerness. And we’ll be closing off the month with Queer Rebels Can Dance, celebrating activism, drag and music through an alternative queer night with Moviment Graffitti.