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Accessing trans healthcare was already a difficult and lengthy process and during the pandemic, it’s virtually ground to a halt. It comes as the government is expected to announce it has ditched plans to allow trans people to self-identify.

Illustration: Sage Brice

The arrival of Covid-19 in the UK catapulted healthcare to the forefront of public awareness, with ‘NHS’ rainbows proliferating in windows and on billboards across the country. Suddenly everyone seemed painfully aware of our mutual vulnerability and our dependence on public healthcare infrastructure. At the same time, the pandemic futher highlighted the impact on the NHS of years of austerity and backdoor privatisation.

For trans people in Bristol, however, things had ground to a standstill long before the pandemic started. Access to trans healthcare is funnelled through a small number of specialist Gender Identity Clinics (GICs), creating a bottleneck. Waiting times for life-affirming treatment should be a maximum of 18 weeks, but have been getting steadily worse for a long time.

Bristol’s nearest GIC now has a wait of over four years just for first assessments, with further delays before actual medical treatment can begin. For the lucky few who had already made it past this hurdle when lockdown began, the freeze on all ‘non-essential’ treatments has brought further rounds of cancellations and delays.

These are scary times for trans and non-binary people. Last month a series of controversial tweets and blog pieces from author JK Rowling sparked an upsurge of anti-trans activity online and in the press. At the same time, new anti-trans legislation in the US, Hungary, and elsewhere raises fears of a reversal of hard-won advances for trans inclusion. This growing political anxiety adds to the stresses of trying to survive a pandemic while being trans.

There is a further dark side to the pandemic, however: some fear the crisis could serve as cover for a political claw-back of civil rights and freedoms. These may include legal protections and recognition for trans people: on 14 June, the Sunday Times reported that the UK Government intends to scrap the proposed reforms to the Gender Recognition Act (GRA).

GRA reform was intended to make trans lives easier by reducing the costs, bureaucratic burden and gatekeeping processes that stand in the way of legal gender certification. Allowing trans and non-binary people to self-identify restores our dignity and removes unnecessary complications affecting legal processes such as marriage and taxation. Strangely, however, public debate about the GRA has tended to focus on unrelated issues such as access to single-sex spaces and protection from discrimination – rights already afforded to trans people by the Equalities Act, and not dependent on legal gender status.

Coronavirus is exacerbating existing vulnerabilities

When the pandemic hit, I was just completing a PhD, with a surgery date imminent. My life was finally coming together after what had been a long, difficult struggle. Then lockdown derailed my hard-won plans. Knowing first-hand how far-reaching the indirect impacts of Covid-19 can be, I invited other trans people in Bristol to share their personal experiences.

Genevieve (28) is hoping to start hormone replacement therapy (HRT), which for many trans people alleviates dysphoria and makes it easier to present safely as themselves.

“It felt like the emergency stop had been hit on transitioning and it was as though I was sliding backwards”

HRT can also impact fertility, however, and Genevieve, who hopes to have children one day, was due to preserve gametes (reproductive cells such as sperm or eggs) when lockdown started and the fertility clinic closed. No longer able to move forwards with her plan to start HRT, she began to lose all hope: “It felt like the emergency stop had been hit on transitioning and it was as though I was sliding backwards […] the deep depressive feelings of my life before coming out began to creep back; there were times I was sure I wouldn’t make it through the night because I couldn’t bear my existence.”

Covid-19 affects us in many ways besides the horrific impacts of the virus itself. Trans people are not alone in this – reports show that groups who are already marginalised are more susceptible to the disease; this includes BME people, who – like trans people – are also more likely to be affected in other ways by the economic and social repercussions of lockdown and financial crisis. In other words, the pandemic exacerbates and highlights existing vulnerabilities, creating knock-on effects in areas such as housing, financial security, personal safety, and wellbeing.

Claire (59), for example, lives with a violent partner, who for health reasons is also following a strict coronavirus screening protocol. This means she is stuck in close confines with someone who actively tries to sabotage her transition: “It has been really tough being stuck with my abuser and unable to be myself without causing an argument,” she says.

Living in constant fear of violence and unable to present safely as herself, Claire is formulating an exit plan with the domestic abuse team, but services are overstretched and she has no definite date in sight.

For most trans people, the freeze on healthcare interacts with other challenges: Claire is also a carer, and Genevieve has recently been through a divorce.

For MJ (39), who has chronic fatigue, the challenges of lockdown are nothing new: “Being cooped up, missing people – these are things I have long come to terms with.” Though they have experienced a tragic loss to the pandemic, in some ways the lockdown has also brought relief: “It’s been good for me because others now have insight on my situation they’ve never been able to experience before.”

MJ also points out a positive social dimension to the pandemic: the way it has opened up space for a new kind of widespread political engagement, including the momentum generated by the Black Lives Matter movement.

“The pandemic brought me anxiety, and the political unrest that naturally followed brought me sleeplessness. But I’m glad for the pandemic, that it gave people the opportunity to rally for their rights.” Trans and anti-racist struggles have been explicitly brought together by protesters and political commentators, with thousands turning out for ‘Black Trans Lives Matter’ rallies globally, including in the US and London.

Recent YouGov polls and responses to the GRA consultation in 2018 both show majority public support for self-identification, despite the negativity of media coverage. Yet the government continues to stall despite expressions of support from a broad coalition of women’s rights organisations and LGBTQI+ charity Stonewall, as well as an unprecedented cross-party statement from LGBTQ MPs, and a second from the Welsh cabinet.

More worryingly, however, the leaked plans imply a move to restrict existing rights of trans women to use facilities such as public toilets, changing rooms and refuges. While such a reversal of rights would be difficult to legislate for, the government seems poised to launch a cynical ‘culture war’, leveraging toxic debate about trans lives in order to foster popular support for increasingly authoritarian and discriminatory policies.

Covid-19 has shaken up our sense of what constitutes ‘normal’. It seems likely that the pandemic will bring momentous social and political change. Whether the path leads deeper into authoritarianism or heralds a new age of solidarity and liberatory politics depends on the choices and actions we take.

The current government seems ready to try for the former – but has shown itself susceptible to public pressure. Trans lives will serve as a test case in this struggle; Equalities Minister Liz Truss is expected to make an announcement on the GRA consultation before parliamentary recess begins on 22 July. A strong public response at this moment could help turn the tide.

What you can do

Trans activists are calling on allies to educate themselves, to speak up against transphobia, and to support trans groups – especially black trans organisations (some suggestions here).

In Bristol, a protest against transphobia will be held this Saturday (18 July 2020) from 12pm at College Green in Bristol city centre, as part of a day of national action against transphobia taking place across the UK.

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