Hannah Kia, PhD, RCSW is an assistant professor at the University of British Columbia’s School of Social Work in Vancouver, BC. Her research centres on LGBTQ+ aging and health, a program of study that draws on Hannah’s lived experiences as a trans woman and queer person and growing up as a newcomer in Canada. Before becoming an academic, Hannah practised as a social worker in acute care and hospice palliative care.
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I came of age when the height of the HIV/AIDS epidemic was really abating. I have vivid memories from my childhood of adults telling me things like, “I really hope you’re not queer because if you are, you’re going to grow old alone and without a family. That’s going to be your fate.” The language of fate was very central to these oppressive narratives. As a queer person who was also a newcomer to Canada, I wasn’t being exposed to other queer people or culture very much during this time, so I didn’t have a sense of alternative possibilities.
As an adult, I became a social worker. I started my social work practice in an urban hospital where my colleagues were queer positive, though at the time conversations about being trans positive weren’t happening very openly. While my colleagues were well-intentioned, the system was constructed in such a way that whenever I encountered queer and trans people accessing health care in my capacity as a social worker, I would notice that their issues, needs, and experiences were either ignored or rendered invisible or, on the other hand, responded to completely inappropriately.
I noticed that a lot of folks accessing services would often be left in situations of great vulnerability without any kind of appropriate supports in place to mitigate the issues accompanying the vulnerabilities they faced as a result of these systemic failures. So that’s where my passion for aging research, specifically in relation to queer and trans lives, took root. I wanted to learn more about how queer and trans people cared for one another as they aged, both the rich, beautiful stories and the more difficult ones that reflect the influence of oppressive forces on our lives.
Part of the beauty of queer and trans lives is the diversity of our experiences, which shows up in our experiences of aging. There are tremendous generational differences in how folks relate to queer and trans identities and what that means for them in terms of whether they want that dimension of their identity to be seen, and to what extent, as they age.
Some queer and trans folks consider it necessary to express their queerness or transness in the context of aging. Others want these aspects of their identities to be a more private or intimate aspect of their lives. Both are perfectly valid choices. I think these differences are something we need to think about more in relation to the varied ways people make sense of and experience aging, and what kinds of services and supports they might need as a result.
We [also] live in a context of neoliberalism that has privatized and limited access to care, and often rests on the assumption that people will be able to rely on their spouse or families of origin to care for them as we age. There are so many queer and trans folks who, as a result of lacking access to their families of origin and the supports they need to continue living in the community, end up being coerced into situations where they transition into residential care environments. And that can be a very scary prospect for a lot of queer and trans people.
A lot of the research and writing on LGBTQ+ aging focuses on the invisibility and erasure of older queer and trans lives. The silencing of older queer and trans lives and a shortage of research on aging in our communities can lead to professions like nursing, social work, rehabilitation sciences, and others not being informed about the unique experiences and needs of older queer and trans adults. You end up with a whole health care system that is then developed without accounting for the issues of older LGBTQ+ people.
While it’s true that queer and trans aging is invisible in many contexts, I argue there are ways we also become hypervisible as we age. Neoliberal ideology favours the individual, the nuclear family, and normative family structures and relationships. If you conform to this norm, you’re less visible to and less at risk of being disciplined or controlled by the state. Queer and trans family structures come under far greater scrutiny than those of people who live in hetero-, cis-, mono- and amatonormative family structures. We are punished for existing in contexts of interdependence that are validating to our identities, because these come under scrutiny a lot more than normative family structures do.
For example, we may be more likely to be coerced into residential care facilities as we age, because home care providers might assume we don’t have kin-based caregivers and are therefore incapable of successfully aging at home in our communities (sometimes referred to as “aging in place”) without these normative family structures.
When and if we end up in settings like residential care facilities, we may end up labelled as LGBTQ+—sometimes without our consent—and then face the repercussions of being intelligibly “different” (or hypervisible) within these dominant systems. For example, a woman in a residential care facility who is visited by a seemingly same-gender partner might, without her consent, be labelled a “lesbian” by residents and care staff. Because of this, she might be targeted with violence, harassment, and discrimination at the facility since these kinds of state institutions are often not set up to support care recipients—as well as unpaid caregivers—existing outside of a normative family structure.
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Image: Meech Boakye
That’s definitely a reality for trans and queer people. I certainly had an awareness of my trans identity from a very young age. But I ruled out transition until I was 30. I adopted a queer identity for much of my childhood, adolescence, and adulthood until I started transitioning, even though I did this privately during my younger years. Because of the messages I’d received growing up about many queer people only living until their twenties and thirties during the height of HIV/AIDS epidemic, I didn’t expect to live beyond 30, so I built a life narrative for myself that didn’t really take into account what aging would look like.
I think a lot of queer and trans folks are in this predicament. I’ve been privileged enough to have the opportunity to live authentically. And yet, I still have this amount of life left and what do I do with it, and how do I make it meaningful? These are questions I ask myself and that I see reflected in the stories I hear from my research participants—questions around meaning and family as we enter middle adulthood and later stages of our lives.
A lot of the gay men in one of my studies would talk about how, when they would enter health care settings, they would make themselves identifiable as HIV positive. Their HIV status would be synonymous with queerness in a lot of those settings, even though we’ve gone through generations of trying to disentangle gay men from the HIV epidemic. In relation to this idea of visibility, HIV is something that outs people as having a queer body, a body that is non-normative in some way.
Some of the men who participated in my study really took pride in being positive. They saw opportunities in laying claim to their positive bodies and using their bodies to educate providers, and in that way working towards systems change. I remember one of my research participants talking passionately about how, although he had been heavily marginalized in mainstream health settings as a result of being gay and HIV positive, he joined community groups mandated with advocating for better patient conditions and had capitalized on those opportunities to make his voice heard as an HIV- positive person. In this way, he used his body to cultivate change.
It definitely resonates with me. I’m fortunate to have relationships with some older queer and trans folks who I very much see as mentors and as wonderful family of choice for me. And yet I often feel like there are so many folks out there who I could learn from and there would be no way for me to find them. I suspect there are a lot of people in my age category who are longing for connection across generations and struggle to find it. I think what this points to is the need for a greater number and quality of structures that allow for cross-generational connections in queer and trans communities.
There are local organizations that have started programs providing peer-to-peer connections between younger and older folks who are queer and trans. I’d like to see us create more room for programs like this in the health system—for example, a peer navigation program for older queer and trans folks who are navigating health care systems, being paired with somebody who also identifies as queer and trans and might have some experience as a service provider as well. We also need to create peer-run programs in community organizations where cross-generational connections are really the main point of those programs and where there’s a lead person connecting people across generations.
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Honour control and autonomy. Starting from there is absolutely critical because there are so many variations on what being queer and trans actually means to folks as we age, how we relate to those identities, and whether or not we want people around us to know we identify in these ways. Health care systems and health care providers are responsible for creating conditions that allow queer and trans older adults to have full control and choice over how we make ourselves visible, if at all, in health care systems. Every other practice should stem from this starting point.
For example, follow older adults’ lead in terms of language use and pronoun use, even if it’s sometimes counterintuitive. When I was practising as a social worker, one of my patients was a gay man who identified as gender nonconforming and used “he” pronouns. A lot of well-meaning practitioners at my place of work started referring to him as “she” and “her.” This was profoundly stigmatizing for this person and outed him as being gender nonconforming; he then became a target of violence from other patients.
I see emancipatory potential in making ourselves visible in health care contexts, in other institutional contexts where our voices might be silenced or used against us, grounded in careful reflection on our social positions and whether there are specific spaces where we might feel safe to make ourselves visible.
There are, for example, trans folks who have gone on to “live stealth” because they needed to. They do not disclose that they’re trans, they do not make themselves visible, and that is a perfectly valid decision because it usually comes from a place of careful reflection on whether the spaces they’re in are safe for them to be visible or not.
On the other hand, queer and trans folks who are in relative positions of power and advantage need to practise finding spaces where we can make ourselves visible and have our voices heard, because I think that’s a place where we can begin a process of cultivating change. For trans people like me who are in relative positions of power and privilege, this presents opportunities for us to use our bodies to draw attention to the idea that what’s often seen as “non-normative” is just a variation on the body as it ages. I’m really excited at the prospect of aging and being able to use my body in this way.
I’m approaching this with a little bit of trepidation because, already, my experiences with health care systems haven’t always been the greatest. That being said, I have a lot of hope and I think we have to start by making ourselves visible. That’s what I mean by “emancipatory potential,” making ourselves visible to hopefully work towards a better world for queer and trans folks who are aging.
“The Emancipatory Potential of Aging: Interview with Hannah Kia.” Excerpted with permission from the book The Care We Dream Of: Liberatory and Transformative Approaches to LGBTQ+ Health by Zena Sharman, published by Arsenal Pulp Press, 2021. Available wherever books are sold.
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