(i) Am Equal

Message from the Minister for Health and Minister for Equality

The Victorian Government values and celebrates diversity. This commitment extends to improving the health and wellbeing outcomes and experiences of people with intersex variations, and to improving the quality of their interactions with hospitals and other health care settings.

Having an intersex variation is not a sexual or gender identity, it’s having variations of physical or biological traits. People with an intersex variation are as sexually and gender diverse as other people.

(i) Am Equal: Future directions for Victoria’s Intersex community details the Victorian Government’s commitment to ensure the delivery of high-quality care and support to people with intersex variations and their families, within the Victorian health system.

In delivering on (i) Am Equal: Future directions for Victoria’s Intersex community, I thank the members of the Intersex Expert Advisory Group, their families, healthcare professionals and human rights experts for their dedication to driving this work to improve the health and wellbeing of people with an intersex variation.

I would also like to acknowledge the work of the Victorian Commissioner for LGBTIQA+ Communities, Ro Allen in advocating for the rights of people with an intersex variation and providing advice to the Victorian Government.

The Hon. Martin Foley MP

Minister for Equality

Message from the Co–Chairs of the Victorian Intersex Expert Advisory Group

I’ve been telling people that 2021 is the year of the I. This work is long overdue for the I in the alphabet, often mentioned, all too often overlooked.

I’m hoping that (i) Am Equal: Future directions for Victoria’s Intersex community has the reforms and support that people require. It’s been my absolute pleasure to work through the highs and lows of this project over the years. I want to thank the community members of the Intersex Expert Advisory Group over those years for their commitment and candour.

I’d also like to thank the clinicians, and the departmental staff who have worked on this along the way.

This work has always been helped by the commitment of everybody to the human rights of every person with intersex variations born in Victoria.

Ro Allen

Victorian Equal Opportunity and Human Rights Commissioner

Addressing the human rights and treatment of Victorian children born with variations of sex characteristics has been a long time in the making, but it’s important we get it right.

I’m proud the Victorian Intersex Expert Advisory Group - which includes intersex people, clinicians, human rights advocates and departmental staff – has put together the foundations for the work ahead to truly make 2021 the year of the I.

I thank them for their work and longstanding commitment to intersex people. It’s through working together collaboratively, respectfully and based on evidence that we learn from the past to protect and nurture intersex children in the future.

Tony Briffa

Future Intersex Resourcing

Aim: Increase awareness and knowledge of intersex variations to support informed decisions and quality practice.

• Develop a suite of resources for parents, children and families, health professionals, service providers and community members to complement existing resources and increase awareness of intersex variations.

Resources will be highly accessible and inclusive of information for parents, children and families; with consideration of information in languages other than English and for various faith groups; for young people; ensuring alignment with the Intersex Practice Guide to support clinicians and services.

• Ensure that the Victorian Government LGBTIQA+ Inclusive Language Guide continues to recognise the range of preferred terms used to describe or refer to people with variations in sex characteristics.

This aims to improve Victorian Government departments and funded services’ knowledge of intersex variations and the appropriate terminology.

Future Intersex Health and Wellbeing Centre

Aim: Ensure health and LGBTIQA+ services and programs are inclusive of intersex variations and support the establishment of specific intersex health and wellbeing services.

• Develop a proposal for a state-wide community-managed intersex Health and Wellbeing Centre (service/clinic) that demonstrates proof of concept and provides holistic, safe and co-designed lifelong care, education and peer-based support in a safe space; inclusive of virtual services to ensure regional access.

• Incorporate a central place for relevant and useful resources, information and research into the functions of the intersex Health and Wellbeing Centre.

• Deliver an Intersex Standards of Care and Support Guideline to improve the experience and outcomes of people with intersex variations using health services. This aims to provide high level basic advice for health and human service providers to provide person-centred care for people with intersex variations across their life-stage.

• Work with organisations responsible for LGBTIQA+ accreditation programs, training, research and data collection in order to increase awareness and improve intersex inclusiveness.
• Support the update of new data reporting guidelines adopted by the Victorian Government, to include changes to how intersex status is reported, ensuring alignment with the Australian Bureau of Statistics.

Improving future treatment

Aim: Improve the treatment and care of people, especially infants and children, with an intersex variation.

• Develop an intersex protection system inclusive of:
• a mechanism to prohibit deferrable medical interventions modifying a person’s sex characteristics without personal consent
• an oversight panel to ensure compliance with the prohibition
• provisions which ensure the collection of data and transparency over what treatments are being performed, including a requirement to report to the Department of Health when medical treatment modifying sex characteristics is provided to people with intersex variations without personal consent

• In order to ensure that treatment and care is improved, the Victorian Government will ensure:
• that a human rights evidenced-based framework is enacted prior to determining that any medical interventions, including surgeries and hormonal interventions, are performed on people, especially infants and children
• that any mechanisms are also able to provide recommendations to government including strategies for data collection and reporting where appropriate
• there are processes that ensure psychosocial supports are available to consumers.
• there is transparency, accountability, and honesty in decision-making

Establishment of this system should be inclusive of a review of equivalent models already implemented across jurisdictions, be informed by best-practice evidence-based decision making and support community advocates to be central in the process.

• Assist health practitioners and healthcare services to apply clinical best practice via determining the feasibility and pathway for developing National Guidelines that prescribe mandatory standards of care for people with intersex variations that are consistent with the system proposed above.

Next steps

The Victorian Government will continue to work and engage with the intersex community, families and clinicians to design and implement (i) Am Equal: Future directions for Victoria’s Intersex community.

This will include engaging the expertise of the Intersex Expert Advisory Group and the Health and Human Services Working Group to refine the directions and to prioritise implementation.

Monitoring and reporting over time will be undertaken by the Intersex Expert Advisory Group through to the LGBTIQA+ Taskforce, which is chaired by the Minister for Equality. It is anticipated that this will link to work undertaken in the whole-of-government LGBTIQA+ Strategy.

Vision

A Victoria where people with intersex variations are recognised as having natural variations in sex characteristics, their human rights are upheld and they have the opportunity to achieve the best health and wellbeing outcomes.

Principles

Human rights: The rights of people with intersex variations are promoted and protected, reflecting the values of freedom, respect, equality and dignity.

Self-determination: The experience and voice of people with intersex variations is centred and protects their rights to autonomy, bodily integrity, and supported decision-making.

Holistic care: People with intersex variations have access to health and human services that are life-long and respond to their diverse health and wellbeing needs.

Person-centred care: People with intersex variations have access to inclusive, streamlined and equitable person-centred care (and where appropriate, family-centred care) that is non-judgemental, non-pathologising, intersectional and destigmatising.

Accountability & transparency: Health and wellbeing services accessed by people with intersex variations are affirming, of high quality, timely, underpinned by appropriate oversight, and support people to make informed-decisions.

Consultation

(i) Am Equal: Future directions for Victoria’s Intersex community seeks to improve health and wellbeing outcomes, health-related services and policy, and health system interactions for people with intersex variations and their families by exploring systems-level opportunities to inform future legislative, regulatory, policy, and program directions.

(i) Am Equal: Future directions for Victoria’s Intersex community have been informed by a range of consultations with key stakeholders including:

• Intersex Expert Advisory Group
• Intersex Human Rights Australia
• Intersex Peer Support Australia
• Royal Children’s Hospital
• Monash Hospital
• Human Rights Law Centre
• Equality Australia
• Australian Human Rights Commission
• Victorian Government departments
• Other key health stakeholders and clinical organisations including the Royal Australasian College of Surgeons

This work has primarily been framed in relation to initiatives over the last 10 years that have inquired into and explored policy solutions with respect to human rights and legal reform; health and wellbeing; peer support; education, awareness and employment for people with an intersex variation, including:

• Surgery on intersex infants and human rights, Australian Human Rights Commission (2009)
• Decision-making principles for the care of infants, children and adolescents with intersex conditions, Victorian Department of Health and Human Services (2013)
• Involuntary or coerced sterilisation of intersex people in Australia, Australian Senate Community Affairs References Committee (2013)
• The Darlington Statement, A joint consensus statement by Australian and New Zealand intersex organisations and advocates (2017)
• Intersex information and resource paper, Victorian Department of Health and Human Services (2019)
• Legal recognition of sex and gender, Tasmania Law Reform Institute (2019)