Page 10 - ONLINE – Nursing Matters October 2020_Vol 11

current issues

rejected and become isolated, which – struggles to access masculinising or By using a participatory approach,
further affects their stress levels and mental feminising hormonal treatment. the healthcare workers and the trans
health. In order to cope with minority community can become part of the team
stress, some TGD people self-medicate Due to previous transphobic experiences in that initiates and upholds trans-affirming
with alcohol and substances. [12, 13] the healthcare system, many TGD people healthcare. Through an informed con-
[2]
fear approaching healthcare providers for sent approach, the TGD person can make
TGD people can also present with gender-affirming healthcare. This often decisions pertaining to their body and
[10]
depression, anxiety and other mental leads to self-medicating, risky behaviours medical transitioning. [11]
health challenges. High rates of suicidality and mental healthcare challenges.
have also been reported, especially It is healthcare educators’ ethical duty
in TGD people who are unable to An ethical response to include gender-affirming healthcare
[14]
access gender-affirming healthcare and in training curricula. Not only will this
psychological support. [1, 2] In South Africa Affirmative practice is key when working in enable healthcare professionals to assist
[11]

gender-affirming treatment is not readily the field of gender-affirming healthcare. TGD people but also to prevent harm to
available and TGD people need to By affirming a person’s gender identity, the their patients/clients. [14]
overcome various challenges. TGD client is respected and recognised
for the person they are. A person is also
Gender-affirming healthcare: Challenges accessing healthcare seen as the expert of their own life and As healthcare providers we are
their experience of self is validated.
Healthcare and mental healthcare
Our ethical response providers are mostly not trained in Research has indicated that TGD called to serve our communities.
For far too long we have ignored,
[14]
gender-affirming healthcare. This leads people experience fewer mental health
l
to challenges for TGD people wanting chal enges when they are able to
community. Not only is it TGD
(17)
to access treatment. Often when they access gender-affirming treatment. and even marginalised, the TGD
approach the healthcare provider, they Benevolence and non-malevolence are people’s human right to access
Chris/tine McLachlan, MSocSc, Clin Psych, MTh, MA find that the person questions them, at two of the core principles that healthcare healthcare, but it is also our ethical
[16]
Department of Psychology, University of South Africa times ignores them or even stigmatises providers uphold. Withholding health- obligation to provide medical
and victimises them. [15] care could lead to heightened gender treatment for those who need
dysphoria, depression and suicide it in order for them to live their
[1)
Furthermore, due to societal inequalities, and does not support these previously authentic self.
In South Africa access to gender-affirming gender dysphoria. ‘Gender dysphoria TGD person to access gender-affirming most TGD people cannot afford treat- mentioned ethical principles.
[4]
healthcare has been increasing over the refers to discomfort or distress that is healthcare, if they so wish. ment, and even if the person is on
[2]

last ten years. Trans and gender-diverse caused by a discrepancy between a medical aid, most medical aids will not
(TGD) people are accessing affirmative person’s gender identity and that person’s For many TGD people, identifying as cover gender-affirming healthcare. In
[1]
psychotherapy, speech therapy, hormone sex assigned at birth and the associated transgender can be self-affirming and South Africa, people from more rural
[8]
replacement therapy and gender- gender role and/or primary and inherently healthy. It enables the person areas are unable to access gender-
affirming surgery. But, the majority of TGD secondary sex characteristics’. [5] to live authentically which again has a affirming healthcare at their nearest
people experience challenges as they try positive impact on their mental health clinic, and in some provinces, treatment is
to access gender-affirming healthcare. A gender identity that is incongruent and well-being. The challenge that often unavailable. References
with a person’s assigned sex at birth arises is that the community and society as 1. Koch JM, McLachlan C, Victor CJ, Westcott J, Yager C. The 10. Academy of Science of South Africa. Diversity in human sexuality:
Research has indicated that most TGD is not a mental illness. Using a mental a whole do not accept people who have Regrettably, a mental illness or psycho- cost of being transgender: Where socio-economic status, global Implications for policy in Africa. Pretoria: Academy of Science of
South Africa: 2015.
health care systems, and gender identity intersect. Psychology &
people, who are unable to access gender- illness/psychopathology diagnosis can gender incongruence. pathology diagnosis is often required Sexuality 2019. https://dx.doi.org/10.1080/19419899.2019. 11. McLachlan C, Nel JA, Pillay S, Victor CJ. The Psychological
1660705
Society of South Africa’s guidelines for psychology professionals
affirming healthcare, experience higher lead to further stigmatisation of the TGD in order to access gender-affirming 2. McLachlan C. Que(e)ring trans and gender diversity. South working with sexually and gender-diverse people: Towards
inclusive and affirmative practice. S Afr J Psych. 2019. https://
African Journal of Psychology. 2019;49(1):10–13.
levels of gender dysphoria, depression, person. Pathologisation also creates Minority stress has a significant impact on healthcare. Although the informed 3. World Health Organization. International classification of dx.doi.org/10.1177/0081246319853423journals.sagepub.
[6]
[2]
com/home/sap
anxiety and suicidality. Furthermore, for the perception that a variation in gender South African TGD people. The minority consent model is being adopted by diseases and related health problems-10th revision. Geneva, 12. Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC,
[1]
Switzerland: WHO, 2007.
many TGD people to live authentically it expression, gender role and gender stress model indicates that harassment, many psychologists and clinicians, 4. American Psychiatric Association. Diagnostic and statistical Garofalo R, et al. Syndemic theory and HIV-related risk among
young transgender women: The role of multiple, co-occurring
manual of mental disorders (5th ed.). Washington, DC; 2013.
becomes a necessity to transition in order identity is an illness and should be seen social exclusion, stigmatisation, victimi- there are still healthcare providers who 5. World Professional Association for Transgender Health. health problems and social marginalization. Am J Pub Heal.
2012;102(9):1751–1757.
for their body to present and reflect their as abnormal. sation and discrimination have an are incorporating a more paternalistic Standards of care for the health of transsexual, transgender and 13. Müller A. Sexual and reproductive health for transgender and
gender non-conforming people. 2011. http://www.wpath.org/
gender non-conforming people: Guidelines for healthcare
gender identity. This inability to access impact on the mental health and stress medical model and/or actively gate- documents/SOC%20V7%2003-17-12.pdf workers in primary care. Cape Town: Gender DynamiX: 2012.
[2]
[9]
this very important healthcare increases The International Classification of Diseases levels of minority groups. The mental keeping access to healthcare. [16] 6. Wilson D, Marais A, De Villiers A, Addinall R, Campbell MM. 14. De Vries E, Kathard H, Müller A. Debate: Why should gender-
Transgender issues in South Africa, with particular reference
affirming health care be included in health science curricula?
to the Groote Schuur Hospital Transgender Unit. S Afr Med J
BMC Med Educ. 2020;20(1):51.
the mental health risks and challenges that and Related Health Problems10th revision health consequence of minority stress is 2014;104(6): 449-451. 15. Luvuno ZP, Ncama B, Mchunu G. Transgender population’s
this marginalised population faces. [1] (ICD-10) led to the depathologisation worsened by the intersection of multiple South Africa also subscribes to the 7. World Health Organization. ICD-11 for Mortality and Morbidity experiences with regard to accessing reproductive health
Statistics (December 2018). https://icd.who.int/browse11/lm/
care in Kwazulu-Natal, South Africa: A qualitative study. Afr J
of trans and gender diversity by the oppressed identities, less privilege and Western binary concept of gender. en#/http://id.who.int/icd/entity/90875286 Prm Heal Care Fam Med. 2019;11(1):a1933. http://dx.doi.
[2]
org/10.4102/phcfm.v8i1.1054
Trans and gender-diverse people’s World Health Organization. Trans and restricted access to resources. [10, 11] Being Gender is seen as either being man or 8. American Psychological Association. Guidelines for 16. Tomson A. Gender-affirming care in the context of medical
Psychological Practice with Transgender and Gender
Nonconforming People. 2015. http://www.apa.org/practice/
mental health challenges gender diversity now falls under a new invalidated, for example by the misuse of woman, masculine or feminine. A person guidelines/transgender.pdf ethics – gatekeeping v. informed consent. S Afr J Bioeth Law.
2018;11(1):24–28.
chapter namely, ‘Conditions Related pronouns, further elevates the stress that who falls outside this binary concept – e.g. 9. Psychological Society of South Africa. Practice guidelines for 17. Olson KR, Durwood L, DeMeules M, McLaughlin KA. Mental
psychology professionals working with sexually and gender-
health of transgender children who are supported in their
TGD people have often been diagnosed to Sexual Health’ and classified as the TGD person may experience. Many a person that is gender-queer or agender diverse people. Johannesburg, 2017. identities. Pediatrics. 2015;137(3):e20153223.
with gender identity disorder and/or gender incongruence. This enables a TGD people are also marginalised,
[7]
[3]
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