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current issues

data, policies and practice guidelines, surgery), and/or legally (legal gender of transgender men. Regarding access
[16]
resulting in a paucity of programmes that and name change). to healthcare, 48% reported having
cater for TGD patients. [1, 6] been called names or insulted in a health
South African reality facility, and 39% reported that they had
Evidence suggests that South African been denied healthcare because of their
[20)
healthcare workers are not adequately Transgender women have been found to gender identity.
trained to deal with health issues faced be at high risk for HIV and are therefore
by TGD people. [7, 8] As a result, they often included in South Africa’s National Experiences in health facilities
lack sensitivity, thus exhibiting various Strategic Plan for HIV, TB and STIs 2017 -
[17]
degrees of transphobia. 2022 as a key population. A systematic In a KwaZulu-Natal study, participants
[1]
[9]

review reported that TGD women were at reported encounters with hostile
Yet, TGD people experience an increased 48.8 times higher risk for HIV infection health services, in instances of micro
burden of disease, specifically in the compared with all adults of reproductive aggressions, which are ‘subtle forms
[10]

areas of HIV, mental health, violence age across 15 countries. A study of of discrimination, often unintentional
and victimisation. Notably, TGD people 230 TGD women in New York found and unconscious, which send negative
have a disproportionately high HIV that ‘gender abuse predicted depressive and denigrating messages to various
acquisition rate even in areas with low symptoms, and gender abuse combined individuals and groups’. Participants
[21]
HIV prevalence. [10, 11] with depressive symptoms predicted both reported experiences of denial of
high-risk sexual behaviour (unprotected privacy: violation of bodily privacy
Definition of key concepts receptive anal intercourse) and HIV’. through healthcare worker voyeurism and
[18]
A Cape Town study of men who have deliberate exposure of their transgender
Transgender is a term that refers to sex with men (MSM) found that 57% the status to other patients, and being made a
persons whose gender identity is gender non-conforming participants (who spectacle to other patients and healthcare
Challenges faced by trans and different to that expected on the basis of identified as female or transgender) had workers. There is evidence that some
[1]
sex assigned at birth.
tested HIV-positive compared with 31% healthcare workers tend to use religious
[12]
[19]
gender-diverse people in accessing ‘Gender diverse’ is a term to describe of the male-identifying participants. and cultural beliefs to explain their

behaviour towards sexual minorities.
[9]
‘people who do not conform to society’s A recent survey on the realities of violence, Barriers can be created by healthcare
public sector healthcare services or culture’s expectations for men and mental health and access to healthcare workers citing their belief system, in what
[13]
related to sexual orientation, gender is termed spiritual violence, referring to the
women’.
identity and expression (SOGIE), oppression of sexual- and gender-minority
[20]
[22]
‘Cisgender’ is a term for someone whose found alarming rates of mental health people through religion.
gender identity is the same as that challenges among the trans and gender-
Zamasomi Luvuno, BCur, MCur, PhD expected on the basis of sex assigned at diverse respondents: depression (63%), In addition to the difficulties accessing
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban birth. [12] anxiety (39%) and suicide attempts in the general healthcare, TGD people find

Elma de Vries, MB ChB, MFamMed, FCFP (SA) past year (16%). Experience of sexual it very difficult to access hormone
School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town For this article, trans and gender-diverse violence in the past year was reported replacement therapy and surgery for
(TGD) will be used as an umbrella by 35% of transgender women and 28% gender affirmation.
[23]
term to include transgender, gender
-nonconforming, genderqueer and
gender-diverse people.
‘Yes, I have been to the clinic. It was just for a broken bone, but they made me undress. Maybe they wanted to see if I was really a
girl? I don’t know. They were asking me silly questions and coming in and out of the room while I was waiting for the ambulance. It is important to note that gender identity
Like: ‘Uyisitabane?’ (Are you gay?) They don’t understand, they don’t know about us transgender?’ (the gender I know myself to be) is
different to sexual orientation (who I am
romantically or physically attracted to). [14]
This excerpt details the experience of African citizens, including minority provide a conducive environment such
a transgender person at a clinic, from groups such as trans and gender-diverse as unisex bathrooms and appropriate Transphobia is emotional disgust, fear,
a study conducted in KwaZulu-Natal [1] (TGD) persons. Despite such political ward arrangements for trans and gender- hostility, violence, anger or discomfort
[2]
that aimed to detail experiences of will and legal protection, TGD people diverse persons who are admitted to felt or expressed towards people who do
transgender people seeking care at in South Africa report poor access to hospital. [1, 4] not conform to the gender expectations
government health facilities. health services, both intentionally and of society. [15]
unintentionally, due to structural and Systemic barriers include erasure
The South African Government has systemic barriers in health facilities. [3] through failure to acknowledge the Gender affirmation is a process of
developed a constitution that is existence of TGD people within the affirming one’s gender identity, either
[5]

exceptional as far as human rights are Structural barriers encountered include health system. This erasure can be by social expression, psychological
concerned, granting rights to all South failure of the healthcare system to passive, through lack of knowledge, validation, medically (hormones,

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