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 The National Department of Health   or female in different situations.   for being different, the quicker that I
 added hormones for the treatment   Resist  the  urge to  place me  into   can feel like I am moving toward the
 of ‘gender dysphoria’ to the Tertiary   descriptive buckets and respect my   body I am inside, the better and more
 Essential Medicines List in December   individual identity, which may well   comfortable I will feel with myself.
 [24]
 2019.    be somewhere along a continuum.  8.  Please train your staff as well. There
 4.  Names,  pronouns,  and  gender   have been many times where I go
 How would trans people like to   markers are important. I want people   to medical appointments and I
 be treated?  to understand me and respect me   am called by my birth name and
 for the person I am. When you call   am looked at funny or questioned
 Gender-affirming healthcare is more   me by the wrong name or pronoun,   because my outward appearance
 than just transition-related care and   this can feel like an insult. If you are   might not match the gender marker
 refers to an affirming experience in   not sure what to call me, just ask, it is   in my medical record. Please train
 all healthcare encounters.  A focus   always better to ask than to assume.  your staff to look for my preferred
 [16]
 group  of  transgender  and  gender-  5.  Don’t ask about my genitals unless   name in my medical record, as this
 nonconforming  youth  identified  the   medically necessary. Many people   might differ from my legal name, and
 top  ten  things  they  want  healthcare   are  curious  about  what  I  have  or   ask me what my preferred pronoun
 workers to know, in their own words: [25]   want ‘down there.’ But please,   is, rather than assuming.
 don’t ask me about my genitals just   9.  If I am depressed or anxious, it’s
 1.  Sexuality and gender are two   because you’re curious. I wouldn’t   likely not because I have issues with   Harm reduction for people who
 different things. Totally separate.  ask you about yours. If there is a   my gender identity, but because
 2.  Talking to strangers about these   medical reason to ask me about my   everyone else does. Many of us are
 things is uncomfortable. Talking to a   genitalia, please let me know the   anxious and depressed not because   use drugs in Southern Africa
 medical provider about my gender   reason before asking the question.  we are transgender, but because
 identity and puberty can be painful   6.  Genital and breast exams are   other people have a problem
 and awkward. Be patient and do   uncomfortable for most people,   with  us  being  transgender.  Please
 all you can to create a comfortable   and they can be particularly   acknowledge this when talking to
 atmosphere.   uncomfortable for me. I may be   me about my mental health.  A P Scheibe, MB ChB, Dip HIV Man, MPH
 3.  Nonbinary people exist. When   extremely uncomfortable with my   10.  Let me know that you are on my
 health workers think of transgender   current physical body, because it   team. Many of us have had to put up
 people, they usually think of people   doesn’t match who I know myself to   with bullying and misunderstanding

                                                                                                                 [6]
 who identify as 100% girl or 100%   be. If it is necessary to examine me,   in school and in our communities.   Drugs  Sugar is an extreme example, but shows  of economically powerful nations.
 boy. A lot of us don’t think that way.   please explain the reason.    We want to know that health   how we view various mind-altering  Several international conventions outline

                                                                                                                 [7]
 I may feel that neither label fully   7.  Cross-sex hormones can save my life.   professionals are on our side and   We all use psychoactive substances.  substances that have the potential to do  the international scheduling of drugs.
 describes me or that I feel male   As I know people are judging me   will not judge us.   This includes substances we may not  harm differently. The example highlights  However, this classification is not based
          think of as drugs.  Sugar, for example,  how regulations have life-changing,  on scientific evidence. The Single
                        [1]
          is a substance that releases endogenous  often unacknowledged consequences.  Convention on Drugs (1961) framed the
          opioids in our brain, giving us a sense  As healthcare providers, we would  use of drugs as ‘evil’, and this moral view
                                                                                            [8]
 References   of pleasure when consumed. Animal  not accept using interventions to treat  has endured.  Schedule 1 substances
 1.   Luvuno ZP, Ncama B, Mchunu G. Transgender population’s experiences with regard to accessing   for lesbian , gay , bisexual and transgender people in South Africa. BMC Int Health Hum Rights.   models show that the repeated use of  diabetes that do not work or that harm  (1961 Single Convention) were noted
 reproductive health care in Kwazulu-Natal, South Africa: A qualitative study. Afr J Prm Heal Care Fam   2017;17(16):1–10.
 Med. 2019,11(1):a1933.   15.   Psychological Society of South Africa. Practice Guidelines For Psychology Professionals Working With   sugar leads to tolerance and cessation  people. Nor would we require people  to be ‘highly addictive and liable to
                                    [2]
 2.   Republic of South Africa. Constitution of the Republic of South Africa. 1996.  Sexually And Gender-Diverse People. 1st ed. Victor CJ, Nel JA, editors. Johannesburg: Psychological   of intake results in withdrawal.  Even  with diabetes to reuse or share their  abuse’ – and included heroin, cocaine
 Society of South Africa; 2017.
 3.   Newman-Valentine D, Duma S. Injustice to transsexual women in a hetero-normative healthcare   though sugar is a causative factor of  injecting equipment. So why do we look  and cannabis. The 1971 Convention
 system. African J Prim Heal Care Fam Med. 2014;6(1):1–5.   16.   Reisner SL, Radix A, Deutsch MB. Integrated and Gender-Affirming Transgender Clinical Care and
 Research. J Acquir Immune Defic Syndr. 2016;72:S235–S242.
                           [3]
 4.   Roberts TK, Fantz CR. Barriers to quality health care for the transgender population. Clin Biochem   obesity and diabetes, it is widely used,  at illegal drugs and the people who use  on Psychotropic Substances included
 2014;47(10–11):983–987.   17.   SANAC. Let our actions count: South Africa’s national strategic plan for HIV,TB and STIs 2017–2022.
 5.   Bauer GR, Hammond R, Travers R, Kaay M, Hohenadel KM, Boyce M. “I Don’t Think This Is   The South African National AIDS Council. 2017.   often several times daily. The consumption  them so differently?    an additional group of schedule 1
 Theoretical; This Is Our Lives”: How Erasure Impacts Health Care for Transgender People. J Assoc   18.   Nuttbrock  L,  Bockting  W,  Rosenblum  A,  Hwahng  S,  Mason  M,  Macri  M,  et  al.  Gender  abuse,   of sugar is culturally acceptable so there   substances with ‘high risk of abuse, posing
 Nurses AIDS Care. 2009;20(5):348–361.   depressive symptoms, and HIV and other sexually transmitted infections among male-to-female
 transgender persons: A three-year prospective study. Am J Public Health. 2013;103(2):300–307.
 6.   Snelgrove JW, Jasudavisius AM, Rowe BW, Head EM, Bauer GR. “Completely out-at-sea” with   is not much  stigma associated with its  Moral views on drug use  a particularly serious threat to public
 “two-gender medicine”: A qualitative analysis of physician-side barriers to providing healthcare for   19.   Jobson G, Tucker A, de Swardt G, Rebe K, Struthers H, McIntyre J, et al. Gender identity and HIV risk   [4]
 transgender patients. BMC Health Serv Res. 2012;12(1):110.   among men who have sex with men in Cape Town, South Africa. AIDS Care - Psychol Socio-Medical   use, unless connected to obesity.  As   health with little or no therapeutic value’
 Asp AIDS/HIV 2018;30(11):1421–1425.
 7.    Müller A. Teaching lesbian, gay, bisexual and transgender health in a South African health sciences   it is legally regulated, sugar can be  Drugs  may  (positively  or  negatively)  – and included 3,4-methylene-dioxy-
 faculty: addressing the gap. BMC Med Educ. 2013;13:174.   20.   Müller A, Daskilewicz K, Southern and East African Research Collective on Health. Are we doing
 alright? Realities of violence, mental health, and access to healthcare related to sexual orientation and   bought in pure form from a reputable  affect  an  individual  physically,  mentally  methamphetamine (MDMA), commonly
 8.   Müller A. Professionalism is key in providing services to LGBTI. S Afr Med J.  2014;104(8):558–559.   gender identity and expression in South Africa: Research report based on a community-led study in
 nine countries. Amsterdam; 2019.                                                                [7]
 9.   Luvuno Z, Ncama B, Mchunu G. Knowledge, attitudes and practices of health care workers related to   seller, with very low risk of poisoning from  and socially. They may also affect society  known as ecstasy.  Despite the risk of
 treatment and care of transgender patients: A qualitative study in Kwazulu-Natal, South Africa. Gend   21.   Nadal KL, Davidoff KC, Davis LS, Wong Y, Marshall D, McKenzie V. A qualitative approach to
                                                         [5]
 Behav. 2017;15(2):8694–8706.   intersectional microaggressions: Understanding influences of race, ethnicity, gender, sexuality, and   adulterants, and can be used without risk  in these ways.  However, society’s view  developing dependence, or public health
 10.   Baral SD, Poteat T, Strömdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in   religion. Qual Psychol. 2015;2(2):147–63.   of arrest. Healthcare workers are aware  of drugs like heroin (also known as  implications, neither alcohol, nor tobacco
 transgender women: a systematic review and meta-analysis. Lancet Infect Dis 2013;13(3):214–222.   22.   Diz S. Spiritual  Violence: Queer People  and the  Sacrament of Communion.  Florida International
 11.   Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental   University; 2013. https://pdfs.semanticscholar.org/a0e8/0f65bf70a785189e43c8296bd000f16  of diabetes and are equipped to manage  (aka) nyaope or whoonga), cocaine,  were scheduled and their use is rarely
 8d474.pdf?_ga=2.163824703.1885290564.1584561546-870278534.1578857443
 health, and resilience in an online sample of the US transgender population. Am J Public Health
 2013;103(5):943–951.   23.   Spencer S, Meer T, Müller A. “The care is the best you can give at the time”: Health care professionals’   it following evidence-based guidelines.  methamphetamine (aka tik, crystal or  viewed as ‘evil’.
 12.   de Vries E, Kathard H, Müller A. Debate: Why should gender-affirming health care be included in   experiences in providing gender affirming care in South Africa. PLoS One. 2017;12(7):1–18.   Insulin is affordable and accessible at all  meth) or cannabis (aka dagga) has been
 health science curricula? BMC Med Educ 2020;20(1):51.   24.   Department: Health Republic of South Africa. National Essential Medicines List Comittee. Teritary and
 Quaternary level essential medicines list. December 2019. http://www.health.gov.za/index.php/  levels of care, and needles and syringes  significantly influenced by global drug  Alcohol  was  responsible for  the  most
 13.   Oliphant J, Veale J, MacDonald J, Carroll R, Johnson R, Harte M, et al. Guidelines for Gender   standard-treatment-guidelines-and-essential-medicines-list/category/457-hospital-level-tertiary-and-
 Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in   quaternary  – along with counselling – are provided  policy. And global drug policy has been  overall harm in a scientific review of
 Aotearoa, New Zealand. N Z Med J. 2018;131(1487):86–96.
 25.   Turban J, Ferraiolo T, es Martin A, Olezeski C. Ten Things Transgender and Gender Nonconforming
 14.   Müller A. Scrambling for access : availability , accessibility , acceptability and quality of healthcare   Youth Want Their Doctors to Know. J Am Acad Child Adolesc Psychiatry 2017;56(4):275–277.   for its injection for those who need it.   greatly swayed by the political agendas  harm done to individuals and society in
 HIV Nursing Matters | October 2020 | page 12                           HIV Nursing Matters | October 2020 | page 13
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