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Transgender-inclusive healthcare ensures access for the marginalised

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The transgender manager of a hardware store is claiming R3 million from the Gauteng department of health after a complication of a gender reassignment. Picture: iStock
The transgender manager of a hardware store is claiming R3 million from the Gauteng department of health after a complication of a gender reassignment. Picture: iStock

In the inner city of Johannesburg, at Esselen Clinic in Hillbrow, there is a set-up of white shipping containers in which pertinent healthcare services are being provided for transgender people.

Although only temporarily operating at this location, plans are under way for a permanent transgender-inclusive healthcare services clinic in Braamfontein.

“It has been a challenge for people seeking healthcare access from areas, such as Ekurhuleni and Pretoria, who have called us,” said a nurse working in the mobile units.

She said the operating times of the clinic, which closes at 4.30pm, had been a challenge for patients, specifically for follow-ups, as many are still at work or not always reachable during the clinics’ operating times.

This would explain how calm it was with not many patients to chat to at the trans-specific service unit.

Between March and April this year the Wits Reproductive Health and HIV Institute opened Africa’s first dedicated clinics for transgender health in Cape Town, East London, Port Elizabeth and Johannesburg.

The clinics focus on gender-affirming healthcare for transgender and gender-diverse people living in the respective cities.

The institute, which seeks to address gaps in service delivery and create health services that the community is comfortable using, said that when visiting public health services, transgender individuals remained marginalised.

transgender women globally are 50 times more likely to be HIV positive than the general population

Individuals face issues from being misgendered to being questioned about identity, often experiencing rejection because of their identity.

The institute said transgender women globally are 50 times more likely to be HIV positive than the general population.

Rutendo Bothma, the institute’s senior adviser of community engagement, said the four transgender health clinics were still under renovation but were operational, as were the mobile units.

For now the Johannesburg facility is working from the same site as the sex workers’ health clinic.

The model for the clinic is that there is a site manager responsible for oversight and engagement with that specific district.

There are also nurses, coordinators and the trans-agents, who are transgender people, who are responsible for the engagement with and mobilisation of the trans communities.

The institute said the clinics provide services to prevent HIV transmission in high-risk populations. Their job includes providing health information products, HIV testing and counselling, distribution of condoms and oral pre-exposure prophylaxis.

Further services include giving antiretroviral therapy and support to HIV-positive clients. They plan to provide primary healthcare, family planning, tuberculosis screening and treatment for sexually transmitted infections in future.

The institute said there was a need for bias-free healthcare – an undervalued necessity for people whose gender identity can limit their access to healthcare.

The initiative is funded under the President’s Emergency Plan for AIDS Relief Key Populations Award, a US government initiative to address the global HIV/Aids epidemic.

Tebogo Nkoana, executive director at Transgender and Intersex Africa, said: “We hope that government is put to task and realises that transgender-inclusive healthcare is a need.”

Transgender and Intersex Africa, founded nine years ago by African transgender individuals, provides services in previously disadvantaged communities in South Africa.

“This is a first for South Africa,” said Bothma, adding that there was no identified network providing gender-affirming healthcare for trans and gender-diverse people.

Bothma said the goal was to set up comprehensive holistic clinics that also provide psychosocial support. She said nurses had gone through gender-affirming sensitisation which was facilitated by Gender DynamiX.

“We sent two people to visit the Johannesburg clinic where they waited a while before being helped. The services available were limited to HIV healthcare and we were told that the psychology services were still being rolled out.”

A nurse told City Press that a social worker had been providing counselling services.

“Healthcare providers are generally not trained in this field and as more and more trans and gender-diverse people access gender-affirming care, training is becoming necessary. Not only for doctors, psychologists, social workers and speech therapists but also nursing staff,” said Bothma.

Chris McLachlan, a healthcare practitioner who provides training for the Psychological Society of SA and Gender DynamiX, said they worked strongly from an affirming stance where they acknowledged the diversity in gender identity.

“When one works from an affirming perspective, in which a person is accepted for who they are, people experience it as a safe place,” said McLachlan.

  • This series on LGBTIQ life in Africa is made possible through a partnership with The Other Foundation. To learn more about its work, visit theotherfoundation.org


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