By Keabetswe Makhotla and Nomsa Manzini.
As a transgender woman, having to go to a healthcare facility can be daunting, not only to get what I’m looking for, like medication and regular check-ups, but because I receive hostile treatment from the medical professionals employed to provide patients with healthcare.
In addition to the hostility in the healthcare space, another plight I face is the issue of legality, i.e. having the proper identity documentation that reflects who I truly am – as part of my Legal Gender Recognition (LGR).
This was my experience: I went to the Department of Home Affairs to apply for a new Identity document (ID), but the staff did not know what a gender marker is, yet they also asked me why I am using my current ID, as it is inaccurate. Instead of feeling triumphant because of this implicit acknowledgement of my gender identity, I only felt defeat. This showed me that this journey was not going to be a ‘walk in the park’, because we face prejudice every day for being who we are, as a community and individually.
According to the South African Constitution and The Alteration of Sex Description and Sex Status Act, known as Act 49 of 2003, I have the right to change my gender description on my Identity Document. Having an ID that does not reflect my true gender identity and gender expression ignites confusion, brews prejudice and ultimately ensures that I am barred from accessing the services I need.
Discrimination harassment and ill-treatment of LGBTQIA+ patients are rife in medical facilities across South Africa due to their medical staff lacking sufficient training on how to care for diverse patients. They often don’t practice the simplest courtesies of their profession such as, addressing patients by their correct pronouns and practicing confidentiality. Instead, they express their religious beliefs and personal opinions without regard for our dignity and use these as a basis for not rendering services that they’re mandated to provide.
A vast majority of LGBTQIA+ persons in South Africa have to rely on themselves and each other for survival because many of us don’t receive support from our families, the communities we live in or society at large. We’re entrenched in a cycle of poverty and harmful and destructive behaviour in an attempt attain our basic needs. The constitution ensures protection and rights for us, but our voices fall on deaf ears as the government lags in ensuring that policies, like Act 49 and the National Health Act, are implemented effectively.
Public servants and service providers tend to shun and discourage LGBTQIA+ patients by humiliating them privately and in the presence of other patients and staff and not respecting their pronouns. This does immeasurable psychological harm which often results in transgender patients then looking for ways to self-medicate and many end up defaulting on other chronic medications because they are avoiding the violent experience of having to collect their medication at these facilities.
Accessing gender affirming healthcare such as hormone replacement therapy and surgery is difficult as most clinics, hospitals and other healthcare facilities don’t have information on how to begin the process and how to monitor it. Furthermore, public hospitals claim to have a “serious backlog” and turn us away. This perpetuates discrimination against transgender patients, and this forces us to then explore other avenues in order to continue the struggle towards living the authentic and affirming life we seek for ourselves. This often means seeking medication via back doors and the black market, which causes more harm than good.
Social stereotypes play a pivotal role as well because they encourage and perpetuate trans people’s dysphoria. This leads to depression and suicidal thoughts – many of which become suicide attempts, with far too many being successful. Suicides by LGBTIQ people in general, and trans people in particular, make a big contribution to our country’s alarming youth suicide rates. Suicide not only affects us as a community and our loved ones, but our society as a whole. The bottom line here is that being discriminated against based on your sexual orientation and gender expression is dehumanising and harmful.
Although we have seen or heard of transgender people who have successfully transitioned, many of them are still waiting for their new ID applications to processed – months, and in some cases years, after submitting the application. While they await their new ID numbers, they are considered to be ‘non-existent’ within the Home Affairs system. This means they have no form of identification, are erased and are effectively rendered stateless and without citizenship and therefore cannot have access to state services (such as healthcare and education) and are also barred from accessing simple things like a bank account until they receive their new ID.
The world needs to know that despite Section 27 of the South African constitution guaranteeing everyone’s the right to health care services, including reproductive health care, transgender people are being discriminated against, excluded and barred from accessing this right and this has dire consequences.
Transgender people have specific health care and public service needs that must be addressed, and it is critical that health care providers learn about and equip themselves with knowledge concerning transgender health issues. We deserve access to paramount services.