“The care is the best you can give at the time”: Health care professionals’ experiences in providing gender affirming care in South Africa

Abstract

BackgroundWhile the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is—theoretically—available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options.MethodBased on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines.ResultsOur findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider.ConclusionAccordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems.

Experiences of transgender and non-binary youth accessing gender-affirming care: A systematic review and meta-ethnography

“…Multiple studies describe the arduous experiences of trans adults seeking healthcare [43][44][45][46][47][48][49][50][51][52]. Notably, most will report experiences of stigma and discrimination when accessing healthcare, from encounters with administrative staff to encounters with healthcare providers [53][54][55][56][57][58].…”

Missing knowledge of gendered power relations among non-governmental organisations doing right to health work: a case study from South Africa

“…Understanding gendered power relations is fundamental for the LN, as a human rights-based network, to continue to inclusively advocate for health and human rights [ 57 ]. Despite progressive legislation, South Africa has profound gender inequality; women in South Africa are more likely to suffer health and rights violations, and there is emerging evidence that transgender and gender diverse people are systematically excluded from health policy and healthcare delivery [ 58 , 59 ]. Our findings suggest that the member organizations of the LN push for the empowerment of women.…”

“I Get Fire Inside Me That Tells Me I’m Going to Defy.”: The Discursive Construction of Trans Masculinity in Cape Town, South Africa

“…The limited research in South Africa on transgender identities and experiences focuses primarily on psychomedical narratives of transgender identity and on the attitudes of health care workers toward gender diverse individuals (see Luvuno, Ncama and Mchunu 2017; Newman-Valentine and Duma 2014; Spencer, Meer and Müller 2017). Scholarship here evinces the frustrations and barriers to accessing gender-affirming health care—particularly medical transitioning (Husakouskaya 2013).…”

“…As in other nations, the cost of medical transition presents barriers to many transgender people seeking gender affirmative health care in South Africa. While Karabo self-funds his medical transitioning and can access private medical care, many transgender people in the country rely on an under-resourced and overwhelmed public health care system (Camminga 2019) with long waiting lists for accessing medical transitions (Spencer et al 2017). Most of the participants in this study had already begun the process of medical transitioning and reported relative ease in accessing gender-affirming health care as a result of their financial stability.…”