Sexual and reproductive rights are a fraught topic in South Africa, and if one is transgender, there are even more barriers to quality, affordable care and access to knowledge. Access Chapter 2, a LGBTQI+ advocacy group, that tackles the health, social and justice systems in the country — believes that the current legislation, although “fundemental”, is not practical for transgender people in South Africa.

Steve Letsike from Access Chapter 2 explains further.

“We have a big issue — we have Act 49 [The Alteration of Sex Description and Sex Status Act] which allows sex reassignment. It’s a fundamental legislation piece for the country, particularly transgender persons. You can change your sex and also apply for documents that matches your gender. But the issue here is that while we have that legislation, it’s not in use because it’s not practical in many instances.”

Despite efforts by the Department of Home Affairs to ensure that people who apply for gender markers get the right document, barriers to this exist.

“The department has moved to ensure that people who apply for a gender marker change can get their rightful documents, but you can only do that at particular stages. Those stages include health access — access to hormonal therapy, access to surgical care — so it’s a big issue,” says Letsike.

“Here in Gauteng, we had Baragwanath, Charlotte Maxeke, George Mukhari and Steve Biko Academic — all hospitals that provided these excellent services. But now we only have Steve Biko Hospital and the challenge is that only four patients [who need to transition] can be seen in a year, countrywide.”

Lack of knowledge about trans healthcare

In tandem with the challenges of changing one’s gender marker, such as discriminatory staff, Letsike says that the communication about transgender care services offered in the public healthcare system is poor, and that not many people know the scope of care available to them.

“There are services, but they are not known to people and that’s the biggest challenge. That’s what we need to fundamentally address,” she says.

Despite these challenges, Letsike says that the public healthcare sector does get it right — if only sometimes. 

“The public sector, if they do it — they do it right. We have access to excellent case studies where people have gotten into, and out of the system very well. They’ve had no complications or health implications, and they are living their life as transgender individuals.”

Everyone has a right to reproductive choices

Reproductive medicine specialist at Steve Biko Academic Hospital, Dr Zozo Nene, says that education is needed about how health facilities cater to patients of diverse sexual and gender orientations.

“We’ve had a few same sex couples that come to our clinic, and yes we do our best to make sure they are in a welcoming environment. But I have noticed that there are certain things that we don’t take into account, such as the fact that a person has changed their name and we still call them by the ID name because they’re registered with the name on the ID. That is uncomfortable for someone who is transgender, so we still need a lot of education into how we make our clinics and our environment gender neutral,” Nene says.

 Nene adds that other options are available for people who want to ensure that they can have their own biological children before they transition.

“So, now we want to say to them that there are other options. You can actually freeze your gametes before you transition into whatever sex you would like to transition to. If it’s a woman, they can freeze their eggs and use them later, because they take a lot of hormones and then gender-affirming surgery, but then we know that their fertility is preserved. We do offer this, and we would like to see more and more of this happening because everyone has a right to their reproductive choices.”

Lowering wait periods

Gauteng Health MEC, Bandile Masuku, acknowledges that more needs to be done to reduce the waiting period for trangender patients who seek fertility treatment and gender-affirming surgery.

“Currently in Gauteng we only have one centre that deals with fertility and that’s not enough. We know that over the years it has been overwhelmed with numbers, it has been overwhelmed with requests — and it’s now time that as a government, as a province we build other centres.”

Masuku says that discussions about having another facility that offers reproductive health services in the South of Gauteng is one of his office’s priorities.

“We also want to have a broader discussion about access to fertility treatment for LGBTQI+ individuals who can also have access to this good treatment that we want to do. It’s also a matter of fundamental human dignity. Currently, we are working on a 25-year waiting period and it’s something that we need to bring down.”

Steve Biko Academic Hospital is one of two facilities that offers transgender services in the country — and it’s an issue that Letsike, Nene and Masuku all agree needs to change in order to increase and improve access for all South Africans.-Health-e News