When the Wits Reproductive Health and HIV Institute (Wits RHI) transgender clinic where Kamogelo Moamogoe received her hormone treatment closed last year following cuts to US funding, she says she was given a prescription to buy her hormones herself, but was not told where she could continue receiving care.

Moamogoe, a 29-year-old transgender woman from Mofolo in Soweto, collected her final supply of hormones from the clinic in April 2025. She says she received a three-month supply and a prescription to buy the medication from a pharmacy.

By August last year, her supply had run out. Unemployed and unable to afford about R900 a month for her hormones, Moamogoe stopped her prescribed treatment until April this year.

Wits RHI told Health-e News that all its clients’ records were transferred to local clinics where arrangements had been made for continued care. But Moamogoe says she received no formal communication telling her that she had been transferred or where she should go.

No money to buy hormones

Moamogoe started transitioning in 2020 after learning about transgender healthcare services from her peers.

“I grew up a very feminine individual and I always observed myself as a girl. I did not know much about transitioning growing up. In my adult years I heard from my peers about transgender clinics. That’s when I started to be interested and went to access healthcare services at WITS-RHI gender-affirming clinic”.

Initially, Moamogoe collected her hormone treatment monthly. Her appointments were later extended to every two months and eventually every three months.

She says she had no problems accessing her medication before the clinic closed.

“I never had any challenges to collect my treatment. Even the service at the Wits RHI Clinic was excellent.”

Moamogoe says a friend who worked at the clinic contacted her informally last year and told her to come and collect a final supply because the facility was closing due to funding cuts.

She received three months’ medication and a prescription to buy the hormones herself from a pharmacy.

Moamogoe uses Estrofem. She says a box costs about R300 and she needs three boxes a month.

“I am unemployed. One box approximately cost R300 at the pharmacy and personally I use 3 boxes of hormones. R900 per months was not feasible for me to buy medication.”

She says she was not referred to another clinic or hospital.

“I did not receive any formal transfer or a communication to alert me of where I will be collecting my treatment going forward. From that day it was a struggle to get my hormones and I had to stop.”

Trying to find treatment

Moamogoe says she considered getting her hormones at Chiawelo Community Health Centre in Soweto. She asked a peer who receives treatment there whether her medication was available and was told it was not.

Without her prescribed hormones, Moamogoe says she became stressed and worried about having stopped treatment.

She says she tried contraceptive tablets after hearing from peers that these could be used when her hormones were unavailable. She cannot remember the name of the tablets.

Moamogoe says they caused dizziness, nausea and vomiting. She stopped taking them because she was worried about using medication without medical supervision.

Her experience comes amid widespread disruption to specialised transgender health services following cuts to US-funded programmes.

Health-e News reported in April 2025 that the closure of dedicated transgender clinics was threatening access to gender-affirming hormone therapy. 

Professor Elma de Vries, chairperson of the Professional Association for Transgender Health South Africa (PATHSA), told Health-e News at the time that the dedicated clinics had demonstrated that gender-affirming hormones could be provided through primary healthcare.

“The closure of these clinics is devastating, as gender-affirming hormones are not accessible at government clinics,” De Vries said at the time. 

In recent reporting on the scale of the disruption, the Aurum Institute – a South African public health organisation working in HIV and TB research and healthcare delivery – confirmed that one Aurum programme operating across five districts went from providing care to nearly 4,000 transgender women to just 11 following the US funding cuts.  

Research presented at the International AIDS Conference in July found that 72% of surveyed PEPFAR-funded organisations providing services to key populations had been forced to close these services. The survey covered 166 organisations across 46 countries.  

Researchers reported 1,714 service points had closed, while 58% of organisations providing HIV treatment reported some disruption to treatment services.  

Records transferred, but patient left looking for care

Wits RHI told Health-e News that arrangements had been made to continue patients’ care.

“We transferred all client records to the local clinics with which we had established data-sharing and commodity/medication provision arrangements in each of the four districts where we operated,” says Naomi Hill, Programme Head for Key Populations at Wits RHI.

“In some instances, including Johannesburg and Cape Town, we were also able to establish relationships with either a hospital or an incoming Global Fund partner to facilitate continuity and transition of service, says Hill.”

But transferring a patient’s records did not mean that Moamogoe knew where she had been transferred.

She says Wits RHI did not formally contact her about a receiving facility and she received no call from another clinic where her files had been transferred to. She says the prescription she was given was to buy her medication from a pharmacy, rather than a referral to another clinic or hospital.

“I did not receive any formal transfer or communication to alert me of where I will be collecting my treatment going forward. From that day it was a struggle to get my hormones and I had to stop,” she says.

Back on treatment but further from home

In March this year, Moamogoe says a friend told her that she could access her hormone treatment at Charlotte Maxeke Johannesburg Academic Hospital.

She says she went to the hospital without a referral. After being assessed, she was able to restart her hormones free of charge in April.

“I was welcomed well and the necessary examinations were done and I am back on my hormonal treatment”.

But accessing treatment now comes with another problem.

Moamogoe has to travel from Soweto to Charlotte Maxeke to collect her medication. She is unemployed and struggles to afford the journey.

Moamogoe says she is uncomfortable travelling by minibus taxi because of discrimination she faces, and would need to take several taxis to reach the hospital. Instead she uses e-hailing taxis, which is more convenient but more expensive. A return trip costs her R280.

Moamogoe wants commonly used gender-affirming hormones to become available closer to where patients live.

“I wish most types of commonly used hormones can be made available at our nearest local clinics so it can be easy to get treatment nearer. Or the community health workers can deliver for us. Most of the transgender individuals are not working, so getting our treatment far is a big challenge,” says Moamogoe.

The Gauteng Department of Health did not respond to Health-e News’ questions by the time of publication.