| Transgender people and HIV interventions: Debunking some myths |
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What is transgender? Transgender people express a  Gender identity that is different from their birth sex. Male people identify as female and vice versa. Some of them change their bodies with gender affirming hormone treatments and surgeries, if they are able to gain access to this kind of health care. Many cannot access this kind of health care due to health issues or lack of availability in South Africa. Some of them are able to express their gender by permission of their communities and do not choose medical intervention. Some trans people in South Africa, prefer to make use of traditional and indigenous medicines. Position paper from Gender DynamiX*
Myth 1: Transgender is MSM?
• Current HIV interventions in South Africa mistakenly subsume feminine identified trans people within the MSM (men who have sex with men) category.
• There is a mistaken assumption that men who have sex with men and feminine identified trans people have the same sex organs and thus have the same practices and vulnerability.
• It is crucial to examine the gendered roles of trans feminine people in context of sexual practices. Where MSM and Transgender research considered gender identity, trans people’s acute vulnerability was clearly distilled. Their higher rates of infection and difficulties to gain access to health care became clear.
• Including feminine identified transgender persons in MSM research invibilises the acute vulnerability of trans feminine identified people and propels inappropriate programming and health sector response for both groups. (men and trans people.)
Myth 2: Transgender people are gay?
• The popular acronym LGBT (lesbian gay bisexual transgender) creates the impression that the sexual orientation of trans people only concerns same sex desire.
• However it is crucial to understand that transgender issues are about gender identity concerns outside of context of sex and sexual practices.
• Feminine identified trans people (born male, gender identity female) who have sex with men often calculate their sexual orientation on the basis of their gender identity not their birth sex. Thus they identify as heterosexual women. Others partner with women and thus identity as lesbian (women who love women). Within this context it is clear that transgender people find themselves within various groups with regards to sexual orientation.
• Gender identity and sexual orientation are two distinct separate categories. This consideration is important when highlighting vulnerabilities within all categories relevant to HIV/AIDS interventions.
• When this separation is acknowledged in research and programming it clearly highlights how the stigma associated with gender variance results in acute discrimination and creates barriers to HIV/AIDS prevention and access to post exposure interventions.
• When realising that transgender issues are about gender and not sexual desire it is easy to see that trans men and women are within all groups and are not a necessarily a homogenous group to target for interventions.
Myth 3: Masculine identified trans people are lesbians?
• New research efforts are starting to examine the sexual practices of women who have sex with women. (WSW) This category includes women who identify as lesbian and women who have sex with women, but do not identify as lesbian.
• Within this category there is a mistaken assumption that masculine identified trans people (born female) are women, that they have the same sexual organs and thus have the same practices and vulnerability.
• There is very little statistical research, in the world, about these two groups. A salient issue that needs to be considered is how masculine identified trans people do not necessarily identify with lesbian communities. Many identify as men, partner with women and thus identify as heterosexual. (Pre medical intervention and post)
• Many masculine identified trans people have sex with men. There is no information, research or statistic about this group who identity as gay men. It stands to reason that their vulnerabilities are similar to other groups who engage in receptive and insertive sex with a penis.
• This group of gay transmen also cannot be considered within the category of women who have sex with men. They do not identify as women and will not respond to interventions that attempt to include them in this manner.
Myth 4: Transgender people just walk into a hospital one sex and out as another?
• In South Africa there are two government hospitals (Pretoria and Cape Town) who offer transgender related health care. Both clinics are only able to assist 4-6 people per year. This does not address the demand in any way.
• Trans people who are able to access private sector care are in similar situations and need resources to leave the country for gender confirming surgeries and health care.
• Trans children are particularly vulnerable in the social services system which is unable to shelter them. Facilities and policies are highly gendered and do not acknowledge gender identity separate from birth sex.
• South African law allows people to change the gender in their documents without genital surgery or sterilisation. This is an important measure in context of lack of gender affirming health care.
• However there is very little knowledge of this in the country and the Department of Home Affairs consistently neglects to implement this law.
• Not all Trans people choose the whole spectrum of gender affirming health care (hormonal, secondary and primary sexual reassignment surgeries).
• In South Africa most transgender people are faced with lives where they are unable to align their bodies with their gender identity. Due to their gender presentation they face continuous stigma, discrimination and so have very little access to services and their rights.
Recommendations for HIV/AIDS interventions
• Feminine identified trans people’s presence should be highlighted within MSM research and other MSM interventions by adding the category of gender identity to administrational processes like questionnaires and forms. (along with sex ID numbers and other personal details)
• When gender identity is acknowledged within administrative processes trans people (feminine and masculine identified) should be enabled to use their chosen names and have their gender identity acknowledged when accessing service. This should happen even where ID books have not been gender altered.
• There needs to be a realisation and recognition by policy makers and service providers that transgender people are a diverse group of individuals (by body and gender identity).
• Transgender people should have self-determination and not be limited through inclusion under MSM and WSW or any other gendered categories, by default of their birth sex.
• Acknowledge gender identity within all groups of HIV interventions.
• Ensure meaningful participation of trans people within all groups and sectors - MSM WSW MSW Children, men, women and key populations.
• Transgender individuals and organisations must be invited, not as tokens but be actively consulted and included in examining issues affecting them, at all levels of decision making.
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