The socio-economic determinants of health for transgender women in South Africa: findings from a mixed-methods study

abstract

Research conducted among transgender women in South Africa shows a marked tendency toward health disparities and poor access to appropriate mental, sexual and reproductive health services. Little is known about the socio-economic conditions underlying the health of transgender women in the country. A study was conducted to examine the cost of being a transgender woman in South Africa, in relation to physical, psychological, economic and social well-being, and vulnerability to gender-based violence. Among other disparities, the findings revealed a high level of substance abuse and poor access to hormones for gender affirmation. These findings are consistent with already published literature on stigma, discrimination and poor health outcomes among transgender women. This paper draws on the findings to report on the socio-economic determinants of health for transgender women in the South African healthcare context. It argues that efforts must address the intersections of transgender women’s lives, such as economic, health and educational status, and geographic location, to ensure comprehensive health and human rights services reach transgender women. It also proposes that further research is needed to understand the forces that shape the public health landscape for transgender women in South Africa.

keywords:

• transgender
• HIV
• health
• stigma

Acknowledgements

The authors would like to acknowledge the data collectors, capturers, and administrators who ensured the success of this project.

Notes

1 A sangoma is defined as a “living drum”, a person who is drawing on spiritual connection as part of their healing abilities, in African custom (Kelatwang & Duvel, 2002).

2 A South African Zulu term denoting an ancestor.

3 The concept of socially acceptable use varies from one context to the next and it was difficult to define this because of the diverse cultures in South Africa. In the context of this paper, drinking more than what is socially acceptable means to get intoxicated by the use of alcohol.

4 This was understood to mean living with family, partner or friends.

Additional information

Notes on contributors

L. Leigh Ann Van der Merwe

LEIGH ANN VAN DER MERWE is the Coordinator of Social health and empowerment (SHE), an NGO based in the Eastern Cape province, South Africa. Her research focus is on HIV and violence in the context of key populations, especially transgender women. Leigh Ann holds a Postgraduate Diploma in Public Health. Email: [email protected]

Cheryl Nikodem

CHERYL NIKODEM, V.C. DCUR is a Professor in the Department of Nursing Science, at the University of Fort Hare in the Eastern Cape, South Africa. She specialises in women, maternal and infant health Email: [email protected]

Deborah Ewing

DEBORAH EWING is an independent researcher, writer and advocate for gender equality and inclusive sexual and reproductive health rights. She is based in Durban, South Africa. Email: [email protected]