oa South African Health Review - Transgender women outreach workers and their role in South Africa’s HIV response - review

Volume 2018 Number 1
  • ISSN : 1025-1715



Transgender women (TGW) are women whose gender identity differs from the sex assigned to them at birth. South Africa’s legal framework protects the rights of TGW and their right to health care. Improving our nation’s health requires that health services be accessible and appropriate for all. However, TGW are often reluctant to access health care due to the lack of services that affirm their gender and meet their needs in a holistic manner. Many who do access these services experience stigma and discrimination. Innovation and efficient and effective utilisation of human resources are critical for health-system strengthening, and peer-driven delivery approaches are considered best practice to access, foster and provide responsive, quality health services to marginalised groups, including TGW. This chapter provides a synopsis of the global and local context for TGW from an HIV perspective. The role of TGW outreach workers in South Africa’s HIV response is described. Three case studies are presented to provide insight into how TGW outreach workers support their clients to cope with the key issues they face, namely stigma and discrimination; the consequences of non-conforming gender expression; scarce employment opportunities; the inadequacies of bio-medically focused HIV services and limited resource allocation for TGW programming. The case studies highlight how outreach can comprise mentorship between older and younger TGW and support community building among the women. Important challenges facing outreach services for TGW in South Africa include the uncertain funding landscape; limited interventions for socio-economic empowerment and harm reduction around substance use; and lack of access to hormone therapy and gender-affirming surgery. Recommendations are made for increased support of outreach services and initiatives that take a multi-sectoral and comprehensive approach to TGW.

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