A concerning opinion was published in The Witness on News24 on 25 August 2021: 

https://www.news24.com/witness/opinion/columnists/guestwriters/breaking-boundaries-safely-20210824

PATHSA’s response was published on 3 September 2021 at this link https://www.news24.com/witness/opinion/columnists/path-to-quality-of-life-a-response-to-diesel-20210903

The full letter follows below.

In addition, a trans activist Kellyn Botha wrote a beautiful response which was also published on 3 September 2021 at this link https://www.news24.com/witness/opinion/columnists/facts-over-phobia-a-response-to-diesel-20210903 The full text be posted on this website.

The Witness published a response by Diesel to PATHSA’s letter by Diesel on the same day (3 September 2021), see https://www.news24.com/witness/opinion/columnists/sa-situation-has-not-demonstrated-openness-to-critical-discussion-20210902

PATHSA letter to The Witness regarding “Breaking boundaries safely” (25 August 2021) – published on 3 September 2021

As the Professional Association for Transgender Health, South Africa (PATHSA), we would like to respond to “Breaking boundaries safely” (25 August 2021) by Alleyn Diesel as we believe it is not an accurate reflection of gender-affirming healthcare. PATHSA is an interdisciplinary health professional organisation working to promote the health, wellbeing, and self-actualisation of trans and gender diverse people.

While we acknowledge that a minority of individuals who accessed gender-affirming healthcare will detransition and that their stories need to be taken seriously, we assert that this is not the whole picture. Regret is very rare and the majority of people who access gender-affirming healthcare have significant improved quality of life.

The approach to gender-affirming healthcare is different for prepubertal children, adolescents and adults. An affirming approach is followed for prepubertal children, which means that instead of attempting to direct a child toward a particular identity, parents and

caregivers accept a child’s own individual journey. (Temple Newhook et al., 2018) Following careful assessment by a qualified mental health professional, social transition may be recommended. (Durwood et al., 2017) Within this model of care, it is understood that the gender that is the “right fit” may differ at different ages and stages of life. Research has shown that transgender and gender diverse children who are affirmed in their gender have mental health outcomes equivalent with cisgender children (whose gender identity and sex assigned at birth are aligned). (Olson et al., 2016)This is in stark contrast to the high levels of psychological distress and behavioral problems documented among children who were discouraged from asserting their identities in childhood. (Turban, 2017)

It can be very distressing for a transgender adolescent to experience the puberty changes in their body, of a gender they do not experience themselves as. In this context, puberty blockers can be safely used to halt the progression of physical changes. Gonadotrophin-releasing hormone agonists (GnRHa) suppress the hormonal axis that results in secretion of endogenous oestrogen and testosterone responsible for induction of secondary sexual characteristics, such as breast growth and menstruation in trans boys and voice deepening and facial hair development in trans girls. This permits the adolescent to develop emotionally and cognitively, before making decisions on gender-affirming hormone therapy which is likely to have irreversible effects. Pubertal suppression has been shown to improve mental health and decrease suicidality. (Turban et al., 2020) The effects of puberty blockers are reversible and when the treatment is stopped, the development of secondary sexual characteristics will continue unless the adolescent is started on hormone treatment. Follow-up studies after puberty suppression from the Netherlands show that the rate of adolescents that stop the reversible blockers because they no longer wish to transition is very low; between 1.9% (Wiepjes et al., 2018) and 3.5% (Brik et al., 2020) in two respective studies.

For older adolescents, hormone treatment is an internationally accepted option. Given that this can have potentially irreversible effects, the International Endocrine Society Guidelines recommend initiating treatment after a multidisciplinary team has confirmed gender incongruence and sufficient mental capacity to provide informed consent. While we agree with Diesel that “hasty and ill-considered diagnoses and treatments” are not in the best interest of anyone, gender-affirming healthcare that follows a thorough informed consent process can be lifesaving and improves the lives of many transgender and gender diverse people, including in South Africa. The informed consent model of care ensures a process where the risks and benefits of various treatment options are discussed with the adolescent and their parents / legal guardians to enable an informed decision. The membership of PATHSA includes health professionals who have collectively cared for hundreds of transgender and gender diverse young people, who have better lives as a result.

Diesel uses very distasteful language to describe gender-affirming surgery such as “mutilations” and “a Frankenstein body”. This is an insult to both transgender individuals who access surgery and the surgeons who perform these procedures. Research has shown that satisfaction following gender-affirming surgery is usually high, with less gender dysphoria, reduced psychological turmoil, and resulting in better integration into society. In contrast to Diesel’s allegation of bodies being “frequently not sexual functioning”, research shows improved sexual functioning following vaginoplasty with high satisfaction reported for intercourse and orgasm. (Zavlin et al., 2018)Regret following surgery is very low, with a large Dutch cohort reporting regret in 0.6% of trans women and 0.3% of trans men. We would like to clarify that gender-affirming surgery is rarely performed in adolescents. There are cases where a multidisciplinary team will recommend mastectomy for a trans boy with severe chest dysphoria before the age of 18, but that will be following careful consideration that it is indeed in the best interest of the specific individual.

Diesel refers to the principle in medical ethics of “first do no harm”. We would like to point out that withholding gender-affirming treatment is not a neutral act and can indeed be harmful, as South African doctor Anastacia Tomson argues eloquently in an article on Gender-affirming care in the context of medical ethics. It would be unethical to withhold treatment with a strong evidence base for benefit, because of the small percentage of individuals who may later regret their decision and detransition. The autonomy of transgender and gender diverse individuals needs to be respected to make choices about their treatment, and our role as health professionals is to facilitate safe access to care. We certainly do not force any individual down a particular path.

Although Diesel calls for a more “tolerant world”, she appears not to be tolerant of either health professionals providing gender-affirming healthcare or transgender and gender diverse individuals who make autonomous decisions to access care. PATHSA yearns for a world where all transgender and gender diverse people will be respected and accepted as fellow human beings and be able to access responsible and quality gender-affirming healthcare.

References

Almazan, A. N., & Keuroghlian, A. S. (2021). Association between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surgery, 156(7), 611–618. https://doi.org/10.1001/jamasurg.2021.0952

Brik, T., Vrouenraets, L. J. J. J., de Vries, M. C., & Hannema, S. E. (2020). Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. Archives of Sexual Behavior, 49(7), 2611–2618. https://doi.org/10.1007/s10508-020-01660-8

Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental Health and Self-Worth in Socially Transitioned Transgender Youth. J Am Acad Child Adolesc Psychiatry, 56(2), 116–123. https://doi.org/10.1016/j.jaac.2016.10.016.Mental

Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869–3903. https://doi.org/10.1210/jc.2017-01658

Olson, K. R., Durwood, L., Demeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-3223

Telfer, M. M., Tollit, M. A., Pace, C. C., & Pang, K. C. (2018). Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents. The Medical Journal of Australia, 209(3), 1. https://doi.org/10.5694/mja17.01044

Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M. L., Jamieson, A., & Pickett, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism, 19(2), 212–224. https://doi.org/10.1080/15532739.2018.1456390

Tomson, A. (2018). Gender-affirming care in the context of medical ethics – gatekeeping v . informed consent. S Afr J Bioethics Law, 11(1), 24–28. https://doi.org/10.7196/SAJBL.2018.v11i1.616

Turban, J. L. (2017). Transgender Youth: The Building Evidence Base for Early Social Transition. In Journal of the American Academy of Child and Adolescent Psychiatry (Vol. 56, Issue 2, pp. 101–102). Elsevier. https://doi.org/10.1016/j.jaac.2016.11.008

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2). https://doi.org/10.1542/peds.2019-1725

Wiepjes, C. M., Nota, N. M., Blok, C. J. M. de, Klaver, M., Vries, A. L. C. de, Wensing-Kruger, S. A., Jongh, R. T. de, Bouman, M.-B., Steensma, T. D., Cohen-Kettenis, P., Gooren, L. J. G., Kreukels, B. P. C., & Heijer, M. den. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets. The Journal of Sexual Medicine, 15(4), 582–590. https://doi.org/10.1016/J.JSXM.2018.01.016

Zavlin, D., Schaff, J., Lellé, J. D., Jubbal, K. T., Herschbach, P., Henrich, G., Ehrenberger, B., Kovacs, L., Machens, H. G., & Papadopulos, N. A. (2018). Male-to-Female Sex Reassignment Surgery using the Combined Vaginoplasty Technique: Satisfaction of Transgender Patients with Aesthetic, Functional, and Sexual Outcomes. Aesthetic Plastic Surgery, 42(1), 178–187. https://doi.org/10.1007/s00266-017-1003-z

 Trans young people and school uniforms

https://select.timeslive.co.za/news/2021-07-19-all-for-a-piece-of-clothing-school-puts-trans-boy-through-the-wringer/

This article was published today and refers to the open letter to the Education Department regarding discrimination against LGBTQI learners, of which PATHSA is a signatory. It is great that different organisations are working together for a common aim, to improve the lives of TGD people. The letter can be viewed here:

https://triangle.org.za/wp-content/uploads/2021/07/TP-LRC-et-al-2021-July-Open-Letter-to-WCED-Discrimination-against-LGBTQI-learners-in-schools-based-on-SOGIESC.pdf

“Dit is beter om te dink oor gender as ’n spektrum eerder as twee pole. Omdat daar meer openheid is, is dit ook nou meer moontlik vir niebinêre persone om uitgesproke te wees oor hulle genderidentiteit.” ‘n Gesprek tussen die teoloog Pieter GR de Villiers en Elma de Vries.

Lees die hele artikel hier.

Difficult questions about gender diversity, and how church communities can be more understanding – for the Afrikaans journal LitNet.

The New Deal[1] was a domestic programme of the administration of U.S. President Franklin D. Roosevelt between 1933 and 1939, to bring about immediate economic relief after the Great Depression. Opposed to the traditional American political philosophy of laissez-faire, the New Deal  embraced the concept of a government-regulated economy aimed at achieving a balance between conflicting economic interests.

Where human rights in South Africa are concerned, and perhaps trans rights more specifically, there has been a similar balancing act between regulation and freedom. We forbid hate speech but we recognise freedom of speech. We recognise the rights of trans people to self-identify and change important official documents, but Home Affairs officials seem to get away with indulging their personal scruples about processing a trans person’s papers.  

How does the State enforce contemporary rights when social attitudes are stuck in the 1950s? This is the quandary for trans people, and their allies, in South Africa. Push too hard and there is resistance, act too timidly and trans lives not only don’t matter, they are invisibilised (or sensationalised for clickbait).  

On paper, trans and gender diverse people in South Africa have a good deal. Or do they? All deals are a compromise, and some deals aren’t worth the paper they’re written on, negotiated by unequal partners. Often subsumed into rights for same-sex loving people, trans rights are in some ways the “poor cousin” of the greater queer struggle, tacked on to conversations about gay men and lesbian women, bogged down in prurient curiosity about hormones, surgeries and genitalia. Or the push for trans dignity is reduced to “gender panic” conversations about toilets, or sporting codes where winning is everything.

So what are the rights trans people have in South Africa? Well they have a number of general rights enshrined in the Constitution, including rights in workplaces, places of education, in health care settings, and in the broader society where they may face harassment and harm. And trans people can change their legal sex marker on identity documents. These rights come with caveats of course, largely that these are paper rights and worth nothing if there is no implementation or oversight. There are very few resources for trans people to access hormones and surgeries through the State, and only two hospitals carry out gender affirming surgeries, and then sometimes at the whim of over-burdened practitioners. Covid has also caused a brutal prioritisation of services, and trans people are very low on that list.

Where recognition of sex markers is concerned, activists have noted that beyond the often hateful treatment trans people receive in Home Affairs offices, the system is still steeped in the gender binary: one must be one thing or another. All credit to the State, a proposal is on the table for the development of an identity system which simply provides a newborn with a number, with no reference to sex. This would allow people to move in the world freed from the constrictions of gender binaries. Of course there will be other ways for gender data to be aggregated, but the trans and gender diversity struggle has shown that many people are simply beyond the binary, and should be free to be so.

Trans activist and psychologist working in sexualities, gender and trauma in KwaZulu-Natal province, Chris McLachlan, spoke recently of their sense that hate crimes against trans people are on the rise. Against a backdrop of recent murders of queer people, this makes sense. Well it does and it doesn’t, because making sense of anti-queer hate crimes is always a tortured exercise in psychological and sociological theorising. It’s also almost impossible to access a reliable and updated database of hate crimes aimed at trans and gender diverse people. What you don’t record you don’t plan for.

So what is the plan? Perhaps we don’t just need a New Deal on trans rights, but a New Deal on human dignity, recognition of which is in short supply in our country. As an organisation PATHSA recognises the resistance to trans rights, but argues that meeting the needs of trans people, not just in health but in all spheres of social engagement, is a social good. While it’s unhelpful to position trans people only as marginalised victims, the truth is rather bleak. We need a New Deal on human dignity, one where there is no compromise, just an unflinching aim at the highest possible target, respect, equality, equity and the freedom to be.

[1] https://www.britannica.com/event/New-Deal

South Africa, it is enough

 Over the past two and half months, South Africa’s LGBTIQ+ community has been rocked by a series of brutal hate crimes against its members – from KwaZulu-Natal to Gauteng, from the Eastern Cape to the Western Cape. At least six lives – that we know of – have been snuffed out in cold blood. 

• Bonang Gaelae, 29, whose throat was slashed in Sebokeng on 12 February. 
• Nonhlanhla Kunene, 37, whose body was found half naked in Edendale, Pietermaritzburg on 5 March. 
• Sphamandla Khoza, 34, who was beaten, stabbed and had his throat slit on 29 March in Kwamashu, Durban. 
• Nathaniel ‘Spokgoane’ Mbele, who was stabbed in the chest in Tshirela, Vanderbijlpark on 2 April. 
• Andile ‘Lulu’ Nthuthela, 41, whose mutilated and burned body was found on 10 April in KwaNobuhle, Kariega. 
• Lonwabo Jack, a young LGBTIQ+ individual who had just celebrated his 22nd birthday on 17 April. His lifeless body was found on a pavement the next day in Nyanga, Cape Town. 

Also, 

• A lesbian couple who was refused service at a health institution after they had been assaulted on the University of Fort Hare Alice Campus on 16 April amid a claim that “ibutch isithathela amacheri” (butch lesbians are taking our women). 
• This morning we learned of another suspected hate crime case in the Eastern Cape, the circumstances of which are still coming to light. 

We have been here before

Since the dawn of democracy, LGBTIQ+ South Africans have been brutalised, raped and killed across our nation. The list is long. Names like Sizakele Sigasa, Salome Maoosa, Eudy 

Simelane, Gift Makau, Sana Supe, Nare Mphela, Kirvan Fortuin and Lindo Cele may stand out but so many others did not make headlines. So many more have gone unrecognised as hate crime victims at all because even today we still have no hate crime legislation in this country.

Today we still fear to simply be ourselves, to dress how we choose or to share an embrace – not only in public but also among those who we may count as friends and neighbours. They too are our murderers; sometimes children as young as 14. 

Not only do we fear for our very lives, but we continue to face discrimination all around us. Social media platforms are replete with queerphobic words, threats and slurs with no consequences. Religion continues to be used as an excuse to debase our community in ways that would never be tolerated when it comes to other citizens or groups. Our state dehumanises us in police stations and government offices. 

Our community’s plight is a bloody stain spreading across our constitutional democracy and our leadership. We’ve seen a seemingly endless stream of conferences, workshops, task teams and statements but truthfully there has been little action. 

South Africa’s Constitution does not just come with rights but also responsibilities, including leading by example. Our great continent is still plagued by LGBTIQ+ hate that has roots in its colonial past; a twisted heritage that we simply refuse to acknowledge or shake off and have misguidedly embraced as African. 

Today, we are here to say enough. We are tired of lip service. We are tired of promises. We are tired of excuses. Today we demand the following: 

That by the end of this week (Friday 23 April 2021) the President of the Republic of South Africa unequivocally speaks out, condemns and calls for an end to the violent attacks on the LGBTIQ+ community. 

Furthermore, the Government of South Africa must: 

• Urgently finalise and enact the Prevention and Combating of Hate Crimes and Hate Speech Bill, which was first drafted in 2016 and was approved by Cabinet in 2018.
• Properly fund, resource and restore the functionality of failing entities such as the National and Provincial Task Teams and the Rapid Response Team that were meant to address violence against LGBTIQ+ South Africans.
• Create dedicated LGBTIQ+ Desks in each province to address the needs of LGBTIQ+ citizens.
• Ensure that sensitised and safe shelters are provided or are funded for LGBTIQ+ people who are in crisis in each province.
• Embark on a mass LGBTIQ+ sensitisation programme of government institutions, especially the SAPS and the Department of Home Affairs.
• Speed up proposed changes to South Africa’s identity laws and related government policies to allow LGBTIQ+ individuals to self-identify when it comes to their gender and sex.
• Combat heterosexism on an administrative and government level: This includes providing inclusive forms in all government departments; gender-neutral bathrooms, gender-neutral hospital rooms, and gender-neutral detention centres. 

We also demand that Religious, Spiritual and Traditional Leaders and Organisations:

• Speak out and condemn the violence perpetrated against the LGBTIQ+ community as unacceptable and immoral.
• Stop using so-called religious, cultural or traditional values as excuses to exclude or discriminate against members of the LGBTIQ+ community.
• Live the values of our Constitution and actively work to promote the inclusion and acceptance of LGBTIQ+ people in congregations and communities across the country. 

We also demand that the South African Media more comprehensively report and speak out on these incidents to raise awareness and provide information to society. 

Finally, we demand that all of South Africa’s citizens take responsibility to stamp out the abhorrent queerphobic views and actions of their friends, families and neighbours. 

South Africa, enough is enough! 

This statement is supported by the following organisations:

• Access Chapter 2 (AC2) 
• The Aurum Institute (POP INN) 
• Exit 
• Forum for the Empowerment of Women (FEW) 
• GALA Queer Archive (GALA) 
• Gay and Lesbian Alliance of South Africa (GLASA) 
• Gay and Lesbian Network 
• Gender and Religion Program at UKZN 
• Gender Dynamix 
• Global Interfaith Network for People of All Sexes, Sexual Orientations, Gender Identities and Expressions 
• Inclusive & Affirming Ministries (IAM) 
• Iranti 
• Just Detention International-South Africa (JDI-SA) 
• KwaZulu-Natal LGBT Recreation 
• Lawyers for Human Rights 
• MambaOnline.com 
• Matimba 
• The Other Foundation 
• OUT LGBT Well-being
• Pan Africa ILGA 
• Parents, Families & Friends of the South African Queers (PFSAQ) 
• PASSOP
• PATHSA (Professional Association for Transgender Health South Africa)
• Psychological Society of South Africa  (PsySSA)
• Same Love toti
• Scope
• Sexual and Reproductive Justice Coalition
• The Thami dish Foundation
• Triangle Project
• The Ujamaa Centre at UKZN
• Vaal LGBTI
• We’re Queer My Dear (WQMD)

#SpeakUpCyril #JusticeForQueerSA #EnoughIsEnough

PATHSA response to the Bell vs. Tavistock judgement

PATHSA with professional conviction disagrees with the recent judgement of the London High Court in the strongest possible terms.  

The judgement concludes that:

1. Children under 16 are highly unlikely to be able to give consent to taking hormone blockers.
2. It will force them to be assessed by the law courts, as to whether they are able to consent.
3. They conclude that hormone blockers set children on an irreversible path of taking cross-sex hormones later and have surgeries, that they might otherwise not have chosen to have.
4. It also concludes that there is “no proven benefit to this treatment physically or psychologically” for children under 16 years old and that
5. The practice is ‘experimental’.

Each point will be discussed below.

1. Transgender youth are invariably significantly/profoundly advanced in understanding gender identity as compared to their cisgender peers, as they are faced with prejudice and their gender dysphoria on a daily basis and usually constantly think and reflect critically and deeply about all the potential issues, including taking hormones and outcomes, on a daily basis.
2. Putting essentially bureaucratic and legalistic obstacles in place and slowing down the process by getting courts to assess and decide, is not only unnecessary, but unethical. Appropriately trained gender specialists, with the appropriate clinical knowledge, skills and expertise, should assess transgender youth, not courts. Slowing down the interventions can produce permanent damage, as bodies go through puberty and develop irreversible changes before 16, worsening outcomes permanently. The Tavistock waiting list is unethically long (22 to 26 months as of November 2019) for youth urgently needing to get onto hormone blockers to stop their bodies changing. Further lengthening this period by getting courts to give their consent seriously worsens this situation. Parents and children should be presented with the known facts relating to the child’s situation and make their own informed decisions accordingly. They make the best decisions they can, and neither health professionals nor the courts should be making these decisions for them. This judgement has demonstrated how bad the courts could be at understanding transgender youth and how paternalistic they are towards them and their families. They are likely to be very poor at helping them make appropriate decisions. Where there is uncertainty, we should be letting young people and their families make the decisions and not making decisions for them.
3. Youth are given hormone blockers only at Tanner stage 2 at a stage where research had already shown over 90% of them will not change their gender identity. Deducing that hormone blockers cause more children to sustain a transgender gender identity is simply false.
4. It is alarming that the court has deduced there is no proven benefit of the hormone blockers. The judgement fails to recognize how essential ‘passing’ as their identified gender is for the future happiness and wellbeing of trans and gender diverse children.  The judgement fails to appreciate the permanent poor outcomes of transgender youth having to go through the psychological trauma of going through a puberty that they do not want and which result in permanent physical changes (e.g. voices dropping and growing breasts) that cause them to face a life time of discrimination and gender dysphoria. Their chances of having a good mental health outcome are seriously reduced. Any health professional working with transgender youth receiving hormone blockers will know how patently false these statements are, as will the vast majority of their parents. The effects of the hormone blockers are life changing in a positive way and in numerous cases life saving for suicidal transgender youth. No mention is made of the 50% suicide rate if young people are not given appropriate support in line with the evidenced based guidelines.
5. The court judgement ignores the proven benefits and over-emphasizes fears of the unknown, concluding that there is real uncertainty of the short- and long-term consequences of treatment, and that the treatment is ‘experimental’. This ignores the fact that transgender youth have been put on hormone blockers for over 20 years now and the outcomes are overwhelmingly positive, among a group of teenagers with a very high risk of poor mental health outcomes without these interventions. There is a major concern about evidence base in the literature from the Tavistock and the judgement ignores the fact that the WPATH protocols with hormone blockers are now practiced all over the world, as not doing so is clearly unethical in terms of poor outcomes for the transgender youth involved. The well understood and proven risks of not giving them to appropriately assessed and supported transgender youth far outweigh the possible risks of giving them, which have so far been shown to be minimal in comparison. There are numerous studies to support the WPATH guidelines.

This judgement has profoundly serious and damaging consequences to the future health and happiness of transgender youth, not only in the UK, but potentially all over the world. They appear to have relied heavily on information from transphobic ‘experts’ who have presented a very inaccurate picture of the reality of why hormone blockers are standardly used in gender clinics all over the world. The language used is at times transphobic and disrespectful of young transgender youth’s gender identity. (e.g. natal girls and natal boys as opposed to birth assigned girls and boys.)

The conclusions drawn in this judgement indicate that these judges have failed in several ways to understand transgender youth and their needs.

We, as PATHSA, strongly oppose this appalling judgement and support the appeal with the hope that the judgement will be overturned.

16 days of activism – relevance for trans and gender diverse people

As South Africans we often say we have a remarkable constitution and bill of rights; it is the realisation of those rights at the coalface that remains a challenge. Now in 2020, we can add to that: we have a new National Strategic Plan on Gender-Based Violence and Femicide 2020-2030(1); the challenge will be the implementation of this ambitious plan. This document defines “woman” in the glossary of terms, as “a person that defines themselves as female and includes not only cis women, but also trans women and femme/feminine-identifying genderqueer and non-binary persons”. The vision is a South Africa free from all forms of gender-based violence (GBV) directed at all women, children and LGBTQIA+ persons. One of the ten principles that will guide the implementation is “Inclusiveness, embracing diversity and intersectionality, recognising the importance of being rooted in women’s experiences who are most marginalised by poverty, race, age, disability, sexual orientation, sexual identity, gender identity and nationality.”

From a recent research report by Muller et al.(2), we know that trans persons in South Africa experience alarming high levels of violence, with 33% of trans women and 23% of trans men reporting physical violence in the past year, and 35% of trans women and 28% of trans men reporting sexual violence in the past year. The lifetime exposure to sexual violence is devasting: 67% of trans women and 50% of trans men(2). Part of the complexity for trans men is that many carry the painful memories of sexual violence before transition. Trans and gender diverse persons, who present visibly as non-conforming, experience more violence compared to their gender-conforming counterparts(3). There is often little tolerance in our society for people who do not fit neatly into the western construct of a gender binary, such as masculine expressing and presenting lesbian women and trans men. Many trans and gender diverse persons who experience violence are reluctant to access health care for fear of discrimination. Sadly, discriminatory and insensitive treatment by health care providers have been well documented(4). Trans and gender diverse children are at increased risk of bullying, because they do not conform to society’s expectations(5).

Intersectionality theory says that various oppressions create and mutually constitute one another to sustain a complex matrix of power that is rooted in, and actively maintained by, social structures and institutional systems(6). GBV happens in a context where trans and gender diverse people may experience intersecting oppressions due to their gender identity, race, poverty, HIV status, and other factors(7).

As PATHSA, we share the vision of the national strategic plan, where president Ramaphosa wrote in the introduction, “The South Africa we want is a country where all its citizens are able to lead their lives of dignity and freedom, and where the vulnerable and marginalised are protected by our Constitution and Bill of Rights.” Though there are no quick solutions, we are encouraged that there is a national strategic plan on GBV that specifically includes violence directed at people based on their gender identity or gender expression. We would like to work with others towards the realisation of this vision.

References

1. South African Government. National Strategic Plan on Gender-based Violence & Femicide: Human dignity and healing, safety, freedom & equality in our lifetime [Internet]. Pretoria: South African Government; 2020. p. 1–128. Available from: https://justice.gov.za/vg/gbv/NSP-GBVF-FINAL-DOC-04-05.pdf
2. Müller A, Daskilewicz K, Southern and East African Research Collective on Health. Are we doing alright? Realities of violence, mental health, and access to healthcare related to sexual orientation and gender identity and expression in South Africa: Research report based on a community-led study in nine countries. Amsterdam; 2019.
3.  Miller LR, Grollman EA. The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health. Sociol Forum. 2015;30(3):809–31.
4. Luvuno ZP, Ncama B, Mchunu G. Transgender population’s experiences with regard to accessing reproductive health care in Kwazulu-Natal, South Africa: A qualitative study. Afr J Prm Heal Care Fam Med [Internet]. 2019 [cited 2019 Nov 27];11(1):a1933. Available from: http://dx.doi.org/10.4102/phcfm.v8i1.1054
5. Strauss, Penelope, Cook A, Winter S, Watson V, Wright Toussaint D LA. Trans Pathways: the mental health experiences and care pathways of trans young people - Summary of results. [Internet]. Perth; 2017. Available from: https://www.telethonkids.org.au/transpathways
6. Wesp LM, Malcoe LH, Elliott A, Poteat T. Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities. Transgender Heal. 2019;4(1):287–96.
7. Logie CH, James Ll, Tharao W, Loutfy MR. HIV, gender, race, sexual orientation, and sex work: A qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med. 2011;8(11).

The Professional Association for Transgender Health South Africa (PATHSA) would like to reach out to the parents who were present at, or impacted by, the meeting held by the Western Cape Education Department on 16 October 2020 about the Draft Guidelines for Sexual Orientation and Gender Identity in schools. We understand that this has been experienced by many as pathologizing your children, traumatising and infuriating.

We recognise the importance and crucial role that parents, family and friends play in supporting trans and gender diverse people and wish to applaud you for your compassion and understanding. As parents, you know first-hand the lived experience of trans and gender diverse young people and that this is a reality, and not an “ideology” as alleged by FOR-SA.

 

The standards of care for trans and gender diverse individuals have improved to a point where professionals world-wide realise that they should be committed to supporting and helping all trans and gender diverse individuals, and in particular those who are teens and adolescents, as they are especially vulnerable.

As an association we recognise that many harmful practices were allowed in the past and were driven by fundamentalist, conservative and subjective thinking.  We are committed to correcting these inhumane practices and encourage all professionals to have compassion and empathy for all trans and gender diverse individuals.

Whilst we know that some professionals may still have outdated or historical approaches to care, we are committed to bringing them up to date with current standards of care that aim to help, support and affirm our young people’s gender identity.

PATHSA would like to be an ally for parents of trans and gender diverse young people.

“For those who have realized that rainbows exist on the inside. The ones that have stopped searching for gold but have found gold within themselves and have realized that the true value of a human life is rooted deep inside of each and every one of us. The ones that know that the true value of each breath is in the journey of becoming who you are, is in living an authentic life, is in being truthful and affirmed, being colorful in a world of black and white.” Charlie, 2020.

Individuals, organizations and associations around the globe participate in Transgender Awareness Week, to help raise the visibility of transgender people and highlight issues that the members of the trans community face in our societies, prior to the Transgender Day of Remembrance on November 20th. Transgender Day of Remembrance (TDOR) is an annual observance on November 20th that honors the memory of the transgender people whose lives were lost in acts of anti-transgender violence in that given year (Glaad, 2020).

As the Professional Association for Transgender Health South Africa (PATHSA), we are in support of trans and gender diverse individuals, organizations and allies that are taking action during this important time to raise awareness of trans related issues by becoming visible agents for change, through community engagements, sharing of narratives and experiences. We support those that advance advocacy work around the issues of prejudice, discrimination, and violence that continues to affect the trans and gender diverse community across the country and the globe.

As PATHSA we acknowledge that the majority of trans and gender diverse persons in our country still face harrowing amounts of prejudice, including when accessing healthcare. We remain committed to our PATHSA constitution that seeks to promote trans-led, trans-centered and trans-focused access to healthcare and gender-affirming healthcare services. Through our continued support and consultations with professionals who work in trans health, as well as trans and gender diverse individuals and families, we aspire to become a knowledge-hub, for healthcare practitioners in the country, across a variety of disciplines, to sensitize them about the trans experience. We believe that the more educated each one of us becomes and the more aware of the context  in which we find ourselves, the more confidently we will be able to enter into these amazing giving and learning experiences tailormade, to undo the power injustices of the past.

Nee. Jy kan nie iemand wat transgender is met “terapie” en/of gebed “genees” nie. Ook nie mense wat gay is nie, want indien jy dit voorstel, is jy bloot onsensitief en onkundig.

Baie kinders en volwassenes word verneder, geboelie, en gehaat; party neem hul eie lewe, omdat hulle nie aanvaar word vir wie hulle is nie. Soms word mense doodgemaak.

Hulle menseregte word vertrap, terwyl ons Grondwet duidelik sê dit mag nie gebeur nie. Maar, al was mense se regte nie verskans in ’n kragtige Grondwet nie, behoort ons nie só om te gaan met ander wat boonop ’n minderheidsgroep is nie. Die beskerming van minderhede se regte sorg dat ’n demokrasie sterk is. Wanneer mense regte bykry, verloor ’n ander groep nie hulle regte nie – dit is nie ten koste van iemand anders nie; dit is ten beste van ons almal.

Dit het nou weer gebeur dat minderhede se regte misken word.

’n Kaapse dokter wat besig is om as psigiater te kwalifiseer, het op 16 Oktober tydens ’n vergadering van die Wes-Kaapse Departement van Onderwys (WKOD) na bewering iets gesê wat hy nie moes nie, naamlik dat genderdiversiteit ’n keuse is en terapie gebruik kan word om dit te “verander”. Dít is eintlik maar niks anders as die gruwelike “omkeringsterapie” nie. Dit werk nie; dit is nie wetenskaplik nie, en dit is onmenslik.

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Dit werk nie; dit is nie wetenskaplik nie, en dit is onmenslik.
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Die dokter was deel van ’n afvaardiging van ’n organisasie genaamd Freedom of Religion of South Africa, ’n redelik uitgesproke organisasie wat ook uiters homofobies is, sou jy lees en luister wat hulle op video’s sê. Dit is nie mense wat liefde uitstraal nie.

Maar, waar kom dié vergadering vandaan? In Maart 2017 het die Gelykheidshof in Seshego in Limpopo ’n uitspraak gelewer nadat die Suid-Afrikaanse Menseregtekommissie opgetree het namens ’n transgender kind. Die kind is by die skool verneder en geteister, maar die skool het niks gedoen om ’n veilige omgewing vir haar te skep nie. Uiteindelik kon sy nie matriek voltooi nie.

Die hof het bevind dat die skoolhoof en Departement van Onderwys verantwoordelik was en is om ’n veilige, beskermende, stresvrye omgewing vir leerders daar te stel. In haar geval het hulle versuim.

Intussen het die Wes-Kaapse Departement van Onderwys riglyne ontwikkel om openbare skole en gemeenskappe te help om ’n omgewing te skep wat nie teen enigeen diskrimineer op grond van gender, geslag, seksuele oriëntasie, oortuiging, geloof of kultuur nie. Dit was op só ’n vergadering, waar daar openbare insette gevra is, dat die betrokke dokter en die geloofsgroep opgedaag het.

Die Sexual and Reproductive Justice Coalition het ’n petisie geloods wat vra dat die Raad vir Gesondheidsberoepe vir Suid-Afrika (HPCSA) dié saak moet ondersoek, onder meer omdat die geneesheer ’n konserwatiewe geloofsgroep verteenwoordig het en nie klinies objektief was nie; omdat hy klaarblyklik praktyke voorgestel het wat skadelik is en glad nie op bewese praktyk geskoei is nie; dat hy nie opgelei is op die gebied nie; en dat aversieterapie oneties is. Dit is waarskynlik teen die Suid-Afrikaanse Grondwet, en in sommige lande is dit reeds onwettig.

Die Professional Association for Transgender Health South Africa (PATHSA) het ook ’n standpuntsverklaring uitgereik. PATHSA sê dat dit verkeerd is om ’n transgender kind of tiener te probeer oortuig om die gender wat by hul geboorte toegeken is, te aanvaar al strook dit nie met hulle genderidentiteit nie. Dit verhoog aansienlik die kanse op selfdood, of om hulself te beseer. Sulke tipes praktyke is oneties en daar moet sanksies wees teen mense wat dit bedryf. Boonop kan sulke uitsprake ouers verwar om nie in die beste belang van die kind op te tree nie.

Die WKOD het op 23 Maart hulle konsepriglyne in die provinsiale staatskoerant gepubliseer. Hulle behoort geprys te word dat hulle skole vry van diskriminasie wil maak; ook dat hulle ’n bewustheid van die spektrum van genderidentiteit en -uitdrukking probeer bevorder. Die beleid sê sulke leerders moet sensitief hanteer word, met professionele hulp, en dat die kind die reg het om sy of haar eie voornaam en kleredrag te kies. Hulle mag nie afgeknou en geteister word nie, en die toilet gebruik wat hulle verkies. Verder mag die kind die tipe klere dra wat hulle wil, dus by die gender waarin hulle gemaklik voel, ook na die matriekafskeid, en hulle kan ’n maat van hulle keuse saamneem.

Daar word aanbeveel dat skole daarna strewe om ’n omgewing te skep waar LGBTQI+-leerders die versekering kan kry dat hulle ongeag hulle seksuele oriëntasie en genderidentiteit gerespekteer en waardeer sal word en beskou sal word as deel van die normale spektrum van seksuele oriëntasies en genderidentiteite. Hulle beveel aan dat skole die stigting van sosialediversiteitsverenigings, waar die viering van diversiteit aanvaar word, sal ondersteun en erken, lui die konsepdokument.

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Ek hoop hierdie konsepriglyne van die WKOD word deurgevoer, want dit is die wêreld waarin ek kinders wil sien groei en grootword...
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Skole moet ook lesplanne gebruik wat leerders sal help om genderstereotipering te identifiseer en gesprekke te voer en om maniere te oefen waarop leerders genderstereotipering en -verkleinering op skool kan staak.

Skoliere moet ook leer hoe hulle bondgenote kan wees en mekaar kan ondersteun. Presies dit: As jy dit nie by die huis kan leer nie, leer dit dan op skool dat ons in die wêreld bondgenote kan wees en mekaar kan ondersteun, altruïsties kan wees en empaties kan wees, twee van die eienskappe van die mens wat alte min gesien word; om jouself in ’n ander se skoene te plaas en oor hulle seer te huil en saam oor hulle geluk te lag.

Die kerk is nie (meer) die staat nie en biologie en wetenskap berus op bewese praktyke, anders as geloof. Die wetenskap het deur al die eeue aangepas en geleer. Wat is feit en wat is fiksie? Dit is naïef om te dink die lewe is binêr. Selfs van die kerke is besig om hieroor na te dink; vergelyk byvoorbeeld hierdie artikel in LitNet Akademies deur Ian Nell. Daar is ’n wye spektrum van gender- en seksuele oriëntasie. Ons is nie meer die mense van 2 000 of 20 000 jaar gelede nie, want ons het intussen geleer oor onsself.

Ek hoop hierdie konsepriglyne van die WKOD word deurgevoer, want dit is die wêreld waarin ek kinders wil sien groei en grootword; een waarin almal aanvaar word om te wees wie hulle weet hulle is, waar daar nie meer gefokus word op of jy by die groot groep “inpas” nie, maar waar individue aanvaar word vir wie hulle is.

Waar elkeen saak maak.

Want ons lewe is maar kort en dan gaan ons dood en wat maak al die veroordelings van mekaar dan saak? Kom ons probeer om goed dood te gaan, op ’n aarde waar daar plek is vir almal.

Terme sodat ons almal kan verstaan:

Geslag: Dit is die biologiese geslag waarmee jy gebore is, of wat by geboorte aan iemand toegewys word; in die geval van interseksmense is die geslag nie duidelik nie.

Gender: Gender het te doen met die manier waarop ons in en vir sekere rolle grootgemaak word en wat ons assosieer met wat ’n man en vrou is. Dit gaan onder meer oor hare-, klere- en gedragskeuses en sogenaamde norme, maar daar is ’n baie wye genderspektrum.

Genderidentiteit: Dis wat jou brein vir jou sê jy in terme van gender is. Is ek ’n man? Is ek ’n vrou? Of iewers tussenin? Dit het te doen met wat jy as individu voel en is.

Om ’n transgender persoon te wees beteken dat die geslag waarmee jy gebore is en die een waarmee jy jou identifiseer (jou genderidentiteit), nie met mekaar strook nie. Die wêreld sê dat ons moet konformeer en in spesifieke kassies van “streng manlik” en “streng vroulik” moet pas, maar dit is nie vir almal so eenvoudig nie. Sommige mense se genderidentiteit stem nie ooreen met hul biologiese geslag nie.

’n Transgender vrou is met geboorte as manlik geïdentifiseer, maar haar genderidentiteit is vroulik.

’n Transgender man is met geboorte as vroulik geïdentifiseer, maar sy genderidentiteit is manlik.

’n Cisgender persoon is iemand wie se genderidentiteit ooreenstem met die biologiese lyf waarmee sy/hy gebore is.

’n Gender-vloeibare persoon is iewers op ’n spektrum en pas nie in die binêre definisies van “manlik” of “vroulik” nie.

Seksuele oriëntasie: Gender moet hoegenaamd nie met seksuele oriëntasie verwar word nie. Dit is glad nie dieselfde nie. Jou seksuele oriëntasie het te doen met tot wie jy seksueel aangetrokke is.

’n Gay persoon is iemand wat aangetrokke voel tot ’n persoon met dieselfde genderidentiteit. Gayverhoudings kan dus tussen twee gay mans wees, of tussen ’n gay man en ’n transgender man, of tussen twee transgender mans. Of dit kan ’n verhouding tussen twee gay vroue (sommige verkies die woord lesbies) wees, of tussen ’n gay vrou en ’n transgender vrou, of tussen twee transgender vroue.

https://www.litnet.co.za/ons-moet-almal-veilig-voel-en-dit-geld-vir-gender-ook/