Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study

Background: Few data are available on the presence and characteristics of transgender populations in sub-Saharan Africa (SSA), which makes the provision of health services for key populations difficult. Aim: This study aimed to ascertain the presence and characteristics of trans women in seven cities in Tanzania, East Africa.Setting: Tanzania, East Africa. Methods: Outreach to men who have sex with men (MSM) in seven large cities in Tanzania was carried out by non-governmental organisation (NGO) staff familiar with this community. Survey questions administered via interviews were used to identify participants who self-identify as trans. From the self-identification data, an estimate of the relative size of the trans women population in this sample was calculated. Results: In the sample of 300 participants, 17.0% of participants were identified as 'transsexual or transgender' (survey wording); 70.1% of these trans participants indicated that they identify themselves as a woman. Of those identifying themselves as transsexual or transgender, 43.1% reported living part- or full-time as a woman and eight (15.0%) reported hormone use. The highest percentage of hormone use (40.0%) was found in those living as a woman full-time. Notably, there was significant ignorance amongst the sample of the terms 'transsexual and transgender' or their explanation in Swahili, reported by interviewers. Conclusion: In this study, it is clear that trans women populations exist in Tanzania, with high levels of stigmatisation and threats to their lives. They should be included in health outreach and services to key populations. One in six self-identified as trans women, although the lack of knowledge of this concept in Swahili or English may have inaccurately represented numbers.

Transgender population's experiences with regard to accessing reproductive health care in Kwazulu-Natal, South Africa: A qualitative study

Background: The transgender population has unique health risks, including increased risk of mental illness, substance abuse, suicide and a high prevalence of human immunodeficiency virus (HIV). Worldwide studies indicate that this population is marginalised and faces barriers in accessing health care. In South Africa, there is limited information and research on the transgender population's interaction with health services. Aim: The purpose of this study was to examine the experiences of the transgender population in accessing health care facilities for sexual and reproductive needs. Setting: The study took place in KwaZulu-Natal province of South Africa. Methods: A qualitative study combining phenomenological and critical ethnographic approaches was conducted to explore the experiences of the transgender population in the health care setting. Critical ethnography was chosen because it is an emancipatory method that highlights the plight of disenfranchised groups, and phenomenology was used to illuminate experiences of the transgender population. Purposive snowball sampling was applied to select nine transgender participants who had experiences of contact with a health care setting. Data collection was performed through semi-structured interviews and a focus group discussion. Results: Participants provided details about the paucity of facilities, resources and targeted programmes to cater for the transgender populations' sexual and reproductive health needs. The participants engage in high-risk behaviour, comprising unprotected sex and use of cross-gender hormones without medical supervision. Furthermore, the participants reported experiences of hostile and discriminatory behaviour by healthcare workers. Conclusion: It emerged that there is a paucity of resources and knowledge to provide appropriate health care services to the transgender population, resulting in adverse experiences. Policies on transgender care and training of health workers will contribute towards improvement of health care access for the transgender population

Transgender in Africa: Invisible; Inaccessible; or Ignored?

Transgender people are an important key population for HIV risk globally; and several studies have found HIV prevalence rates in transgender populations that are significantly higher than those among other key populations such as men who have sex with men (MSM). There is a lack of research on transgender populations in Africa; and at present; there is almost no data available on HIV prevalence and risk among transgender people on the continent. It is possible that the invisibility of transgender people in epidemiological data from Africa is related to the criminalisation of same-sex behaviour in many countries and the subsequent fear of negative repercussions from participation in research. Alternatively; transgender people may be being overlooked in research due to confusion among researchers about how to ask questions about gender identity. It is also possible that transgender populations have simply been ignored in research to date. Without research on transgender-specific HIV prevalence and risk; it is very difficult to know what interventions and services are needed for this risk population. Therefore; it is important that researchers; governments; Non Governmental Organisations (NGOs) and donor organisations begin to pay explicit attention to transgender people in their HIV-related research and programmes in Africa