During a support group meeting for transgender women – held in a tiny, two-bedroom RDP house in the rural North West town of Schweizer-Reneke – one of the women started coughing violently.
“We were all really concerned for her,” says Seoketsi Mooketsi, the trans rights activist who established the group. “I advised her to go to the local clinic, but all she said was: ‘It’s not that easy, chommie.’”
It being her hometown, Mooketsi knows all too well what makes accessing this service “not that easy”.
“There is still a lot of stigma,” she says. “Going into a healthcare facility, telling healthcare workers that you are transgender and facing that stigma is something that keeps many from accessing healthcare.
“You’d go to the hospital and nurses would say things to their colleagues like: ‘Yhu, this one is gay …Must be HIV-positive.’ There is this presumption that if you’re queer and going to the hospital, it can only be because you’re HIV-positive. It can’t be because you have flu or whatever.”
Mooketsi adds that, for queer and transgender people, accessing healthcare in the “extremely religiously conservative”, predominantly Christian town is “still very difficult”.
Anastacia Tomson, a transgender woman and medical doctor, says the principles of medical ethics “demand that we as clinicians treat patients fairly and without prejudice, irrespective of our personal beliefs or positions.
“The reality is, we know that transgender patients benefit tremendously from inclusive and accessible medical care, including surgical procedures, and that encouraging doctors to withhold treatment from trans individuals cannot be considered ethical, safe or efficient. Furthermore, strong scientific evidence exists to dispel the idea that gender identity is at all a matter of choice.”
Ronald Addinall, a clinical social worker and sexologist at the University of Cape Town, facilitates a transgender support group at sexuality healthcare organisation the Triangle Project.
“One of the core challenges faced by transgender people in their journey to coming to terms with who they are is shame,” he says.
“They have often been judged or rejected or told that they are bad or wrong or evil or sick. If a transgender person in that position comes across a health practitioner who holds these conservative beliefs – and, more importantly, acts on those beliefs in a way that further deepens and entrenches this sense of shame – the transgender individual comes away feeling a deeper sense of shame. This can, and does, impact significantly on their self-esteem in a very profound way.”
Addinall says such conservative attitudes exacerbate depression, anxiety and suicide rates in transgender communities, which are higher than those of the general public. A 2008 study found that “the prevalence of attempted suicide was 32% [among transgender people because of] depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination and gender-based victimisation independently associated with attempted suicide”.
The study found that suicide prevention interventions for transgender persons were urgently needed.
“This is not because depression and anxiety are innate to trans people, but because they often find themselves in environments in which they have to battle for acceptance,” says Addinall.
He says, although this study is an overseas one, “if one factors in the levels of poverty and trauma in South Africa, this figure would more than likely be much higher locally”.
As with many transgender people who come up against health practitioners who refuse to acknowledge their innate dignity, the women in Mooketsi’s rural hometown have very little, if any, choice.
“There were times during our meetings when some of the women would break down in tears, saying that if they had the resources – the money – they would pack up and leave this town,” she says.
“It’s the conservatism here, the extreme religious conservatism. It has become too much for them.”
Doctors group slated for calling trans people ‘counterfeits’
The intersection between healthcare, religion and human rights was highlighted recently when Doctors for Life International issued a statement denouncing a call by queer activists for South Africa’s government to improve healthcare for transgender people.
The statement labelled trans-gender people as “counterfeits” and “impersonators of the sex with which they identify”.
Issued by the group on July 11, the statement said it was responding to lesbian, gay, bisexual, trangender and intersex (LGBTI) nongovernmental organisations that have called on the South African government to make health facilities available to transgender people for hormone treatment and surgeries.
The NGOs also said that any policy that excludes transgender or homosexual persons could be challenged and invalidated.
Quoting Dr Paul McHugh, the former head psychiatrist at Johns Hopkins Hospital in Maryland in the United States, Doctors for Life said the idea that one’s sex was fluid and a matter of choice was “extremely damaging … to families, adolescents and children, and should be confronted as an opinion without biological foundation wherever it emerges”.
Linking queer communities to paedophilia in a recent Facebook post, the group also said: “There is a reason why we instinctively feel alarmed when a creepy man watches our children because it causes us to protect our children from being molested and traumatised – the LGBTI pushing to have us accept them wanting to have sex with our children.”
According to its website, Doctors for Life is made up of “medical doctors, specialists, dentists, veterinary surgeons and professors of medicine from various medical faculties across South Africa and abroad, in private practice and in government institutions”.
“We bring together medical professionals to form a united front to uphold the following three principles: the sanctity of life from fertilisation till death, sound science in the medical profession [and] a basic Judeo-Christian ethic in the medical profession.”
Membership offers medical practitioners “a credible mouthpiece to air their views, a platform to live out their convictions in society, and scientific arguments on important issues (such as abortion, cloning, euthanasia, pornography [and] prostitution).”
Chief executive Albertus van Eeden says the organisation has “approximately 1 500 members, of which three-quarters are in South Africa and the rest abroad”.
Anastacia Tomson, a transgender woman and medical doctor, says: “It is concerning that the organisation represents so many South African doctors, especially considering that finding a healthcare provider who is competent in caring for transgender patients, and who does so with sensitivity and respect, is already difficult.”
Calling the Doctors for Life statement “shameful”, she said: “This group is propagating harmful ideas that actively damage an already marginalised group.”
In response to questions posed by the Mail & Guardian, Van Eeden said: “We are merely quoting the work of scientific scholars. McHugh was … one of the most respected medical and psychiatric authorities on transgender [sic] [and] Michelle Cretella [was] president of the American College of Paediatricians.”
Tomson counters this. “McHugh has been widely discredited by his colleagues and professional medical bodies. Several respected organisations, including the American Psychological Association … explicitly oppose McHugh’s position.”
A letter signed by 600 LGBTI health experts criticised McHugh’s report, Sexuality and Gender: Findings from the Biological, Psychological and Social Sciences. The nonpeer-reviewed report was published in 2016.
The report, the letter stated, “misleads readers about the state of scientific research and evidence-based clinical practice guidelines addressing the health of people who are LGBT and queer. As researchers with expertise in gender and sexuality, and/or as clinicians who serve LGBTQ people, we are called to correct the record. A substantial body of research points to stigma and its consequences as contributing to the mental and physical health disparities among LGBTQ people.”
McHugh’s report, it added, does “not reflect current scientific or medical consensus”.
‘Healthcare cannot be ruled by religion’
As part of their work as Christian ethicists, Benae Beamon and Thelathia “Nikki” Young study the moral systems people generate based on beliefs and ideas found in Christianity, with a focus on black, queer and transgender people.
“Linking healthcare to religious or political perspectives is problematic,” says Young, who is an assistant professor of women’s and gender studies and religion at Pennsylvania’s Bucknell University. “I do not believe that an ethical practice of medicine should ever be based on race, religion, beliefs or creed. Any medical practice that is based on such things is treading the line of dehumanisation and enslavement … And if a medical group is providing healthcare based on their beliefs about how one ought to use one’s body, then we could argue that they are in some way practicing authority over another person’s body.”
Beamon, a doctoral student of Christian ethics at Boston University, adds: “When someone is coming into a new understanding of their sexuality or gender and it is denied or negated – and their agency thereby taken from them – those who do so are willing participants in that person’s enslavement.”
For Young, this is tantamount to “medically funded neocolonialism in that we are dealing here with an imperialist notion of who has dignity and who has worth”.
Ronald Addinall, a clinical social worker and sexologist at the University of Cape Town, says: “Any healthcare practitioner has a right to hold their personal beliefs. But … the moment you allow those beliefs and values to shape and inform your practice, that is significantly problematic.”
Carl Collison is the Other Foundation‘s Rainbow Fellow at the Mail & Guardian