A Response to “Frustrations of a transgender man”

Posted on October 30, 2013 on ikanyiso.org here

As Transgender and Intersex (TIA) we have decided to respond to an article that appeared on the Inkanyiso website on the 13th of October 2013 titled “Frustrations of a transgender man”.

The reason for the response is because we felt that as a transgender and intersex organisation, we are clearly implicated in the article.
The article clearly expressed the challenges that are faced by most transgender people in South Africa, especially those that are based in townships and rural areas.

In this response we will try to make a few points clear about how the organisation works and explain the state of transgender health care in South Africa.

In early 2013, we conducted a Needs Assessment report from the six provinces that we serve in South Africa; Gauteng, North West, Limpopo, Mpumalanga, Kwa-Zulu Natal and the Free State province.
From the report we realized that 67% of our constituents are unemployed, that is quite a high number considering the fact that we have over 520 transgender and intersex constituents as an organisation.
These are people who need access to health care, assistance with their Identity documents or psycho-social support.
Because of the high unemployment rate, most of them are completely dependent on public health care; the problem becomes even bigger considering the fact that only two public hospitals in Gauteng can cater to some degree for the needs of the trans* population; Steve Biko Academic Hospital and Chris Hani Baragwanath Hospital, the only other hospital that has done great work in terms of trans* health care is Groote Schuur in Cape Town.
Unfortunately in terms of surgeries for transsexual patients, Steve Biko only takes up about four new state subsidised trans* patient per year and Baragwanath does between 6 to 8 state subsidised surgeries per year.

This means with all the people we have on database, only 10-12 actually receive surgeries per year as they cannot afford private health care.
We constantly refer our constituents to these two hospitals and have even started a close working relationship with Baragwanath, unfortunately the hospitals can take you in as a patient for a psychologist’s diagnosis and for a few sessions with the psychologist, but in most cases that’s the most they can do, as the waiting lists for seeing an endocrinologistor surgeon are usually very long at these hospitals.

Additionally the Groote Schuur Hospital (GSH) is committed to 4 surgeries per year, and with the huge amount of visibility created over the years about trans* in SA, the GSH waiting list is at this point 26 years long!

This is the bleak picture of trans* healthcare in South Africa, there are no hospitals in two thirds of the country that adequately cater for the needs of trans* patients, as a result most of our constituents usually travel monthly from their provinces to Gauteng in order to access some degree of healthcare, some of them have even migrated to Pretoria or Johannesburg for healthcare.

Trans* healthcare in this country is expensive, you lose so much in the pursuit of healthcare, you lose your money, sometimes you lose relationships with your family and friends and sometimes you lose your life while waiting for healthcare. If you really want to transition using the public health system, you must be prepared for long and difficult process, healthcare for transitioning will not come to you, you have to fight for it, you need patience and perseverance, that is why we have support groups in Pretoria, Johannesburg and Mpumalanga for trans* people, because we understand that this can be a very frustrating journey.

The problem with our community is that they almost don’t understand that as an organisation the best we can do is offer assistance to you by referring you to a hospital, tracking your case and intervening when the hospital does not treat you well and offering psycho-social support.
But we cannot guarantee that you will get the surgery you seek at the time that you want, this can be a very long process, and you need to work with us.
That is why when people ask for referral letter from us, we ask them to come to the office because we cannot give a referral letter that we have signed and clearly bears the letter head of the organisation to a person we have never met or interviewed.

If the constituent says they do not have the bus fare to come to us, sometimes we assist when we have the funding and sometimes we tell them they will come to us when they have enough money to do so or they can wait for the time when we have an outreach activity in their province.
This is a struggle that we all have had to undergo as trans* and intersex people form disadvantaged backgrounds. The Director of TIA, Tebogo Nkoana had to leave his family and friends and move to Cape Town as a 19 year old in order to get his transition.
He had to work once he got to Cape Town in order to meet his daily needs as his family couldn’t afford to send him money.
Our Advocacy coordinator had to move from the North West and move to Pretoria for health care.
We have all made sacrifices to get where we are, and we are still struggling with access to health care. This should not be the case in a democratic state, but unfortunately that is how things are at the moment and until the time when our health care system prioritises trans* and intersex health care.
We are going to need a whole lot of perseverance and unity.

The struggle for the right to healthcare for trans* persons is not a battle that we can fight alone.  We need the trans* community to come on board.
This is not a struggle that TIA and Gender DynamiX can fight alone.

The biggest problem that we have at the moment is the lack of the trans* community’s interest in organising and owning their movement.
It is very common for trans* people to request assistance from us but when we need assistance from them in terms of organising or needing information through surveys very few of them actually take part.
All three of the trans* organisations in the country are actually very small in terms of staff numbers, as TIA we have only four permanent staff members and because of a lack in funding only two of the staff members are paid. As a result, we cannot afford to subsidise or fund anyone’s medical assistance when our own staff members can’t even afford to pay rent.

Trans* organisational funding is one of the biggest problems at the moment, most of us don’t even know if our organisations will still exist in the coming year as funding is very difficult to come by. Adding the total number of staff members at TIA and Gender DynamiX equals to 9 people.  We cannot expect 9 people to lead and take charge of a trans* movement that includes thousands of trans* people.
We all need to own the movement and be the change we want to see in the world.

In order to serve the trans* and intersex people based in provinces outside of Gauteng, we conduct outreach activities. We visit these provinces with the intent of getting in touch with the trans* and intersex people in these provinces, sensitising service providers and collecting data that can be used for advocacy. In fact, in the coming two months, we will be conducting outreach activities in the North West, Mpumalanga and Limpopo in collaboration with Gender DynamiX.
We ask the trans* and intersex community to attend these activities and events so that we can figure out how to organise and bring about a change in our country in terms of transgender and intersex human rights.
In most cases when we organise these activities only a few trans* people attend even though we do our best to inform them a long time in advance.

We cannot reiterate any further that this is a struggle.
A struggle we will all have to take part in, we might not see the results immediately but we will definitely see them in the future.
The trans* movement has made great strides in the past few years considering how small it is.
It is time that we united and forced government to prioritise trans* health care because regardless of gender identity or expression, we are also citizens of this country who deserve health care and full human rights like anyone else.

Aluta Continua.

Related articles

2013 Oct. 24: Jack Daniel’s


2013 Aug. 9: Transgender youth suicide in Johannesburg


2013 Oct. 4: I sensed something was wrong


To Conform or Not To Conform?

For as long as I can remember, I have always wanted to fit in, to be “normal” and be a part of a clique or group of people who accepted me. There was a point in my life where my desire to be accepted by others outweighed my desire to live, a point where I gave up my values, interests and ideas— just so that I could fit in. Well I have always been different. I was the girl that listened to rock music in a Black township where most teenagers listened to house music, hip hop or Kwaito (a South African style of popular music similar to hip hop). Having taste in music that is considered “white” in an African black township is not the coolest thing to do. I was the girl that preferred to go to the library while everyone went partying; being a nerd is also not easy in the township.Being intersex just made things worse and my attempts to fit in were sabotaged by my clearly androgynous appearance. I had to deal with daily whispers and comments such as, “Is it a boy or is it a girl?” My refusal to undress in front of other girls further ignited the curiosity from others regarding my sex and gender.

I hated the fact that I am intersex, I hated my “ambiguous” genitalia, and I hated the fact that I could not wear a tight fitting bikini like other girls or have honest conversations with them about periods. My only desire at that time was to have surgery because I imagined stepping out of the operation room and my life instantly transforming into a state of bliss. The information that I received regarding genital reconstruction surgery for intersex people only painted a positive picture and left out any mention of the detrimental effects it might have on me. At this time I even started to hate my parents because they previously refused surgical procedures on me. Even if they had signed off on surgery, I was frustrated because doctors in public hospitals did not have any experience on how to deal with my case and we could not afford private medical care. I began to think that my only option was suicide, but I couldn’t even take my own life because I kept thinking that once I am dead I would have to be undressed at the mortuary and the world would know my secret.

After meeting with many intersex individuals and seeing the detrimental effects that childhood surgeries had on them, I now consider myself privileged that I did not have to go through early genital reconstruction. I have seen the pain and trauma that unnecessary and non-consensual genital mutilation has had on the lives of intersex people and now I am grateful that my parents chose not to have any surgery done on me as a child. I am grateful that the decision to have or to not have surgery rests with me—the owner of this body. If I were to decide to have surgery I would have to live with the consequences knowing that I made an informed decision. At this time I can say that I no longer want to have genital reconstruction surgery. I have learned to love myself. I have learned that we are not all the same—we cannot be. I have learned that I will never completely fit in anywhere and the more I try to—the more I stick out like a sore thumb. If nature wanted me to be like everyone else then we would have all been born exactly the same. A world without diversity is a world not worth living in.

Unfortunately we live in a world that does not celebrate or respect diversity, a world where people are obsessed with fitting you into neat little boxes of norms and stereotypes. Any contradictions to these rigid norms are quickly eliminated. A world where everything is in black and white. Grey areas are not approved of. The grey areas are often painted over in solid black or white and it is hoped that no one sees beyond the surface. I am now at a point where I have to fight to keep my “difference”. Every trip to the doctor becomes an argument and battle about what is “right” for me. My doctor keeps telling me about how having different looking genitals will lead to personal distress. He read this in some medical journal and refuses to hear any other opinion. The fact that I live a perfectly happy life as an intersex person without any surgical intervention clearly bothers him. They told him in medical school that every intersex person should be operated on as an infant or else they will grow up traumatised and confused. My life refutes that statement and that is why I believe he is obsessed with trying to get me to undergo genital reconstruction surgery even though I have had no health complications. I often tell him of the negative effects of early, unnecessary and non-consensual surgeries on intersex bodies and he responds by saying that he is a doctor and therefore knows better and that surgeries are for the “good” of the child. Before you misunderstand me, I am not against surgery but I am against IMPOSED surgery on intersex persons. I am against NON-CONSENSUAL surgery and I am against UNINFORMED and UNNECESSARY surgery on intersex people—especially if their intersex variation has no immediate life threatening implications. I have to go on a mission to find a new doctor since my current doctor and I can’t seem to agree on anything.

The right of bodily integrity and self-determination of intersex people should be ensured and maintained. This is my body and I have the right to personal control of my own genital and reproductive organs. Do I still want to fit in? No, I am too fabulous to fit in anywhere! I shall not conform.

By Nthabiseng Mokoena


Originally posted here

An Open Letter to the One-in-Nine Campaign


… in Response to the Exclusion of Transgender and Intersex Persons in the Feminist Political Education Training

The divisions in an already fragile women’s movement in South African are not helpful.

Dear colleagues

It is with great disappointment that we learnt about the exclusion of transgender and intersex persons from a feminist political education training, presented by the One in Nine Campaign. We were truly shocked when a colleague forwarded to us an invitation for the Feminist Political Education 2013 Programme, which set out, amongst others, the following requirement:

The course is open to female-born people who are not male-identified.

This requirement effectively sets out to exclude transgender and intersex individuals from the course. Asked about this blatant exclusion, 1 in 9 campaign director, Carrie Shelver responded as follows:

“I am glad that you raised these concerns with us directly and we welcome the opportunity to respond and share with you our ideas and thinking. I need to forward your email to the board of the Campaign so that we can collectively respond to the issues raised with the seriousness they warrant. I am cc’ing Pumla Gqola, One in Nine Campaign Chair of the board. I hope you will give us a few days to do this. Once we have sent this through we would also be happy to meet and discuss it in person with you and others who may be interested”.

The final response from the One in Nine Campaign came on 23 February 2013 from which we drew two very disturbing implications:

“The organisation (One in Nine) is not an LGBT organisation, even though many of the active members identify as lesbian, bisexual and gender non-conforming. Based on our analysis of social oppression and our capacity to respond, the campaign focuses its limited resources on developing leadership of female born people who are socialized as women and who live their lives within the social category women and whose access to resources and spaces are accordingly determined and so frequently under attack”.

The interpretation of this sentiment wishes to imply privilege on the part of transgender and intersex women in South Africa. This is not a true reflection of the lived experiences of this group of vulnerable women often excluded from mainstream personal development opportunities, and the denial of basic human rights such as education, exacerbate this context for transgender and intersex women in South Africa.

“The criteria for the One in Nine Feminist Political Education Program is an articulation of patriarchal values. As a woman, I was born intersex, socialized as a woman and lived within the social category of woman. Intersex women also experience limited access to resources, their lives and health are frequently under attack, and therefore, you can never imply privilege on my part”. – Nthabiseng Mokoena, Transgender and Intersex Africa (TIA).

“On 13 April 2013, the One in Nine Campaign is called all on LGBTI persons to gather for a public mass meeting to discuss Joburg Pride. As much as we don’t support the privatisation of our sexual identities, as has been the case with Joburg Pride. We find it ironic that Transgender and Intersex person affected by Joburg Pride is called upon to support this initiative, however, the One in Nine Campaign in not clear on its partnerships in a broader feminist agenda that advances all women and feminists irrespective of how society has biologically imposed an identity. The One in Nine Campaign seems to affirm this very state construction of gender which goes against the human rights approach taking place in other countries”. – Jabulani Perreira – Iranti-org.

Carrie went on to explain that in the past “One in Nine Campaign had very successful collaborations with a broad range of progressive organisations – including those that work with men, including gay and transgender men and women”.

This statement echoes the very problematic categorization of gender, gender identities and sexual orientations. From where we are, this seems to echo the conglomeration of both gender identities and sexual orientations into one big category of masculinity and masculine identities. This does not speak to the autonomy of transgender people as an identity separate from those of both cisgender and gay men. Moreover, this places transgender women on a very masculine spectrum of identities. With all due respect, no feminist, no women and no person can determine the gender identity of another human being, least of all, the expression thereof. Says Liesl Theron of Gender DynamiX: “This is an articulation of 1970’s, second wave feminism characterised by a very transphobic attitude”.

S.H.E, the social, health and empowerment FEMINIST collective of transgender and intersex women of Africa is an organisation established in 2010 to address the concerns and issues of transgender and intersex women through feminist analysis. We have organised and established ourselves to advocate against the very attitude portrayed by the One in Nine campaign.

We are familiar with this mentality of exclusion and have long been advocating against it. What is particularly disappointing about this instance is that it plays off against the backdrop of an already very fragile women’s sector.
At S.H.E, we advocate for women, all women, despite the fact that our name mentions only transgender and intersex women. We advocate for transgender and cisgender sex workers alike. Our work in the Amanitare coalition on sexual and reproductive health rights had a broad focus and as an organisation, we particularly voiced for rural, HIV+, transgender & intersex women, and sex workers. Our focus has always been to create an enabling legal and policy environment for all women.

“If you can recall, I was one of the women in the audience at a presentation on the IPAS tool used in surgical abortions at the People’s Healthy Assembly during July 2012. This was not because I want to force myself and the organisation I represent in cisgender women spaces but because abortion rights is a cross cutting issue in all our communities. Again, with women at the centre of this problem, as a transgender woman, I fully support abortion rights for ALL women, even those gender non-conforming. The same goes for all the other women issues like breast cancer, domestic violence, discrimination in employment and high HIV rates amongst women. These issues and many others we support for transgender and cisgender women alike. We do this because we don’t believe in the creation of categories of women. This is the very tendency that creates hierarchies of power, the same hierarchies of power visible in patriarchy. What we need, as a country right now, is to look beyond our differences and recognise the bigger issues that oppress and marginalise women”.– Leigh Ann van der Merwe – S.H.E

An interesting question on which we are pondering is whether this sentiment is supported by all the members of the One in Nine Campaign? We do believe that your membership comprise some transgender and intersex supportive organisations and it would be interesting to find out whether or not they support the sentiment uttered by the secretariat.

“On 13 April 2013, the One in Nine Campaign has called all on LGBTI persons and organisations to gather for a public mass meeting to discuss Joburg Pride. As much as we don’t support the privatisation of our sexual identities, as has been the case with Joburg Pride. We find it ironic that Transgender and Intersex person affected by Joburg Pride is called upon to support this initiative, however, the One in Nine Campaign in not clear on its partnerships in relation to its broader feminist agenda that advances all women and feminists irrespective of how society has biologically imposed an identity. The One in Nine Campaign seems to affirm this very State construction of gender which goes against the human rights approach taking place in other countries,” says Jabu Pereira, Director of Iranti-Org.

We believe this attitude is merely taking us backward and breaks down an already fragile feminist and human rights movement.

We urge the One in Nine Campaign to do away with this discriminatory requirement for participation in this training course. It echoes inequality and discrimination, the very qualities that we see in the transphobic societies in which we live and survive each day of our lives. I am ending my letter with a quote from the transgender feminist, Julia Serano:

“Feminism is based on the conviction that women are far more than merely the sex of the bodies that we are born into, and our identities and abilities are capable of transcending the restrictive nature of gender socialization we endure in our childhoods”. Love and kinship are two of the most central tenets of feminism.

We trust our words will find a place in your hearts and minds. Moreover, we hope this letter will set off some much needed dialogue to bridge the divide that exists.

We shall await a response from you.

Best regards
Leigh Ann van der Merwe – coordinator S.H.E

This letter is endorsed by the following organisations:
Gender DynamiX
Transgender and Intersex Africa

A Response to “Definitely Not Gaysbian” Article

On the 1st of March 2013, we at Transgender and Intersex Africa read a piece on the Inkanyiso website titled “Definitely Not Gaysbian” (link below).The article was interesting as it discussed one of the most “taboo” subject within South African LGBTI community, but it was also confusing for us.

What caught our attention was the definition of gaysbian. The definition in the article read as follows; “The term Gaysbian is used for people who are gay men/trans-woman dating butch lesbians/trans-man.” From our understanding the term “gaysbian” came from a combination of two words, ‘gay’ and ‘lesbian’, in other words a combination of two words expressing sexual orientations. So what were the words “transman” and “transwoman” doing in this definition? These are gender identities not sexual orientations. The definition made use of forward slash signs (/) allowing the juxtaposition of the names in use, in other words from the definition we could deduce four statements that “define” gaysbian;
Gaysbian is used for people who are gay men dating butch lesbians.
Gaysbian is used for people who are trans-women dating butch lesbians.
Gaysbian is used for people are gay men dating trans-men.
Gaysbian is used for people who are trans-men dating trans-women.

So from the four statements, the only statement that can stay true to the definition of gaysbian is statement one, when a gay man dates a butch lesbian. Including trans*people in this definition is both disrespectful and contributing to the misunderstanding of transgenderism.

When a trans*woman dates a butch lesbian, is it a “gaysbian” relationship? The trans*woman is not a gay man, she identifies as a woman and she is dating a woman. So in this relationship one of them is a lesbian woman and the other is a trans-woman, a gender identity. The trans* woman might be homosexual, bisexual, pansexual, etc. but she definitely is not a gay man, so the definition of “gaysbian” does not apply in this context.

When a trans*man dates a gay man, he is a male identifying person dating another male identifying person, they might both be gay (when we consider their sexual orientation), yes there are gay trans* men, in this case none of them is lesbian, so how can we use the “gaysbian” term to define their relationship?

When a trans* man dates a trans* woman, this is a relationship between a man and a woman, who both might be heterosexual, so how can we call this “gaysbian”?

Transgender is an umbrella term for persons whose gender identity or gender expression does not conform to that typically associated with the sex to which they were assigned at birth. Transgenderism is primarily about gender identity and gender expression. Transsexual refers to people who wish to undergo sex reassignment surgery to align their bodies to their gender identity. “Trans” could either mean a transgender person or a transsexual person. From the definition “transwoman” or “transman” could either mean that these people are just transgender or they are transsexual. So here is a scenario, if a transsexual woman dates a butch lesbian, is it a” gaysbian” relationship? No it’s a relationship between two women.

The structure of the definition also indicated one of the biggest problems within the South African LGBTI community; the continuous clustering of transwomen with gay men and the clustering of transmen with lesbians, as if “gay men “ and “transwoman” is the same thing or butch lesbian and transman is the same thing. As already stated they cannot fall into the same boxes, clustering transwoman with gay men is disrespectful to their gender identity and it is a constant reminder of the body they were born in regardless of their identity, a gay man is a man and a trans* woman is a woman. The same goes for transmen; it is disrespectful to cluster them with lesbians, as if the two are synonyms of each other. A lesbian woman is a woman and a trans* man is a man.

Yes, a lot of transwomen “hangout” with feminine gay men and a lot of transmen “hangout” with butch lesbians, but it is not the same these identities are not the same and should not be treated as if they are the same, gender identities in this context differ and that cannot be ignored. Many trans* people use the LG community as an “entry point” in other words a point to discover yourself and build social circles before you “truly” come out or identify as trans*, but we cannot continue to label a person as a gay man even at the point when they have discovered themselves and are identifying as female.

One of the most dangerous forms of this “clustering” is within HIV/AIDS studies, you will realize that in most cases when it comes to HIV/AIDS prevention campaigns, transwoman are put in the same category as gay men and MSM individuals. This has then created a situation where the majority of transwomen then choose not to read or access this HIV/AIDS prevention information because it does not explicitly respect their gender identity but rather concentrates on the bodies they were born in and equates their situations to those of gay men.

Gender identity politics and Queer politics are complicated but we just need to learn to respect each other and remember that as we try to fight heteronormativity we must not in the process create homonormativity.

About the Author
Nthabiseng Mokoena is an Advocacy Coordinator at Transgender and Intersex Africa (TIA)

2013 Mar.1: Definitely NOT “Gaysbian”
… But a Relationship between Two People
by Yaya Mavundla & Lesego Tlhwale