Academic journal article Gender & Behaviour

Knowledge, Attitudes and Practices of Health Care Workers Related to Treatment and Care of Transgender Patients: A Qualitative Study in Kwazulu-Natal, South Africa

Academic journal article Gender & Behaviour

Knowledge, Attitudes and Practices of Health Care Workers Related to Treatment and Care of Transgender Patients: A Qualitative Study in Kwazulu-Natal, South Africa

Article excerpt

Background

Transgender is an umbrella term that describes individuals whose gender identity is different from the sexual identity assigned to them at birth and traditional societal expectations. Transgender people may be male-to-female (MTF), viz. people who were assigned a male gender at birth, but who identify as female, or female-to-male (FTM), viz. assigned a female gender at birth, but who identify as male (Bockting, Rosser, & Scheltema, 1999; Coleman et al., 2012; Wilson et al., 2014).. It is important to note that gender identity is not related to a given individual's sexual orientation, where transgender people can be heterosexual, homosexual, or bisexual (Clements-Nolle, Marx, Guzman, & Katz, 2001; Kenagy, 2005). (Refer Table 1 for a comprehensive list of transgender terminology).

Due to marginalisation and stress from societal stigma, the transgender population engages in high risk behaviour, such as substance abuse, receptive unprotected anal sex, and commercial sex work (Herbst et al., 2008; Kenagy, 2005; Kenagy & Hsieh, 2005). In some cases, the risky behaviour is an effort affirm gender identity, for example, a transwomen (MTF) would engage in receptive anal and oral sex to affirm the female identity (De Santis, 2009). This risky behaviour increases the possibility of the transgender peoples' infection with Human Immune deficiency virus (HIV) (Nemoto, Operario, Keatley, Han, & Soma, 2004; Reback). A systematic review estimating HIV prevalence and risk behaviors of transgender persons in the United States conducted by Herbst et al. (2008) yielded 29 studies across 10 states, indicating an average of HIV prevalence of 27.7% in the MTF population (Herbst et al., 2008).

Furthermore, studies indicate that the transgender population often self-administer cross-gender hormones in an effort to attain the physical characteristics of the desired gender (Sanchez, Sanchez, & Danoff, 2009). The use of hormones without medical supervision poses the potential for adverse effects, such as cardiovascular diseases, hyperlipidaemia, and thrombosis (Herbst et al., 2008). Due to increases risk of HIV infection, transgender people are likely to be on HIV anti-retroviral medication. The interactions between hormones and anti-HIV medication may pose the risk of complications. Some transgender patients would rather chose the benefit of a physical body in harmony with their gender identity over their own health and safety, thus may not disclose the use of hormones to HCW (Cobos & Jones, 2009).

The South African (SA) Bill of Rights Section 27(1) asserts that transgenderpeople have a right to access health care services and may not be refused services or treatment, or provided with an inferior care due to gender minority status (Act, 1996). Despite such political will and legal protection, the South African sexual and gender minorities report poor access to health services (Cele, 2015; Lane, Mogale, Struthers, McIntyre, & Kegeles, 2008; Smith, 2015), where they were denied access to quality sexual health care services both intentionally and unintentionally due to structural and institutional barriers in the South African Health facilities (Bateman, 2011; Newman-Valentine & Duma, 2014; Stevens, 2012). Consequently, transgender people tend to avoid health care facilities and delay seeking care, and may self-medicate or seek care outside formal health care facilities, resulting in unnecessary complications (Klein, 2009; Stevens, 2012).

Amongst the barriers faced by the transgender populations in South Africa, is a limited number of HCW trained and skilled on gender and sexual minority issues, as there are no accredited courses on sexual health (Campbell & Stein, 2014). For HCW, issues of sexuality and gender identity were not covered adequately in the medical and nursing curriculum (Brennan, Barnsteiner, de Leon Siantz, Cotter, & Everett, 2012). Consequently, there were no health programmes targeted at the risk factors and the needs of the LGBT population, in particular the transgender population. …

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