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    • Natasha displays her school pride at a stop on Chapman's Peak Drive, looking down at Hout Bay in the Western Cape of South Africa.

Natasha Graves

Gender DynamiX South Africa, Summer 2013

I spent the summer of 2013 learning about the transgender population in South Africa and the relationship between culture and health.  I worked on the South African Transgender Health and Research Initiative, primarily with the organization Gender DynamiX, which is Africa’s first transgender organization.  I also traveled around South Africa learning and working with Transgender and Intersex Africa and Social, Health, and Empowerment Feminist Collective for Transgender and Intersex Women in Africa.

The transgender population in South Africa faces an obscene amount of discrimination, hardship and even violence.  This population is widespread but significantly marginalized.  Transgender is an umbrella term for people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth. Some transgender people opt for gender affirming treatment, while others choose to not, or only partially, undergo such treatment.   In South Africa, there is difficulty in accessing hormone therapy and extreme wait times for surgical transition, if you are even able to get onto the list at all. 

There are only two public hospitals willing to perform the requested surgeries in the country, and the waiting list to receive these surgeries is now 26 years long.

Health professionals play a sizeable part in the psychological and physical changes that these individuals undertake.  Although much of the transgender health discussion focuses on transitioning, health service providers play an integral role in the general health and wellbeing of the individuals in this population.

Working on need assessments to inform future programing, I focused on the utilization and access to health services among this population.  Specifically, I surveyed and interviewed health service providers about their awareness and knowledge of this population.  Preliminary data shows that these health service providers have a limited awareness and many are unwilling to work with this population.  The ideas and perceptions of these health service providers towards the transgender population may influence the care received, thus leading to limited access and utilization of care among this population. 

I also learned about traditional cultural circumcision among transgender women in the amaXhosa culture in the Eastern Cape region.  I listened to women painfully speak of being forced by their families into this traditional rite of passage in becoming a man, when they believe they are female.   I also heard women speak about not being accepted and being discriminated by their families due to their gender identity, leading to isolation.  These are powerful experiences that I will never forget and I am thankful for this internship opportunity.


Natasha Graves
Global Health