Violence during transition: accounts of gender-affirming care in South Africa’s public health system

Despite constitutional protections afforded to the LGBTQ+ community, South Africa remains a society violent towards gender minorities. With public healthcare over-burdened, this system of care remains particularly unresponsive to the needs of transgender people who seek to affirm their gender medically. With a narrative design, this research explored the experiences of transgender people of violence through their access to gender-affirming care. This study troubled the notion of violence from a social determinant of health to situate it as an unexplored mechanism of meaning-making in the South African context. Using gatekeepers aligned with LGBTQ+ support groups, 15 volunteer participants recollected their accounts through semi-structured interviews. Using this undirected talk, the narrative analysis found that gaps in care become a key point in the narrative trajectory of participants shaping their decision-making around experiences of interpersonal violence and for personal advocacy with healthcare professionals. Similarly, the clinic was narrated as a site of violence both symbolically through invasive bodily examinations and structurally as a place for perpetrators of anti-transgender violence to target transgender patients. Transition in this context can be seen as a mode to understand several competing violence/s where the body is treated as a site for physical, psychological and structural harm.