This chapter provides a synopsis of the global and local context for TGW from an HIV perspective. The role of TGW outreach workers in South Africa's HIV response is described. Three case studies are presented to provide insight into how TGW outreach workers support their clients to cope with the key issues they face, namely stigma and discrimination; the consequences of non-conforming gender expression; scarce employment opportunities; the inadequacies of bio-medically focused HIV services and limited resource allocation for TGW programming. The case studies highlight how outreach can comprise mentorship between older and younger TGW and support community building among the women. Important challenges facing outreach services for TGW in South Africa include the uncertain funding landscape; limited interventions for socio-economic empowerment and harm reduction around substance use; and lack of access to hormone therapy and gender-affirming surgery. Recommendations are made for increased support of outreach services and initiatives that take a multi-sectoral and comprehensive approach to TGW.
Human Sciences Research Council (Sat,) studied this question.