[By Miriam Chabala]
Transgender individuals and other key populations in Zambia suffer significant health disparities coupled with discrimination, stigma, and violence, along with other social factors that significantly affect their physical, mental, and behavioral health status.
A Gender, Sexuality and Sexual Orientation Training Manual produced by FHI360, an American international nonprofit organisation working to improve the health and well-being of people across the world revealed that, compared with the general population, transgender persons experience higher rates of health problems related to substance use, mental illness, and sexual and physical violence, as well as higher prevalence and earlier onset of disabilities that can also lead to health issues.
Additionally, transgender individuals encounter unique challenges and inequalities in their ability to access health insurance and adequate care. The public health and economic crises spurred by the COVID-19 pandemic have only exacerbated already existing disparities and barriers to care for transgender persons, especially transgender people in developing countries like Zambia.
A local activist for key populations who asked to remain anonymous told this author that the biggest barrier to health care services for transgender individuals in Zambia is a lack of health care providers who are sufficiently knowledgeable and understanding of their needs.
“The healthcare system is unreceptive to transgender persons, and health services in Zambia are not transgender-specific,” the source said. “They might need therapy because they are transitioning, but then also they might be misgendered [called ‘he’ when they identify as ‘she,’ for example]. When transgender persons go to healthcare providers, stigma is already there, just from the misgendering and how healthcare providers and other people at the health facilities may look at them.”
The source said he works with transgender-specific organisations that give technical advice to ensure that transgender people are meaningfully engaged in the delivery and monitoring of services.
“There’s need for continued collaboration between implementing partners in the HIV response, who are focusing on transgender persons and other key populations in ensuring that they engage the transgender community so that service providers are aware of transgender issues and transgender persons are also appreciated or affirmed to be part and parcel of the delivery of services to transgender persons.”
Transbantu Association of Zambia (TBZ) is the leading organisation that works to inform, educate, and sensitise trans and intersex persons, particularly young people, families, and support structures in Zambia. The organisation has made a lot of strides in ensuring good healthcare services for trans and intersex persons but continues to face obstacles and resistance.
“Despite the strides that have occurred with regards access to HIV testing services, care and treatment, including STI screening and treatment and cervical cancer screening, there remains a gap in as far as affirming services tailored to the specific needs of transgender people such as appropriate, accessible, affordable and quality hormone replacement therapy, access to legal identity documents that begin at the births & deaths registrar’s office; inevitably affecting the access to other social services,” a statement by TBZ read.
The statement highlights some of the unique challenges trans people in Zambia face in obtaining adequate health care services.
“Health facilities that provide prejudice-free services to transgender people are not easily accessible. Additionally, the prejudice-free centers often lack capacity. Furthermore, facilities that provide friendly services often have no provision for primary health care needs, as the focus is on HIV testing, treatment and care,” the statement explained.
TBZ said some health care providers do not offer certain services to trans people, including gender reassignment surgeries, for fear that their medical licenses will be revoked. Surgeries can be accessed in both public and private health institutions that have the equipment and appropriate staff, but the procedures in private facilities are very costly to the average trans person with limited access to employment or economic independence.
Asked how accessible hormone replacement therapies are to trans clients in Zambia, Trans Bantu explained that such services are often only available at a high cost from pharmaceutical outlets.
“In other cases, trans people purchase hormones from neighbouring countries in the event that over-the-counter access proves difficult. The unavailability of commodities and necessary tests and counselling does not hinder access, but it does increase the health risks associated with self-medicating,” the roganisation stated.
Despite these challenges, TBZ is working to change the way transgender people are perceived and to promote an inclusive society where everyone is treated equally regardless of their gender identity or expression. Working by their side is Zambia National AIDS Council Donor coordinator and public relations manager Justine Mwiinga, who described his organisation’s experience working with transgender persons to improve access to quality health care services.
“From our work with transgender community members in Zambia, we have come to learn that they are largely rejected by society. This rejection extends to health facilities where they are treated with hostility and in some cases threats of being handed over to police for prosecution,’’ explained Mwiinga. Obviously, such harsh treatment becomes a barrier to accessing health and other related services and ultimately pushes incidence of illnesses including HIV infections in this sub population.”
As a mitigating measure, NAC and partners have carried out media trainings around the country to help the media gain a deeper understanding of transgender issues and thereby helping reduce stigma against this group of people.