Abstract
Migration studies in post-Apartheid South Africa have maintained a strong focus on cross-border mobility while often narrowing health-related research to HIV/AIDS concerns and framing gender in woman-oriented approach with a gradually emerging area of research on migrant sex workers. This article offers to bridge certain gaps in migration research on health, internal mobility, and gender. It revolves around experiences of black unprivileged transgender internal migrants accessing medical services in the public health sector in urban Gauteng, in particular, Johannesburg and Pretoria. The article explores their experiences of migration focusing on analysis of their “transition”—both “gendered transition” (different medical interventions that alter/modify gender-related attributes of the body) and “spatial transition” (diverse mobility patters, relocation, renegotiation of place of living and belonging)—and ways they negotiate belonging. The analysis outlines challenges that transgender individuals face in the public health sector and affects these challenges have on mobility of transgender South Africans. Further, the article delves into exploration of transgender internal migrants’ experiences and understanding of “migration” that arises from sense of (non)belonging and ways to negotiate dynamic subjective sense of being (or not) part of physical (and sometimes imaginary) social groups and places, such as family/home, local (“host”) community, lesbian, gay, bisexual and transgender (LGBT) community, and religion/spirituality.
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Notes
Terms “MSM” and “WSW” reflect sexual practices rather than sexual identities (such as “lesbian” and “gay”).
In 2012–2013, LGBT organizations in South Africa started tackling interconnected areas of migration and sexuality by launching a range of activities, projects, and research that dealt with very particular social groups—LGBT refugees and asylum seekers. Thus, LGBT activist arena mirrored approach of South African migration studies sidelining internal movers as well as transgender individuals (Husakouskaya 2012).
All participants self-identified (strongly) as “black” and offered a term “unprivileged” during one of the focus group discussions to describe their collective identity pertaining to class while discussing the social and economic challenges they face. In this article, “internal migrant” refers to an individual moving within the borders of her/his/their country. For definition of “transgender,” see the footnote 6 in this article. For further discussion on subjective understanding of “internal migration,” see a separate section of this article.
It is important to mention that along with the public and private sectors of the medical system in South Africa, there are traditional health practitioners. According to AIDS Foundation South Africa (2010; quoted in Kim 2011), there are more than 185,000 traditional health-care practitioners in South Africa. It is estimated that around 80 % of South Africans use traditional health practitioners’ services and consult with them on a regular basis (Mafisa 2010, referred in Kim 2011).
Based on my 10-month fieldwork, I use the term “transgender” in its narrow meaning referring to people whose gender does not match the sex category they were placed into at birth and who therefore usually opt for medical interventions (hormone replacement therapy and/or gender affirmation surgery/surgeries) to align body with gender identity. None of my 22 participants identified as “queer,” “non-binary,” or “gender non-conforming.” Therefore, I am not using “trans*” or “queer” as ostensibly more encompassing terms (see, for example, Klein 2008, 2014). The term “transman” refers to those who were assigned female sex at birth and have male gender identity; “transwoman” is used for those who were assigned male sex at birth and have female gender identity. Even though I do not have enough space in this article to go into discussion over the terminology I would like to acknowledge that I am aware that my use of a term “transgender” (as well as its usage by the participants) has been deeply influenced by vocabulary that TIA deploys as an organization that works with constituencies in Gauteng. In turn, their choice of terminology has been largely defined by discursive framework of donors’ agenda (based on informal talks with members of TIA and other LGBT organizations in Johannesburg).
Hormone replacement therapy for transmen includes intake of testosterone that causes a process of bodily masculinization (deepened voice, clitoral enlargement, growth in facial and body hair, cessation of menses). Transmen can opt for all or some of the following gender affirmation surgeries: mastectomy/chest reconstruction aims to remove breasts and create a male-looking chest; hysterectomy removes a womb; oophorectomy removes ovaries; vaginectomy removes a vagina; and genital reconstructive surgery aims to transform genitalias associated with female sex to those associated with male sex. Transwomen are prescribed two types of hormones—estrogen and anti-androgen (blockers). In case of transwomen, hormone replacement therapy leads to breast growth (variable), decreased libido and erections, and increased percentage of body fat compared to muscle mass. Gender affirmation surgeries for transwomen include mammoplasty (breast enlargement), penectomy (removal of a penis), orchidectomy (removal of testicles), and vaginoplasty (creation of vagina) (WPATH 2011). Hormonal treatment for transgender individuals is individually prescribed by an endocrinologist (excluding cases of self-medication which are not rare) and may last for their whole life, especially, when due to biological conditions and/or surgeries performed the body does not produce its own hormones. Transgender person can opt for full or partial transition (different scales of medical interventions); the choice depends on desire/need for a certain scale of body modifications, health conditions, doctors’ advice, accessibility, and availability of medical services, and financial situation (affordability of treatment).
Psychotherapy as an absolute requirement for hormone therapy and surgery was introduced in previous versions of SOC (5th and 6th). In the 7th edition of SOC, it is stated: “A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy – although highly recommended – is not a requirement” (WPATH 2011: 28).
As Nthabiseng Mokoena, an intersex and trans* activist, clarified as for current development in transgender activism in Gauteng: “Iranti has taken up a lot more trans* work and they have become more visible with trans* work ever since they hired Joshua Sehoole as their Human Rights Coordinator. What is more interesting though is that there are more smaller non-NGO based groups and people that are organizing support groups by themselves and that seems to be working for most people, it is great to see people organize outside of the NGO industrial complex” (correspondence from 31 June 2015).
“Passing” in case of transgender individuals refers to one’s ability to be perceived by others as the gender one identifies as (for example, as a cisgender man or a cisgender woman).
Cisgender as a term describes a type of gender identity when one’s experience and self-realization of own gender matches the sex one was assigned at birth. Cisgender is usually used in opposition to transgender experience. Heteronormativity refers to the system of beliefs that involves alignment of biological sex, sexuality, gender identity, and gender roles. It is characterized by firm believe that (1) people fall into two distinct and complementary genders (man and woman); (2) man and woman have natural roles in life; (3) heterosexuality is the only sexual orientation and/or only normal sexual orientation; (4) sexual and marital relations are most (or only) fitting between people of opposite sexes.
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Acknowledgments
I would like to acknowledge the support of the African Centre for Migration and Society (ACMS) at the University of Witwatersrand where I was affiliated as a visiting researcher from August 2012 till June 2013. My deep appreciation goes to the Pretoria-based NGO Transgender and Intersex Africa (TIA) for all their efforts and arrangements that made the fieldwork possible. I thank my supervisor Dr. Joanna Vearey and my colleague and friend Nthabiseng Mokoena for being with me all the way in this journey. I pay tribute to all the amazing participants that shared their stories. Finally, I extend thanks to the anonymous reviewers for their valuable and thoughtful comments.
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This article is based on my master thesis “Becoming a transgender/intersex internal migrant in Urban Gauteng: Challenges and experiences of transition while seeking access to medical services” (Husakouskaya, 2013a).
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Husakouskaya, N. Queering Mobility in Urban Gauteng: Transgender Internal Migrants and Their Experiences of “Transition” in Johannesburg and Pretoria. Urban Forum 28, 91–110 (2017). https://doi.org/10.1007/s12132-016-9286-8
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DOI: https://doi.org/10.1007/s12132-016-9286-8