Intersex and transgender persons struggle to access gender-affirming healthcare services in Zimbabwe

By Paul Sixpence

“YOU know the problem in Zimbabwe, that group of people [intersex and transgender persons] doesn’t exist,” said a medical doctor who spoke on condition of anonymity.

When quizzed further on what they meant, the medical doctor said, “they don’t disclose,” their gender identity when they visit public health facilities for medical assistance.

Sam Ndlovu, director at Trans Research Advocacy and Training (TREAT), a transgender rights and issues advocacy organisation says that public health facilities in Zimbabwe exist as gendered spaces making it difficult for transgender persons to freely express themselves.

“As an intersex person accessing gender-affirming healthcare services has been quite a horrible experience,” said Ronika Ronie Zuze, Programme Director at Intersex Community of Zimbabwe. “Our healthcare system does not acknowledge or accommodate any other gender apart from the male and female genders.”

“They do exist” – defining intersex and transgender persons

The term transgender refers to persons who do not identify with the gender identity and sex assigned at birth.

An Intersex person is an individual born with reproductive or sexual anatomy that does not fit the traditional definition of “female” or “male.”

Gender affirming healthcare services for intersex and transgender persons refers to comprehensive access to primary care, gynaecologic and urologic care, sexual and reproductive health options, voice and communication therapy, mental health services, hormonal and surgical treatments.

Access to gender affirming healthcare services

Zimbabwe’s intersex and transgender community express concern over the lack of access to gender-affirming healthcare services forcing gender non-conforming persons to travel outside the country to access the same.

“In Zimbabwe, there is no comprehensive access to sexual and reproductive health services through the public health system for transgender persons,” said Bee Chihera Meki, of Trans and Intersex Rising Zimbabwe (TIRZ) and a fellow with AVAC’s Research, Outreach, Advocacy and Representation (PxROAR) Transgender Africa fellowship programme. “Trans persons who are in need of hormone replacement therapy, mostly purchase it outside the country. For those without financial and materials resources to do so, they purchase hormone replacement therapy on the black market.”

The queer community in Zimbabwe also voiced reservations on the professional capacity of health workers to provide appropriate health care for intersex and trans persons.

“I am hypertensive and on hormonal [replacement] therapy. At times this triggers my blood pressure levels to go up,” said Ras (not their real name) a transgender man from the resort town of Victoria Falls. “I always have a challenge with [medical] doctors because they do not have adequate information on gender affirmative healthcare for transgender persons. I use the internet to self-diagnose and medicate.”

Ras further added that due to the non-availability of gender affirmative health care services through the public health system, the trans community is exposed to the dangers of self-medication, such as drug overdose.

Accommodations for intersex and trans persons in national public health policies

In June 2018, Zimbabwe’s Ministry of Health published a training manual for use by health care professionals when providing services to key populations, which include intersex and transgender persons. Transgender persons criticise the manual for being generic and non-specific to gender-diverse communities.

“All states need to ensure access to gender-affirming health care for persons experiencing gender dysphoria,” said Carl Orre, Policy and Advocacy Manager at the Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights (RFSL). “It is very important that these services are covered within the regular system of health insurance or general health coverage so that people needing this care do not have to pay out of pocket for this life-saving health care service.”

In order to address the lack of access to gender-affirming healthcare services, intersex and transgender persons urged duty bearers to put in place policies and accommodations that will allow gender non-conforming and diverse persons to access comprehensive health services through the public health system.

“Health workers need to be more aware of LGBTIQ persons and their needs,” said Dingumuzi Sithole, a medical doctor.

The World Professional Association for Transgender Health (WPATH) in its Standard of Care (SOC) manual advocates for access to comprehensive gender-affirming health care services for trans and gender non-conforming persons. WPATH notes that “health is dependent upon not only good clinical care but also social and political climates that provide and ensure social tolerance, equality, and the full rights of citizenship.”

Questions sent via email to the Ministry of Health’s public relations and protocol manager, Donald Mujiri, on the government’s policy position in availing gender-affirming healthcare services to the queer community had not been responded to at the time of publication.

The right to health for intersex and transgender persons

“Intersex persons are naturally born like that, they are born intersex,” said Zuze. “We have [cases] where medical practitioners medically alter, through surgery, bodies of intersex persons at public health facilities…I consider it a violation of human rights if they [State] alter a person’s body without their consent and then fail to provide gender affirmative health care services.”

Section 29(1) of the Zimbabwe constitution places a positive obligation on the state to provide, “basic, accessible, and adequate health services.” This includes access to comprehensive sexual and reproductive health services.

Zimbabwe does not have specific laws that provide for access to gender-affirming health care services for intersex and transgender persons.