Johannesburg Trans health conference gets introspective about representation
South Africa, 3 March 2017
After a long dry spell in South Africa, Johannesburg experienced near-constant precipitation for much of the second half of February. But between the 23rd and 26th there was a flood of a different kind in Boksburg. The 3rd Biennial Trans Health, Advocacy and Research Conference saw transgender and gender-diverse visitors from across the African continent descend to discuss the state of healthcare and activism work within the transgender community.
The conference, organised by Gender DynamiX with the assistance of Iranti-org, focused its programme on the themes of decolonisation and depathologisation of trans spaces and identities.
"We wanted to create a platform, by which we would say as the African trans movement, as the African gender-diverse community can we come and speak to one another? Can we come and unpack what it is on the continent that we are already able to unearth about ourselves and who we conceptualise ourselves to be?" Says Tshepo Ricki Kgositau, Executive Director of Gender DynamiX. "While doing that there's also the question of how we conceptualise our own identities away from biomedical kinds of constructs and definitions, away from pathologising definitions of who we are as Africans and even as transgender persons and gender-diverse persons on the continent."
Guests arrived from Zambia, Namibia, Kenya, Liberia, Seychelles, Zimbabwe and a number of other African countries to attend panels and workshops; reporting back on the state of transgender healthcare and legal recognition in their countries; generally share knowledge; and debate the way forward for the transgender community. Topics ranged from: ‘Advocating for Trans Human Rights in Rural and Traditional Settings’; ‘Access to HIV Programming and Services’; as well as two discussions on the topic of depathologising transgender identities.
One of the focal points surrounding the depathologisation talks was that of the World Health Organisation's (WHO) pending reforms to the International Classification of Diseases (ICD). ICD-10, in use by health practitioners around the world since the 1990s, classifies transgender and gender-diverse persons under the chapter titled ‘Mental and Behavioural Disorders’, and has been a matter of controversy in the trans movement. The tension lies between maintaining access to healthcare while at the same time removing barriers to access such as psychological evaluation, limiting possibilities for ‘corrective’ or ‘reparative’ treatments, and questioning the the very framework that defines one group as "normal" and another as ill.
ICD-11, still under review by the WHO, seems set to account for the objections from transgender rights groups and modern medical understandings of gender identity and neurology by reclassifying ‘Gender identity disorder’ as ‘Gender incongruence’. This shift in language is intended to move medical professionals away from considering transgender people as mentally ill, while still highlighting the need for medical intervention for those who feel they need it. However, certain points of contention remain.
In their keynote address, Dr B Camminga highlighted the need for these discussions around medical intervention, pathologisation and identity, by asking delegates if Western medical definitions should be “the determinant of who we are or how our states acknowledge us?" and went on to highlight that pathologising definitions from the West were hindering Africans from constructing their own identities as trans and gender-diverse persons. But despite calls for psycho-depathologisation of gender identity by some, citing its classification as a disorder as grounds for discrimination, other delegates chose to advocate in favour of maintaining gender identity as a mental illness as defined by the WHO.
"You find that when being transgender is listed as a psychological issue there is a certain level of empathy from your family. You're more likely to get medical care," said Lexi Ogeta, a delegate from Kenya where recent rulings have allowed transgender citizens to change the gender markers (changing the sex by which one is registered at birth) on their passports under certain circumstances. Several other delegates expressed similar concerns, stating that discussing depathologisation was a privilege they could not afford in countries where recognition, healthcare access and state-sanctioned discrimination was still a daily reality.
Discrimination and violence against transgender people is common across the globe, and many delegates expressed this fact by stating that the safety and luxury of the conference did not reflect or represent their lived experiences. For the duration of the seminars, nearby toilet facilities were converted into gender-neutral spaces for trans and gender-nonconforming guests to feel safe and secure, but such facilities are a rarity in South Africa and across the continent, very often with severe consequences. Glenton Liberty Matthyse, a representative from the Western Cape, told of how they had their stall knocked down violently at a men’s restroom in the Western Cape, and was soon thereafter harassed by a security guard for utilising the women's facilities.
Another delegate chastised the speakers and organisers of the conference for planning events based on their needs, forgetting the many destitute transgender persons living on the margins of society. "This isn't movement building. You expect me to speak based on what you want me to talk about, but there's nothing on the programme for me. Where is my representation?" asked Leigh Davids. She went on to say that while the conference was debating access to surgery and hormone treatment, trans women such as herself would be returning to living in a shack after the proceedings.
Neo Musangi, co-founder and former member of Iranti-org, seemed to have foreseen the direction the conference would take in their address as Camminga's respondent, saying that they did not think all the issues on the programme would be sufficiently addressed in the allotted time.
Many attendees had hoped that the conference would address real progress for the movement, such as working toward greater funding, expanding activism frameworks and pressing for improved HIV programmes for those affected. While these issues were certainly interrogated and discussed vigorously much of the conference debates remained focussed inward, toward the organisation of the conference and the power dynamics between the organisations present.
The irony of NGOs utilising a Western system of hierarchy and exercising more sway over the topics of discourse was addressed extensively. The issues of using English as a medium was also raised, given that the theme of the conference was ‘decolonisation’ yet communication was predominantly done through a European language.
Musangi later acted as a facilitator of a dialogue aimed at hearing out the concerns and ideas of those on the floor, writing them up on a board for all to see. Suggestions ranged from the translation of literature into more languages; making resources available to smaller organisations so as to better represent the community at all levels; and having a counselor available during future conferences for those in need of support. Both Iranti-org and Gender DynamiX assured delegates that their concerns and recommendations would be taken into account, promising to find ways of remaining accountable to the trans African community.
Despite the disagreements that emerged during the conference, a often common by-product of open debate, the atmosphere appeared to be that of old friends and comrades reuniting after a long separation. The transgender community is small, making up less than 1% of the world's population, and the fact is that many survive only because of the connections and bonds they find through social media or gatherings such as the ‘Trans Health, Advocacy and Research Conference’.
With many African governments there is little recognition of the persecution of transgender people, with some states actively involved in the persecution of their trans citizens. In addition, factors such as poverty and reduced access to healthcare, means that people cannot always make it to conferences and meetings. In many cases, these factors combine with fatal consequences. As such, the weekend closed with a memorial ceremony to remember those activists who had passed away, with many delegates being deeply affected by personal losses.
The aim of the conference was to report back on the challenges faced by activists and Africans on the ground. The introspection that resulted, while unplanned, is perhaps a natural extension of the need and desire for a truly representative space. As the trans movement grows to encompass more people, so too will it encompass more diverse identities, experiences and viewpoints. The discussions that occurred meant that all who were involved could be given a voice and build a stronger movement from within.