For those of you who need some basic info – here goes:

A person’s sex refers to the anatomy that someone is born with, their reproductive organs, and secondary sex characteristics like a beard or breasts.

Gender is constructed. It refers to social roles or personal identification, which can be related to one’s sex, but is not necessarily determined by it. Gender is not fixed and can change over time.

Your sexuality is determined by who you are attracted to sexually and romantically.

Now that you’re caught up on the basics, let’s get to the story at hand.

Transgender people’s sense of personal identity and gender does not correspond with their birth sex. It also isn’t a choice.

According to CNN, in the United States at the moment, a leaked memo has been uncovered that suggests that the Trump administration is seeking to redefine sex as “a biological, immutable condition determined by genitalia at birth”.

The problems with this are obvious – Trump and his administration are trying to define transgender people out of existence. This shows up the ways that policies and legalities can shape and change a society. Which brings us to South Africa.

While we have a solid Constitution, the rights that trans people have to inhabit the gender that they identify with can be hindered by a number of factors, from violence against the LGBTQIA+ community to the high cost of healthcare and gender reassignment surgery.

In order to inhabit their identity, a trans person will often have gender-affirming surgery that could include the removal of breasts, testicles or the penis. Follow-up surgeries could include reconstructive surgeries such as breast implants, or the construction of a vagina, reports Bhekisisa. The surgeries often correspond with hormone replacement therapy.

For some transgender people […] hormone replacement therapy (HRT) is a crucial part of finally feeling like themselves. As part of this, people take either the hormone oestrogen or testosterone along with other drugs to help them attain the physical characteristics that society normally ascribes to the gender they identify with.

HRT is a life-long commitment and the costs add up over time. They are a necessary part of the process because they change the body physically. Transgender women on oestrogen will notice fat redistributing around their hips and thighs, and their faces take on a more feminine appearance. Transgender men, on the other hand, can take testosterone to achieve the opposite effect. Fat begins to move towards the stomach area, the arms become more muscular, and the face becomes more masculine.

Medical aid does not cover what they consider to be ‘lifestyle choices’ that necessitate ‘elective procedures’ or treatments, which means that trans people have to pay for their surgeries and HRT themselves.

Bhekisisa surveyed six of the country’s largest medical schemes: the Government Employees Medical Scheme (Gems), Fedhealth, Discovery Health, Momentum Health, Bonitas and Profmed. Together, these schemes are responsible for more than three-million people — or almost a third of all privately insured South Africans, according to the  Council for Medical Schemes’ latest annual report.

Momentum Health and Bonitas declined to comment. But the survey found that Gems, Fedhealth and Profmed require members on HRT to pay for the chronic medication out of their medical savings and when that is exhausted, eventually, their pockets.

Discovery Health is running a pilot programme that pays for surgery as well as hormonal treatment. So far it has approved care for two out of the five patients who applied to be part of the programme.

Statistically, the stress and pressure that comes with concealing one’s identity or facing discrimination because of said identity have led to high rates of suicide amongst trans people. Transitioning can make all the difference to how someone is perceived by and navigates society.

Legally, medical aids that don’t cover such treatment may be violating trans people’s constitutional rights, Legal Resource Centre attorney Mandy Mudarikwa argues.

“Section 9 of the Constitution prohibits discrimination, among others, on the grounds of gender. The blanket exclusion of all gender-affirming care in the PMBs is contrary to the Constitution, specifically the rights to equality, dignity and access to healthcare among others,” she explains.

But, she says, the crux is that many medical aids continue to believe that gender-affirming treatment is a choice, rather than a health need.

Acknowledging the necessity of these procedures, not only for trans people but other members of the queer community like gender non-conforming people whose physical form doesn’t correspond with their identity, would be a step in the right direction towards a truly equal society.

[sources:cnn&bhekisisa]