Doctoral Degrees (Psychology)

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Browsing Doctoral Degrees (Psychology) by browse.metadata.advisor "Hoddinott, Graeme"

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    Gender identity and gender fluidity amongst low-income transgender and gender diverse people in the Western Cape, South Africa: Implications for HIV service access
    (Stellenbosch : Stellenbosch University, 2023-12) de Villiers, Laing; Swartz, Leslie; Hoddinott, Graeme; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
    ENGLISH ABSTRACT: Transgender women are at high risk for HIV globally. HIV amongst transgender women has been largely under-researched in the South African context. Even less is understood about the experiences and risk levels of a particular group of people who fall under the trans umbrella but do not identify as transgender. These are feminine identifying trans women who have been assigned male sex at birth, termed in this study as transfeminine women. I aimed to understand the lived experiences of transfeminine women in lowincome and high HIV prevalent communities of the Western Cape of South Africa. I conducted a secondary analysis of data from a qualitative cohort nested in an HIV prevention trial. Eight transfeminine participants were repeatedly interviewed over one and a half years using themed discussion guides and participatory methods. The study was a dissertation by publication with the first publication a scoping review, to form part of the literature background of the study. The other three manuscripts were grouped into three themes to contextualise the experiences of transfeminine participants: gender expression, stigma and social support structures. Results from the scoping review showed research that used limited gender identification terms for transfeminine women, and that biologically assigned male sex persons who have a feminine gender identity were either conflated into key population groups of transgender women or men who have sex with men (MSM). We concluded in the gender identity manuscript that gender expression amongst the participants was very fluid and context bound – relating to the people they were relating to, the time and place. We found in the stigma manuscript transfeminine women anticipated, experienced and internalised both gender-related stigma and HIV-related stigma. There were added layers of stigmatisation related to other parts of participants’ social identities, such as being sex workers and their sexual orientation. These factors contributed to difficulty in accessing HIV services. In the social support manuscript we found that in and amongst largely discriminated lived realities, participants could rely on familial and household structures for social support. When the initial family or household unit neglected to support the participant, some participants were able to recreate and re-structure their support systems from peers, friends and extended family members, reorganising their social support structure to be better supported. These are some of the first results from a core sample of transfeminine women in the local South African context, in particular to lived experience around HIV service access, stigma, gender expression and social support. My recommendations are not to identify another sub-group of key-populations, but clearly point to disparities and variation within the key population groups of MSM and transgender. In this case I recommend gender sensitive services, training and intake forms to allow for people to be able to openly express their gender, sexual and other selfidentities. Clearly more work needs to be done with this group, and with sub-groups of key population groups, to allow for inclusion of services for everyone, especially groups such as transfeminine women with a very high HIV risk and low service uptake.