Southern African HIV Clinicians Society Gender-Affirming Healthcare Guideline for South Africa

The "Southern African HIV Clinicians Society gender-affirming healthcare guideline for South Africa" is a comprehensive guide for healthcare professionals to provide gender-affirming care to transgender and gender diverse (TGD) individuals. The guideline emphasizes a multidisciplinary approach, involving mental health professionals, endocrinologists, and surgeons, and the need for HIV prevention and treatment strategies tailored to this population. It covers informed consent, primary care, non-medical gender-affirming practices, psychosocial care, hormone therapy, and surgery. The guideline also discusses the role of mental healthcare providers and the specific needs of children, adolescents, and adults. It covers feminising and masculinising hormone therapies, preoperative and peri-surgical care for gender-affirming surgeries, and the importance of comprehensive care, including addressing issues of violence, mental health, substance use, fertility and contraception, cancer, sexual health, sexually transmitted infections, and HIV. The guideline was developed by a committee of 17 people, including providers, advocates, and TGD individuals, and is based on evidence-based research and provider experience. It also provides guidelines for gender-inclusive language in healthcare settings and respectful communication with clients. The guideline emphasizes the high HIV prevalence rate of 46% among transgender women in South Africa, recommending all TGD clients be offered pre-exposure prophylaxis (PrEP), which does not impact oestradiol or testosterone levels. It also provides information on surgical options for feminizing and masculinizing procedures and the importance of post-surgical care, including psychological support and physiotherapy. The guideline also addresses the importance of voice and communication in gender identity, recommending referral to a speech-language therapist for TGD individuals seeking to alter their voice. It also discusses the potential impacts of hormone therapy (HT) on TGD individuals, including changes in emotions, relationships, sexual orientation, safety, employment, and physical attributes. The document also addresses the legal aspects of gender transition, including changing gender markers and names on official documents. The cost of HT is estimated to be around R300–R500 per month, excluding monitoring blood tests or doctor’s visits.