South Africa constitutionally enshrined protection against discrimination based on sex, gender and sexual orientation in 1996 after the end of apartheid, emerging as one of the most progressive nations in the world by pledging the rights and dignity of its LGBTQ+ populations. Several sections of the constitution guaranteeing equality, freedom and security, privacy, and health care secure rights for the transgender community and sexual minorities. For instance, according to the Alteration of Sex Description and Sex Status Act 49 of 2003, transgender people can apply to change their sex description in the birth register. The Civil Union Act 2006 legalised same-sex marriage. These laws are in addition to the Domestic Violence Act 116 of 1998 which offers protection to transgender people who have been physically, sexually or emotionally abused, or who have been harassed or intimidated by their families, housemates or partners. One landmark judgement in 2011 in the Equality Court in Lallu v Van Staden held that a neighbour’s verbal abuse of a transgender woman amounted to harassment, hate speech, and unfair discrimination. The Court also awarded damages for infringement of the transwoman’s dignity and costs for remedial psychological counselling.
Besides these legislative provisos, representations of trans lives over the past two decades have created public awareness of concerns faced by trans populations in the country. In 2009, Gay and Lesbian Memory in Action (GALA), committed to producing, preserving, and disseminating information about LGBTQIA+ lives in South Africa, published a landmark collection, Trans: Transgender Life Stories from South Africa with over twenty contributors from across the racial, ethnic, class spectrum, and various geographical locations in South Africa narrating experiences of transition. Many who faced confusion, isolation, and challenges during the process mention they were supported by the Cape Town based Non-Profit Organization, Gender Dynamix. Two recent life narratives carrying this discussion forward are Anastacia Tomson’s Always Anastacia: A Transgender Life in South Africa (2016), relating her transition from man to woman, and Landa Mabenge’s Becoming Him: A Trans Memoir of Triumph (2018), which speaks of his long road to transformation from woman to man. While Tomson describes a relatively privileged transition with access to psychiatric and surgical services, coming out on social media, a support network, and negotiation of her Jewish faith and new identity, the narrative is not representative, as the experiences of trans people of colour are quite different. Mabenge, in contrast, details a more difficult, and likely more representative, path to transition, especially as his biological parents did not support his chosen gender and sexual identity. It is only after their death that he moved towards gender affirming procedures once he was approved for hormone replacement therapy at the Groote Schuur Transgender Clinic in Cape Town. He faced an uphill battle in seeking medical aid for a double mastectomy and a laparoscopic hysterectomy, becoming the first transgender man in the country whose surgeries were paid for by medical aid.
Are trans-formations physical or spiritual or both?
While these are narratives of physical transformations, the late Nkunzi Nkabinde’s memoir Black Bull, Ancestors and Me: My Life as a Lesbian Sangoma (2009) is written in a bilingual register and uses Zulu words to describe the various aspects of isangoma, or the practice of being a traditional healer. Hers is a spiritual rather than a physical transgender identity since she is convinced that one of her ancestral spirits is male. As with the anthology of trans life narratives, Nkabinde’s memoir was published by GALA. She worked as a GALA tour guide and found steady employment through her GALA contacts.
Scholars often reference Nkabinde’s memoir in their discussion of African lesbian and queer narratives. These discussions emphasise the connection between African traditional practices of healing and the explicitly Western lesbian and queer subjectivities inhabited by Nkabinde. In their interviews with lesbian sangomas, Ruth Morgan and Graeme Reid mention that personal agency in relation to gender identity is less important than the influence of the ancestral guides as “the sangomas often express a reluctant compliance with the ancestor’s wishes… very different from the sense of personal self-identification understood by the identity categories of ‘lesbian’ or ‘bisexual’ in a Western context.” For Nkabinde, her lesbian sexuality precedes her training as a sangoma, and at no point does she face dilemmas about sexual choice, as she has some supportive family and a sangoma community to rely on despite the threat of violence faced by lesbians in townships.
Morgan and Reid’s interviews with the community also revealed that younger women had a more “hybrid” sexual identity as both sangomas and lesbians. They first came out as lesbians before they became sangomas, and they negotiate their gender and sexuality in relation to their primary male ancestors. The emerging pattern is that younger women attribute more agency to themselves in relation to same-sex desire while acknowledging the role of their male ancestors. This is clear from Nkabinde’s narrative about how her ancestor Nkunzi (Nkabinde’s middle name which means “Black Bull”) desires a woman, Jabulisile, an order that she resists even as she negotiates with her ancestral spirit. A compromise emerges from that process of negotiation, one in which Nkabinde takes Jabulisile, the older woman, for a wife, not for sexual purposes but to learn ways of healing. Jabulisile emerges as a female ancestral spirit who complements Nkunzi, the male ancestral spirit, who too inhabits Nkabinde in her role as sangoma. Both impact Nkabinde’s sexuality and relationalities, indicating that the ancestral spirits are as dichotomously gendered as people, thus introducing a spiritual transgender self when one or the other dominates.
Gender and sexuality are connected in the category ‘lesbian sangoma’. However, the spiritual transgender identity described in sangoma narratives is quite different from physical transformations undertaken by more ‘modern’ subjects to attain their desired gender. Many transmen and transwomen describe taking on butch lesbian or gay male identities during the process of transition, which in South African (and other) contexts sometimes contributes to the (mis)understanding of trans identities as necessarily connected to sexual choice.
Does gender affirming health care and legislation lead to social acceptance?
Trans populations already at -risk face increased precarity when trans is conflated with gay and lesbian, especially since South Africa, like India, has alarmingly high rates of rape and other forms of gender-based violence. The incidence of rape has created what Pumla Gqola calls “the female fear factory,” where lesbian women, transwomen, and transmen are most vulnerable. The phenomenon of corrective rape against lesbian women also impacts transwomen, with rapists aiming to “correct” their sexual orientation or gender identity. Confused conflation of being trans with sexual identity, and other factors including misogyny, and violently enforced (hetero)sexual normativity prevent social acceptance of trans people despite progressive legislation.
Nor is existing progressive legislation free of problems of interpretation and implementation. The Alteration of Sex Description and Sex Status Act 49 of 2003 in South Africa, though capacious in its coverage, has the same bureaucratic and implementation shortcomings as Indian laws, recently compounded by the Transgender Persons (Protection of Rights) Amendment Bill of 2026. South African applicants must provide proof of gender affirming surgery and very often applications are rejected based on insufficient proof. There are also long waiting periods for processing applications. Even after a successful transition and alteration of sex description, married applicants face problems as the Marriages Act and Recognition of Customary Marriages Act does not recognise same-sex marriage. This means married couples are required to remarry in terms of the Civil Union Act. Additionally, government-issued IDs carry identifying information where the seventh digit of the ID number indicates the gender of a person. Trans citizens can apply to change their gender marker on their ID after their successful transition, thus ‘outing’ them and increasing vulnerability to bureaucratic procedural and social discrimination. And it is unclear whether trans people who reside in South Africa but are not yet citizens are offered the same protections as trans South Africans.
Similarly, though gender affirming surgery is supposedly available free of cost at two main public hospitals, Groote Schuur Hospital in Cape Town and the Steve Biko Academic Hospital in Pretoria, there are limits on the number of surgeries which can be performed. This leads to long waiting times among those who may already be suffering greatly from anxiety, depression, and social awkwardness. In this situation, many who can afford to do so travel overseas for surgery. For those who cannot, such as Mabenge, the only option is to battle the system and force the hand of medical agencies to cover the cost of surgical procedures otherwise deemed cosmetic. In a country where over ninety percent of transgender and gender non-conforming people are people of colour, and most of these are from historically disadvantaged groups, these medical provisions are clearly insufficient. Without surgical procedures, many live a life between two genders, rendering them even more susceptible to quotidian and extreme forms of violence.
Where are the support structures?
Given a situation when the governmental machinery cannot provide adequate support, non-profit organisations such as Gender Dynamix in Cape Town, TransHope in Umlazi, and Be True2Me in Gauteng offer physical and virtual services to the community. In addition, efforts by individuals such as Mabenge, who consulted with Stellenbosch University and offered services to the Transgender Clinic, and short-lived student organisations such as The Trans Collective at the University of Cape Town offered faint glimmers of hope. Such structures are especially needed when documentation of gender on IDs can lead to campus housing situations which are at odds with those who are contemplating, undergoing, or have successfully transitioned. Fortunately, since the 2015-2016 waves of student activism in South Africa during the #RhodesMustFall and #FeesMustFall protests, there is greater awareness of trans concerns on university campuses across South Africa. Additionally, increased trans presence on social media allows for virtual modes of connection in the absence of physical meetings especially when such meetings might be prohibited by families or risky for people living in communities with high incidence of social and sexual violence. No state has thus far provided guaranteed medical and social structures to support trans citizens to the extent that they need. Yet, having progressive laws is crucial to imagining the possibility of systemic transformation, however, long the road may be to trans-supportive healthcare and unqualified integration in society. In this respect many nation-states, including India and the United States can take lessons from South Africa’s progressive legislation.
