MADELEINE HICKLIN: USAID/Pepfar and ‘only two sexes’ policy is healthcare crisis for SA

US President Donald Trump’s USAID-Pepfar funding review and his “only two sexes” policy will pose a healthcare crisis for SA if funding for healthcare is denied to SA’s transgender community.

The executive order to halt all foreign aid programmes includes donations made to NGOs and healthcare providers providing life-saving hormone replacement therapies used in gender reassignment. This move would be unconstitutional if it denied citizens access to high-quality healthcare because of a lack of finances.

Since the executive order signed by the Trump administration declaring that US agencies only recognise two sexes, reports of increased attacks — both verbal and physical — have caused the global transgender communities to, once again, go into hiding.

I have engaged three transgender women in SA who have undergone gender-reassignment surgery and who are on hormone therapy. Speaking to the DA Gauteng strictly anonymously because they have all been threatened and fear reprisals at work or attacks on their family, they said the current shift in world politics is having a negative effect on their community’s mental health and will lead to a lower life expectancy and quality of life among targeted demographics.

They are not alone. USA Today reported that more than 175 organisations advocating for women’s and transgender rights released a letter blasting Trump’s “only two sexes” policy as “cruel” and “lawless”, stating that it “could put people in harm’s way by spreading disinformation, and lead to harassment of people in the transgender and other communities”.

They highlighted the foreign funding freeze puts SA healthcare providers in direct conflict with our constitution, because many in the transgender community are now being denied access to quality healthcare due to budgetary constraints, as the majority of organisations offering services such as hormone replacement therapy, trans mental healthcare and gender-based violence assistance received their funding via either USAID or the US President’s Emergency Plan for Aids Relief (Pepfar).

The immediate suspension of aid, which has seen the immediate closure of the Wits Reproductive Health & HIV Institute’s (RHI) four centres in Johannesburg, East London, Cape Town and Gqeberha — has forced the community, which has depended on Wits RHI centres for years, to go to government clinics for assistance.

Many of the standard municipal or provincial clinics cannot adequately address the needs of the transgender community, have a long-standing reputation of doctors and nurses with deeply ingrained transphobia, or have little or no training, knowledge and skills on how to treat transgender patients. Each affected patient reiterated that the move had put their mental health at further risk.

The DA Gauteng believes this is a clarion call for SA to take control of its own destiny and reduce our dependence on foreign aid and donations — especially those that could have a devastating effect on healthcare and job stability.

USAID and Pepfar donations are used primarily for HIV/Aids, TB, Malaria, maternal and child health, family planning, nutrition, gender-based violence, and gender reassignment hormone replacement therapy at state and provincial clinics and facilities across the country. Any treatment offered to members of the LGBTIQ community or clinics offering termination of pregnancy options will never be resumed.

The consequences of Trump’s actions are far-reaching and devastating. Many clinic staff have lost their jobs, and countless transgender individuals face severe health complications due to sudden medication withdrawal. This move by Trump is not an attack on the LGBTQ community; it is an attack on human rights, dignity and the most basic principles of compassion. Our constitution guarantees the rights of all individuals, regardless of their sexual orientation, gender identity or expression. It is time for all of our government leaders to uphold these principles.

The SA government must honour its obligations to all of its citizens and find the budget to ensure quality healthcare is afforded to those in the transgender community who cannot afford private healthcare. Not only in select clinics and hospitals that cater specifically to trans healthcare, but wherever they have access to primary healthcare, HIV, TB, HRT and mental healthcare as well.

• Hicklin is a Gauteng MPL and DA spokesperson for health.