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Lived experiences of transgender forced migrants and their mental health outcomes: systematic review and meta-ethnography
- Susannah Hermaszewska, Angela Sweeney, B Camminga, Riley Botelle, Kate Elliott, Jacqueline Sin
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- Journal:
- BJPsych Open / Volume 8 / Issue 3 / May 2022
- Published online by Cambridge University Press:
- 10 May 2022, e91
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- Article
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Background
Owing to multiple, complex and intersecting health inequities, systemic oppression and violence and discrimination in their home countries, some transgender people are forced to migrate to countries that offer them better legal protection and wider social acceptance.
AimsThis review sought to explore and understand the multiple factors that shape the mental health outcomes of transgender forced migrants (TFMs).
MethodWe systematically searched nine electronic databases for multidisciplinary literature (PROSPERO ID: CRD42020183062). We used a meta-ethnographic approach to synthesise data. We completed a quality appraisal and developed a socio-ecological model to draw together our findings.
ResultsWe retrieved 3399 records and screened titles, abstracts and full text to include 24 qualitative studies in this review. The synthesis identified individual survival strategies and factors in interpersonal, organisational and societal environments that contributed to profound deprivation and mental distress in TFMs. Pervasive and persistent violence and discrimination, economic exclusion, barriers to healthcare and a dependency on legal documentation were identified as key factors leading to poor mental health outcomes. Sources of resilience included community acceptance and support, being granted asylum, societal affirmation of gender, fulfilment of basic rights and healthcare access. Individual strategies for survival, such as hope and having purpose in life, were important in bringing relief from distress.
ConclusionsImproved communication and knowledge about the unique needs and concerns of TFMs through interventions at the individual, interpersonal, organisational and societal levels are necessary to improve mental health outcomes.
10 - Marooned: Seeking Asylum As A Transgender Person in Johannesburg
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- By B Camminga
- Edited by Nicky Falkof, University of the Witwatersrand, Johannesburg, Cobus van Staden, University of the Witwatersrand, Johannesburg
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- Book:
- Anxious Joburg
- Published by:
- Wits University Press
- Published online:
- 16 June 2021
- Print publication:
- 01 January 2020, pp 205-225
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Summary
When I come here for me, my perspective about South Africa is that it is a gay-friendly country … when I … get in the plane I was crying because I felt relieved. I say, ‘Oh my God!’ and I cried. There was a … woman on the plane who said, ‘Why are you crying?’ I know why I am crying. I know because I was feeling, when we land to Johannesburg I will say, ‘Thank you, God, now I am safe!’ (Alex, 10 August 2012).
South Africa is the only country on the African continent that recognises sexual orientation and gender – including gender identity and expression – as human rights, enshrined within the country's Constitution (1996). Although other countries across the continent have increasingly begun to decriminalise homosexuality, most recently Angola and Botswana, South Africa is the only country that offers particular rights and protections to transgender people, including access to affirming health care. In recent years, in part owing to these far-reaching constitutional protections, the country has seen the emergence of a relatively new class of refugee – those who identify as transgender or ‘gender refugees’. In essence, these are people who can make claims to refugee status, fleeing their countries of origin based on the persecution of their gender identity.
As the opening comment from the East African refugee Alex suggests, for transgender people who journey to the country from other parts of the continent, South Africa is synonymous with safety, possibility and protection. Indeed, so wide is this reputation for constitutional protection that some gender refugees have even been told by assailants in countries of origin, ‘We will kill you … go to South Africa.’ Two primary cities or sites structure this notion of safety: Cape Town and Johannesburg. The former has a prominent place within the global queer imaginary as the African continent's not uncontroversial ‘gay capital’, while the latter maintains an identity as a ‘world-class African city’ and economic hub (Narsee 2013). As a country of asylum, South Africa does not practise encampment but rather a system of local integration, meaning that asylum seekers experience freedom of movement. It is perhaps unsurprising that the majority of those entering the country who identify as transgender, like Alex, have in the past chosen not to remain in Johannesburg.