Many activists use the term “trans*” to encompass a broad range of identities. The asterisk signifies that the prefix “trans-“ maybe be followed in a number of ways to yield “transgender,” “transvestite,” and “transsexual.” For many, the asterisk also opens up the category of trans* to other categories of gender identification, such as genderqueer and androgynous.
In general, trans* people self-identify or present as a gender other than the one they were assigned at birth. Some trans* people may have surgery or hormonal therapy to make their bodies congruent with their identities. Trans* people undergoing or who have undergone surgery or hormone therapy are often called transsexual. In contrast to trans* people, cis-gender people are people whose gender identities align with those they are assigned at birth.
Trans* people are considered a key population in the South African response to HIV, AIDS, STIs, and TB, but there is not much evidence around HIV epidemiology among trans* people. Nonetheless, trans* people are vulnerable to HIV because of widespread discrimination within their communities and within the healthcare and police systems which often force trans* people into poverty, substance abuse, unemployment, and sex work . Unlike most other countries, in South Africa trans* people can change their legal gender with or without gender reassignment surgery. This process, however, can often take a long time.
The health needs of trans* people are distinct from those of men who have sex with men (MSM) and women who have sex with women (WSW), although many in public health lump trans* women with MSM and trans* men with WSW. Lack of access to gender reassignment surgeries and hormone therapies, to resources for gender reassignment surgeries and hormone therapies, to mental health resources, and to recourse for victims of violence and discrimination present persistent challenges for the health of the trans* community, as does a poor national response to trans* health issues.