Redefining ‘family’: Conceptualising social support networks of transfeminine women in the Western Cape, South Africa - A case descriptive study of in-depth qualitative data from the HPTN 071 (PopART) trial

Transfeminine women (assigned male sex at birth and identifying with a feminine gender identity) are at risk for intersectional stigma related to their gender, sexual orientation, and other parts of their social identities (including age, class, and race). These layered stigmas can result in increased physical and mental health concerns related to physical and emotional violence, substance use, high risk sexual behaviour and HIV exposure. Social networks are important support structures for transfeminine women to ameliorate imposed risk and stigma. We investigated the family networks, household structures and community support systems of eight transfeminine women in the Western Cape, South Africa. The data for this study are embedded in a qualitative component of the larger HPTN 071 (PopART) trial. Data included in-depth interview transcripts, genogram activities and community map drawings. We found that participants who were not living in a supportive family and household structure faced stigma and health risks. In addition, we found examples of how transfeminine women in unsupportive social situations constructed their own family and household unit for support. Our findings agree with those of other studies in that transgender people often rely on extended family members, friends, or peers as social support when their families do not support or ostracise them. Understanding how transfeminine women re-organise social units to be better supported is important so that better health services can be provided to them in the local South African and international context. Further research on family re-structuring among gender and sexual minority groups is needed.