* Trans Burkinabes struggle with lack of healthcare, stigma
* Many take transition-related hormones without prescription
* Lack of expertise, awareness blamed for scant gender care
By Sam Mednick
OUAGADOUGOU, Dec 30 (Openly) - It took Aicha Sylla three attempts to get a prescription for hormones in Burkina Faso so she could start to transition gender. In the end, one doctor agreed - if she had sex with him first.
"I didn't have any choice ... The other doctors didn't even listen to me; they refused," Sylla, 22, told the Thomson Reuters Foundation, visibly upset, as she sat in a restaurant in the capital, Ouagadougou.
Despite the health risks, she has been self-medicating ever since using the same prescription, a practice that trans rights advocates say is widespread among transgender people in the conservative West African country.
A shortage of qualified doctors who are willing to work with trans patients, and fear of seeking medical help due to social stigma, lead many trans people to take hormones without proper supervision, campaigners and community members said.
Another trans woman in Ouagadougou said many transgender people feared being "outed" by doctors to family and friends, or on social media.
"(People don't go to doctors) because you risk your image on social networks ... because this doctor will talk. Maybe you won't be well received (or) you'll be discriminated against," said Naomi Campbell, 27.
Taking hormones improperly can lead to complications such as hypertension and cardiac arrest and can be fatal, medical experts said.
"It takes a knowledgeable healthcare professional and a well-educated patient to make informed decisions," said Jean-Baptiste Guiard-Schmid, an internal medicine and infectious diseases specialist who has worked with Burkinabe trans people.
The Thomson Reuters Foundation spoke with five trans women, including Sylla, three of whom said they had self-medicated with hormones.
They buy the medication from local pharmacies that do not ask for a doctor's prescription, or ask friends to send them from neighbouring countries, such as Ivory Coast, they said.
In contrast to many African countries, gay sex is not illegal in Burkina Faso, but LGBT+ people often face discrimination and physical or verbal abuse that is rarely punished by state authorities, advocates said.
Lawyer Prosper Farama said openly LGBT+ people can be prosecuted under legislation on indecent assault or the violation of morality, facing penalties of up to five years in prison.
Trans people in particular are at risk of arrest for identity theft because the personal details on their ID cards do not match their physical appearance, said Ismael Cisse, head of local LGBT+ group Association Vision Plurielle.
His group is among 11 LGBT+ rights organisations calling on the government to tackle such discrimination.
It is also demanding state-run health programmes to equip and train doctors to be specialists in gender care including the provision of hormones and follow-up care to help patients transition.
"Transgender people prefer to go to community medical centres or even outside the country for their health problems," Cisse said.
"These community health centres lack adequate technical facilities for holistic care and some of their doctors have not received all the capacity building necessary for this care," he added.
The Health Ministry did not respond to requests for comment, while the country's doctors' association said its members were rarely asked for help.
"I've never received a transgender person in my career," said Norbert Ramde, the association's chairman, emphasising that trans people were equally entitled to medical assistance.
Some members of the trans community are trying to build bridges with doctors and raise awareness about the needs of transgender patients.
Another trans woman in the capital, who asked to remain anonymous to protect her identity, organised a conference this month, bringing together doctors, psychologists, lawyers and activists to discuss key concerns including self-medication.
As much as self-medicating is a problem, she said it was part of a much larger issue facing the community - a lack of protection by the state.
"Physical protection, mental protection, access to all these normal services," she said.
For now, many trans Burkinabes dream of being able to leave the country to transition.
"I'd like to (transition) but not in Burkina, otherwise, I'll put my life at risk," said Kimble, 31, a trans woman who asked to use a pseudonym to protect her identity.
Six years ago, she self-medicated with hormones for a year but stopped because she started having palpitations. She was also attacked on the street.
"(Transitioning) became dangerous," she said. "You're obliged to stop or your life is at risk."
(Reporting by Sam Mednick @sammednick; Editing by Helen Popper and Hugo Greenhalgh. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)
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