Edited by: Ana Álvarez-Muelas, University of Granada, Spain
Reviewed by: Gracia María Sánchez Pérez, University of Granada, Spain
Laura Elvira Muñoz García, University of Granada, Spain
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
In South Africa’s diverse population, queer voices emerge as change agents, proposing new and critical solutions to reform sexual and reproductive healthcare services in the pursuit of inclusivity and equality. Our research aimed to explore and describe queer individuals’ perceptions and solutions for promoting sexual-reproductive healthcare services and needs (SRHSN) in Gauteng Province, South Africa.
An explorative-descriptive study was performed for this research. A total of 22 queer individuals was recruited using respondent-driven sampling (RDS) within a queer-inclusive non-governmental organization (NGO) clinic in Gauteng Province, South Africa. Semi-structured interviews and an interview guide were utilized to collect data using English. Thematic content analysis was applied using NVivo 14.
Four main themes and related sub-themes were revealed from the study including the creation of healthcare equity for queer individuals, empowering and supporting healthcare providers (HCPs) to enhance skills, knowledge, and expertise, raising awareness on queer-related issues, and different stakeholders’ involvement.
As we navigate South Africa’s complex landscape of SRHSN for queer individuals, the crucial opinions and solutions offered by queer people not only challenge the status quo but also reveal an approach to a better, more equitable, empathetic, and accommodating healthcare system for everyone. Future studies should ensure the inclusiveness of queer individuals with the interest of improving their health not just for research outputs.
South African queer individuals continue to experience challenges of access to healthcare services due to unfriendly HCPs, non-inclusive healthcare facilities, and poorly equipped infrastructures (
Queer is an inclusive expression that includes not only lesbian and gay people but also anybody who feels discriminated against because of their sexual behaviors and practices (
However, based on the different South African studies, queer individuals continue to experience prejudice, judgment, discriminatory comments, and healthcare disparities (
Addressing the issues that queer individuals face is critical for reducing health risks on time. For instance, if these issues are not addressed and prioritized, there will continue to be barriers to receiving some of their SRHSN, such as condoms, lubricants, dental dams, and human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) (
We performed an explorative-descriptive qualitative study to better understand and identify answers to the issues queer people encounter when promoting SRHSN in Gauteng Province, South Africa. Before the start of the study, the protocol was reviewed by various research committees at Sefako Makgatho Health Sciences University (SMU), including the Department of Public Health Research Committee (DPHRC) and the School of Healthcare Sciences Research Committee (SHSRC), before being approved by the Sefako Makgatho Health Sciences Research Ethics Committee (SMUREC): Protocol number (SMUREC/H/291/2023:PG). The empirical study began in November 2023 and ended in December 2023.
Considering the difficulties of easily finding queer individuals, we carried out our research at a queer-inclusive NGO clinic in Gauteng Province, South Africa. The research was done at two study sites: Pretoria and Kempton Park. This inclusive healthcare institution provides free sexual healthcare to homosexual, bisexual, queer, and men who have sex with men (MSM).
We recruited 22 queer individuals who attended and used the services. Due to population restrictions and a lack of accurate data, all 22 queer individuals were sampled via RDS. We began by interviewing queer individuals who work at the two branches and then asked them to refer additional participants they know who might be interested. All interested queer individuals were solicited during their consultations the day before data collection, and those who consented were paid 250ZAR for transportation costs. Participants provided a verbal and written agreement form before data collection after outlining the study’s purpose, research questions, and objectives. The written consent form included further details about the study such as the purpose, their rights of voluntary participation, and demographic data without a column for writing their names, thus ensuring that no confidential information is captured to ensure the privacy of the participants.
Our study included all queer individuals aged 18 and older in the study settings. Our study eliminated those individuals who did not self-identify as queer, those who did not consent, and participants under the age of 18 years. The interviews were conducted in English as the medium language; however, participants were able to react in their native language, and the most usually responding languages were Isizulu and Sesotho, which were then translated into English.
For this study, we collected data through semi-structured interviews and a semi-structured interview guide. Our semi-structured interview guide was divided into sections, including participant demographics, generic SRHSN questions, and study-specific questions. The interview guide was derived from prior peer-reviewed and published studies (
We followed TCA to analyze our data while applying four interrelated steps suggested by
Three queer participants were recruited to test the semi-structured interview guide in early November 2023. The pilot study was conducted at the Pretoria branch before initiating the main study. Participants for the pilot study were recruited in the same way as the participants in the main study. The principal researcher transcribed the recorded audio and evaluated three transcripts with NVivo 14 software to verify the codes and themes that emerged, verifying that the interview guide outcome was aligned with the intention of the study. Following a meeting between the principal researcher and the main supervisor who acted as a peer reviewer to examine the pilot study data, the semi-structured interview guide was revised twice before being finalized for use in the entirety of the research. Minor updates to the semi-structured interview guide, such as sexual orientation in the demographic section and more probing questions, were implemented. No questions were excluded from the semi-structured interview guide. The pilot research results were eliminated from the main study to avoid inconsistency and misrepresentation of the participants as the initial interview guide was amended twice before the main study; therefore, the results were going to be inconsistent and not representing the same questions, especially probing questions.
Our study included 22 queer participants (refer to
Refer to
The importance of developing a healthcare sector that is equal and inclusive for queer individuals emerged strongly from the participants’ feedback. In addition, participants stated that more queer healthcare services should be established at a faster pace and that the reintroduction of school healthcare services to improve health literacy for queer matters among teachers and learners be prioritized. Participants highlighted that the equalization of queer healthcare services throughout different healthcare sectors is required.
The majority of queer participants suggested that queer healthcare services should be prioritized, and implementation accelerated to ensure their wellbeing and that their needs are met. In addition, issues of long waiting lists and waiting for basic services were stated to be one of the things that should be avoided and healthcare facilities to ensure that long processes are shortened.
“It took me two years to be able to start receiving hormonal therapy, also here at this clinic, because in government I was in a waiting list since then, I would advise that they should try to avoid keeping us waiting for nothing and for long, like again at government for the surgery, you see that one, it is crazy, it’s even worse because like it’s crazy and you can’t be on the waiting list, you wait for a doctor, then psychologists, before a doctor can deem you fit that okay now you are so ready for surgery, Yoh!!” (P11, transgender woman).
The majority of queer respondents put forward that government should work together with funders and NGOs to develop additional clinics around Gauteng Province that would cater for queer healthcare needs and services around different areas in the province. Other participants compared NGO clinics with public clinics and recommended that if the government cannot build new clinics, they should at least ensure that the public clinics are inclusive, similar to selected NGO clinics.
“So, I personally, I think that we need more places like this, yah, we need more organizations whereby government will fund them and cater specifically for us. I know they will say that we are not a huge number and stuff, but okay even in that government-clinic then, let us have a portion whereby that would be referred as LGBTI alone and we have people who are conscious, like people who are trained or people who live that lifestyle who are qualified” (P15, transgender woman).
“I don’t know what is it the government that must do this but there just has to be-you know if there was a clinic specifically for us, not just lesbians but even gay men, the queer community, like the LGBTQI, if there was a clinic specifically or like in a clinic a unit that is dedicated to us that said okay for conceiving there’s section whatever at whatever clinic or whatever hospital where we offer sperms or whatever there’s a list of sperm donations, you just come, uhm they give you counselling basically” (P22, Lesbian).
Predominantly, queer participants advocated for the reintroduction of school healthcare services whereby HCPs would teach, share, disseminate, and inform learners, teachers, school governing bodies, and parents about gender identity. Queer participants believed that this information would help to address the issues of gender confusion, bullying at schools due to different sexuality and gender preferences, and prevention of sexual illnesses and will influence the school policies thus protecting young, vulnerable, queer learners.
“So, I feel and think that people need to be educated in schools, especially like young kids today so that when they grow up, they know that like I’m a queer person, if ever like I want to be like sexually active I have to do these steps and all of that” (P2, gay).
“Let me say like queer kids, I even say teenagers from the age of say like 15 upwards, already they are engaging in sexual acts, and they don’t know the STIs. They only like learned about-I’m not going to lie, in high school they taught us about HIV and STIs I didn’t care, so if school health nurses should be brought back to teach them about protecting themselves because you can’t stop them from having sex, but you can teach them about protecting themselves, seeking medical attention” (P7, gay).
Most queer participants proposed that uniform and consistent care across the different healthcare facilities, whether private or public, should be ensured and implemented. For example, participants showed that the hormonal services they receive at NGO clinics are not the same as the ones they requested at the public clinics.
“Sometime last year, I went to a public clinic I was asking about hormones, I have asked them if they do have them or not, nurses there said they do have them, but they called it Premarin, I was confused because here we use Estrofem so I would suggest that they should at least have same medications so that when I short of my hormones I can easily go to the clinic without wasting transportation money” (P11, transgender woman).
Lack of queer skills, knowledge, and expertise among HCPs became apparent among queer participants as a vast majority of them put forward a need for enriching and guiding HCPs with queer-related healthcare matters. In addition, some queer participants recommended that HCPs should be encouraged to be sympathetic, empathic, and sensitized toward them. Most importantly, queer participants suggested hiring queer individuals across healthcare facilities with a belief that it will enable access and usability of healthcare services by queer.
An increased need for HCPs training was recommended by queer participants. Some queer participants indicated that it is the responsibility of the Department of Health to ensure that all HCPs are trained, and some suggested the use of queer activists to assist in training HCPs through workshops and seminars. In addition, queer participants indicated that if HCPs are trained, there would be less judgment rather than an increased understanding of queer patients’ needs.
“I believe people should be educated, like especially, when you go to a public clinic or a public hospital which is like for government. At least have some workshops which your staff, nurses to know how to deal with queer people, you will see us going to public clinics and hospitals without fear” (P6, bisexual).
“I feel like the health service workers should be trained on how to treat us because of obviously now ever since that there are hormones that are involved our emotions are very high sometimes and then like we are very short tempered, emotional, and whatsoever, I’m very emotional. So now I believe that they do not even accommodate us when it comes to that you know” (P13, transgender woman).
The majority of queer voices conveyed that employing queer individuals, who focus and deal with their matters, could be one of the solutions to prejudice, discomfort, and changing of the negative attitude of HCPs toward them, thus improving accessibility and usability of SRHSN by queer individuals in the public healthcare facilities.
“I think the only thing that might be done in public hospital, I think they should hire more queer health professionals, like two maybe-like two or three will make a difference. Those people are going to be-they’re going to teach; they’re going to teach. Like if ever, imagine like its 50 nurses, all of them are straight they don’t know anything about queer except of you trying to be a girl, you trying to do one, two, three, but whenever we hire queer health professionals or nurses, queer nurses, they’re going to use that platform to teach. Like if ever you are handling a queer person, you don’t ask this-certain questions, you treat them like this, you treat them like how you treat every patient” (P7, gay).
“I think maybe they should employ two gays or two LGBTQ+ member to be there, you know, maybe they can’t be that judgmental because they’ll have always taught them-each and every day they will be seeing that person as their colleague too” (P16, gay).
The consensus among queer participants leaned toward a need for encouraging HCPs to become more considerate and harmonized whenever talking and rendering healthcare services to queer patients.
“I think more sensitization, I think that’s the only, well not only, but that’s what comes to mind. So, if the people that are accessing the services are sensitized and the people that are providing the services are sensitized, I think that would be a little bit better. So, I think the staff has received sensitization so that’s why there is less or no challenges, or you know, but maybe clients. So, you meet somebody on the street who might need the service but, you know, just because it’s a gay-it’s seemed as a gay clinic, or its-don’t know how to put it but, it’s seemed as everyone who’s gay goes there then they would not want to. But if that person has been sensitized, I don’t think they would have that assumption” (P5, gay).
“I think, how can I say it? if the-let’s say government officials the ones who works at the clinics and stuff, they could be taught to sensitize things because we are very sensitive because every time a person will call you names you will automatically retaliate, so if they could just speak from a sense of sensitivity and also know that I should approach this person with a sense of sensitivity, that I should not just speak however I want” (P12, transgender woman).
Increasing awareness of queer healthcare matters was proposed by the majority of queer participants stating that information regarding queer existence should be shared with different campaigns and social media sites. In addition, some queer participants suggested that the selected NGO clinic, and other queer NGOs, should be made public so that all queer individuals can access and utilize them, thus improving their health and wellbeing.
Different types of campaign locations, such as malls, hospitals, community halls, and schools, were pointed out and recommended as some of the ways that could address stigma and discrimination, thus enhancing the sexual-reproductive health wellbeing of queer individuals across the Gauteng Province.
“I really think that if we can get like a lot of activists who can have different engagements. They talk to people using these things, what do you call them? Oh yeah, campaigns, not just only at the streets, but go to the mall, have campaigns, tell people, show yourself, teach them about their sexual health. I feel like that’s how you can thingy-yah. Many queers will be free and feel safe” (P18, transgender woman).
“I guess more awareness, more maybe like campaign for awareness, I mean that used to happen but doesn’t happen anymore. I mean you know what I mean like-and even in that it’s like have somebody who is not even in the healthcare facilities come to that awareness and maybe speak about their journey in not that it’s a journey it’s you but it’s like the way in which maybe they became very comfortable around them being homosexual and stuff like awareness are really important for everybody, teach people about the importance of condom use and also share what we needs for our reproductive health” (P21, lesbian).
Online social networks were recommended as some of the ways that sexual and reproductive healthcare needs and services can be met and be inclusive. Queer participants believed that every person in this era is using different media platforms such as television, Facebook, Instagram, and Twitter. If information is disseminated using different media platforms, it will reach a lot of queer individuals who never had information, thus improving inclusivity and their sexual and reproductive health.
“So, if ever maybe we government introduce like educational programs that appear on television, you know people would be like I want to see more of this, and the more they are hooked, that’s the more they learn. Imagine a program that speaks about sexual diseases that affects queer people or things like how queer people can protect themselves” (P12, transgender woman).
“You know, there was a programme that focused on queer health, like Soul Buddy, so if we can have like something similar can be introduced but on social media platforms like Twitter, your Facebook, and your Instagram, it would be nice and helpful, that’s my advice, you know. To have different topics every now and then so that maybe if you discover that there’s a new illness or whatever you can just put up did you know about whatever, and then it shows you, while you’re scrolling through those social networks” (P20, lesbian).
A significant number of queer individuals proposed that existing queer NGOs, such as the selected NGO clinic, should be advertised and made known to the public. Queer participants trusted that if these places are publicized, queer individuals will be able to obtain and use different sexual and reproductive services such as PrEP and HIV testing.
“Honestly speaking I think uhm because a lot of gay people-let me just speak-let me just say gay people don’t even know that this place exists so if ever like this place can be marketed in like uhm social media and let people know, spread the word about it. It will make gay people feel more responsible because a gay person will literally be so comfortable coming here than going to a uhm government hospital and dealing with the nurses’ bad attitudes and whatever. But another important thing is they will be able to access different sexual services such as PrEP, HIV testing, you see. Because a lot of people they can, even if you get sick, for an example, maybe I have a sore on my private part, I want to seek medical attention, it’s going to be-I’m just going to be like let me just go to the pharmacy and get maybe antibiotics, it’s going to die down, I don’t want to go to uhm the clinic because I don’t want to be judged” (P7, transgender woman).
Most queer participants recommended that HCPs are not the only group of professionals and people that need to be involved in ensuring that SRHSN for queer individuals is inclusive. The majority of queer participants further suggested active engagement, participation, and involvement of different key players and relevant parties such as police officers so that queer participants are included in their SRHSN thus reducing judgment.
The importance of involving community members and governmental officials is one of the strategies that could improve sexual and reproductive health for queer people. Queer participants stated that police officer’s attitudes hinder them from reaching and utilizing SRHSN such as rape kits.
“Most of us when we are raped, we are scared of going to the police station, they do not want to help us and they call us with names, I suggest that all government staff, whether its clinics, hospitals, police stations everywhere, home affairs, everything, let them be trained, understand, on how to address and service the LGBTI community. Also, educate the entire community” (P11, transgender woman).
Policymakers and authorities’ duties should be to promote inclusivity, thus achieving queer SRHSN. Queer respondents recommended that policymakers and authorities are the ones to lead the change and be role models.
“Uhm, I think, I think this should be addressed especially when it comes to the President, should you know, at least listen to us so that we can tell him like the things that we need and whatever we are going through when it comes to public spaces so yah, I think so” (P13, transgender woman).
Queer-identifying individual’s responsibility to take full care of themselves was suggested by queer participants themselves. Queer participants alluded to the fact that if they take complete care of themselves, many sexual and reproductive health issues will be resolved.
“I think LGBTQI+ people should take a big responsibility for their health, So, like how do I first take responsibility for my life, one, two for my sexual health because I mean HIV is up there and STIs, so how do I become responsible, you know, do I use a condom every time when I have sex. If I’m on Grindr, how am I taking precautions, not only keeping my life safe but also sexually, how do I make sure that I protect myself, do I get on PrEP, you know. Also, if-to such an extent, the community, how do I make sure that I’m safe. Do I-when I go out do I go out alone, you know, with these men that I know that would-they would want a beer, or they would want money, or they would want cigarettes, or they would want to have sex with me. How do I make sure that I protect myself? We-sensitization and as individuals, how do we take care of ourselves and protect ourselves, either physically, sexually, mentally, and otherwise. How do we take on us and say I’m going to take care of myself because other people that have been sort of like in this journey or are out there to really-unfortunately they are overstretched so they cannot reach this point but how do I carry myself from this point to make sure that I’m safe” (P5, gay).
Our study aimed at exploring and describing queer individuals’ perceptions and solutions to promote SRHSN in Gauteng Province, South Africa. Our research revealed the critical need for the creation of an equal and inclusive healthcare system for queer individuals. Our findings support
Furthermore, there was a need for the restoration of school healthcare services to improve health literacy regarding queer issues among both teachers and learners. Our research aligns closely with several studies that showed that school-based interventions can improve the wellbeing of queer learners (
Queer participants emphasized the significance of HCPs obtaining specialized training in queer healthcare. We can be confident that if HCPs are educated on queer-related health issues, there will be a significant improvement in knowledge, attitude, and/or practice after training (
Participants agreed that more awareness should be raised regarding gay healthcare issues. The recommendations included promoting awareness about queer existence via campaigns and social media platforms. Our research found that the majority of literature from various spheres and areas emphasizes the need to raise LGBTQ+ understanding. For example,
In terms of using social media to raise awareness, several studies agree with our findings that it promotes support and development, general educational goals, and the acquisition of LGBTQ+-specific material (
Furthermore, it was advised that groups, such as the selected NGO clinic and other queer services NGOs, be made more accessible to the public to enhance the health and wellbeing of queer individuals. Our findings are consistent with the agreement in the field of social advertising that many LGBT concerns can be addressed (
Importantly, participants emphasized that healthcare practitioners are not the only stakeholders in safeguarding queer individuals’ SRHSN. The inclusion of varied experts and stakeholders in many settings was judged critical to attaining complete and inclusive healthcare for queer individuals. A literature study showed that training professionals in different fields improve the attitudes toward LGBT+ individuals, as shown in a study by
Moving forward, future studies must prioritize the inclusion of queer individuals to ensure that their health needs are served properly, even outside the scope of research efforts. By amplifying and adopting queer voices’ proposals, we can strive toward a healthcare system that is truly empathetic, accommodating, and equitable for all.
Furthermore, the research findings could be used to advocate for policy changes that promote queer rights and improve SRHSN services. Collaborating with lawmakers, advocacy groups, and community organizations can help to advance legislative reforms and institutional improvements that emphasize the needs of queer individuals. Community engagement and empowerment measures should be used to involve queer people in advocacy efforts and make their views heard. This could include the creation of support networks, peer education programs, and community-led initiatives to reduce healthcare inequities. Finally, future directions ought to emphasize queer individuals’ active participation in shaping research agendas and interventions, fostering collaboration among researchers, policymakers, healthcare providers, and community stakeholders to create meaningful and long-term change in SRHSN services.
Our study used an explorative-descriptive methodology, which allowed us to gain a thorough grasp of queer people’s experiences and viewpoints inside the healthcare system. RDS is a regularly utilized strategy for reaching out to hidden communities, such as queer individuals, and it can help to assure sample diversity. Semi-structured interviews provide flexibility in data gathering, allowing participants to comment on their experiences in their own words. Allowing participants to respond in their preferred language improves accessibility and may result in more real responses. Thematic analysis is an effective tool for discovering patterns and themes in qualitative data and using NVivo can improve the rigor and efficiency of the analysis process.
Despite the use of RDS, there is a possibility of sample bias because participants were recruited from a single NGO in Gauteng Province, South Africa, which may not represent all queer individuals in the region. The sample size was one of our study limitations as the study focused on a single NGO and due to the scarcity of queer individuals. While efforts were taken to translate interviews done in Isizulu and Sesotho into English, nuances and meanings may have been lost during translation, thereby affecting the data’s inherent meaning. The findings may not be generalizable beyond the unique setting of Gauteng Province, South Africa, and may not reflect the experiences of queer people from other areas or nations.
Our research emphasizes the valuable viewpoints and recommendations made by queer people regarding sexual and reproductive healthcare services in the Gauteng Province, South Africa. We conducted semi-structured interviews with 22 participants in English, Isizulu, and Sesotho, using respondent-driven sampling inside the NGO clinic, to explore their perceptions and solutions. These findings emphasize the importance of including queer voices in discussions about sexual and reproductive health, as they provide unique and critical ideas that challenge existing conventions and pave the way for a more inclusive and equitable healthcare system.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving humans were approved by Sefako Makgatho Health Sciences Research Ethics Committee (SMUREC): Protocol number (SMUREC/H/291/2023:PG). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
RS: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Software, Writing – original draft, Writing – review & editing. MM: Formal analysis, Methodology, Supervision, Validation, Visualization, Writing – review & editing. HS: Methodology, Supervision, Validation, Visualization, Writing – review & editing.
The author(s) declare that financial support was received for the protocol development of this research, authorship, and/or publication of this article. The protocol development of this study was sponsored by the National Research Funding (NRF) for Research Development Grants for New Generation of Academics Programme (nGAP) Scholars [grant number NGAP23021680129] and subsidized by the Department of Higher Education and Training’s (DHET) Staffing South Africa’s Universities Framework (SSAUF) through the New Generation of Academics Programme (nGAP). The publication fee payment of this manuscript was paid by the Sefako Makgatho Health Sciences University (SMU), department of Public Health.
The researchers would like to thank the Aurum Institute for granting permission to conduct the study in their facility. In addition, we thank Mr. Happy Phaleng, Mr. Pontsho Komane, Ms. Mapaseka Mabena, and Mr. Nico Machobane for their assistance with RDS and all the queer individuals who decided to participate in our study willingly.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The Supplementary material for this article can be found online at: