I first became interested in the topic of lesbian, gay, bisexual, and transgender (LGBT) health care and health education while working as a country lead for the Presidential Emergency Plan for AIDS Relief (PEPFAR). During my time there I had the opportunity to travel to South Africa and understand their community and health care system a bit better, with an emphasis on their HIV/AIDS epidemic. This post focuses on the LGBT history in South Africa, recent developments, addressing that there is a gap between homophobia and non-judgmental care, and the importance of health care workers understanding LGBT health education.
More and more countries around the world are opening their arms to welcome and embrace LGBT pride. South Africa has one of the world’s more progressive constitutions which legally protects LGBT people from discrimination, although current research indicates that they continue to face discrimination and homophobia in many different facets of life. The most recent milestone occurred in 2006 when the country passed a law to recognize same-sex marriages. Nevertheless, LGBT South Africans particularly those outside of the major cities, continue to face some challenges including conservative attitudes, violence, and high rates of disease. As the country continues to grow there seems to be an increase in LGBT representation (with approximately 4,900,000 people identifying as LGBT) whether it is through activism, tourism, the media and society or support from religious groups. So, what about LGBT health education?Little information is known about LGBT health in South Africa, and many speculate that gay men and lesbians might face unique challenges in health care. By better understanding the difficulties the LGBT community faces when accessing health care or sexual information or when ‘coming out’ to health care providers, public health efforts might be better equipped to provide meaningful and affirming services to these individuals. One of the main health concerns for this particular community is HIV/AIDS, with men who have sex with men (MSM), women who has sex with women (WSW) and transgender people who demonstrate the highest HIV prevalence. HIV is only one health concerns, there are several other concerns such as STI's, contraceptive education/use, or mental health issues. Although the South African constitution guarantees LGBT people the right to non-discriminate and the right to accessing health care, homophobia in society abounds. There have been recent studies that suggest there are significant barriers in accessing health care. For example, in a recent study several individuals have reported experiences and violations with a lack of public health facilities, refusal to provide care, articulation of moral judgment and disapproval, and lack of knowledge about LGBT identities and health needs. The last point is key. While most people in these scenarios recognize that their health rights are being violated, few seek out accountability or complaint within the health system due to fear or repercussions or the belief that homophobia is extremely pervasive in the system.
While South Africa was the first country in the world to outlaw discrimination based on sexual orientation and the only country in the African region to legalize same-sex marriage, there is a considerable amount of public health facilities and health care workers that fail LGBT people. There is a need to challenge and instruct health care workers and educators attitudes towards homosexuality and educate them about LGBT health. As time goes on the hope is that the country addresses the gap and provides recommendations that will continuously strengthen existing services and uphold human rights. If successful, these guidelines could spread to other parts of the region. Of course, this is only skimming the surface but it's a start.