Queer South Africa’s health system

Health systems in South Africa operate in a cis-heteronormative way that favours heterosexuality and binary gender identities.

This practice marginalises the LGBTQI+ community and creates systemic barriers for appropriate healthcare, said Lynn Bust, a project manager at the LGBT+ Health Division at the Desmond Tutu Health Foundation, which is based in the University of Cape Town’s (UCT) Faculty of Health Sciences (FHS).

Bust was speaking during day one of the LGBTQ+ Health and Advocacy Symposium on Friday, 1 November. The two-day event was held in the Neuroscience Institute on the Groote Schuur Hospital precinct. It joined academia, civil society and provincial government for discussions and debates on how to create inclusive healthcare environments and improve access to health services for transgender and gender-diverse individuals.

Prejudicing LGBTQI+ people

According to Bust, healthcare workers in the country lack the knowledge and skills to provide adequate care for LGBTQI+ patients, which ultimately leads to prejudices.

She said something as simple as patient information forms still include binary and limited gender options. What this means is that healthcare workers then assume patients’ heterosexuality, which is why patients often conceal their sexual orientation.

“This contributes to adverse health outcomes and challenges with combating STI and HIV epidemics.”

And the knock-on effect is enormous.

“Marginalisation of LGBTQI+ communities limits access to essential services such as gender-affirming healthcare, mental health and substance abuse services [as well as] LGBTQI+-friendly sexually transmitted infection (STI) and HIV treatment and prevention services,” she said. “This contributes to adverse health outcomes and challenges with combating STI and HIV epidemics, particularly in the public health sector.”

Queering the health system

To address these challenges, South Africa must make a concerted effort to queer its health system. But what does this mean?

Bust said it starts with challenging embedded assumptions and redesigning health systems and services to be inherently inclusive, rather than exclusionary by default.

“To queer is to disrupt or make something strange, twisting or unsettling meanings, pushing the invisible into the spotlight. These techniques have the potential to transform normative (taken for granted) assumptions and have been widely used to challenge assumptions about sexuality and gender,” she pointed out.

To make the health system more inclusive, we need to:

• sensitise all staff
• upskill healthcare providers
• improve staff representation (include LGBTQI+ individuals)
• showcase an inclusive environment with posters/flags
• collect and report accurately on data
• adapt policy
• review gender-neutral bathrooms

continue with necessary outreach programmes in partnership with non-profit organisations.

Championing the cause

The LGBT+ Health Division is committed to creating pathways to achieve health equity for the LGBTQI+ community.

Bust said they’ve already developed the South African LGBTQI+ Healthcare Equality Programme, with the aim to create inclusive healthcare environments through organisational change. The programme promotes equality, collaboration and access to high-quality, appropriate health services for the LGBTQI+ community.

As part of the programme, the team facilitated several workshops that focused on sexual orientation and gender identity, to increase healthcare workers’ understanding of gender identity and sexual orientation, gender-diverse youth, homo- and transphobia and the barriers to healthcare for LBTQI+ populations. The second and third workshop, she said, explored the need for organisational change and looked at strategies to facilitate the process and introduce gender-affirming care for healthcare providers.

“This requires an integration of health system thinking, community-led solutions and practical implementation tools.”

“Queering health systems strategies to fundamentally reimagine healthcare delivery through addressing systemic barriers, centring [the] LGBTQI+ community’s needs. This requires an integration of health system thinking, community-led solutions and practical implementation tools,” Bust said.