Skip to main content
SpringerLink
Log in

Heteronormativity in Health Settings: Realities of LGBT Youth’s Access to Healthcare in South Africa

  • Chapter
  • First Online:
Young People, Violence and Strategic Interventions in Sub-Saharan Africa

Part of the book series: Clinical Sociology: Research and Practice ((CSRP))

Abstract

In South Africa, sexual and gender minorities experience a wide array of health inequities and face many difficulties in accessing health services. This is largely due to the general heteronormative-based health system that is not well equipped to meet the needs of those not conforming to “normal” forms of gender and sexuality. In addition, the heteronormative-based approach to LGBT health has rendered the unique needs and experiences of sexual and gender minorities invisible within mainstream health data, systems and policies. Increasing evidence suggests that the COVID-19 pandemic has worsened health disparities and this is likely a consequence of existing challenges related to structural violence that persisted prior to its emergence. Given the current structure of South Africa's health system, this chapter examines structural violence in the context of healthcare and draws on in-depth interviews conducted with 12 LGBT students at a university in South Africa. The findings highlight the importance of raising awareness on the spectrum of sexual orientation and gender identity, applying an intersectional lens to the health system to address health inequities and gearing healthcare programs to provide services for all. 

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    See Constitution of South Africa (1996), Article 7(2).

  2. 2.

    M Warner Introduction: Fear of a Queer Planet (1991).

  3. 3.

    Outing refers to an act of disclosing or publicizing an LGBT person’s sexual orientation or gender identity without their consent.

  4. 4.

    It is important to note that a person may be homosexual or transgender but not sexually active, while another individual may be heterosexual and engaging in anal sex; hence, prevention and sexual health needs differ based on risk, not only on SOGI.

References

  • Ahmed, F., Ahmed, N. E., Pissarides, C., & Stiglitz, J. (2020). Why inequality could spread COVID-19. The Lancet Public Health, 5(5), e240.

    Article  Google Scholar 

  • Albuquerque, G. A., de Lima Garcia, C., da Silva Quirino, G., Alves, M. J. H., Belém, J. M., dos Santos Figueiredo, F. W., et al. (2016). Access to health services by lesbian, gay, bisexual, and transgender persons: Systematic literature review. BMC International Health and Human Rights, 16(1), 1–10.

    Google Scholar 

  • Alli, F., Maharaj, P., & Vawda, M. Y. (2013). Interpersonal relations between health care workers and young clients: Barriers to accessing sexual and reproductive health care. Journal of Community Health, 38(1), 150–155.

    Article  Google Scholar 

  • Amoroto, B. (2016). Structural-systemic-cultural violence against LGBTQs in the Philippines. Journal of Human Rights and Peace Studies, 2(1), 67–102.

    Google Scholar 

  • Ansara, Y. G. (2012). Cisgenderism in medical settings: Challenging structural violence through collaborative partnerships. In I. Rivers & R. Ward (Eds.), Out of the ordinary: LGBT lives (pp. 102–122). Cambridge Scholar Publishing.

    Google Scholar 

  • Basnyat, I. (2017). Structural violence in health care: Lived experience of street-based female commercial sex workers in Kathmandu. Qualitative Health Research, 27(2), 191–203.

    Article  Google Scholar 

  • Bauer, G. R., Hammond, R., Travers, R., Kaay, M., Hohenadel, K. M., & Boyce, M. (2009). I don’t think this is theoretical; this is our lives: How erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20(5), 348–361.

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical guide for beginners. Sage.

    Google Scholar 

  • Campbell, M. M., & Stein, D. J. (2014). Sexual health in the South African context. SAMJ: South African Medical Journal, 104(6), 439–440.

    Article  Google Scholar 

  • Cele, N. H., Sibiya, M. N., & Sokhela, D. G. (2015). Experiences of homosexual patients’ access to primary health care services in Umlazi, KwaZulu-Natal. Curationis, 38(2), 1–9.

    Article  Google Scholar 

  • Çinar, M. (2011). They make your life like shit. Masculinity and violence against transgender people in Istanbul. Retrieved June 28, 2021 from https://www.fu-berlin.de/sites/gpo/int_bez/frauenmenschenrechte/theymakeyourlifeshit/MelikeCinar.pdf

  • Cloete, A. (2017). Do healthcare systems in South Africa provide for the healthcare needs of gay, lesbian & transgender populations? Human Sciences Research Council.

    Google Scholar 

  • Colpitts, E., & Gahagan, J. (2016). I feel like I am surviving the health care system: Understanding LGBTQ health in Nova Scotia, Canada. BMC Public Health, 16(1), 1–12.

    Article  Google Scholar 

  • Constitution of South Africa. (1996). Constitution of the Republic of South Africa, Act No. 108 of 1996. Parliament of the Republic of South Africa, Cape Town.

    Google Scholar 

  • Coovadia, H., Jewkes, R., Barron, P., Sanders, D., & McIntyre, D. (2009). The health and health system of South Africa: Historical roots of current public health challenges. The Lancet, 374(9692), 817–834.

    Article  Google Scholar 

  • De Cock, K. M., Jaffe, H. W., & Curran, J. W. (2011). Reflections on 30 years of AIDS. Emerging Infectious Diseases, 17(6), 1044.

    Article  Google Scholar 

  • DeMulder, J., Kraus-Perrotta, C., & Zaidi, H. (2020). Sexual and gender minority adolescents must be prioritised during the global COVID-19 public health response. Sexual and Reproductive Health Matters, 28(1), 1804717.

    Article  Google Scholar 

  • Duby, Z., Nkosi, B., Scheibe, A., Brown, B., & Bekker, L. G. (2018). Scared of going to the clinic: Contextualising healthcare access for men who have sex with men, female sex workers and people who use drugs in two South African cities. Southern African Journal of HIV Medicine, 19(1), 1–8.

    Article  Google Scholar 

  • Dworkin, G. (1972). Paternalism. The Monist, 56, 64–84.

    Article  Google Scholar 

  • Farmer, P. (2010). On suffering and structural violence: Social and economic rights in the global era (1996, 2003). In H. Saussy (Ed.), Partner to the poor (pp. 328–349). University of California Press.

    Google Scholar 

  • Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2019). Structural violence and clinical medicine. The Social Medicine Reader, 2(3), 156–169.

    Google Scholar 

  • Finley, C. (2020). Paternalism and autonomy in transgender healthcare. Honors dissertation, Butler University.

    Google Scholar 

  • Gaillard, J. C., Gorman-Murray, A., & Fordham, M. (2017). Sexual and gender minorities in disaster. Gender, Place & Culture, 24(1), 18–26.

    Article  Google Scholar 

  • Galtung, J. (1969). Violence, peace and peace research. Journal of Peace Research, 6, 167–191.

    Article  Google Scholar 

  • Gridley, S. J., Crouch, J. M., Evans, Y., Eng, W., Antoon, E., Lyapustina, M., et al. (2016). Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. Journal of Adolescent Health, 59(3), 254–261.

    Article  Google Scholar 

  • Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82.

    Article  Google Scholar 

  • Harris, B., Goudge, J., Ataguba, J. E., McIntyre, D., Nxumalo, N., Jikwana, S., & Chersich, M. (2011). Inequities in access to health care in South Africa. Journal of Public Health Policy, 32(S1), S102–S123.

    Article  Google Scholar 

  • Hawke, L. D., Mehra, K., Settipani, C., Relihan, J., Darnay, K., Chaim, G., & Henderson, J. (2019). What makes mental health and substance use services youth friendly? A scoping review of literature. BMC Health Services Research, 19(1), 1–16.

    Article  Google Scholar 

  • Heck, J. E., Sell, R. L., & Gorin, S. S. (2006). Health care access among individuals involved in same-sex relationships. American Journal of Public Health, 96(6), 1111–1118.

    Article  Google Scholar 

  • Heckathorn, D. D. (2011). Comment: Snowball versus respondent-driven sampling. Sociological Methodology, 41(1), 355–366.

    Article  Google Scholar 

  • Ilyayambwa, M. (2012). Homosexual rights and the law: A South African constitutional metamorphosis. International Journal of Humanities and Social Science, 2(4), 50–58.

    Google Scholar 

  • Javaid, A. (2018). Out of place: Sexualities, sexual violence, and heteronormativity. Aggression and Violent Behavior, 39, 83–89.

    Article  Google Scholar 

  • Johnson, L., Shipherd, J., & Walton, H. M. (2016). The psychologist’s role in transgender-specific care with US veterans. Psychological Services, 13(1), 69.

    Article  Google Scholar 

  • Kuyper, L., & Vanwesenbeeck, I. (2011). Examining sexual health differences between lesbian, gay, bisexual, and heterosexual adults: The role of sociodemographics, sexual behavior characteristics, and minority stress. Journal of Sex Research, 48(2–3), 263–274.

    Article  Google Scholar 

  • Lane, T., Raymond, H. F., Dladla, S., Rasethe, J., Struthers, H., McFarland, W., & McIntyre, J. (2011). High HIV prevalence among men who have sex with men in Soweto, South Africa: Results from the Soweto Men’s study. AIDS and Behavior, 15(3), 626–634.

    Article  Google Scholar 

  • Lee, E. O. J. (2019). Responses to structural violence: The Everyday ways in which queer and trans migrants with precarious status respond to and resist the Canadian immigration regime. International Journal of Child, Youth and Family Studies, 10(1), 70–94.

    Article  Google Scholar 

  • Lester, K. (2008). Encyclopedia of violence. Peace, and conflict. Elsevier.

    Google Scholar 

  • Luvuno, Z. P., Ncama, B., & Mchunu, G. (2019). Transgender population’s experiences with regard to accessing reproductive health care in Kwazulu-Natal, South Africa: A qualitative study. African Journal of Primary Health Care & Family Medicine, 11(1), 1–9.

    Article  Google Scholar 

  • Lynch, I., & Teagle, A. (2020). The COVID-19 impact on sexual- and reproductive-health rights and gender-based violence. HSRC Review, 18(2), 36–37.

    Google Scholar 

  • Matolino, B. (2017). Being gay and African: A view from an African philosopher. Phronimon, 18, 59–78.

    Article  Google Scholar 

  • Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counselling Psychology, 56(1), 23.

    Article  Google Scholar 

  • Mkhize, S. P., & Maharaj, P. (2020). Structural violence on the margins of society: LGBT student access to health services. Agenda, 34(2), 104–114.

    Article  Google Scholar 

  • Mkhize, S. P., & Maharaj, P. (2021). Meeting the sexual health needs of LGBT youth: Perceptions and experiences of university students in KwaZulu-Natal, South Africa. Journal of Social Service Research, 47(1), 56–72.

    Article  Google Scholar 

  • Mkhize, S. P., de Kadt, J., Naidoo, Y., & Parker, A. (2021). Health. In J. de Kadt, C. Hamann, S. P. & A. Parker (Eds.), Quality of life 6 (2020/21) Survey: Overview report (Section 7). Gauteng City-Region Observatory (GCRO).

    Google Scholar 

  • Moagi, L. A., & Mavhandu-Mudzusi, A. H. (2020). Violence against LGBT (QI) persons in Africa. The Palgrave Handbook of African Women’s Studies.

    Google Scholar 

  • Mprah, A. (2016). Sexual and reproductive health needs of LGBT: Commentary. African Journal of Reproductive Health, 20(1), 16–20.

    Article  Google Scholar 

  • Mulé, N. J., Ross, L. E., Deeprose, B., Jackson, B. E., Daley, A., Travers, A., & Moore, D. (2009). Promoting LGBT health and well-being through inclusive policy development. International Journal for Equity in Health, 8(1), 1–11.

    Article  Google Scholar 

  • Müller, A. (2016). Health for all? Sexual orientation, gender identity, and the implementation of the right to access to health care in South Africa. Health and Human Rights, 18(2), 195.

    Google Scholar 

  • Müller, A., Röhrs, S., Hoffman-Wanderer, Y., & Moult, K. (2016). You have to make a judgment call: Morals, judgments and the provision of quality sexual and reproductive health services for adolescents in South Africa. Social Science & Medicine, 148, 71–78.

    Article  Google Scholar 

  • Müller, A. (2017). Scrambling for access: Availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa. BMC International Health and Human Rights, 17(1), 1–10.

    Article  Google Scholar 

  • Müller, A., & Daskilewicz, K. (2019). Are we doing alright? Realities of violence, mental health, and access to healthcare related to sexual orientation and gender identity and expression in East and Southern Africa: Research report based on a community-led study in nine countries. COC Netherlands.

    Google Scholar 

  • Newman-Valentine, D. D., & Duma, S. E. (2014). Transsexual women’s journey towards a heteronormative health care system: Gender and equity. African Journal for Physical Health Education, Recreation and Dance, 20(Suppl 1), 385–394.

    Google Scholar 

  • Nordhues, H. C., Bhagra, A., Stroud, N. N., Vencill, J. A., & Kuhle, C. L. (2021, April). COVID-19 gender disparities and mitigation recommendations: A narrative review. In Mayo Clinic proceedings. Elsevier.

    Google Scholar 

  • Osseni, I. A. (2020). COVID-19 pandemic in sub-Saharan Africa: Preparedness, response, and hidden potentials. Tropical Medicine and Health, 48(1), 1–3.

    Article  Google Scholar 

  • Parsons, V. (2020). Muslim leaders of Ghana blame coronavirus on ‘transgender and lesbianism’. Again. Pink News. Retrieved from https://www.pinknews.co.uk/2020/03/27/ghana-coronavirus-muslim-mission-pandemic-transgender-lesbian-homophobia/

  • Quinn, G. P., Sutton, S. K., Winfield, B., Breen, S., Canales, J., Shetty, G., et al. (2015). Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) perceptions and health care experiences. Journal of Gay & Lesbian Social Services, 27(2), 246–261.

    Article  Google Scholar 

  • Rebe, K. B., De Swardt, G., Berman, P. A., Struthers, H., & McIntyre, J. A. (2014). Sexual lubricants in South Africa may potentially disrupt mucosal surfaces and increase HIV transmission risk among men who have sex with men. South African Medical Journal, 104(1), 49–51.

    Article  Google Scholar 

  • Reif, S., Wilson, E., & McAllaster, C. (2018). Perceptions and impact of HIV stigma among high risk populations in the US Deep South. Journal of HIV and AIDS, 4(2), 1–7.

    Google Scholar 

  • Rispel, L. C., Metcalf, C. A., Cloete, A., Moorman, J., & Reddy, V. (2011). You become afraid to tell them that you are gay: Health service utilization by men who have sex with men in South African cities. Journal of Public Health Policy, 32(1), 137–151.

    Article  Google Scholar 

  • Romijnders, K. A., Nyoni, J. E., Ross, M. W., McCurdy, S. A., Mbwambo, J., Kok, G., & Crutzen, R. (2016). Lubricant use and condom use during anal sex in men who have sex with men in Tanzania. International Journal of STD & AIDS, 27(14), 1289–1302.

    Article  Google Scholar 

  • Ruprecht, M. M., Wang, X., Johnson, A. K., Xu, J., Felt, D., Ihenacho, S., et al. (2021). Evidence of social and structural COVID-19 disparities by sexual orientation, gender identity, and race/ethnicity in an urban environment. Journal of Urban Health, 98(1), 27–40.

    Article  Google Scholar 

  • Salerno, J. P., Devadas, J., Pease, M., Nketia, B., & Fish, J. N. (2020). Sexual and gender minority stress amid the COVID-19 pandemic: Implications for LGBTQ young persons’ mental health and well-being. Public Health Reports, 135(6), 721–727.

    Article  Google Scholar 

  • Siedner, M. J., Kraemer, J. D., Meyer, M. J., Harling, G., Mngomezulu, T., Gabela, P., et al. (2020). Access to primary healthcare during lockdown measures for COVID-19 in rural South Africa: An interrupted time series analysis. BMJ Open, 10(10), e043763.

    Article  Google Scholar 

  • Subhrajit, C. (2014). Problems faced by LGBT people in the mainstream society: Some recommendations. International Journal of Interdisciplinary and Multidisciplinary Studies, 1(5), 317–331.

    Google Scholar 

  • Sutherland, C., Roberts, B., Gabriel, N., Struwig, J., & Gordon, S. (2016). Progressive prudes: A survey of attitudes towards homosexuality & gender non-conformity in South Africa. Human Sciences Research Council.

    Google Scholar 

  • Tucker, A. (2020). Geographies of sexualities in sub-Saharan Africa: Positioning and critically engaging with international human rights and related ascendant discourses. Progress in Human Geography, 44(4), 683–703.

    Article  Google Scholar 

  • van der Miesen, A. I., Raaijmakers, D., & van de Grift, T. C. (2020). You have to wait a little longer: Transgender (mental) health at risk as a consequence of deferring gender-affirming treatments during COVID-19. Archives of Sexual Behavior, 49, 1395–1399.

    Article  Google Scholar 

  • Vance, S. R., Jr., Halpern-Felsher, B. L., & Rosenthal, S. M. (2015). Health care providers’ comfort with and barriers to care of transgender youth. Journal of Adolescent Health, 56(2), 251–253.

    Article  Google Scholar 

  • Warner, M. (1991). Introduction: Fear of a queer planet. Social Text, 3–17.

    Google Scholar 

  • Winter, D. D., & Leighton, D. C. (2001). Structural violence. In D. J. Christie, R. V. Wagner, & D. D. Winter (Eds.), Peace, conflict, and violence: Peace psychology in the 21st century. Prentice-Hall.

    Google Scholar 

  • Wood, S. M., Salas-Humara, C., & Dowshen, N. L. (2016). Human immunodeficiency virus, other sexually transmitted infections, and sexual and reproductive health in lesbian, gay, bisexual, transgender youth. Pediatric Clinics, 63(6), 1027–1055.

    Google Scholar 

  • World Professional Association for Transgender Health. (2012). Standards of care for the health of transsexual, transgender, and gender nonconforming people [7th version]. WPATH Publications.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gauteng City-Region Observatory, University of Johannesburg, University of the Witwatersrand, Johannesburg, South Africa

    Sthembiso Pollen Mkhize

  2. South African Research Chair in Economic Development, University of KwaZulu-Natal, Durban, South Africa

    Pranitha Maharaj

Authors
  1. Sthembiso Pollen Mkhize
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pranitha Maharaj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sthembiso Pollen Mkhize .

Editor information

Editors and Affiliations

  1. Department of Sociology, University of Johannesburg, Johannesburg, South Africa

    Kammila Naidoo

  2. Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa, IA, USA

    Oluwafemi Adeagbo

  3. Arnold School of Public Health, University of South Carolina, Columbia, IN, USA

    Xiaoming Li

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mkhize, S.P., Maharaj, P. (2023). Heteronormativity in Health Settings: Realities of LGBT Youth’s Access to Healthcare in South Africa. In: Naidoo, K., Adeagbo, O., Li, X. (eds) Young People, Violence and Strategic Interventions in Sub-Saharan Africa. Clinical Sociology: Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-20679-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-20679-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-20678-8

  • Online ISBN: 978-3-031-20679-5

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation