Written by Marion Stevens, Tracey Naledi, Richard Kaplan, Lynn Bust, Chante Arab, Gita November, Katlego Sepotokele, Thuli Mjwara, and Linda Gail Bekker

In early November an LGBTQIA+ Health and Advocacy Symposium was held at the University of Cape Town (UCT) Neuroscience Institute facilitated by the Desmond Tutu Health Foundation (DTHF) and UCT Faculty of Health Sciences in partnership with a range of civil society organizations including Triangle Project, GenderDynamiX and Inclusive and Affirming Ministries (IAM). The symposium had a bold vision of ‘working towards an accountable, inclusive South African health system that fully integrates LGBTQIA+ health into national politics and health service provider education, and actively engages and empowers marginalised LGBTQIA+ communities to guarantee equitable access and inclusive care for all LGBTQIA+ individuals’. Given previous challenges and contested spaces on the campus, as in many other universities, these efforts serve to pave a constructive passage for creating a more supportive environment and positioning UCT as a leader in inclusive care. DTHF a UCT research entity is pioneering a South African LGBTQIA+ Healthcare Equality Program to promote inclusive healthcare environments which is at the cutting edge of research into models of care for LGBTQ+ people. This symposium brought together key national players from government, civil society and academic institutions to discuss health needs and services for the LGBTQIA+ population.

South Africa stands as a beacon in the current geopolitics of queer health. Elsewhere, controversial health system and economic reforms have led to the unfortunate dismantling of care in the UK for transgender and gender diverse individuals. In addition, care for gender diverse people has become a central issue in conservative election politics, with parties investing heavily in advertisements that often amplify controversy and misinformation. This focus not only diverts attention from the real healthcare needs of transgender individuals but also weaponizes the issue for political gain, creating barriers to compassionate and informed policy discussions. Work on health systems reform and financing are also underway in South Africa to foster improved access and equitable care. A key moment from the symposium was an engaging panel that brought together views from local, provincial and national government, academia and the LGBTQIA+ community to discuss the importance of making universal health care inclusive and responsive to the needs of LGBTQIA+ communities. This dialogue highlighted both the opportunities and challenges in ensuring equitable access to appropriate and affirming health services within the envisaged National Health Insurance.

Our uneven legacy of injustices informs us in South Africa, a devastating history has been the practice of conversion therapy  in the apartheid military. Conversion therapy attempts to “change, suppress or divert one’s sexual orientation, gender identity or gender expression” due to religious, family or cultural pressures. These methods include talk therapy that promotes shame, aversion techniques using discomfort or pain, religious interventions like prayer or exorcisms, behaviour modification to enforce gender stereotypes, and even harmful medical procedures that suppress sexual desire. Such practices have been widely condemned for their ineffectiveness and for causing significant psychological harm, including increased rates of anxiety, depression, and suicidal thoughts. Sadly these practices persist, research launched this year documenting these practices showed that 22% of respondents experienced “conversion therapy” directly and 34% of people sought it for themselves with others coerced into the therapy. These unfortunate and harmful practices have filtered into health care spaces with new languages and approaches calling it “reparative care for LGBTQIA+ youth” which are completely contrary to our legal and policy provisions on care. Instead of conversion therapy, individuals should have access to affirming, evidence-informed care that supports their sexual orientation and gender identity. This includes trauma-informed therapy, peer support groups, and counselling that fosters self-acceptance and well-being. Health services should offer gender-affirming care, sexual health education, and create safe, inclusive spaces where people can explore their identity without judgment. These approaches empower queer individuals to live authentically and thrive.

A leading group, the PATHSA – Professional Association for Transgender Health South Africa, had different members engaged in the symposium and provided insights into educating health providers and integrating evidence-informed knowledge on gender affirming care into medical curriculums. Of note is their recent statement launched in August 2024, ‘Embracing Diversity, Upholding Rights, A South African Position Statement on Evidence-Based Care for Transgender and Gender-Diverse Young People’ endorsed by a number of A-rated scientists and researchers who were present at the symposium. The background states,

Gender diversity is a fundamental aspect of the human experience, and the right to explore and affirm one’s gender identity is integral to the individual, relational and social wellbeing of our youth. To honour and affirm the existence and dignity of transgender and gender-diverse young people is to challenge the societal norms that seek to diminish their identities, allowing them not just to survive but to flourish in a world that too often denies their very humanity.

South Africa is a country built on healing from a past which harmed and divided us. We are all called to commit to a future which is rooted in compassion and acts of care and belonging that bring forth the tangible recognition and affirmation of our shared humanity. In this pursuit, transgender and gender-diverse young people are not only fully recognised for their inherent worth but are also honoured as indispensable and cherished members of our society, deserving of the opportunity to reach their fullest potential and contribute to our shared future. As a nation founded on Ubuntu and the principles of equality, dignity, and unity, it is our collective responsibility to ensure that every young person in South Africa is afforded the opportunity to live authentically and without fear.

These efforts go a long way to counter misinformation that has filtered into South Africa as imposed ideas from conflicts in the Global North. At the symposium sessions at UCT, participants emphasized the urgent need for water, sanitation, and reliable access to basic services, shifting focus away from divisive debates over bathroom access. The discussions shed light on the social determinants of health, recognizing the interconnected impacts of race, gender and class. It was underscored that, like everyone else, most queer individuals should have guaranteed access to essential health services without fear of judgment or discrimination from healthcare providers. This perspective calls for a more compassionate and equitable approach to public health.

The symposium was a breath of fresh air for many participants who had the opportunity to express themselves in a safer place and to listen and learn from each other. Open and constructive conversations were held in the afternoons where break out groups discussed key health issues for the LGBTQIA+ population and potential solutions to these. The main health issues included:

1. Lack of consideration and integration of LGBTQIA+ health needs, and pervasive cis-heteronormative assumptions, within policy at the national level;
2. Lack of standardized health service provider training on LGBTQIA+ health
3. Exclusion of marginalised LGBTQIA+ people from the health system and decision-making processes concerning the provision of health services and health related research.

The findings of these working groups are being collated and analysed by a writing group composed of attendees of the symposium and will be published in the next while. However we write to underline the importance of this gathering in the current political space. Reports indicate that Family Watch International (FWI), a U.S.-based Christian conservative group labelled a “hate group” by civil rights advocates for its anti- LGBTQIA+ views, has been advising influential African politicians, religious figures, and civic leaders on how to resist comprehensive sexuality education (CSE) throughout the continent. Within South Africa there are Christian medical groups where leaders are actively organising and training on advocacy on what is termed gender critical activism. These efforts explicitly aim to equip individuals with tactics and resources to challenge gender-affirming policies, despite overwhelming evidence supporting such care.  This ideological resistance stands in stark contrast to evidence-informed healthcare practices and jeopardizes the progress toward inclusive and informed medical services. Alarmingly, some clinicians offering gender-affirming care in Cape Town have faced legal battles, highlighting the personal and professional risks imposed by these movements. Furthermore, the disturbing convergence of anti-vaccination and anti-rights factions threatens to erode public health advancements, undermining efforts to deliver compassionate, science-driven healthcare. Links between anti vaccination and anti-rights groups are becoming increasingly coordinated, with the shared objective of undermining progress in public health and obstructing the development of evidence-informed healthcare services. This alliance poses a significant threat, as their combined influence seeks to derail advancements that prioritize science and compassionate care. By spreading misinformation and promoting ideologies that disregard established medical research, these groups endanger both public trust and the ability to provide equitable, high-quality health services.

Indeed the academy provided courageous and important leadership in stewarding and curating an excellent space for the sharing and engaging of evidence to inform care. This achievement is a potential model for advancing LGBTQIA+ healthcare in South Africa, marked by meaningful collaboration among academic institutions, government, and civil society.

Authors affiliations:

Marion Stevens, Consolidoc Fellow, SARChi Chair Gender and Politics, Department of Political Science, Stellenbosch University
Tracey Naledi, Deputy Dean: Social Accountability and Health Systems, Faculty of Health Sciences, University of Cape Town
Richard Kaplan, Desmond Tutu Health Foundation
Lynn Bust, Research Project Manager, Desmond Tutu Health Foundation
Chante Arab, Gender and Sexual Diversity Advocate, Faculty of Health Sciences, University of Cape Town
Gita November Gender DynamiX
Katlego Sepotokele, Triangle Project
Thuli Mjwara, IAM
Linda Gail Bekker, Director, Desmond Tutu Health Foundation