Müller, A., Daskilewicz, K. and the Southern and East African Research Collective on Health (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’. Amsterdam: COC Netherlands. A series of ten reports.
This report presents research findings on the mental health and well-being of lesbian, gay, bisexual, transgender and intersex (LGBTI) people in East and Southern Africa. It also presents findings on LGBTI people’s experiences of violence, and experiences in accessing healthcare.
It is part of a series of reports based on research in nine countries of Southern and East Africa: in Botswana, Ethiopia, Kenya, Lesotho, Malawi, South Africa, eSwatini, Zambia and Zimbabwe. In this series, we have published a report for each country, as well as this report, which summarises the findings for the entire region. The research was done collaboratively by a consortium of non- governmental organisations (NGOs), academic researchers from the University of Cape Town, and COC Netherlands who funded the project and provided logistical support.
Across those nine countries, we used a standardised questionnaire to survey 3,796 people, and ask about physical and sexual violence, depression, anxiety, suicidality and substance use, as well as experiences of discrimination when accessing healthcare.
The findings give us a sense of the precarious state of LGBTI people’s mental health and well- being in East and Southern Africa, and the high levels of violence that LGBTI people experience: compared to what we know from the general population, LGBTI people have higher levels of mental health concerns, have experienced more violence, and have faced barriers to healthcare that are directly linked to their sexual orientation, gender identity or gender expression.
Our findings show that in the East and Southern African region, as elsewhere in the world, discrimination, stigma and marginalisation related to sexual orientation, gender identity and gender expression place LGBTI people at higher risk for mental health concerns and violence.
Over the last two decades research on lesbian, gay, bisexual and transgender persons, health and violence has highlighted substantial vulnerabilities and health disparities based on sexual orientation, and gender identity and expression in many parts of the world. There is growing awareness of the broad ranging negative consequences of stigma, marginalization and discrimination on the health of people who identify as, or are perceived to be, lesbian, gay, bisexual, transgender and gender diverse (LGBT) (Mayer et al., 2008; Institute of Medicine, 2011; Logie, 2012; Pega and Veale, 2015). For example, in a recent landmark report on LGBT health (Institute of Medicine, 2011), the United States Institute of Medicine pointed out that LGBT people are at increased risk of violence, harassment, and victimization. These findings underscore the link between stigma, marginalization and discrimination and corroborate that sexual orientation, gender identity and expression are important determinants of vulnerability and health (Logie, 2012; Pega and Veale, 2015).
LGBT people are not a homogenous population. The acronyms LGBT or LGBTI (“I” for intersex1) group individuals together based on similar experiences of discriminatory treatment in society because they fall outside of social norms about sexuality and gender, due to their sexual orientation, gender identity, gender expression, and/or sex characteristics. While this is helpful to analyse the consequences of marginalization, it is important not to assume that individuals under this umbrella acronym necessarily have similar experiences or needs. In fact, individual experiences differ greatly across the populations covered under the acronym. Thus, the populations represented by each individual letter in the acronym are complex and heterogeneous, even more so when differences in race, age, ability, religion, culture, socioeconomic class, and geographic location are also taken into account. In this report, we use the acronym LGBTI in order to point to similar experiences of stigma, marginalization and discrimination based on sexual orientation, gender identity, gender expression and sex characteristics in heteronormative societal frameworks. However, frequently we disaggregate this umbrella into its constituent groups in order to highlight specific characteristics and differences.