An exploratory survey of the lived experiences of lesbian, gay, and bisexual South Africans of Indian descent: towards intersectional insights

Despite a substantial body of research on Indian sub-culture in South Africa, few studies have explored its intersection with sexual and gender diversity. Similarly, despite growing research on the lives of lesbian, gay, bisexual, and transgender people in South Africa, there are few studies exploring its intersection with local Indian sub-groups. This article presents the results of the first national exploratory survey of the psychosocial experiences of lesbian, gay, bisexual, and transgender South Africans of Indian descent. A qualitative, online survey was conducted between June 2017 and July 2020. Participants were invited through a mix of purposive and snowball sampling. Descriptive statistics present a demographic profile of who responded to the survey and reflexive thematic analysis was used to analyse the qualitative data ( n = 73; aged 18–60). Most participants were gay males, lesbian women, and bisexual men and women, mostly from KwaZulu-Natal and Gauteng province. Participants’ religious affiliations were mostly Hindu, Muslim, or Christian. Majority reported a postgraduate education and full-time employment. Four psychosocial themes are discussed: Conforming to conservative cultural norms; navigating a double life; troubled inclusion within lesbian, gay, bisexual, and transgender communities; and the possibilities of hope and acceptance. Findings point to a need for an intersectional understanding of lesbian, gay, bisexual, and transgender identity among South Africans of Indian descent, to deepen psychosocial theorization and empirical work on sexual and gender diversity within this historically excluded sub-group.

Positioning resilience science more centrally in affirming LGBTIQA+ persons and communities

Historically, in psychology, there was a tendency towards focusing on the individual and intrapsychic pathologisation of LGBTIQA+ persons. Despite a recent shift to affirmative, systemic, interpersonal, and contextual stances, too much emphasis in South African LGBTIQA+ scholarly work remains on adversity. Adversity derived from historical tensions may have accelerated adaptive problem-solving capabilities and solution-focused behaviours in some LGBTIQA+ populations. Certain solutions have generated creative resilience responses inexorably situated in race, ethnicity, culture, religion, gender, history, political oppression, and social class. Resilience science that has similarly evolved from the individual trait conceptualisation may have an important complementary contribution to make in affirming LGBTIQA+ persons and communities and enhancing the understanding of their resilience. Exploring resilience for wellbeing and survival addresses the infinite streams of human experiences of vulnerability and sustainable adaptive solutions. The multisystemic resilience perspective in this article endeavours to summarise current thinking in resilience science and position its applicability to future South African LGBTIQA+ scholarly work, building on existing systematic and critical reviews relating to the resilience of LGBTIQA+ persons. The aim of this position piece, suggesting the expansion of a ‘resilience’ frame, is to offer an important intervention in the overarching ways in which South African scholars and psychology professionals theorise and conduct research; to inform therapeutic and other psychological services to LGBTIQA+ persons and provide an important counterweight to the more general focus in South African LGBTIQA+ scholarship and psychological practice on adversity.

Reframing Personal and Professional Values: A Substantive Theory of Facilitating Lesbian, Gay, Bisexual, Transgender and Intersex Youth-Inclusive Primary Health Care by Nurses

LGBTI youth are prone to health-care inequalities and experience poorer health outcomes than the general population. Nurses are not always equipped to effectively respond to LGBTI healthcare needs. The aim of the study was to develop substantive theory based on the social processes involved in facilitating LGBTI youth-inclusive primary healthcare. Using a constructivist grounded theory approach, a sample of seven nurses was interviewed. The codes and categories, that emerged during data analysis were conceptualized to develop the theory: "reframing personal and professional values" which is outlined in three phases. Phase 1 illuminates subtle and covert ways that nurses used to identify value-laden tension and conflict as barriers to LGBTI youth-inclusive care. Phase 2 and 3 reflect thoughtful and reflexive strategies that nurses used to facilitate nurse-patient interaction to resolve value-laden tension and conflict. The substantive theory provides a way of improving the healthcare and health-seeking behavior of LGBTI youth.

The Psychological Society of South Africa’s guidelines for psychology professionals working with sexually and gender-diverse people: towards inclusive and affirmative practice

In this article, we outline the practice guidelines for psychology professionals working with sexually and gender-diverse people, ratified by the Psychological Society of South Africa’s Council in 2017. The guidelines are an augmentation of the Psychological Society of South Africa’s position statement of 2013 providing a framework for understanding the challenges that sexually and gender-diverse people face in patriarchal and hetero- and cis-normative societies. An affirmative stance towards sexual and gender diversity enables psychology practitioners to work ethically, effectively, and sensitively in this field. The guidelines – a first for Africa – are aspirational in nature and call on psychology professionals to become aware of their own biases, conscientise themselves of the best practices in the field by continued professional development, and to utilise the guidelines as a resource in their related work. Brief mention is made of the development process, before the rationale and possible applications of the 12 guidelines are explored.

"The care is the best you can give at the time": Health care professionals' experiences in providing gender affirming care in South Africa

Background

While the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is—theoretically—available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options.

Method

Based on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines.

Results

Our findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider.

Conclusion

Accordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems.

Lesbian, gay, and bisexual clients’ experience with counselling and psychotherapy in South Africa: implications for affirmative practice

The Psychological Society of South Africa has embarked on a process of developing affirmative practice guidelines for psychology professionals working with sexually and gender-diverse people, inclusive of, but not limited to, lesbian, gay, bisexual, transgender, and intersex concerns. Towards informing the guidelines, we explored self-identified lesbian, gay, and bisexual people’s experiences of psychotherapy and counselling in South Africa. A total of 15 qualitative in-depth interviews were conducted with selected participants. Among others, positive experiences entailed receiving unconditional positive regard, acceptance, and non-judgement from counsellors and/or psychotherapists. This included the counsellors and/or psychotherapists positively affirming participants’ sexual orientation by, for instance, viewing same-sex attractions, feelings, and behaviour as normal variants of sexuality and seeing sexual orientation as one aspect of the person, not the only aspect. Negative experiences were almost exclusively ascribed to the counsellors and/or psychotherapists being disaffirming of the client’s sexual orientation. Findings provide a potential basis for future affirmative practice guidelines and indicate that taking a stance affirming of sexual orientation was considered to be important.