Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa.
Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa.
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DOI：
10.1186/s12914-017-0124-4
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发表时间：
2017-05-30
影响因子：
3
通讯作者：
Müller A
中科院分区：
文献类型：
--
作者：
Müller A
性取向和性别认同是确定为女同性恋者、男同性恋者、双性恋者和变性人(LGBT)的健康的社会决定因素，性少数群体和性别少数群体之间的健康差异越来越为人所熟知。尽管南非宪法保障性少数群体和性别少数群体不受歧视的权利和获得医疗保健的权利，但社会上同性恋和变性人恐惧症比比皆是。人们对南非LGBT人群的医疗经历知之甚少，但坊间证据表明，获得医疗服务存在重大障碍。本研究以联合国《经济、社会、文化权利国际公约》第14号一般性意见为框架，分析了LGBT健康服务使用者使用南非公共医疗保健服务的经历，包括获得艾滋病毒咨询、检测和治疗的机会。定性研究包括对LGBT健康服务用户的16次半结构化访谈和两次焦点小组讨论，以及对LGBT组织代表的14次个别访谈。在联合国《经济、社会、文化权利国际公约》第14号一般性意见的框架内对数据进行了专题分析，重点是护理的可获得性、可获得性、可接受性和质量。所有受访者都报告了保健提供者基于性取向和/或性别认同而受到歧视的经历。与会者叙述了违反联合国一般性意见的所有四个要素的情况：1)可用性：缺乏针对一般和LGBT特定问题的公共卫生设施和服务；2)可获得性：医疗保健提供者拒绝向LGBT患者提供护理；3)可接受性：明确表达道德判断和对LGBT患者身份的反对，以及强迫患者接受宗教习俗；4)质量：缺乏关于LGBT身份和健康需求的知识，导致低质量的护理。参与者过去推迟或避免寻求医疗保健，没有人寻求医疗系统内的问责或投诉机制。性取向和性别认同是健康公平分析的重要类别，导致了第14号一般性意见所界定的医疗保健服务的所有四个方面的差异。医疗保健提供者的歧视性和偏见态度，再加上缺乏能力和知识，是南非出现这些差异的主要原因。
Sexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people’s healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment. A qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care. All interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients’ identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or avoided seeking healthcare in the past, and none had sought out accountability or complaint mechanisms within the health system. Sexual orientation and gender identity are important categories of analysis for health equity, and lead to disparities in all four dimensions of healthcare access as defined by General Comment 14. Discriminatory and prejudicial attitudes by healthcare providers, combined with a lack of competency and knowledge are key reasons for these disparities in South Africa.