“As you are, we don’t want gay”: A mixed methods study of structural healthcare discrimination against LGBTQ+ communities in Kenya and Rwanda
Emmy Kageha Igonya, Kashif Basaria, Cassien Havugimana, Boniface Ayanbekongshie Ushie, Egide Niyotwagira, Everest Turatsinze, Ishmael Bahati, Kristefer StojanovskiBackground
Healthcare discrimination contributes to persistent health inequities among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations in sub-Saharan Africa, yet evidence describing disparities across sexual and gender minority groups and the mechanisms underlying discrimination remains limited.
Objectives
To examine healthcare discrimination among LGBTQ+ individuals in Kenya and Rwanda, assess disparities by sexual orientation and gender identity, and explore how discrimination is experienced within healthcare settings.
Design
Explanatory sequential mixed-methods study.
Methods
Quantitative data were obtained from a cross-sectional survey of 2,055 LGBTQ+ adults recruited through respondent-driven sampling in Kenya and Rwanda. Healthcare discrimination was measured using a nine-item scale, and ordinal logistic regression identified associations with sexual orientation and gender identity. Qualitative data were collected through 29 focus group discussions, 47 in-depth interviews, and 69 key informant interviews with LGBTQ+ community members, healthcare providers, and community stakeholders, and were analyzed using combined thematic and narrative analysis.
Results
Lesbian, gay, transgender, and gender-nonconforming participants reported significantly greater healthcare discrimination than bisexual and cisgender participants, with lesbian and transgender participants exhibiting the highest odds of reporting healthcare discrimination.
Conclusion
Healthcare discrimination experienced by LGBTQ+ populations in Kenya and Rwanda reflects structural and interpersonal stigma operating within healthcare systems. Findings underscore the need for equitable, affirming healthcare environments for all sexual and gender minority populations, particularly lesbian and transgender individuals who experienced the greatest burden of discrimination.