Lesbian, Gay, Bisexual, Transgender, Queer/Questioning and Intersex (LGBTQI+) populations are marginalized and discriminated against in South Africa, placing them at high risk for poor physical and mental health. Despite this, access to LGBTQI+ sensitive and affirming health services is severely limited.
The LGBT+ Health Division, based at Groote Schuur Hospital in Cape Town, was established in 2008. Our aim is to promote equitable access to appropriate and affirming healthcare for LGBTQI+ populations through research, community engagement and advocacy.
LGBTQI+ populations, particularly men who have sex with men (MSM) and transgender women, are disproportionately affected by HIV. In South Africa, HIV prevalence is 38.5% for young MSM and over 50% for transgender women in urban areas.
The LGBT+ Health Division has been active in groundbreaking clinical trials particularly in HIV prevention. We were the only site in Africa for the Chemoprophylaxis for HIV Prevention in Men Study (iPrEx) which was the first study to definitively prove that HIV pre-exposure prophylaxis (PrEP) as a concept works. Other studies include the NIH sponsored MTN 017, HPTN 075 and HPTN 083 trials as well as the NIAID sponsored Sibanye Health Project, a pilot study that examined a comprehensive HIV prevention package for MSM in Southern Africa.
Our clinical trials unit at Groote Schuur Hospital continues to participate in innovative HIV prevention research for MSM and transgender populations. We are an accredited clinical research site for the NIH Division of AIDS sponsored HPTN 083 trial. This double-blind safety and efficacy study of injectable Cabotegravir compared to daily oral Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC) as PrEP has shown that injectable Cabotegravir was superior to oral PrEP in preventing HIV infection. This injectable prevention option was registered for use as PrEP in South Africa in November 2022.
Currently, we are enrolling MSM and transgender men and women on PURPOSE 2, which is a PrEP trial of a long working injectable drug that can be given once every six months.
By providing people with better prevention options, we aim to lower the rates of HIV infection in South Africa so that we can move towards a generation free of HIV.
The LGBT+ Health Division supports an extensive community outreach and engagement programme which aims to empower LGBTQI+ individuals and communities to enhance their own health and wellbeing.
The backbone of this programme is a network of safe spaces for MSM and LGBTQI+ community members. In its founding year, the Division established Safe Space groups for LGBTQI+ communities in townships around Cape Town. These are community-led safety initiatives which aim to provide LGBTQI+ community members with safe and open environments to network, build their knowledge and understanding of HIV and other health-related issues as well as develop leadership capacity, and enhance health activism and advocacy in their communities. We have established 10 Safe Spaces including a Trans Safe Space, with whom we have a close working relationship. The Community Liaison team based in Phillipi Village support the Safe Space leaders in the management and coordination of the programme.
Health and Advocacy Day
Our work also promotes community engagement and advocacy through the organisation of an annual LGBTQI+ Health and Advocacy Day. We have successfully hosted two of these events which bring together health service providers, researchers, civil society, and community members to share information about health services, research, and advocacy for the LGBTQI+ community. The Health and Advocacy Day is an opportunity to promote LGBTQI+ affirming health care and grow a network of partners advocating for equitable access to healthcare for LGBTQI+ populations.
In addition, the Division aims to promote inclusion, increase knowledge, and start dialogues around the diversity of sexual orientations and gender identities. To this manner, we have developed a SOGI (sexual orientation and gender identity) Universe which is a free access online resource to be used to promote awareness and provide education around these concepts.
The LGBT+ Health Division is staffed by a diverse, primarily LGBT-identifying team with ample experience working to improve the health and wellbeing of LGBTQI+ communities.
Key staff include:
Amelia Mfiki, Community Liaison Officer
Doerieyah Reynolds, HIV Prevention Trials Coordinator
Lynn Bust, Project Manager
Richard Kaplan, Head of Division