LGBTQI+ persons globally experience healthcare challenges and dissatisfaction with the care they receive in primary healthcare facilities, as evidenced by the constant discrimination, homophobia and stereotypical attitudes from professional nurses (Medina-Martínez et al. 2021). The primary researcher, a senior manager employed in a primary healthcare environment overseeing primary healthcare services, often receives verbal or written complaints relating to discrimination, homophobia and discriminatory attitudes from self-identified LGBTQI+ persons when they access primary healthcare facilities. This prompted a scientific inquiry into understanding what contributes to such experiences, as primary healthcare services should be accessible to everyone, irrespective of race, sex, gender or social standing. This statement is supported by the National Department of Health, which reiterates that accessible healthcare services should be provided to everyone who needs them and without discrimination (www.national department of health 2021). Dahir (2024) affirms that despite the positive commitments various countries made to develop and implement policies to promote inclusive healthcare services, LGBTQI+ individuals still experience health disparities.

Primary healthcare facilities appear to be only providing care to those who are classified as heterosexual, which promotes the experiences of discrimination, stigma and uncaring moments by LGBTQI+ people (McGowan, Lowther & Meads 2021). Various literature concurs that the challenges LGBTQI+ persons experience in primary healthcare facilities are contributed to by a healthcare system that is designed for a heteronormative society, which automatically excludes those who identify as LGBTQI+ individuals (Dube et al. 2026; Ramalepe & Maake 2025). A systematic review study in Canada found that LGBTQI+ people experienced longer waiting times when seeking healthcare services, which often results in them delaying or avoiding seeking medical care (Ansell et al. 2017). Further, Moyo, Macherera and Mavhandu-Mudzusi (2021) unveiled that men having sex with other men in Zimbabwe often experience stigmas and discrimination when accessing primary healthcare facilities, in comparison to heterosexual males. Specifically to the South African context, the lack of resources (lubricants, finger gels, hormonal tablets), non-inclusive environments and clear policies containing content for the LGBTQI+ persons contribute to an unfavourable experience of care in primary healthcare facilities (Sefolosha, Van Wyk & Van der Wath 2021). Subsequently, the WHO has noted that LGBTQI+ persons experience health disparities, especially those who are identified as transgender, and concluded the need for the development of guidelines that promote inclusion and how to prevent stigma and discrimination among LGBTQI+ people (Rosa et al. 2024). The literature and narrative above give insight into the challenges and realities that LGBTQI+ persons encounter globally when accessing primary healthcare facilities.

This study was underpinned by intersectionality theory. The researchers found this theory applicable to this study, as it focuses on components such as oppression, marginalised communities and discrimination (Liu 2023). Moreover, this theory provides a lens into different aspects of an individual’s identity, including class, race, sexuality and nationality (Tracy 2025). Intersectional theory addresses systemic barriers experienced by LGBTQI+ persons (Sekoni, Jolly & Gale 2022). Specific to this study, this theory explored the unbearable experiences encountered by LGBTQI+ persons in primary healthcare facilities and the unpreparedness of professional nurses in providing care to LGBTQI+ individuals. Kline (2022) advises that applying intersectional theory effectively will assist professional nurses and other health professionals in recognising the specific healthcare needs of LGBTQI+ people and in providing mindfulness to LGBTQI+ persons, enabling healthcare workers to provide individualised healthcare.

This study employed an interpretive phenomenological analysis to explore in depth how self-identified LGBTQI+ persons experienced primary healthcare services when accessing these facilities for healthcare services. Interpretive phenomenological analysis appeared relevant for this study as the researchers were not only interested in exploring the participants’ experiences in primary healthcare facilities but also to understand what these experiences meant to them and their interpretation thereof (Smith & Fieldsend 2021). This method was deeply rooted in Heidegger’s hermeneutic phenomenology, which believes that human beings can interpret their own experiences based on their individual experiences (Cooke et al. 2026). Within this study, this method promoted a double hermeneutic, which facilitated meaningful dialogue between the 16 participants understanding, of their own experiences within primary healthcare facilities in Gauteng, and the researchers own interpretative lens as researchers, which assisted the researchers not only to understand what happened but also to understand the meaning of the participants experiences, in order to have transformative insight (Alsaigh & Coyne 2021, Wanat, Day & Larkin 2025).

The population in this study comprised self-identified LGBTQI+ persons accessing public healthcare facilities in the Gauteng province. From the population, 16 (N = 16) participants consented to participate in the study through a non-probability snowball sampling technique. This method was employed because these participants are regarded as a hard-to-reach community that is often marginalised, thus using a peer network (Nkabinde-Thamae & Downing 2026; Tukisi et al. 2025).

The participants were recruited from primary healthcare facilities in Gauteng, South Africa, from all five districts (City of Ekurhuleni, Tshwane, Sedibeng, West Rand and the City of Johannesburg). The primary researcher shared a poster on social media platforms, such as Facebook, which contained all the relevant information about the study, the title of the research study, aims and objectives, inclusion and exclusion criteria, emphasis on the ethical principles and the primary researcher’s contact details for participants seeking clarification or expressing interest in participating in the study. To ensure that even individuals not on social media were reached, the primary researcher hand-delivered flyers at the approved facilities. Potential participants used the primary researcher’s contact details for clarification and to express their interest in participating. Participants were considered enrolled only after attending the information session and signing the informed consent.

This study was conducted in primary healthcare facilities across the entire Gauteng province (City of Ekurhuleni, City of Johannesburg, Sedibeng, Tshwane and West Rand). These are fixed healthcare facilities in urban areas, led by my multidisciplinary team of healthcare workers, comprising primary healthcare nurses and medical doctors, operating Monday to Friday, 08:00 am-16:30 pm (Mashazi et al. 2025; Seretlo & Mokgatle 2022). Moreover, these facilities provide healthcare services such as Antenatal Care (ANC), postnatal care (PNC), immunisations and chronic disease management (Kapologwe et al. 2020).

Specific inclusion criteria were used to ensure that relevant participants were recruited, as advised by Keung et al. (2020). Thus, the inclusion criteria for this study were as follows:

Data collection commenced upon receipt of all relevant ethical clearance and gateway approvals. Data collection occurred from June 2023 to November 2023 (6 months). Through face-to-face, unstructured, individual interviews at a place and time convenient for the participants, away from primary healthcare facilities, but rather at community centres or other public places such as restaurants, where noise was minimal, and the possibility of interruption was low. Unstructured individual interviews help researchers collect high-quality data (Tukisi, Matshidza & Malesela 2025). Unstructured interviews were employed so that the sixteen participants could share their lived experiences and be conducted in any format they felt comfortable with (Barnard, Smith & Long 2026). This format promoted the researchers’ reflexive bracketing by ensuring that interviews were focused on the participants’ lived experiences rather than those of the researchers (Smith, Larkin & Flowers 2021). Wanat et al. (2025) note that unstructured interviews are embedded in open-ended questions, which assist researchers to gain a deeper understanding and meaning of the phenomena, which provides the depth as advised by interpretative phenomenological inquiry (Aveyard et al. 2024).

The primary researcher conducted all the interviews; the secondary researcher had a supervisory role, listening to all recorded interviews to assess the authenticity of the recordings and the relevance of the collected data. All participants were asked one central question: ‘What are your experiences with the care you receive when accessing primary healthcare facilities in Gauteng, South Africa?’ This central question allowed self-identified LGBTQI+ persons who access PHC facilities as a point of care to share their lived experiences. In addition to the central question, the primary researcher posed various probing questions that emerged from participants’ responses to ensure the phenomenon was thoroughly explored and that the researchers could understand it from the participants’ perspective (Online Appendix 1, Table 1-A1). All sixteen interviews were conducted in English, lasted approximately 45–60 min and were audio recorded. In this study, interviews were conducted until data saturation was reached. Thus, data saturation was used to determine the sample size when additional participants could no longer provide further information on the phenomenon (Al-Otaibi et al. 2024). Through the individual interviews of the 16 participants across Gauteng province, the researchers determined that interpretative redundancy was achieved, resulting in the data being regarded as a thick, in-depth description of self-identified LGBTQI+ persons’ experiences in primary healthcare facilities in Gauteng, South Africa.

Within this study, the researcher used reflexivity and bracketing to maintain the reliability of the study and to prevent any personal biases from influencing the data (Patton 2015). Further to validate the results of this study, multiple sources, namely audio recordings of all participants, field notes and observation notes, were kept by the researchers, which assisted in identifying and bracketing any biased experiences of the phenomena (Kawar et al. 2024). Further reflexive bracketing was employed to uphold the trustworthiness of the study (LoBiondo-Wood & Haber 2026). The data were obtained by the primary researcher, a PhD candidate with adequate knowledge and skills to conduct individual face-to-face interviews. All the auto-taped interviews were listened to by the secondary researcher, a full professor, to ensure the data collection process was authentic and from the participants’ perspective. In addition, the primary researcher became mindful that his professional background could affect the study’s analytical process; thus, reflexive bracketing was employed, with the primary researcher consciously identifying possible preconceived ideas, theories or biasness regarding the experiences of LGBTQI+ persons when accessing primary healthcare facilities in Gauteng, South Africa. Moreover, the primary researcher used a reflexive journal to continuously document any internal biases or emotional reactions to ensure the authenticity of the data collection and analysis. This allowed the themes and sub-themes to form a clear narrative of the participant’s experience rather than the primary researcher’s (Ybarra & Stephens 2025).

In qualitative research, data analysis aims to reduce the volume of collected data by coding relationships and patterns in the findings to provide the researcher with a comprehensive snapshot of the data (Bush & Amechi 2019; Johnson & Christensen 2024). The researchers applied Braun and Clarke’s six steps (phases) of reflexive thematic analysis (Braun & Clarke 2019, 2022, 2023). Adopting a relativist ontological position guided the researchers to be mindful that there is no single objectivity on self-identified persons’ experiences in primary healthcare facilities, but rather a subjective and multiple one, which during the analysis process gave the researchers insight into how the 16 participants constructed meaning from their own lived experiences. The coding was done manually by the researchers: (1) The researchers engaged and familiarised themselves with the collected data by reading the field notes and listening to the audio recordings several times to understand and derive meaningful interpretations. During this process, bracketing was applied. (2) Thereafter, the researchers focused on segments of meaning that gave insight into the ‘what’ and ‘how’ of the 16 participants’ lived experiences when accessing primary healthcare facilities in Gauteng, South Africa. (3) Thereafter, the researchers determined the different patterns that appear to be true for the LGBTQI+ persons (the participants). During this stage, the researchers reviewed the themes and sub-themes against the raw data from all 16 participants. This involved looking beyond simple positive or negative binary categorisation to identify contradictions and fine details. This process ensured that the themes and sub-themes provided a comprehensive and nuanced account of the participants’ experiences in Gauteng healthcare facilities. (4) During this step, reflexive bracketing was upheld, as the researchers constantly compared the sixteen transcripts, resulting in the themes and sub-themes being captured to present a deeper interpretative meaning of the participants’ own lived experiences. (5) Within this study, the themes and sub-themes were defined to be inclusive of the participants’ verbal contributions to the phenomenon and any underlying emotional nuances, which assisted the researchers to develop a richer understanding of the participants. Lastly, a detailed report was generated, providing interpretative depth by incorporating verbatim quotes, allowing the findings to be grounded in the experiences of the 16 participants (Braun & Clarke 2022, 2023).

Denzin and Giardina (2024) state that researchers play an imperative role within a research process; thus, in this study, the researchers were constantly aware of their own personal and interpersonal reflexivity to avoid bias or preconceived assumptions regarding this phenomenon. The primary researcher used a reflective diary to write down his daily thoughts and feelings (Silverio et al. 2022). Furthermore, trustworthiness was promoted through credibility, transferability, dependability and confirmability as advised by Lincoln and Guba (1965). Credibility was established through prolonged engagement (6 months) with the participants until data saturation was reached. An independent coder with a PhD in nursing and extensive experience in qualitative analysis conducted a secondary data review. The secondary researcher, a full professor at an esteemed university, served as the study’s supervisor. The dependability of this study was upheld through the selection process of participants, data collection and data analysis. The researchers promoted confirmability by remaining objective throughout the research process and by bracketing their own perceptions of the lived experiences of LGBTQI+ persons when accessing primary healthcare facilities in Gauteng, South Africa. Lastly, transferability was ensured by the researchers’ clear description of the study and the sampling methods.

Before the researchers began data collection, the primary researcher held an information session with potential individual participants to provide study details and allow them to ask clarifying questions. Afterwards, participants who met the inclusion criteria were asked to provide their consent to participate. However, the primary researcher informed participants that they had the right to withdraw at any stage of the research process. Confidentiality, privacy, justice and anonymity were maintained throughout the research process (Mulaudzi & Downing 2025). Moreover, this study was subject to ethical review from the University of Johannesburg Ethics Committee (REC-1822-2022). In addition to the ethical review process, permission had to be obtained from all the districts designated as the research settings for this study.

The thematic analysis revealed that self-identified LGBTQI+ persons experienced inhumane and discriminatory treatment in primary healthcare facilities in Gauteng, South Africa. Professional nurses’ bias often overshadowed ethical care, leaving participants feeling dehumanised and fearful of seeking healthcare services.

The thematic exploration of the experiences of LGBTQI+ at primary healthcare facilities in Gauteng, South Africa, yielded three major themes, namely: (1) Social injustice, (2) professional nurses’ unpreparedness for inclusive care and (3) experiences of affirmative care. These three central themes include sub-themes as summarised in Table 1.

Theme 1 hailed from the participants expressing that their human rights were compromised when accessing primary healthcare facilities; thus, the following sub-themes were included in this theme: (1) Human rights violations, (2) discrimination and (3) compromised confidentiality.

The participants reported experiencing social injustice when accessing primary healthcare facilities. Luvo and Kangethe (2023) argue that despite legislative frameworks such as the Constitution of South Africa prompting equality and protection of the LGBTQI+ communities, these individuals still experience violations of their human rights, as evidenced by the constant discrimination and homophobic attacks in primary healthcare facilities. Arora, Bhujang and Sivakami (2022) state that the violations of their human rights in healthcare settings are observed through LGBTQI+ people being denied healthcare services and often being discriminated against because of their sexual preferences. Despite this study being conducted within Gauteng, SA, the literature reveals that the violation of the LGBTQI+ persons appears to be a global challenge. As evidenced in Arkansas, the Medical Ethics and Diversity Act allowed healthcare workers to refuse care to this community, often leading this population to feel they were denied access to care (Suess Schwend 2020). In Brazil, it was found that individuals who were identified as intersex were often subjected to surgical procedures with the attempt to normalise them, thereby infringing upon their rights to autonomy, bodily integrity and well-being (Leivas et al. 2023).

The participants felt that professional nurses demonstrated discrimination towards them by creating a heteronormative environment, making incorrect assumptions about their sexual orientation, misgendering and using derogatory language. Badat, Moodley and Paruk (2023) affirm that LGBTQI+ individuals are discriminated against when accessing primary healthcare facilities in Gauteng. Hosseinabadi-Farahani et al. (2023) report that discrimination in the healthcare setting is associated with unfavourable healthcare outcomes linked to physical and mental deficiencies. The impact of discrimination towards LGBTQI + persons contributes to them suffering from high levels of anxiety, depression, substance abuse and even not making use of healthcare facilities in general (Bayram, Weigand & Flatt 2023). Freaney et al. (2024) conclude that when nurses exhibit discriminatory attitudes towards LGBTQI+ persons, it hinders their ability to provide clinically competent healthcare, further promoting uncaring practices. Hendricksen et al. (2022) argue that discrimination in the healthcare setting occurs unconsciously among healthcare workers, as they often lack the relevant skills to provide the desired healthcare services needed by LGBTQI+ persons. Participants in this study also shared that they wished professional nurses would stop discriminating against them. Hendricksen et al. (2022) conclude that discrimination can be addressed only through training that promotes inclusivity for all patients who require healthcare services. Clark and Koenig (2023) allude that diminishing discrimination within a healthcare setting is imperative as discrimination decreases the usage of healthcare services by LGBTQI+ individuals.

Hudak, Carmack and Smith (2018) support the phenomenon that healthcare workers often compromise confidentiality when providing care to LGBTQI+ patients by not respecting their preferred pronouns or discussing confidential matters with other healthcare workers, even when there is no need. This often leads to LGBTQI+ persons leaving the healthcare facilities in shame and with the view or decision not to use healthcare facilities in the future (Jamieson et al. 2020). LGBTQI+ persons face challenges regarding confidentiality as the healthcare environment lacks inclusivity of LGBTQI+ individuals, which adversely affects their overall privacy and confidentiality (Beagan et al. 2023). Englund, Basler and Meine (2020) assert that the lack of confidentiality that LGBTQI+ people experience is linked to heteronormative beliefs and ignorance by professional nurses. Pezzella (2023) further suggests that compromised confidentiality within primary healthcare facilities towards LGBTQI+ persons is a result of discrimination, stigma and non-inclusive healthcare policies. The lack of confidentiality towards LGBTQI+ persons reflects a breach of their human rights and the core fundamental of the nursing profession, which often results in mistrust and compromised communication between the healthcare workers and the LGBTQI+ persons (Goldberg, Rosenburg & Watson 2018).

This theme depicted that professional nurses were not empowered to provide care to the participants, and the following sub-themes were established: (1) Inadequate knowledge, skills and values, (2) imposing heterosexual norms and values and (3) lack of humanity.

Bloompott et al. (2023) state that the existing nursing curriculum frequently exhibits insufficient incorporation of LGBTQI considerations, which profoundly affects the quality of care provided to this population. In addition, empirical studies suggest that nursing education often neglects critical subjects pertinent to LGBTQI health, resulting in a deficiency in knowledge and readiness among nursing practitioners (Klepper et al. 2023). Furthermore, the lack of representation of LGBTQI+ topics within nursing curricula fosters an environment characterised by invisibility and stigma, which may discourage LGBTQI individuals from pursuing essential healthcare services (Cassidy et al. 2023; Day, Snyder & Dennis Flores 2023). A recent study in the South African context found that professional nurses’ lack of understanding of and training in the LGBTQI+ sexual and reproductive healthcare services compromised access by LGBTQI+ individuals to primary healthcare facilities (Seretlo & Mokgatle 2023). Englund et al. (2020) conclude that the lack of LGBTQI+ content within the nursing curriculum accelerates health disparities and promotes a healthcare environment that focuses on the healthcare needs of heterosexual individuals.

Öcalan and Hicdurmaz (2024) assert that the imposition of personal beliefs by professional nurses upon LGBTQI+ individuals may result in substantial healthcare disparities and a deterioration in the quality of care provided. The reality of professional nurses imposing their personal beliefs and cultures on LGBTQI+ persons emanates from the homophobic and transphobic practices within the nursing environment (Westwood, James & Hafford-Letchfield 2023). A study in Turkey revealed that professional nurses impose their own beliefs and biases on LGBTQI+ persons, as they believe that these individuals disrupt social norms (Aslan & Paslı Gürdoğan 2024). Ghio, Malsch and McGuigan (2025) allude that the phenomenon of nurses imposing their personal beliefs on LGBTQI+ persons raises significant concerns, particularly as healthcare settings have traditionally favoured heterosexual paradigms, thereby marginalising LGBTQ+ identities to a significant extent. Similar findings in Canada concluded that, aside from professional nurses imposing their personal beliefs on LGBTQI+ individuals, nurses often offer false support rather than genuine inclusive support (Haghiri-Vijeh 2023).

Arora et al. (2022) found that LGBTQI+ persons often experience a lack of humanity in healthcare environments, which is the result of constant discrimination, homophobic attacks and nurse bias. Similar studies concur that in healthcare settings, the lack of humanity towards LGBTQ+ persons is often experienced through disrespect, insufficient care, rudeness, bullying and insensitivity from professional nurses (Stein et al. 2023). The lack of humility in professional nurses when caring for LGBTQI+ persons promotes emotional distress among this population, which erodes trust in healthcare professionals and intensifies unmet needs (Allison et al. 2024). A study by Nair et al. (2021) found that barriers, such as professional nurses’ deficient knowledge of the LGBTQI+ community, contribute to a gap in their ability to provide patient-centred, humble care. Pearce and Di Lorito (2023) state that professional nurses have voiced that they lack the relevant skills, knowledge and values required to provide quality care; individualised care that is centred around humanity towards LGBTQI+ persons and other marginalised populations.

This theme unveiled some positive findings which the participants experienced when accessing primary healthcare facilities, as follows: (1) Quality care from male nurses and (2) quality care from younger female nurses.

Callan, Corbally and McElvaney (2023) and Pratt-Chapman et al. (2022) concur that despite the healthcare disparities experienced by LGBTQI+ persons when accessing healthcare facilities, male nurses appear to be providing better care and understanding to this population. Duckett and Ruud (2019) affirm that male nurses are more inclined to provide inclusive healthcare to LGBTQI+ persons and other marginalised groups. The literature provides evidence that male nurses in the nursing profession provide satisfactory healthcare services to all patients and communities, as they appear receptive to diverse cultural dynamics (Budu et al. 2019). Margolies and Brown (2019) assert that it is imperative for all professional nurses to culturally promote competent, caring practices when providing care to LGBTQI+ persons to diminish health disparities and health-related risks. Sirufo et al. (2022) argue that despite the positive experiences LGBTQI+ persons have had with male nurses, healthcare practices can only be improved through the inclusion of approved training and educational content focused on the LGBTQI+ community. Furthermore, Cottingham, Johnson and Taylor (2016) contribute that some men within the nursing profession might still be providing care to LGBTQI+ persons that is based on stereotypes and homophobia, which are promoted through societal heteronormative practices.

Young female nursing professionals frequently display an inclination towards self-reflection and the modification of their communicative approaches, a practice deemed crucial for effectively catering to the distinctive requirements of LGBTQI+ patients (Reeves et al. 2024). Landry and Kensler (2019) state that emerging young female nurses can deliver enhanced healthcare services to LGBTQI patients by understanding health inequities, refining communication practices and fostering inclusive environments informed by culturally sensitive protocols outlined in the document. Similarly, a study in Portugal found that young female nurses can provide better care to LGBTQI+ persons because of their positive attitudes and acceptance of all marginalised individuals (Gomes et al. 2023). Despite the literature indicating the positive contributions young females make to caring for LGBTQI+ persons, Webb and Zablocki (2023) argue that there is still a need for all healthcare providers, including young female nurses, to be empowered with inclusive care skills to promote culturally competent care for LGBTQI+ persons.

The secondary researcher served as the supervisor during data collection, thereby enhancing the credibility of the research findings. To further promote credibility, data analysis was conducted by an independent coder. In addition, the primary researcher remained in the field for approximately 6 months; this allowed the researchers to explore the phenomenon in depth and make sense of LGBTQI+ persons’ experiences when accessing primary healthcare facilities in Gauteng, South Africa.

The study lacked methodological triangulation, as the researchers focused uniquely on face-to-face, unstructured interviews with individuals, limiting the possibility of verifying the experiences of other LGBTQI+ persons when accessing primary healthcare facilities in Gauteng, South Africa.