LGBTIQA and gender diverse persons’ access to healthcare services depends on the types of healthcare services sought. General healthcare services are relatively accessible; however, the quality of care is inconsistent. This is likely due to gaps in cultural competence, including the limited integration of gender-affirming practices within the general healthcare system. LGBTIQA-specific healthcare services remain the least accessible. 

There are significant gaps between the recognition of need and the receipt of appropriate care, particularly for LGBTIQA-specific services. A substantial proportion of participants were unable to access services despite identifying a need.

For example, only half of the 75 participants who required gender-affirming care were able to access it. Among 51 participants who had considered starting a family, only 17 felt comfortable discussing fertility plans with healthcare providers, and just five proceeded with those plans.

Gaps persist in access to HIV services beyond the commonly recognised key affected populations. Trans men, transmasculine persons and cisgender women reported barriers in accessing pre-exposure prophylaxis (PrEP) despite needing it.

Fear of discrimination, trust deficit and lack of knowledge on how to access support services were the most commonly reported barriers to accessing services and redress. Participants reported intersecting forms of discrimination, including ableism, racism, fatphobia, and discrimination based on body size.

Cost emerged as a significant barrier for participants in accessing SRH services, largely due to the fact that such services are primarily available in the private sector and not within the National Healthcare System (NHS). This was particularly evident among those seeking gender-affirming care, with 40% citing cost as a barrier. Participants also highlighted financial barriers in accessing safer sex tools, as some products are not readily available locally.

Between 78% and 90% of the 142 participants reported experiencing GBV across various settings (online, offline, and schools) over their lifetime. The findings indicate that participants’ experiences of GBV due to their SOGIESC often began in childhood and continued into adulthood. 28.2% (40 participants) reported experiencing GBV within the past 12 months. Cisgender queer women and transgender participants reported higher incidences of GBV. 

Sexual violence was among the most commonly reported forms of GBV. While it was experienced across the LGBTIQ spectrum, cisgender queer men reported relatively higher incidences compared to other groups.

Additionally, the survey also found multiple forms of GBV experienced by participants: 

• 33.8% reported experiencing pressure to change their sexual orientation, gender identity and expression, or sex characteristics (SOGIESC).
• 12% reported being forcibly subjected to therapy or institutionalisation in health facilities due to their SOGIESC.
• 12%—mostly cisgender queer women—reported family pressure to marry or change their SOGIESC.
• Three participants (two intersex and one transgender) reported non-consensual medical interventions.

Only 5% of the survey participants reported incidents of GBV, while 10% reported technology-facilitated gender-based violence (TFGBV). Similarly, only nine sought support services. Lack of knowledge on how to access support services was a common barrier.