Health systems responsiveness to queer users in low- and middle-income countries: A narrative thematic synthesis review
1
Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, South Africa
2
Children’s Institute, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2752
ABSTRACT
BACKGROUND:
Health system responsiveness—the ability of health services to meet users’ needs with dignity and equity—is a critical dimension of healthcare quality. Queer populations in low- and middle-income countries (LMICs) face unique barriers to accessing care, yet evidence on their experiences and the systemic factors shaping these interactions remains fragmented. This review synthesizes knowledge on health system responsiveness to queer users across LMICs over a 24-year period.
METHODS:
A narrative thematic synthesis was conducted, including 52 peer-reviewed empirical studies from LMICs. Data on queer users’ experiences and the determinants of these interactions were extracted and analyzed thematically. Analysis was guided by a micro–meso–macro framework to capture individual, organizational, and structural influences on responsiveness.
RESULTS:
Queer users frequently reported negative experiences in healthcare, including verbal abuse, stigma, misgendering, breaches of confidentiality, and restricted access to gender-affirming care, particularly in public sector contexts. Positive experiences were less common and were concentrated in non-governmental, targeted, or private sector services where legal protections and advocacy structures exist. Determinants operated across multiple levels: micro-level factors included provider knowledge gaps, discriminatory attitudes, and fear of social or legal repercussions; meso-level factors included exclusionary organizational practices, inadequate training, and community stigma; macro-level factors included criminalization, heteronormative norms, structural under-resourcing, and policy silence. Notable evidence gaps exist for women who have sex with women, trans men, and intersex populations.
CONCLUSIONS:
Health system responsiveness for queer populations in LMICs is a structurally embedded process shaped by multi-level factors. Addressing inequities requires coordinated interventions spanning provider training, organizational reform, legal protections, and policy frameworks to advance equitable, people-centered care.
Health system responsiveness—the ability of health services to meet users’ needs with dignity and equity—is a critical dimension of healthcare quality. Queer populations in low- and middle-income countries (LMICs) face unique barriers to accessing care, yet evidence on their experiences and the systemic factors shaping these interactions remains fragmented. This review synthesizes knowledge on health system responsiveness to queer users across LMICs over a 24-year period.
METHODS:
A narrative thematic synthesis was conducted, including 52 peer-reviewed empirical studies from LMICs. Data on queer users’ experiences and the determinants of these interactions were extracted and analyzed thematically. Analysis was guided by a micro–meso–macro framework to capture individual, organizational, and structural influences on responsiveness.
RESULTS:
Queer users frequently reported negative experiences in healthcare, including verbal abuse, stigma, misgendering, breaches of confidentiality, and restricted access to gender-affirming care, particularly in public sector contexts. Positive experiences were less common and were concentrated in non-governmental, targeted, or private sector services where legal protections and advocacy structures exist. Determinants operated across multiple levels: micro-level factors included provider knowledge gaps, discriminatory attitudes, and fear of social or legal repercussions; meso-level factors included exclusionary organizational practices, inadequate training, and community stigma; macro-level factors included criminalization, heteronormative norms, structural under-resourcing, and policy silence. Notable evidence gaps exist for women who have sex with women, trans men, and intersex populations.
CONCLUSIONS:
Health system responsiveness for queer populations in LMICs is a structurally embedded process shaped by multi-level factors. Addressing inequities requires coordinated interventions spanning provider training, organizational reform, legal protections, and policy frameworks to advance equitable, people-centered care.
| eISSN: | 2654-1459 |
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