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Cultural competence must not leave anyone behind

Nature Human Behaviour volume 7, pages 2040–2041 (2023)Cite this article

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As recently as 2023, 32 countries in Africa criminalized homosexuality, and four punished same-sex consensual sexual activity with the death penalty. Although the legacies of colonialism and the prominence of certain religions in the region have a role in anti-LGBTQ+ sentiment, another plausible contributor is tension between characteristically African values and individual differences2. For instance, a view of the individual–community relation captured in the maxim that ‘the community is before the individual’ can pressure individuals to suppress sexual orientations that conflict with communal perceptions of acceptable practices2. Those who do not comply may be perceived as cultural traitors, social misfits or sexual predators.

Governments and communities have an important role in the erasure of LGBTQ+ health issues in research agendas in Africa2,3. LGBTQ+ individuals are routinely silenced and punished by social sanctions, stigma, human rights violations and legal codes, which exacerbate health injustices. Some harmful practices include ‘corrective rape’, torture, denial of services, and physical and psychological violence by the public, health professionals and police officers2,4,5. In Ghana, for example, LGBTQ+ youth had a higher prevalence of self-harm and higher alcohol and substance use rates than heterosexual youth4; and in Nigeria, a lack of family protection to LGBTQ+ persons is associated with negative psychosocial outcomes such as anxiety, and suicidal thoughts and attempts6. Additionally, as the Global Fund, UNAIDS and PEPFAR have stated, anti-homosexuality legislation — as is the case in Uganda — could negatively affect the country’s HIV response, as well as other aspects of health (such as mental health). Stigma and discrimination are documented barriers to access to treatment and prevention services among LGBTQ+ persons in Uganda, and an earlier Tanzanian ban on the distribution of lubricant (an important HIV prevention tool) negatively affected vulnerable communities.

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Acknowledgements

L.C.-R.’s research has been funded by Hunan University’s Fundamental Research Funds for the Central Universities, fund number 531118010426. The funder had no role in the decision to publish or the preparation of this manuscript. The opinions expressed in this publication are those of the author(s) and do not necessarily reflect the views of these organizations.

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Authors and Affiliations

  1. Department of Philosophy, Yuelu Academy, Hunan University, Changsha, China

    Luis Cordeiro Rodrigues

  2. Global Health, Youth and Development, International Center for Research on Women, Washington, DC, USA

    Chimaraoke Izugbara

  3. Department of Philosophy, University of the Witwatersrand, Johannesburg, South Africa

    Mary Carman

  4. Stellenbosch University, Stellenbosch, South Africa

    Gideon A. J. van Dyk

  5. Department of Health Systems and Policy, Kamuzu University of Health Sciences (KUHES), Blantyre, Malawi

    Eric Umar

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  1. Luis Cordeiro Rodrigues
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  2. Chimaraoke Izugbara
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Correspondence to Luis Cordeiro Rodrigues.

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Cordeiro Rodrigues, L., Izugbara, C., Carman, M. et al. Cultural competence must not leave anyone behind. Nat Hum Behav 7, 2040–2041 (2023). https://doi.org/10.1038/s41562-023-01739-x

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