When care meets resistance: professional nurses’ real-world struggles in providing primary health services to LGBTQI communities in Amahlathi, Eastern Cape Province, South Africa

Background Access to equitable primary healthcare (PHC) for LGBTQI individuals remains a persistent challenge worldwide, yet little is known about how professional nurses (PNs) in rural South African contexts experience and navigate these challenges. Objective The study aimed to explore and describe the lived experiences of professional nurses in providing PHC services to LGBTQI patients in Amahlathi Municipality, Eastern Cape Province, South Africa. Methods For this research, a descriptive phenomenological research design was used to obtain rich, in-depth accounts of the real-world experiences of nurses. A non-probability purposive sampling method was used to select 23 professional nurses working in PHC facilities in the Amahlathi Sub-district, Eastern Cape. Data were collected through semi-structured face-to-face interviews, which were then analyzed using Colaizzi’s phenomenological data analysis method. Measures to ensure trustworthiness and ethical considerations were maintained throughout the study. Results The findings showed that professional nurses face significant competency gaps, personal biases, and confusion about LGBTQI identities, which negatively affect the delivery of services. They also revealed that LGBTQI patients often fear discrimination, withhold sensitive information, and display defensive behaviors due to past negative experiences. Consequently, these combined provider- and patient-related challenges strain clinical interactions and hinder equitable primary healthcare access in Amahlathi. Conclusion The study revealed that professional nurses in the rural Eastern Cape face both personal and systemic obstacles to providing inclusive care to LGBTQI individuals. Enhancing nurses’ competencies through targeted LGBTQI-focused training, creating supportive clinical environments, and strengthening policy frameworks are critical to improving the quality of care.