Worldwide, sexual and gender minorities struggle to access sexual and reproductive health (SRH) services. In South Africa, sexual prejudice is entrenched and pervasive in health systems and SRH services do not cater for a diverse range of people. Though health reform is underway, little attention has been given to how sexuality is being addressed in this process, particularly in the National Health Insurance (NHI) scheme currently being piloted. We analyse interview data generated in an NHI pilot district, using discursive methodology, informed by a sexual and reproductive justice standpoint. We show how sexual and gender minorities are discursively in/visibilised in health settings and discuss these findings in relation to the social justice and solidarity aims of health systems reform.
Human Sciences Research Council (2026) studied this question.