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Patient-doctor relationships between same-sex attracted women and general practitioners (GPs) have been presented as problematic in the literature. The problems arise from women’s concerns about the potential for negative attitudes amongst GPs. They also relate to GPs’ concerns about offending patients if they ask about sexual orientation due to the stigmatised nature of minority sexual orientation. As a result, disclosure of sexual orientation can be difficult and the patient-doctor relationship can be compromised. The aim of this study was to explore the nature of patient-doctor relationships in this context and how optimal relationships can be achieved. / Using a critical hermeneutic approach, I conducted in-depth interviews with 33 same-sex attracted women and 28 doctors. This included 24 pairs of people in a current patient-doctor relationship. I found that women commonly experienced silencing of their minority sexual orientation within general practice settings, but that this was occasionally desired and not problematic for some women and most GPs. For other women and for many GPs, the silence resulting from a lack of disclosure was a response to perceived risks to women’s personal identity and GPs’ professional identity. Few GPs asked directly about sexual orientation, placing the burden of responsibility for disclosure on same-sex attracted women. Building reciprocal trust could overcome the perceived risks inherent in revealing minority sexual orientation. I initially defined optimal patient-doctor relationships in terms of existing models of cultural competence and patient-centredness; however I found that such relationships were built on cultural sensitivity rather than cultural competence, and relationship-centredness rather than patient-centredness. / I developed a new model of sexual identity disclosure that demonstrated the key influences on disclosure of sexual orientation to GPs for same-sex attracted women. These influences were women’s sexual identity experience, risk perceptions, and the level of knowing within the patient-doctor relationship. The model depicts women’s range and fluidity of sexual identity experiences and challenges current assumptions that disclosure is essential for effective health care. The model has transformative potential for general practice education and research. It could assist GPs to understand that not all women desire disclosure, but that the majority of women are happy to disclose if asked. GPs would be encouraged to take note of the socio-political environment in which women live and its influence on women’s fears and actual experiences of discrimination. Finally, understanding the role of trust and reciprocal knowing in mitigating perceived risks would encourage GPs to focus more on relationship building. This could also assist GPs to overcome their own perceptions of risk and encourage them to broach the subject of sexual orientation, ultimately enhancing the patient-doctor relationship.

South African institutions of higher learning remain unfriendly and hostile environments for queer students who reportedly continue to experience homophobia, biphobia and transphobia in these spaces. This qualitative enquiry explored the experiences of Lesbian, Gay, Bisexual, Transgender, and Intersexed (LGBTI) students in accessing healthcare in a contact higher education institution. The findings suggest that LGBTI issues are silenced within the university spaces and this blocks the availability of a targeted and strategic approach to deal with the healthcare issues of queer students. Furthermore, it was found that the healthcare services are heterocentric in nature, mainly targeting heterosexual students and deliberately excluding LGBTI students from accessing these services. In addition, the heteronormative attitudes held by healthcare professionals create added barriers for LGBTI students to access healthcare services. Religiously motivated stigma and discrimination prevented healthcare professionals from providing culturally appropriate healthcare services to LGBTI students, thereby excluding them from accessing these services. This research concludes that university management should take decisive action in supporting a human rights framework in order to protect the rights of LGBTI students. Sensitization training as well as the training curriculum of healthcare professionals should include aspects of sexual orientation and gender identity. / Health Studies / M.A.(Social Behaviour Studies in HIV-AIDS)