Abstract
A growing body of evidence from high-income countries suggests that Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (LGBTQ+) young people are at elevated risk of self-harm and eventual suicide, compared to their heterosexual counterparts (Miranda-Mendizábal et al., 2017; WHO, 2014). However, self-harm and suicide research and prevention efforts have paid less attention to LGBTQ+ young people in Africa.
Despite the general homophobic environment and social hostilities against LGBTQ+ persons in most African countries, evidence suggests that many young people still identify as LGBTQ+ in the region (Kaoma, 2018). However, neither global nor regional published systematic reviews and meta-analyses have found studies providing evidence on self-harm or suicidality among LGBTQ+ young people in countries in Africa (Liu et al., 2019; Miranda-Mendizábal et al., 2017; WHO, 2014).
Thus far, only three recent primary studies have shown that self-harm and suicide could represent critical mental health problems among LGBTQ+ young people in Africa (Bantjes et al., 2019; Oginni et al., 2018; Quarshie et al., 2020a). University-based studies from Nigeria and South Africa have shown a positive association between atypical sexual orientation, and suicidal ideation and non-fatal suicidal behaviour (Bantjes et al., 2019; Oginni et al., 2018). In Ghana, a higher 12-month self-harm prevalence estimate has been reported among LGBT adolescents (45%; 95% confidence interval [CI]: 33–57), compared to their cisgender, heterosexual counterparts (18%; 95% CI: 14–22) (Quarshie et al., 2020a).
Two key reasons could explain the paucity of research on self-harm and suicidality among LGBTQ+ young people in Africa. Firstly, besides the lack of full-scale studies on self-harm and suicidality among LGBTQ+ samples in African countries, psychiatric research and public health studies have not included items on minority sexual orientation and gender identity as demographic variables (Quarshie et al., 2020b). For example, surprisingly, the WHO has failed to include items on LGBTQ+ identities as key demographic variables in the implementation of the global school-based student health survey across Africa (WHO, 2020).
Secondly, LGBTQ+ identities are criminalised in most African countries, coupled with a strong homophobic and hostile social environment in the region (Kaoma, 2018). This makes LGBTQ+ persons a hard-to-reach population for research in the region.
Against, the foregoing challenges, the following recommendations are made. Besides the inclusion of sexual and gender minority identity variables in mental health and epidemiological research, future studies could consider the use of online research approaches that increase access to LGBTQ+ young population and ensure anonymity of participants (McDermott et al., 2013). In order to access participants in-person, researchers could consider collaborating with pro-LGBTQ+ charity facilities and non-governmental organisations working with LGBTQ+ people. In this approach, waiver of parental permission and appropriate mechanisms for protecting underage participants should be put in place under relevant and appropriate child protection policies and ethical guidelines.
Evidence of sound future research will facilitate prevention and intervention efforts, and progress towards enhanced health of LGBTQ+ young people; community- and school-based sexual health education programmes may benefit from such evidence to help young people who have sexual orientation or gender identity concerns. More imperatively, evidence of sound future studies may be informative for or against the debate regarding the call to (de)criminalise LGBTQ+ identities in Africa.
