Conversion Therapy in Africa: An Assault on Human Rights and Ethical Healthcare

	Author: Dr Jarred H. Martin (PhD Psychology), Department of Psychology, University of Pretoria
	Author: Pierre Brouard (MA Clinical Psychology), Centre for Sexualities, AIDS & Gender, University of Pretoria

Introduction

The recent publication of Outright International’s report, Health Ethics and the Eradication of Conversion Practices in Africa, draws needed attention to the prevalence of conversion practices in Africa, particularly within the context of healthcare settings. As psychologists, we write about conversion therapy as a subset of conversion practices (including those conducted by faith and cultural practitioners, often at the behest of family) aimed at changing an individual’s sexual orientation or gender identity and expression. Conversion therapy can include psychological counselling, medical interventions, and aversion techniques, such as electrical shocks to the genitals during exposure to same-sex sexual imagery.

Underlying Belief System of Conversion Ideology

The ideology underpinning conversion therapy is rooted in heteronormativity and cisnormativity – the belief that heterosexuality and cisgender[i] identities are the default or ‘normal’ state of being. This ideology often draws from religious doctrines and cultural norms that view LGBTQ (queer) identities as ‘deviant’ or morally unacceptable and, with this, has been promoted by religious groups.

Prevalence of Conversion Therapy

Conversion therapy has been widely discredited and outlawed in many countries. In Africa, the practice persists due to weaker regulatory frameworks and deeply ingrained cultural and religious beliefs. While comprehensive data on the prevalence of conversion therapy in Africa is limited, anecdotal accounts and reports from human rights organisations suggest that it remains a significant issue, particularly in countries with strong anti-LGBTQ sentiments.

Legislative Support for Conversion Therapy

In several African countries, anti-LGBTQ legislation has created enabling environments for conversion therapy. While longer-standing colonial penal codes in many African states remained intact after independence, and have come to form the basis for much of the discrimination queer Africans have faced, recent legislative developments in countries such as Uganda and Nigeria, amongst others, have expanded the criminalisation of consensual same-sex sexual relationships. In, for example, the debate surrounding Uganda’s Anti-Homosexuality Act, discourses of ‘rehabilitation’ emerged as an alternative to criminal prosecution, in effect providing credence to conversion ideology and fomenting a culture of misinformation around the viability and legitimacy of conversion practices.

Conversion Therapy in Healthcare Settings

The emergence of conversion ideology in healthcare settings poses a threat to the wellbeing of queer-identifying people. Some healthcare providers, influenced by cultural or religious beliefs, may offer, or even coerce patients into undergoing conversion therapy. This practice violates fundamental healthcare principles, including the patient’s best interest, right to dignity, and informed consent. The lack of human rights-centred healthcare law, challenges in regulatory oversight, as well as the prevalence of stigmatising attitudes towards queer individuals, are further challenges.

Negative Mental Health Consequences of Conversion Therapy

Research consistently highlights the detrimental mental health impacts of conversion therapy. Individuals subjected to it often experience increased rates of depression, anxiety, suicidal ideation, and self-harm. Survivors of conversion therapy also attest to the psychological trauma inflicted on them and the long-lasting impact on their self-worth and mental health; so much so that the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, has likened conversion therapy to torture.

Lack of Scientific Support for Conversion Therapy

There is unanimous consensus among reputable medical and psychological associations globally that conversion therapy lacks scientific validity. Not only does the World Health Organization (WHO) accept diversity in sexual orientation and gender identity, but the American Psychological Association, American Psychiatric Association, World Medical Association, World Psychiatric Association, and the United Nations Independent Expert on protection against violence and discrimination based on Sexual Orientation and Gender Identity, have criticised conversion therapy as ineffective and harmful, calling for its eradication. Regrettably, few African mental health bodies, with the exception of the Psychological Society of South Africa (PsySSA), have denounced conversion therapy. PsySSA also gone on to publish best practice guidelines when working with queer patients, enabled by South Africa’s constitution, health-specific legislation, such as the Mental Health Care Act, and standards of care, such as the Patients’ Rights Charter.       

Ethical and Evidence-Based Norms

Conversion therapy starkly contrasts with evidence-based practices in mental healthcare, which prioritise patient wellbeing, respect for individual autonomy, dignity and informed consent. Ethical healthcare mandates that interventions be grounded in scientific evidence and align with core principles such as beneficence, non-maleficence, respect for autonomy, and informed consent. Conversion therapy fails on all these counts, as it is not supported by scientific evidence, causes harm, and often involves coercion or deception.

Conclusion

Conversion therapy is not only an affront to the dignity and mental health of queer people but also a violation of international and African human rights law. African states need to recognise the profound harm inflicted by these practices and take decisive action to prohibit them. The most effective way to do this would be through enacting legislation that protects queer people from the kinds of dignity degrading practices that constitute conversion therapy. This would however need to be coupled with a multifaceted approach which includes:

• state investment in a comprehensive sexuality education that builds more inclusive and affirmative attitudes to sexual and gender diversity;
• governments amending laws that standardise healthcare practices to ensure these are grounded in evidence and international ethical standards of care;
• introducing anti-discrimination policies that explicitly prohibit discrimination based on sexual orientation and gender identity by registered healthcare professionals within the statutory bodies that regulate them; and,
• integrating sexuality and gender affirmative healthcare approaches in the curricula of institutions responsible for educating and training future generations of healthcare practitioners.

Taken together, these form the crucial steps toward protecting the rights and wellbeing of queer Africans across the continent.

Acknowledgment:

The authors would like to acknowledge the insightful feedback offered by Thiruna Naidoo and Yvonne Wamari of Outright International in reviewing this piece.

[i] To be cisgender is to identity with sex assigned at birth

About the Authors

Dr Jarred H. Martin (PhD) is a senior lecturer in Psychology at the University of Pretoria, South Africa, where he manages the Master of Arts in Clinical Psychology degree programme and teaches in the areas of psychological and psycho-legal assessment as well as ethics and law for psychological practice. His research concentrates on critical studies of bodies, gender/s, and sex/uality/ies. He is a member of the Africa-Europe Cluster of Research Excellence in Health, Gender and Sexualities, and a former Deputy Chair of the Sexuality and Gender Division of the Psychological Society of South Africa.

Pierre Brouard is the Acting Director of the Centre for Sexualities, AIDS and Gender (CSA&G) at the University of Pretoria and a registered Clinical Psychologist. His interests and work include sexualities, gender, violence, transformation, diversity and social justice. He is a board member of the Professional Association for Transgender Health South Africa and sits on the Executive of the Sexuality and Gender Division of the Psychological Society of South Africa.