The Impact of Hate Crimes and Hate Speech on Mental Health and Healthcare Access Among Men Who Have Sex with Men (MSM) in South Africa: A Qualitative Study

Background: Hate crimes and hate speech remain pervasive threats to the safety, dignity, and health of sexual and gender minorities. Although South Africa has a progressive constitutional framework and legal protections, men who have sex with men (MSM) continue to report victimisation, social exclusion, and stigma that can shape mental health trajectories and healthcare seeking. Methods: This qualitative study explored how experiences of hate crimes and hate speech influence MSM’s mental health and their access to and utilisation of healthcare services. Twentyfive MSM from Umlazi Township (KwaZulu-Natal) were purposively recruited through community networks and local LGBTQ+ organisations. Data were collected via semi-structured interviews (average 40–60 minutes), audio-recorded with consent, transcribed verbatim, and analysed using reflexive thematic analysis. Trustworthiness was enhanced through prolonged engagement, memoing, peer debriefing, an audit trail, and member reflections. Results: Four interlinked themes were identified: (1) persistent exposure to hate speech and episodic hate-motivated violence; (2) cumulative psychological sequelae, including hypervigilance, anxiety, depressive symptoms, and suicidality; (3) healthcare avoidance and constrained disclosure driven by fear of judgment, confidentiality breaches, and prior discriminatory encounters; and (4) multi-level intervention needs, including culturally competent care, confidentiality safeguards, accessible psychosocial support, community-based safe spaces, and implementation of hate crime/hate speech protections. Conclusion: Hate crimes and hate speech operate as structural and interpersonal stressors that intensify minority stress and inhibit timely, affirmative healthcare engagement for MSM. Interventions must extend beyond individual-level counselling to include facility-level quality improvement, workforce development, and community–state accountability mechanisms that reduce violence, improve service acceptability, and protect confidentiality.