Analysing the Health of Queer Muslims Through the 4M Framework: A Scoping Literature Review

Abstract

The health and wellbeing of queer Muslims, a group positioned at the intersection of multiple marginalised identities, remains underexplored in academic literature. This scoping literature review critically analyses existing research on queer Muslim health using the 4M framework (Mega, Macro, Meso, Micro) to identify structural and individual determinants impacting health outcomes. The study highlights the profound influence of intersecting factors such as race, ethnicity, gender, sexuality, geographic location, and socioeconomic status on healthcare access and health outcomes. Findings reveal that dominant epistemological assumptions about queerness and Islam perpetuate stigma, discrimination, and minority stress, leading to adverse health outcomes. Key barriers include inadequate funding, homonormative healthcare policies, and exclusionary cultural expectations within healthcare settings. Conversely, supportive familial, peer, and religious networks, along with access to digital resources, are identified as facilitators of better health outcomes. The review calls for culturally competent, strength-based models of care and emphasises the need for future research to address the diverse health experiences of queer Muslims across different regions and identities.

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Sexuality & Culture
https://doi.org/10.1007/s12119-025-10342-3
REVIEW ARTICLE
Analysing theHealth ofQueer Muslims Through the4M
Framework: AScoping Literature Review
ShiaSamad1· SiobhanIrving2 · SujithKumarPrankumar3,4 ·
HorasWong5,6 · MuhammadNaveedNoor6,7,8 · BernardSaliba1,4
Accepted: 2 March 2025
© The Author(s) 2025
Abstract
The health and wellbeing of queer Muslims, a group positioned at the intersection
of multiple marginalised identities, remains underexplored in academic literature.
This scoping literature review critically analyses existing research on queer Muslim
health using the 4M framework (Mega, Macro, Meso, Micro) to identify structural
and individual determinants impacting health outcomes. The study highlights the
profound influence of intersecting factors such as race, ethnicity, gender, sexuality,
geographic location, and socioeconomic status on healthcare access and health out-
comes. Findings reveal that dominant epistemological assumptions about queerness
and Islam perpetuate stigma, discrimination, and minority stress, leading to adverse
health outcomes. Key barriers include inadequate funding, homonormative health-
care policies, and exclusionary cultural expectations within healthcare settings. Con-
versely, supportive familial, peer, and religious networks, along with access to digi-
tal resources, are identified as facilitators of better health outcomes. The review calls
for culturally competent, strength-based models of care and emphasises the need for
future research to address the diverse health experiences of queer Muslims across
different regions and identities.
Keywords LGBTQ + Muslim health· Intersectionality in healthcare· Culturally
competent care· Intersectional health disparities· Minority stress and health
Introduction
In recent years, the health and wellbeing of culturally and linguistically diverse
(CALD) populations, including those with diverse sexualities and genders, has
become a focal point of scholarly interest. Yet, little is known about the health expe-
riences of queer Muslims–a group at the intersection of multiple identities. This
represents a concerning gap, especially considering that intersections of race, eth-
nicity, gender, sexuality, geographic region, and socioeconomic status significantly
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S.Samad et al.
influence healthcare access and overall health outcomes (Medina-Martínez et al.,
2021).
Current research also suggests that religious affiliation can impede health access
for some queer people (Miller etal., 2020). For instance, in religiously conservative
environments, individuals may be reticent to disclose their queer identities and sex-
ual practices to healthcare professionals due to the illegality and stigma attached to
same-sex sexual relationships in their respective contexts. Additionally, laws against
homosexuality have not only eroded Indigenous sexualities but also facilitated the
emergence of a Western-centric concept of homosexuality, used to demonise and
criminalise queer sexual practices (Coll-Planas etal., 2021; Massad, 2019; Rahman,
2010). While many queer people now adapt Eurocentric identity politics to achieve
LGBTQ + rights, this categorisation based on sexual and gender identities contin-
ues to serve as a means for surveillance and control of queer expressions, which
extends into healthcare environments (Coll-Planas etal., 2021; Massad, 2019; Rah-
man, 2010).
Extensive research also demonstrates that secular institutions, government poli-
cies, sociocultural norms surrounding gender and sexuality, family and community
networks can significantly impact healthcare experience, needs, access and outcomes
(Chaudhry etal., 2024; Kassa & Grace, 2019). In light of these wide-ranging influ-
ences, this review employed the 4M framework (Mega, Macro, Meso, Micro) along
with Bourdieu’s theory of capital to explore how factors operating at structural and
institutional levels cascade down to impact individuals, shaping their health, health-
care access, and experiences (Kassa & Grace, 2019; Noor, 2021). Additionally, this
framework also acknowledges the agentive potential of individuals to achieve better
health outcomes within the constraints of their respective environments.
In this context, a review of literature on the health of queer Muslims is timely.
This scoping review aims to critically analyse the existing research on the health
of queer Muslims, with an emphasis on understanding their unique health experi-
ences, needs, and the barriers they face in achieving optimal health and wellbeing.
By addressing this critical research gap, the review aims to contribute to the fields of
public health, queer studies, and cultural competency in healthcare.
Method
Research Questions andProtocol
This review adheres to the PRISMA-ScR checklist and Arksey and O’Malley meth-
odological framework for scoping studies (Arksey & O’Malley, 2005). The protocol
for this scoping review was registered in Open Science Framework and includes a
detailed explanation of the staged PRISMA-ScR process undertaken. This is avail-
able in Supplementary Material S1. The overarching research question, decided
upon collaboratively by the team, was: ‘What does existing research say about the
health experiences and needs of queer Muslims?’ In answering this question, we
also sought to understand whether healthcare services are experienced as accessible
and relevant for queer Muslims, and what similarities and differences exist in the
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
health needs and outcomes for sexuality and gender diverse Muslims, considering
intersectional differences.
Search Strategy
We conducted searches in five databases: MEDLINE, EMBASE, PsycINFO,
CINAHL and Scopus. Only peer-reviewed research articles (i.e. excluding grey liter-
ature) published in English until 2nd November 2023 were included. Search terms,
developed by the whole team, were organised under three major concepts: ‘queer’,
‘Muslim’ and ‘health’. Search strategies for each database (detailed in Supplemen-
tary Material S2) were drafted by a team member [SS], reviewed by another team
member [BS], then evaluated and further refined using the PRESS 2015 Guideline
Evidence-Based Checklist. Consultations were also held with a research librarian,
and among the contributing authors, who participated in a consensus-based process
of developing the search strategy.
After conducting the database searches, duplicate articles were eliminated in
EndNote (Fig.1). To ensure consistency during the screening process, a team mem-
ber [HW] devised a flowchart (see Supplementary Material S3) to determine eligible
papers. Papers shortlisted following an initial screening process by the first author
[SS] were transferred to Covidence for independent title and abstract screening by
all team members. Conflicts during this stage were discussed and assessed using
the flowchart by two members [SS, BS]. All team members then conducted full-text
screening. Conflicts during full-text screening were resolved by three members [BS,
HW, SI]. After the final articles were selected, two team members [SS, BS] re-eval-
uated and cross-checked the articles initially excluded in EndNote.
Eligibility Criteria
Inclusion Criteria
Theoretical and empirical papers published in indexed journals were included in this
review. Theoretical studies had to primarily focus on queer Muslim health, while
empirical studies required either a queer Muslim sample of at least 25% or attend to
specific findings related to queer Muslim health. Given the profound shifts in media,
foreign and military policy, government surveillance, and global perceptions of
Muslims following the September 11 attacks in 2001, the team decided to limit lit-
erature inclusion to those published between September 2001 and November 2023.
Exclusion Criteria
The search strategy resulted in 1393 articles. During the screening process 796 arti-
cles were excluded. Of these excluded papers, 255 papers had a limited health focus
(e.g. homonationalist policies, identity construction with no or tangential references
to health outcomes), and 252 were either irrelevant or included a queer Muslim sam-
ple of less than 25%. 103 papers were excluded on the basis that they focused on
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S.Samad et al.
societal attitudes towards or between queer and Muslim populations, or the attitudes
of Muslim healthcare workers/educators toward queer clients whose religious back-
grounds were not specified. Other papers were excluded on the basis that they were
not journal articles (N = 63), did not specify their participants’ religious beliefs or
conflated Islam with ethnicity (N = 53), were theology-based (N = 43), or were pub-
lished before 2001 (N = 18). The remaining 9 papers were excluded because their
either non-queer or non-Muslim authors presented reductive or stereotypical analy-
ses of homosexuality and transgenderism, or framed Muslims and Islam through a
singular, monolithic lens. These essentialist perspectives limited their ability to criti-
cally engage with the diversity of queer Muslim identities and experiences, perpetu-
ating stigma rather than providing nuanced insights.
Data Extraction andSynthesis
The shortlisted papers were distributed among all team members for extraction.
The extracted information was then cross-checked by another team member. The
Fig. 1 PRISMA Flowchart
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
extracted information included publication details (e.g., authors, study design, coun-
try, and publication year); the specific subpopulation of queer Muslims under exami-
nation (including sample number and percentage of queer Muslim participants for
empirical studies); the specific health focus, key findings and study limitations (see
summary of this information in Supplementary Material S4).
We used an inductive and iterative approach to identify themes. The main find-
ings identified during data extraction and full-text readings were coded, synthesised,
and organised hierarchically by a team member [SS]. These codes were reviewed by
another team member [SKP] before discussion with the rest of the team. Given that
many papers discussed structural issues relating to health, we adapted a multilevel
sociological systems framework, known as 4M (Mega, Macro, Meso, Micro), to
interpret and present the findings (Kassa & Grace, 2019). This model helps explain
the complex interplay between mega, macro, meso and micro level factors(Fig.2).
Findings
A total of 27 papers were included in this review. For clarity, given the linearity
of the text format, findings from these papers are presented as individual themes.
However, we recognise that these themes often intersect and overlap, reflecting the
complex nature of the subject matter.
Overview ofIncluded Articles
The studies spanned fourteen countries: Australia, Canada, France, Germany, United
Kingdom, United States, Turkey, Lebanon, Kuwait, Pakistan, Bangladesh, Malaysia,
Nigeria, and Senegal. Two empirical papers included multi-country samples. There
was a range of study designs: the majority were qualitative (52%), then quantitative
(22%), theoretical (15%), and mixed methods (11%). Participants in empirical stud-
ies were overwhelmingly gay men, men who have sex with men (MSM), men who
have sex with men and women (MSMW), and trans women. Lesbians, bisexuals,
trans men, non-binary or genderfluid individuals constituted a smaller proportion of
the studies. Additionally, we would like to highlight that the health experiences of
queer Muslim individuals in the reviewed literature are all shaped by varying geo-
graphic, legal, cultural, and religious contexts. For instance, in some Muslim-major-
ity countries, accessing healthcare is fraught with legal and social risks. Conversely,
queer Muslims in some secular societies often contend with intersecting stigmas
related to both Islamophobia and homophobia, influencing their healthcare experi-
ences differently.
Mega: Epistemological Assumptions
Epistemologies are foundational beliefs that underpin ways of knowing, perceiving
and being in the world. Conflicts can arise when individuals, groups or institutions
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S.Samad et al.
Fig. 2 Summary of Review Findings
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
hold different epistemological assumptions that lead to contrasting perspectives on
truth and ethics.
Authors of the papers surveyed discussed a range of epistemological assumptions
about sexuality, gender and religion. Notably, they identified several dominant, con-
flicting (and often essentialist) narratives about what it means to be Muslim or to
be queer. These mega-level assumptions not only overshadowed diversities within
and across communities but also invisibilised queer Muslim desires, identities, and
spaces, resulting in significant implications for health, healthcare access and service
delivery at the macro, meso and micro levels.
Assumptions About “Being” Queer
Fourteen papers discussed rigid epistemological assumptions regarding the notion
of being queer (Akolo etal., 2014; Altay etal., 2021; Alvi & Zaidi, 2021; Askari &
Doolittle, 2022; Barmania & Aljunid, 2016; Etengoff & Rodriguez, 2021; Farhadi
Langroudi & Skinta, 2019; Hammoud-Beckett, 2022; Kumpasoğlu etal., 2022; Lim
et al., 2020; Pallotta-Chiarolli etal., 2022; Scull & Mousa, 2017; Semlyen etal.,
2018; Vaughan et al., 2021). The authors highlighted dominant cultures within
LGBTQ + , Muslim and wider communities that construct the hegemonic queer
identity as Westernised, white, urban and secular (or a combination thereof) and
that this ideal is antithetical to (their construction of) being Muslim. The literature
also highlighted how there were implicit expectations of how to “be queer” and pre-
scribed scripts to follow, such as sexual non-monogamy, public displays of affection
and coming out. Three papers interrogated the concept of coming out, describing it
as a Western construct that can be limiting for some queer Muslims as it can create
an added pressure to perform a prescribed identity (Farhadi Langroudi & Skinta,
2019; Hammoud-Beckett, 2022; Vaughan et al., 2021). Hammoud-Beckett intro-
duces the concept of ‘coming in’ (i.e. consciously inviting select people into their
life to share their gender and sexuality with) as another legitimate, more appropriate
pathway for some queer Muslims to affirm and honour both their familial and inti-
mate relationships (Hammoud-Beckett, 2022).
Assumptions About “Being” Muslim
There were also dominant epistemological assumptions about being Muslim.
Almost all papers noted that most Qur’anic interpretations consider queer sexual
behaviour sinful and are cisnormative in that they assume that everyone will ‘natu-
rally’ embrace and perform roles associated with the gender they were assigned at
birth. Six papers from the USA, Australia, Germany, Canada, Turkey and France
also discussed gendered stereotypes about Muslims that arise from legacies of colo-
nialism, nationhood and migration, such as discriminatory ideas that Muslims as
‘feudal’, ‘uncivilised’, ‘backwards’, ‘dangerous’, ‘alien’, ‘invaders’ who contaminate
host nations and require assimilation (Altay etal., 2021; Alvi & Zaidi, 2021; Farhadi
Langroudi & Skinta, 2019; Khan & Cailhol, 2020; Pallotta-Chiarolli et al., 2022;
Vaughan etal., 2021).
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S.Samad et al.
Consequences ofThese Assumptions
The aforementioned epistemological assumptions were found to have profound
implications for health, manifesting in pervasive stigma and discrimination,
heightened experiences of minority stress, and the erosion of Indigenous genders
and sexualities.
Stigma andDiscrimination The dominance of these assumptions has resulted in
pervasive stigma and discrimination, which was discussed in every paper. Stigma
and discrimination manifested across structural, institutional and legislative levels,
community and network levels, as well as familial and individual levels. Due to
its extensive impact, this issue is explored throughout the findings, rather than in
isolation.
Multiple Minority Stress andInternalisation Almost all papers linked the mega
to the micro, emphasising how stigma and discrimination caused adverse health
outcomes among queer Muslims. Ten papers discussed queer Muslims expe-
riencing multiple minority stress and used minority stress theory to guide their
research (Etengoff & Rodriguez, 2021, 2022; Farhadi Langroudi & Skinta, 2019;
Kumpasoğlu etal., 2022; Maatouk & Jaspal, 2022; Ogunbajo etal., 2022; Pallotta-
Chiarolli etal., 2022; Stuhlsatz etal., 2021; Usman etal., 2018; Vaughan etal.,
2021). Three papers described how many queer Muslims experienced adverse
mental health outcomes (e.g., suicidality, depression, anxiety) because they inter-
nalised Islamophobic and queerphobic beliefs (Farhadi Langroudi & Skinta, 2019;
Hammoud-Beckett, 2022; Ogunbajo etal., 2022). In fact, in order to counter this,
one clinician promoted ‘externalisation’ (i.e. exposing sociopolitical discourses
that queer Muslims have internalised as their fault) as a therapeutic technique to
help queer Muslims deconstruct dominant assumptions and construct their own
narratives of empowerment (Hammoud-Beckett, 2022).
These findings caution against adopting the reductionist view that the chal-
lenges faced by queer Muslims is an internal clash between an individual’s
religion and sexuality. Pallotta-Chiarolli and colleagues emphasise how this
neoliberal position diminishes ‘structural and institutional responsibility and
culpability’, while shifting the burden onto individuals (Pallotta-Chiarolli etal.,
2022). It ignores legacies of colonialism, histories of migrations and other drivers
of Islamophobia and queerphobia. Moreover, it fails to recognise that for some
queer Muslims, Islam serves not as a source of conflict but as a strength-giving
force.
Erasure ofIndigenous Genders, Sexualities andWays ofBeing Globally, cultures
exhibit a vast array of understandings and expressions of gender and sexuality, many
of which challenge or outright reject Western binary norms. Ten articles described
some or all queer Muslims in their studies resisting Western LGBTQ + identities.
Since discrete forms of male-male sexual intimacy are common and practiced in
Muslim-majority countries, many participants rejected LGBTQ + identities as
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
they did not perceive themselves to be outside of normative communities (Khan
& Cailhol, 2020; Khan etal., 2005; Sheehy etal., 2014). Some participants also
embraced Indigenous identities specific to their cultural contexts, such as socio-
sexual hijra identities like zanana, narban and khusra in Pakistan (Usman etal.,
2018); overlapping MSM identities like kothi, panthi, giriya and doparata in
Bangladesh (Khan etal., 2005); and two-spirit, in the life, and macha/o identi-
ties in the US (Stuhlsatz etal., 2021). Several papers depict healthcare systems
and institutions not only as perpetuators of dominant Western epistemologies but
also as entities that systematically fail to recognise or accommodate the healthcare
needs of individuals with these Indigenous identities (Altay etal., 2021; Pallotta-
Chiarolli etal., 2022).
Macro: Healthcare Systems
This section focuses on findings relating to the influence of government legisla-
tion, NGOs, and religious institutions on healthcare delivery, funding, and fram-
ing for queer Muslims. It examines the epistemic assumptions perpetuated by
these entities and the systemic barriers to achieving good health outcomes.
Government Legislation andHealthcare
Several studies highlighted that the criminalisation of homosexuality and/or
transgenderism in some Muslim-majority countries posed significant healthcare
challenges for organisations supporting queer Muslims. In one study, an NGO
advocating for trans women needed to register under the guise of “other activi-
ties” due to government pressure (Rashid & Afiqah, 2023). An absence of pro-
tective legislation also resulted in limited access and uptake of essential health
services (Ogunbajo etal., 2022; Rashid & Afiqah, 2023). Five papers described
how punitive laws in Nigeria, Senegal, Pakistan and Malaysia–even if rarely
enforced–challenged effective HIV prevention, treatment, and support (Akolo
etal., 2014; Alio etal., 2022; Barmania & Aljunid, 2016; Sheehy et al., 2014;
Usman et al., 2018). Moreover, stigma on a legislative level also emboldened
some healthcare workers to discriminate against queer Muslims accessing health-
care (Akolo etal., 2014).
The literature addressed how legislation in non-Muslim majority countries
also marginalised queer Muslims. Two main forms of legislative marginalisation
were identified. The first form is evident in laborious bureaucratic procedures.
Two papers highlighted how undocumented Pakistani migrants and transgender-
immigrant Muslim sex workers in Europe were unable to access state medical
aid or employment as they lacked a valid place of residency, passport, insur-
ance, and tax number (Altay etal., 2021; Khan & Cailhol, 2020). Consequently,
many participants sought unsafe and informal healthcare or were forced into
survival sex work in dangerous and unregulated conditions. These ‘labyrinthine
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S.Samad et al.
bureaucracies’ served as significant barriers for vulnerable queer Muslim popu-
lations who lacked the cultural capital to navigate through state systems, proce-
dures, and paperwork (Altay etal., 2021).
The second form of legislative marginalisation related to homonormative policies
that were reinforced by medicolegal institutions within society. Altay and colleagues
described how many general practitioners in Germany only prescribed hormone
replacement therapy (HRT) and gender confirming surgery (GCS) if their client
demonstrated to a psychological counsellor that they met the criteria outlined in the
American Psychological Association’s definition of gender identity disorder (Altay
etal., 2021). However, some participants expressed expansive, fluid gender identi-
ties, which fell outside trans definitions recognised by state and medical authori-
ties. Consequently, participants who failed to perform an idealised trans identity that
aligned with Western binary logics of gender were disqualified from receiving gen-
der-affirming care (Altay etal., 2021).
Funding, NGOs, andHealthcare
The literature underscored glaring deficiencies in funding allocation. For instance,
in 2011, only 1% of the HIV budget in Malaysia was allocated to MSM prevention
programs compared to 58% earmarked for intravenous drug users (Lim etal., 2020).
By 2016, only 0.2% of the total Malaysian HIV prevention budget was allocated to
MSM programming (Barmania & Aljunid, 2016). This is concerning given that five
papers described concentrated HIV/AIDS epidemics among MSM, hijra, and trans
populations in Muslim-majority countries like Malaysia, Nigeria, Senegal and Paki-
stan (Akolo etal., 2014; Alio etal., 2022; Barmania & Aljunid, 2016; Sheehy etal.,
2014; Usman etal., 2018).
While none of the papers focused on government-driven initiatives, eleven
papers described NGO involvement (Afiqah etal., 2022; Akolo et al., 2014; Altay
etal., 2021; Barmania & Aljunid, 2016; Khan & Cailhol, 2020; Khan etal., 2005;
Kumpasoğlu etal., 2022; Lim etal., 2020; Rashid & Afiqah, 2023; Usman et al.,
2018; Zainal-Abidin etal., 2022). NGOs undertook a range of roles including pro-
viding free, confidential medical consultations and treatments; assisting with hous-
ing and access to social welfare; and hosting social events for queer Muslims. In the
absence of government funding, resources, and initiatives to ensure health, NGOs
offered models of service delivery for queer Muslims.
Religious Influence andHealthcare
Religious groups can exert significant influence over public health policy and fund-
ing (Barmania & Aljunid, 2016; Lim etal., 2020; Rashid & Afiqah, 2023; Zainal-
Abidin et al., 2022). One paper described how Ministry of Health officials and
NGOs in Malaysia had to covertly implement harm reduction strategies for MSM.
To ensure funding and placate religious stakeholders, they carefully framed initia-
tives in language that prioritised health outcomes (e.g. “disease prevention”) over
rights-based approaches (Barmania & Aljunid, 2016).
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
Ten papers also described queer Muslims being coerced into conversion therapy,
often by family-of-origin or by religious leaders (Alvi & Zaidi, 2021; Barmania
& Aljunid, 2016; Farhadi Langroudi & Skinta, 2019; Hammoud-Beckett, 2022;
Kumpasoğlu etal., 2022; Lim etal., 2020; Maatouk & Jaspal, 2022; Ogunbajo etal.,
2022; Semlyen etal., 2018; Vaughan etal., 2021). These forced conversions involve
referrals to Muslim or Christian therapists with the aim of ‘returning an individual
to a hypothesised heterosexual self’ or, as a last resort, to practice celibacy (Farhadi
Langroudi & Skinta, 2019). Several papers noted that some queer Muslims actively
sought out conversion therapies to suppress their same-sex desires, with some even
relocating to USA or Europe for ‘treatment’ (Farhadi Langroudi & Skinta, 2019).
In a Nigerian study, Muslim participants were slightly more likely to be forced into
conversion therapy than Christian participants (Ogunbajo etal., 2022).
Meso: Capital andHealth
This section provides an overview of the literature in relation to capital and its influ-
ence on queer Muslim health.
Social Capital
Family‑of‑origin Family-of-origin as a determinant of health was a major theme,
explored in fourteen papers (Afiqah etal., 2022; Alio etal., 2022; Alvi & Zaidi, 2021;
Askari & Doolittle, 2022; Etengoff & Rodriguez, 2021, 2022; Hammoud-Beckett,
2022; Khan etal., 2005; Lim etal., 2020; Maatouk & Jaspal, 2022; Rashid & Afiqah,
2023; Scull & Mousa, 2017; Stuhlsatz etal., 2021; Zainal-Abidin etal., 2022). Stud-
ies showed that levels of familial acceptance are strongly associated with depression
and suicidality scores (Etengoff & Rodriguez, 2021; Rashid & Afiqah, 2023). Par-
ticipants across studies had varying relationships with their families. These included
concealing their queerness to preserve their relationships with family or to safeguard
their family’s reputation within their communities (Afiqah etal., 2022); distancing
themselves from their families or leading double lives to balance familial expecta-
tions with their desire to live authentically (Afiqah etal., 2022; Alio etal., 2022;
Khan & Cailhol, 2020); being disowned by their families (Afiqah etal., 2022; Eten-
goff & Rodriguez, 2021; Scull & Mousa, 2017; Usman etal., 2018); being abused
or forced into conversion therapy by family post disclosure (Afiqah etal., 2022; Alio
etal., 2022; Etengoff & Rodriguez, 2021; Hammoud-Beckett, 2022; Khan & Cailhol,
2020; Pallotta-Chiarolli etal., 2022; Rashid & Afiqah, 2023; Scull & Mousa, 2017);
and experiencing no changes or having an improved relationship with family post dis-
closure (Afiqah etal., 2022; Etengoff & Rodriguez, 2021). Some participants noted
that their families became more accepting over time (Afiqah etal., 2022).
Community andChosen Family Peer networks also had a significant influence on
health outcomes. When they lacked family support, queer Muslim participants often
relied on friends and chosen families. For instance, papers described undocumented
Muslim migrants and sex workers in Europe, trans women in Malaysia and hijra in
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S.Samad et al.
Pakistan forming tightly knit homosocial communities (Altay etal., 2021; Khan &
Cailhol, 2020; Usman etal., 2018). Several studies demonstrated that participants
with robust peer networks had lower levels of depression compared to those who were
marginalised by their peers (Etengoff & Rodriguez, 2021; Rashid & Afiqah, 2023;
Usman etal., 2018). The literature also highlighted the importance of dedicated queer
Muslim spaces, given that participants across studies felt excluded from both Muslim
communities and queer communities (see Compartmentalisation) (Askari & Doolit-
tle, 2022; Etengoff & Rodriguez, 2022; Hammoud-Beckett, 2022; Kumpasoğlu etal.,
2022; Lim etal., 2020; Pallotta-Chiarolli etal., 2022; Semlyen etal., 2018).
Material Capital
Digital and Online Resources Digital capital refers to one’s ability to transform
online resources into social resources. Ten papers explored this concept to varying
degrees (Etengoff & Rodriguez, 2021, 2022; Kumpasoğlu etal., 2022; Lim et al.,
2020; Ogunbajo etal., 2022; Pallotta-Chiarolli etal., 2022; Rashid & Afiqah, 2023;
Scull & Mousa, 2017; Stuhlsatz etal., 2021; Vaughan etal., 2021). They emphasised
that online platforms empowered queer Muslims to express their gender or sexuality
in ways they were unable to do in offline settings (Stuhlsatz etal., 2021), and con-
nected them to local queer Muslim communities and/or to resources and networks
inaccessible locally (Scull & Mousa, 2017). A global study revealed that while 73%
of participants had never attended queer Muslim events in person, 60% belonged to
online queer Muslim networks (Etengoff & Rodriguez, 2022). Moreover, three stud-
ies found that engaging in online queer Muslim communities fostered self-accept-
ance, reduced depression, and promoted resilience when navigating minority stress
(Etengoff & Rodriguez, 2021, 2022; Scull & Mousa, 2017). However, two papers
noted the risks of digital spaces: one detailed how popular dating apps like Grindr,
Hornet, and Jack’d increased the likelihood of unsafe sexual practices, while the other
discussed participants’ experience of transphobic cyberbullying (Lim etal., 2020;
Rashid & Afiqah, 2023).
Cultural Capital
Dominant and Non‑dominant Cultures Cultural capital refers to an individual’s
capacity to leverage the values, resources, knowledge, and dominant culture of a soci-
ety, institution, or organisation. Doing so enables upward mobility and the ability to
navigate complex systems such as healthcare. The literature showed that queer Mus-
lims’ cultural capital (or lack thereof) affected their access to healthcare in various
ways. One paper showed that only two trans Muslim participants qualified for HRT
and GCS because they had the cultural and educational tools (e.g. fluent German, state
education, ability to leverage NGO support) to align their cases with local medicole-
gal standards (Altay etal., 2021). The remaining participants, who did not embody
trans identities recognised by the German system, were denied gender affirming care
(Altay etal., 2021). Other studies from South Asia and Africa revealed a cultural
disconnect in HIV/AIDS organisations and their clientele. Specifically, organisations
that used identity-based strategies aimed at MSM, gay and bisexual men failed to
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
reach clients who also engaged in sexual activity with cisgender women (Khan etal.,
2005; Sheehy etal., 2014). Studies from Australia and the UK also highlighted queer
Muslim anxieties around disclosing their sexual practices (or lack thereof) to health-
care providers. While some feared for their privacy, others felt embarrassed that their
limited sexual experience/knowledge diverged from dominant cultural expectations
of being sexually active/literate (Pallotta-Chiarolli etal., 2022; Semlyen etal., 2018).
Religion andSpirituality For queer Muslims, religion can be both a protective and
risk factor for mental health, depending on their relationship with Islam, and their
religious and/or queer communities. Research indicated that being part of a support-
ive religious community boosts wellbeing and resilience. A North American study
found that participants born into a Muslim faith had higher levels of psychological
wellbeing than Muslim converts – potentially because the former may have more reli-
gio-social capital (Stuhlsatz etal., 2021). Another study found that gay and bisexual
Lebanese men who regularly attended religious services had lower rates of depres-
sion and distress (Maatouk & Jaspal, 2022). However, one study described how queer
Muslims who internalised religious anti-gay messages and frequently attended reli-
gious services exhibited higher levels of depressive symptoms and were more likely
to undergo conversion therapy (Ogunbajo etal., 2022).
We identified three main identity-based coping strategies in the literature
reviewed. First were participants who rejected their Muslim identities to embrace
their queer identities. Second were participants who embraced their Muslim identi-
ties to reject their queer identities. Third were participants who embraced both their
Muslim and queer identities. Research indicated that participants who embraced
both identities reported the highest life satisfaction, suggesting that if these identi-
ties are not in conflict, religiosity might be an important factor for emotional well-
being (Kirac, 2016). Four studies also described queer Muslims using Islam as a
strength-giving force and how religious engagement reduced distress and depres-
sion (Etengoff & Rodriguez, 2022; Maatouk & Jaspal, 2022; Vaughan etal., 2021;
Zainal-Abidin etal., 2022). While many of these participants used religious coping
strategies to embrace gender and sexuality, others used it to practice abstinence and
celibacy (Etengoff & Rodriguez, 2022; Vaughan etal., 2021; Zainal-Abidin etal.,
2022).
Financial Capital
Two studies from Nigeria and the United States showed that queer Muslims with
higher income levels had better mental health and resilience (Ogunbajo etal., 2022;
Stuhlsatz etal., 2021). In contrast, queer Muslims who experienced economic dis-
crimination were less likely to maintain good health. Economic exclusion identified
in literature included being prematurely forced out of school or home thereby lack-
ing income-generating skills; engaging in survival sex work in exchange for accom-
modation or food; experiencing sexual and economic exploitation by employers
(Alio etal., 2022; Khan & Cailhol, 2020); and being denied work due to HIV status
(Lim etal., 2020; Zainal-Abidin etal., 2022). Economic instability hindered access
to healthcare. One paper described how only 50% of people with HIV in Malaysia
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S.Samad et al.
sought HIV treatment: due to economic discrimination, many struggled with the
financial burden of frequent hospital visits (Zainal-Abidin etal., 2022). Many trans
people also relied primarily on their own resources to access gender-affirming care.
Self-funding their own care placed many trans sex workers in a double-bind as many
defined these medical procedures as essential to their profession (Altay etal., 2021).
In a French study, lack of financial capital resulted in Pakistani asylum seekers
resorting to informal, unregulated healthcare from unregistered clinicians in impov-
erished areas of urban Paris (Khan & Cailhol, 2020).
Micro: Individual Health Outcomes
The two main individual health outcomes identified in the literature related to men-
tal and sexual health.
Mental Health
Compartmentalisation Nine papers discussed queer Muslims “packaging” their
identities to fit into different contexts (Afiqah etal., 2022; Altay etal., 2021; Etengoff
& Rodriguez, 2022; Hammoud-Beckett, 2022; Kumpasoğlu etal., 2022; Lim etal.,
2020; Pallotta-Chiarolli etal., 2022; Semlyen etal., 2018). Most often, this involved
downplaying their queer identity in Muslim spaces while amplifying their Muslim
identity; and downplaying their Muslim and/or racial identities in queer spaces while
amplifying their queer identity. Two papers described queer Muslims compartmen-
talising in healthcare settings. In one study, participants deliberated on how to self-
present before British Muslim healthcare practitioners, who could not comprehend
their dual queer and Muslim identities (Semlyen etal., 2018). In the other study,
participants felt that Australian LGBTQ + specific health services pressured them
to abandon their religious and cultural backgrounds and conform to white LGB-
TIQ + norms (Pallotta-Chiarolli etal., 2022). Another paper described how compart-
mentalisation can be a strength as it allows queer Muslims to honour the multiplicity
of their identities in different spaces (Hammoud-Beckett, 2022).
Depression Nineteen papers discussed depression, with some studies suggesting a
higher prevalence within queer Muslim populations (Afiqah etal., 2022; Alio etal.,
2022; Alvi & Zaidi, 2021; Askari & Doolittle, 2022; Etengoff & Rodriguez, 2021,
2022; Farhadi Langroudi & Skinta, 2019; Kirac, 2016; Kumpasoğlu etal., 2022;
Lim etal., 2020; Maatouk & Jaspal, 2022; Ogunbajo etal., 2022; Rashid & Afiqah,
2023; Scull & Mousa, 2017; Semlyen etal., 2018; Stuhlsatz etal., 2021; Usman
etal., 2018; Vaughan etal., 2021; Zainal-Abidin etal., 2022). One study found that
50% of British Muslim lesbians scored from mildly to severely depressed, com-
pared to 11–30% of general lesbian populations (Etengoff & Rodriguez, 2021).
Other studies showed that trans Muslim participants exceeded the clinical depres-
sion threshold (Etengoff & Rodriguez, 2022; Rashid & Afiqah, 2023). Mattock and
Jaspal found that gay and bisexual men in Lebanon with no religious affiliation
exhibited the highest rates of depression, followed by Muslims, then Christians
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
(Maatouk & Jaspal, 2022). Ogunbajo and colleagues’ study also observed that
Nigerian Muslim men had increased risk factors for depression when compared
to Nigerian Christian men (Ogunbajo et al., 2022). Risk factors for depression
included: strained familial relationships due to sexuality or gender, an absence of
families of choice, ostracisation by peers, being a new convert to Islam, difficul-
ties finding employment, lower incomes, a history of physical abuse and a history
of forced conversion therapy. Interestingly, studies presented conflicting findings
on whether disclosure/outness is a risk or protective factor for depression. One
study found that higher disclosure/outness is associated with lower psychological
distress (Stuhlsatz etal., 2021), while another showed that it correlated with higher
rates of depression (Maatouk & Jaspal, 2022).
Suicidality Thirteen papers noted the presence of suicidality in queer Muslim
populations, with five of these papers directly observing their participants having
suicidal thoughts (Etengoff & Rodriguez, 2021; Khan & Cailhol, 2020; Ogunbajo
etal., 2022; Rashid & Afiqah, 2023; Scull & Mousa, 2017). Among British Mus-
lim lesbians surveyed in Etengoff and Rodriguez’s study, 44% reported experienc-
ing suicidal ideation, with 16% expressing active desires to commit suicide, and
one participant disclosing a suicide attempt leading to hospitalisation (Etengoff
& Rodriguez, 2021). Additionally, participants in three other studies, focusing on
Pakistani migrants in Europe (Khan & Cailhol, 2020), Malaysian trans women
(Rashid & Afiqah, 2023), and LGB Kuwaitis (Scull & Mousa, 2017), also revealed
their struggles with suicidal thoughts during interviews with researchers. Further-
more, one study found that while conversion therapy increased the risk of suicidal
thoughts, frequent attendance at religious services was associated with a lower
history of suicidal ideation (Ogunbajo etal., 2022).
Substance Use Fourteen papers discussed the heightened risk of substance misuse
among queer Muslims. Among these studies, four directly documented partici-
pants engaging in drug use (Alio etal., 2022; Altay etal., 2021; Alvi & Zaidi,
2021; Usman etal., 2018). In one study, 88% of hijra sex workers turned to drug
use to cope with extreme ostracisation and isolation, with some succumbing to
addiction (Usman etal., 2018). A social worker in another study also described
trans Muslim sex workers in Europe developing drug addictions and dying at an
early age (Altay etal., 2021). Second generation university students in Canada
also relied on illicit substances to cope with mental illness and the challenges of
navigating their queer and Muslim identities. (Alvi & Zaidi, 2021). While these
participants recognised its harm, it was a normalised coping mechanism.
Sexual Health
HIV/AIDS Eight papers described concentrated HIV epidemics amongst MSM
in Malaysia, Senegal, Nigeria, Bangladesh and Pakistan (Akolo etal., 2014; Alio
etal., 2022; Barmania & Aljunid, 2016; Khan & Cailhol, 2020; Lim etal., 2020;
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S.Samad et al.
Sheehy etal., 2014; Usman et al., 2018; Zainal-Abidin etal., 2022). Many papers
discussed the emotional impact of HIV diagnoses, with participants experiencing
shame, blame, self-hatred, suicidality, and feelings of worthlessness due to the stigma
associated with HIV (Alio etal., 2022; Khan & Cailhol, 2020; Ogunbajo etal., 2022;
Rashid & Afiqah, 2023; Usman etal., 2018). Stigma led some queer Muslims to deny
their HIV status or avoid testing altogether (Akolo etal., 2014; Alio etal., 2022; Khan
& Cailhol, 2020; Usman etal., 2018; Zainal-Abidin etal., 2022). Participants who
were less likely to disclose their HIV status also struggled with medication adherence
(Akolo etal., 2014; Khan & Cailhol, 2020; Zainal-Abidin etal., 2022). In fact, one
study found that, compared to Christian participants, Muslim participants were less
likely to adhere to antiretroviral therapy or disclose to their families and healthcare
providers that they were MSM (Zainal-Abidin etal., 2022). Moreover, HIV preven-
tion strategies focusing on MSM often failed to reach MSMW. This is significant
given that many MSM (100% in Khan and colleagues’ study, and 48% in Sheehy
and colleagues’ study) also engaged in casual sex with women (Khan etal., 2005;
Sheehy etal., 2014). Furthermore, participants across studies exhibited knowledge
gaps concerning HIV, HPV, and hepatitis (Khan & Cailhol, 2020). Finally, HIV risks
were heightened among Muslim asylum seekers, sex workers and individuals with a
history of forced conversion therapy (Khan & Cailhol, 2020; Ogunbajo etal., 2022;
Usman etal., 2018).
Risky Sexual Practices Risky sexual practices identified in the literature included low
condom use, sex work and chemsex (sexual activity under the influence of drugs). Eight
papers discussed low condom use (Akolo etal., 2014; Barmania & Aljunid, 2016; Khan
& Cailhol, 2020; Khan etal., 2005; Lim etal., 2020; Sheehy etal., 2014; Usman etal.,
2018; Zainal-Abidin etal., 2022). Reasons for low condom use included abstinence-
based strategies, succumbing to the ‘heat of the moment’, relying on luck or fate in cas-
ual sex encounters, lacking knowledge about HIV transmission, placing trust in sexual
partners, and not negotiating condom use with partners. Eleven papers described queer
Muslims who engaged in sex work, either as a worker or client (Afiqah etal., 2022; Alio
etal., 2022; Altay etal., 2021; Barmania & Aljunid, 2016; Etengoff & Rodriguez, 2022;
Khan & Cailhol, 2020; Lim etal., 2020; Pallotta-Chiarolli etal., 2022; Rashid & Afiqah,
2023; Sheehy etal., 2014; Usman etal., 2018). Many of these papers described queer
Muslims resorting to survival sex work in exchange for shelter, food and/or accommoda-
tion, often without access to safe sex resources. In Usman and colleagues study, 88% of
hijra participants living with HIV in Pakistan were forced to continue sex work to sur-
vive (Usman etal., 2018). Two papers noted that chemsex was increasing in MSM popu-
lations, including in Muslim-majority countries and in countries with growing Muslim
MSM migrant communities (Barmania & Aljunid, 2016; Khan & Cailhol, 2020).
Discussion
The aim of this study was to review literature on queer Muslim health outcomes, expe-
riences and access to healthcare, taking into account intersectional differences. Our
findings identified a range of factors that impacted health outcomes and accessibility.
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
On a mega-level, dominant epistemological assumptions about being queer and being
Muslim resulted in stigma and intersectional discrimination, multiple minority stress
and the erosion of Indigenous genders and sexualities. On a macro-level, government
legislation, religious influence and funding significantly impacted the ability of queer
Muslims to access healthcare. On a meso-level, participants’ levels of social, cultural,
financial and material capital were identified as both protective and risk factors to good
health outcomes. On a micro-level, many queer Muslims experienced the impact of
Islamophobia and queerphobia, which led to poor mental and sexual health outcomes.
Health Accessibility
This review identified a range of facilitators and barriers to accessing and achieving
optimal health for queer Muslims.
Facilitators
Facilitators identified in the literature occurred mainly at the meso and micro levels.
They included individuals embracing both their queer and Muslim identities, having
supportive familial, peer and religious networks, being connected to online and offline
queer Muslim communities and resources, and having financial capital.
Barriers
Barriers to good health were identified across all 4M levels, but were especially preva-
lent at mega and macro levels and outside the control of queer Muslim individuals.
Various barriers were identified on a governmental and legislative level. Firstly, puni-
tive laws exist that criminalise homosexuality and/or transgenderism and deter queer
Muslims from seeking healthcare. Secondly, inadequate government funding and sup-
port result in a scarcity of public health initiatives aimed at mitigating health disparities
within queer populations. Thirdly, homonormative laws and healthcare policies, which
are rooted in narrow LGBTQ + identity-based models, exclude some queer Muslims
whose experience of sexuality and gender transcend Western frameworks.
Another barrier occurring at the healthcare provider level involved the dominance
of certain epistemic assumptions extending into healthcare environments. Specifically,
some healthcare providers perpetuate dominant narratives that conflate being queer
with being secular and sexually active/literate, and being Muslim with being cisgender,
heterosexual and sexually inactive (outside the boundary of heterosexual marriage),
which results in queer Muslims feeling judged and excluded from healthcare spaces.
Health Outcomes
Given the structural discrimination against queer and Muslim communities, studies
highlighted that queer Muslims were at high risk of experiencing multiple minority
stress. The literature showed that queer Muslims were also more likely to experi-
ence depression compared to general populations. Additionally, suicidal ideation,
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S.Samad et al.
substance use, and risky sexual practices were identified amongst queer Muslim par-
ticipants in the reviewed empirical studies. Various papers also described concen-
trated HIV epidemics amongst gay and bisexual men, MSM and MSMW in Mus-
lim-majority countries.
Intersectional Differences
Several intersectional differences were identified in the literature. Economically vul-
nerable queer Muslims experienced poorer health outcomes. These included Mus-
lims who were expelled from home or school; lacked income-generating skill; were
refused work; were abused by their employers; were HIV positive; were sex work-
ers; or were asylum seeker and migrants with limited cultural capital. Additionally,
converts to Islam limited religious support networks also had poorer mental health
outcomes.
Although the reviewed papers primarily focused on gay men and MSM, there
were several findings that suggest intersectional differences. A Lebanese and Nige-
rian study found that bisexual men had higher levels of internalised homopho-
bia, were more likely to conceal their sexuality from their family and were also
more likely to face familial pressure to have heterosexual marriage than gay men
(Maatouk & Jaspal, 2022; Ogunbajo etal., 2022). The Nigerian study also demon-
strated gay men were more likely to be forced to participate in conversion therapy
compared to bisexual men.
While only one paper exclusively examined the experiences of Muslim lesbians
(Etengoff & Rodriguez, 2021), several studies suggested that lesbian, bisexual and
queer Muslim women may experience the compounded challenge of both their gen-
der and sexuality being invalidated, dismissed or pathologised within the heteropa-
triarchal frameworks of Muslim and wider societies (Pallotta-Chiarolli etal., 2022).
These papers stressed the intersectional impact of sexism, highlighting how women
may experience disproportionate repercussions for rejecting heterosexuality (Eten-
goff & Rodriguez, 2021; Pallotta-Chiarolli etal., 2022; Vaughan etal., 2021).
Nine papers included transgender or hijra participants, three of which exclusively
focused on the experiences of trans women (Afiqah etal., 2022; Altay etal., 2021;
Rashid & Afiqah, 2023). These studies described transgender Muslim experiencing
more overt socioreligious persecution and a higher prevalence of depression, anxiety
and stress compared to cisgender populations (Etengoff & Rodriguez, 2022; Rashid
& Afiqah, 2023).
Implications forPolicy Makers, Researchers, andHealth Clinicians
Cultural Humility andSelf‑reflexivity
Given the dominant epistemological narratives discussed above, it is easy to get
caught in an intersecting monologue that reduces the complexities of queer Mus-
lim health to simplistic binaries of religion vs. sexuality, Muslim vs. non-Muslim,
Global South vs. Global North, and East vs. West.
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
In this context, cultural humility and self-reflexivity become essential for policy
makers, researchers, and health clinicians (Pallotta-Chiarolli etal., 2022; Vaughan
etal., 2021). This involves being cognisant of dominant epistemologies and bodies
of knowledge, and continually questioning: whose way of seeing and being is being
validated? Who is defining sexuality, gender and what it means to be queer? Who
is defining Islam and what it means to be Muslim? Who is defining health? Whose
views are reflected in the dominant epistemological culture?
In turn, it is necessary to cast this critical eye upon the research and policies being
produced, and the healthcare being provided: what are the epistemological assump-
tions embedded within them? Who are these policies serving? Who are they exclud-
ing? Are organisations that deliver healthcare perpetuating dominant worldviews?
What are the dangers of this? How can this be addressed?
Two‑eyed Seeing
In a healthcare context, “two-eyed seeing” is one avenue to bridge diverging knowl-
edge systems. Originating from First Nations Elders in Canada, it involves viewing
the world through a dominant epistemological lens with one eye, while the other eye
sees through a non-dominant epistemological lens (Jeffery et al., 2021). Effective
two eyed seeing requires an equal power balance between the two lenses. In some
of the literature reviewed, we see some healthcare professionals striving to engage
in something akin to it. For example, Hammoud-Beckett’s concept of “coming in”
provides an equally valid way of perceiving self-disclosure for some queer Muslims,
rather than being constrained to a singular lens of the queer individual whose sole
path to liberation is to escape the closet by publicly proclaiming an identity (Ham-
moud-Beckett, 2022).
Similarly, several therapists blended Western modalities like acceptance and
commitment therapy, compassion-focused therapy and narrative therapy with reli-
gious coping mechanisms used by their queer Muslim clients. For example, some
healthcare providers integrate ’two-eyed seeing’ by combining these Western thera-
peutic practices with Islamic practices such as salaah (prayer) and dhikr (recitation)
for mindfulness and a closer connection to God, reclamation of scripture and queer
identity via liberation theology, and theological and self-reflections to cope with the
substantive stress of living within multiple marginalised identities (Vaughan et al.,
2021). Through cultural humility, self-reflexive practice and two-eyed seeing, indi-
viduals and organisations can honour the heterogeneity amongst queer Muslims,
queer communities and Muslim communities, bridge competing epistemic values,
and deliver culturally competent healthcare.
Strength‑Based Models ofCare
Strength-based models of care are also important to consider. Effective strength-
based models do not ignore or diminish the structural barriers to good health,
but rather they recognise that queer Muslims have ‘situated agency’ in that they
work within the constraints of their environments, navigating through oppression
and privilege, to achieve better health outcomes (Etengoff & Rodriguez, 2022).
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S.Samad et al.
Strength-based approaches include leveraging religious scripture for empowerment
through liberation theology or creating safe spaces for queer Muslims to engage in
community-building activities that affirm both their faith and sexual/gender identity.
Furthermore, the literature identified queer Muslims employing various strength-
based strategies including the proliferation of queer-inclusive interpretations of
Quran and sunnah, the growth of online and offline queer Muslim communities, and
development of queer Muslim resources and support groups (Etengoff & Rodriguez,
2022).
Funding andFraming Healthcare
Funding and framing are also crucial issues to take into account. As discussed ear-
lier, in the absence of government funding and initiatives, NGOs often provided
healthcare to queer Muslim populations. However, government outsourcing of care
to NGOs presents several dangers. First, it shifts the onus of responsibility to NGOs,
many of whom work with scarce financial support on a minimal scale. Second, pri-
vatising care for certain groups can deepen siloes within healthcare delivery. Several
papers describe how queer Muslims felt excluded from mainstream health services
and received fragmented care (Pallotta-Chiarolli etal., 2022; Semlyen etal., 2018).
Third, NGOs can inadvertently become vehicles that impose dominant epistemic
frameworks (e.g. homonormative, neoliberal, or rights-based) onto populations
that may not share the same epistemic values. Given this, it is important NGOs also
engage in self-reflexive practice.
The importance of framing was also evident in the Malaysian context, whereby
Ministry of Health officials and NGOs had to tactically present HIV strategies using
health-focused approaches over rights-based ones in order to safeguard funding
from conservative religious stakeholders (Barmania & Aljunid, 2016).. Employing
health-focused approaches has also proven useful in the Australian context as it has
enabled HIV strategies to reach a broader audience of CALD MSM (Saliba etal.,
2024).
Future Research
Research on queer Muslim health remains in its early stages and is primarily lim-
ited to preliminary studies. There is a significant lack of literature addressing the
health of lesbian, bisexual, transmasculine, nonbinary, and genderfluid Muslims, as
well as those who exist outside Western frameworks of gender and sexuality. Fur-
ther research is needed to explore these subgroups, as well as regional and cultural
differences among queer Muslims and their implications for healthcare access and
delivery. Other critical areas that require attention include the impact of govern-
ment legislation on queer Muslims’ access to healthcare, strategies for effectively
framing healthcare services to reach this population, and methods for fostering cul-
tural safety in collaborations involving stakeholders with differing epistemic values.
Additionally, research should examine how Islamic principles can be integrated into
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
existing and future healthcare models for queer Muslim clients, as well as strength-
based studies that explore resilience pathways and protective health factors.
While cross-sectional studies have shed light on correlations between health
outcomes and factors like religiosity, there is an urgent need for experimental and
longitudinal studies to establish cause-and-effect relationships. Expanding research
variables beyond religiosity to include social capital (e.g., family relationships and
access to supportive communities), economic capital, and cultural capital would
yield a more nuanced understanding of the lived reality of queer Muslims. Employ-
ing more comprehensive measures to assess these variables would also enhance the
validity and depth of future research.
Limitations
We identified several limitations in our study. Although our comprehensive search
strategy captured a broad range of relevant publications, it is possible that some
literature was overlooked. Restricting the review to English-language publications
may have also excluded valuable findings published in other languages. Similarly,
the exclusion of grey literature, while maintaining a focus on peer-reviewed research
and ensuring rigour, overlooked insights from grassroots-level initiatives and com-
munity-based studies. Future reviews could address this gap by incorporating grey
literature to provide a more inclusive perspective.
A significant limitation is the presence of data gaps, particularly regarding under-
represented subpopulations such as queer Muslim women, trans men, and nonbinary
individuals. Moreover, the predominance of studies conducted in urban contexts or
the Global North limits the applicability of findings. Due to the limited research
available on the health of queer Muslims, our study had to adopt a broad scope,
including diverse regions, health topics, and identities. While this approach was nec-
essary, it created challenges in creating clear demographic distinctions within our
findings. This difficulty was compounded by the variability in conceptions of gender
and sexuality across sociocultural and economic contexts.
The selection of studies as well as the methodologies of studies reviewed intro-
duces potential biases that could result in incomplete or skewed findings. Geo-
graphically, only a few regions were represented in the literature we reviewed. This
uneven representation fails to reflect the diversity of queer Muslim health experi-
ences, particularly in rural or less-studied regions. Methodologically, the reliance
on qualitative interviews and surveys with small, specific populations (e.g., trans
women in Malaysia or MSM in Nigeria) provides rich localised insights but limits
generalisability. Additionally, studies that rely on self-identified LGBTQ + partici-
pants inadvertently exclude individuals who do not adopt Western identity labels yet
experience similar health challenges.
Finally, theoretical studies and research conducted in the Global North, or by
scholars from the Global North, often draw on epistemological frameworks that
may not align with the lived realities of participants from the Global South. This
misalignment risks overlooking Indigenous understandings of gender and sexuality.
These factors underscore the need for more diverse, inclusive, and representative
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S.Samad et al.
research by researchers with lived experience to more accurately understand the
health needs and experiences of queer Muslims worldwide.
Supplementary Information The online version contains supplementary material available at https:// doi.
org/ 10. 1007/ s12119- 025- 10342-3.
Funding Open Access funding enabled and organized by CAUL and its Member Institutions. This
project was funded by AIDS Council for New South Wales (ACON) and Culturally and Linguistically
Diverse Sexual Health Action Group (CALD SHAG). However, they were not involved in the study
design, search strategy process, analysis, or manuscript preparation.
Declarations
Conflict of interests The authors have no relevant financial or non-financial interests to disclose.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative
Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended
use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permis-
sion directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/
licenses/by/4.0/.
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Authors and Aliations
ShiaSamad1· SiobhanIrving2 · SujithKumarPrankumar3,4 ·
HorasWong5,6 · MuhammadNaveedNoor6,7,8 · BernardSaliba1,4
* Siobhan Irving
siobhan.irving@uts.edu.au
Shiffa Samad
shiffa.samad@uts.edu.au
Sujith Kumar Prankumar
contact@sujithkumar.net
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Analysing theHealth ofQueer Muslims Through the4M Framework:…
Horas Wong
horas.wong@sydney.edu.au
Muhammad Naveed Noor
Muhammad.Noor@umanitoba.ca
Bernard Saliba
bernard.saliba@uts.edu.au
1 School ofPublic Health, University ofTechnology, Sydney, Australia
2 School ofCommunications, University ofTechnology, Sydney, Australia
3 Nottingham Law School, Nottingham Trent University, Nottingham, UK
4 Kirby Institute, University ofNew South Wales, Sydney, Australia
5 Sydney Nursing School, The University ofSydney, Sydney, Australia
6 Institute forGlobal Public Health, The University ofManitoba, Winnipeg, Canada
7 Centre forSocial Research inHealth, The University ofNew South Wales, Sydney, Australia
8 Department ofPathology andLaboratory Medicine, Aga Khan University, Karachi, Pakistan
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