The aim of this study was to understand the health care needs and experiences of black lesbians living in Gauteng townships. Method: This was a mixed-method cross-sectional study, with the qualitative component being dominant. Two focus group discussions were conducted with 22 lesbians from Johannesburg and Pretoria. Qualitative information from spontaneous discussions with survey participants was also included in the data set. Findings: Lesbian health needs range from mental health to sexual and reproductive health. Homophobia and interpersonal violence also contribute significantly to the physical and mental health of lesbians. Health care providers are seen as gatekeepers of health care and often act as barriers for lesbians accessing care. Sensitization of health care providers may increase access to care for lesbians by addressing health care provider attitudes. Conclusion: Lesbian health needs go beyond just sexual and reproductive health. Mental health and substance abuse are prominent unmet lesbian health needs. Both lesbians and health care providers need education about these needs.