Attitudes towards homosexuality among health care providers: a barrier to health care access for lesbian, gay, bisexual and transgender populations in the Caribbean
A. Radix1,2, J. Didier2,3, V. Cenac2,3
1Columbia University, Mailman School of Public Health, New York, United States, 2Caribbean Vulnerable Communities, Kingston, Jamaica, 3AIDS Action Foundation, Castries, Saint Lucia
Background: The Caribbean has the second highest prevalence of HIV world-wide. The regional epidemic is predominantly heterosexual however a significant proportion of cases, estimated at 25%, occurs among MSM. Implementation of targeted prevention interventions in the Caribbean has been slow due to high levels of societal stigma and discrimination towards sexual minorities. When accessing medical care, lesbian, gay, bisexual and transgender (LGBT) persons may not disclose their sexual orientation and behaviors due to fear of discrimination by medical providers, thereby preventing appropriate risk factor identification and effective treatment and care. International studies investigating health care barriers for LGBT populations have frequently cited homophobia amongst medical providers as an important determinant that restricts access. Few studies exist that evaluate the attitudes of Caribbean health care workers toward sexual minorities.
Methods: Government employed hospital and community health workers attending a cultural competency workshop in St. Lucia were invited to complete a validated 21-item Likert-scale questionnaire (Kite and Deaux, 1986) to examine their baseline (pre-workshop) attitudes to homosexuality . Chi Square, Student´s t-Test and multiple regression were used to determine the demographic and other factors associated with attitudes to homosexuality.
Results: Health care workers (n=25) were predominantly female (77%) and averaged 37.6 years. 28.6% of health care workers had scores consistent with negative attitudes toward homosexuals. Male gender, but not age was associated with lower tolerance scores (average male score: 63.25, average female score: 75.53, p = .095). 71% of health care workers indicated that they found homosexuality “sinful” and 36% found same-sex behavior “disgusting”.
Conclusion: This study suggests that homophobic attitudes exist among health care workers in the Caribbean. LGBT sensitization training for health care workers should be incorporated into HIV prevention efforts in the Caribbean as a means of improving access to care and reducing health disparities for sexual minorities.