Title: Attitudes of General Practitioners Toward Homosexuals in the Netherlands Antilles Anita Radix MD MPH
1Attitudes of General Practitioners
TowardHomosexuals in the Netherlands
AntillesAnita Radix MD MPHGerard van Osch
MDCarl Buncamper
AIDS SUPPORT GROUP Saba
2PAHO On Homophobia in Healthcare
- Homophobia in the health services in the (Latin
America Caribbean) region is widely reported
but the extent to which it is a factor in
HIV/AIDS-related discrimination has not been
statistically researched - Such research is essential in the construction of
an appropriate response to stigma and
discrimination
3(No Transcript)
4How the Study started
- HIV prevalence in the Netherlands Antilles is
2.5 and rising
- The current understanding in the Caribbean is
that HIV transmission is mainly heterosexual
-majority of programs have therefore been based
on this assumption - No government funded programs specifically
directed at MSM exist in the Netherlands
Antilles
5But..
- Data from CAREC indicate records of risk activity
for PLWHAs are incomplete
- ADC laboratory statistics in Curacao suggest HIV
prevalence in men is 3X that of women
- Data from Saba, St. Eustatius and St. Maarten
show MSM transmission is still important
- (PLWHAs in St. Maarten 18 MSM, Saba 50 MSM)
6Gender Distribution of Reported Adult AIDS Cases
1982 1998CARICOM member countries (CAREC)
MF ratio 21
33 Female
67 Male
7Categories of Transmission in Reported AIDS Cases
in CMC 1982-2000
MSM 11
Unknown 17
Heterosexual 64
8Categories of transmission in men Jamaica 1998
(CAREC)
7
???
46
47
9HIV incidence per 1000 tested ADC-LAB
Curacao, Netherlands Antilles
Epidemiology Research Unit Curaçao
10Why are homosexual/bisexual men not disclosing
their sexual orientation?
- Institutionalized homophobia as evident in
popular reggae/dancehall lyrics - Chi chi man,
Bun out di chi chi Log on
- Legislation in many Caribbean islands
criminalizes homosexual activity
- e.g. CARICOM Model Legislation - allows for
5 year prison sentence for "gross indecency. The
law clearly states that heterosexual couples are
exempted
11Andwhat about the role of the healthcare
providers?
- Do healthcare providers in the Caribbean
contribute to nondisclosure of sexual orientation
by way of their
- Homophobia Heterosexism?
12Impact of Nondisclosure
- unrecognized homosexuality by the physician or
the patients reluctance to report his or her
sexual orientation can lead to failure to screen,
diagnose, or treat important medical problems. - Journal of the American Medical Association,
Report 8 of the Council of Scientific Affairs,
1996
13Homophobia in the Healthcare System
- 87 gay, lesbian and bisexual Ontarians had been
discriminated against within the health care
system
- 70 had been insulted on the basis of their
sexual orientation
- (Project Affirmation, Coalition for Lesbian and
Gay Rights in Ontario, Toronto unpublished data,
1995)
14GLMA Study
- 67 of surveyed physicians report knowledge of
substandard care or denial of care to gay and
lesbian patients
- 64 believe patients risk their quality of care
by coming out.
- 1994 Gay and Lesbian Medical Association (GLMA)
survey, "Anti-gay Discrimination in Medicine,"
15- The American Medical Association in 1991 reported
that
- 35 of general practitioners and internists feel
nervous around gay people.
- 35 felt that homosexuality is a threat to many
of our basic social institutions.
16Study Question
- Does a high level of homophobia/ heterosexism
exist amongst general practitioners in the
Caribbean?
- Could this contribute to an atmosphere that
prohibits disclosure of risk behaviour by their
patients?
17Investigation
- Focus groups with Gay men and lesbians in the
Netherlands Antilles
- Questionnaire to General Practitioners in the
Windward islands to gauge level of homophobia
18Focus Group Questions
- 1. Have you ever had a homophobic encounter with
a physician or other healthcare provider?
- 2. Would you feel comfortable coming out to your
healthcare provider?
- 3. Are you comfortable requesting advice on gay
related health issues from your health care
provider?
- 4. Has your physician or healthcare provider ever
asked you about your sexual orientation? If so,
did you perceive any discomfort on their part?
- 5. Do you think that a homophobic physician can
provide appropriate healthcare to lesbian and gay
patients. If not, list some reasons.
19Results from Focus Groups
- 80 had never been questioned about their
sexual orientation by their GPs
- 73 stated that they did not think that a
homophobic physician could provide appropriate
healthcare to GL patients and would not disclose
homosexuality- because -
- Improper advice may be given
- Couldnt give good care if homophobic
- Drs may purposely undertreat/ delay treatment
doing Gods will
- Would not understand psychosexual issues/ not
supportive
- Discomfort around Gays would prevent proper care
20GP Study
- In November 2003, all GPs were contacted in St.
Maarten, St. Eustatius and Saba.
- Questions included The Index of Attitudes
towards Homosexuality (Hudson and Ricketts,
1980) as well as 1 question from the
International Social Survey Program 1998/1999 - Demographic data collected included gender, age,
country of medical training nationality
21International Social Survey Programs ISSP
1998-1999
- Do you think it is wrong or not wrong sexual
- relations between two adults of the same sex?
- Not wrong at all 100 points
- Wrong only sometimes 67 points
- Almost always wrong 33 points
- Always wrong 0 points
22Index of Attitudes to HomosexualityHudson
Ricketts, 1980
- 25-item scale designed to measure individuals'
affective responses toward gay men lesbians.
- IHP uses a Likert-type response format from 1
strongly agree to 5 strongly disagree.
- Total scores range from 0 to 100, with higher
scores indicating greater homophobia
- Score from 0 to 25 high grade non-homophobics
- 26 and 50 low grade non-homophobics
- 51 and 75 low grade homophobics
- 76 high grade homophobics
23Results
- 20/22 General practitioners participated (91
response rate)
- Age range 32 to 56, average 44.8
- 20 women
- 30 Caribbean born, 60 EU, 5 Africa Asia
24Results cont.
- No significant association between age and scores
noted
- No gender differences noted
- No differences in country of medical study (most
Dutch Antillian GPs receive medical training in
The Netherlands)
- Large differences in response rates by country of
birth (Caribbean vs. other)
25Results (Index Attitudes to Homosexuality)
- Lower scores on this scale reflect more tolerant
attitudes to homosexuals
- Caribbean-born doctors had average score of 54.2,
non-Caribbean born doctors scored 29 (p - 67 Caribbean born physicians had scores in
homophobic range c/w only 14 non-Caribbean born
(Dutch/EU)
26Results (ISSP)
- Higher scores on this scale reflect more positive
attitudes to homosexuals
- Caribbean-born doctors had average score of 19.8,
non-Caribbean born doctors 71.4 (p0.016)
- A high correlation was noted between individual
scores on the ISSP and IAH scales (r0.79)
27Tolerance Scores (ISSP)
28Conclusions
- Nondisclosure of homosexual activity exists as
evident by
- high numbers of HIV men with unknown risk
factors and
- higher sex ratio men women
- Physicians in the Caribbean may contribute to the
problem by their homophobic attitudes
- Fear of discrimination by healthcare providers is
an important factor preventing disclosure by MSM
29Barriers to Healthcare for GLBT
- Discrimination - Anticipated, perceived, or
actual discrimination by health care provider
based on sexual identity/ behavior
- Exclusion Perceived exclusion from health
promotion campaigns.
- Fear - Disclosure of sexual orientation may lead
to criminal charges substandard or refusal of
health care
30What can be done?
- Greater awareness that a significant factor
driving the HIV epidemic in the Caribbean is
stigma and discrimination against MSM
- Informed and open discussions regarding sexuality
are needed
- A call for legislation guaranteeing equal
protection for GLBT persons
- Funding agencies should require inclusion of
programs that prioritize reduction of MSM
transmission in the Caribbean
31- The failure of programs to specifically address
risk reduction in MSM, despite the evidence that
this is clearly an important factor in the
Caribbean HIV epidemic is itself indicative of
homophobia and heterosexism within the healthcare
profession -
AIDS SUPPORT GROUP Saba
32Thank You
Saba, Netherlands Antilles