Attitudes of General Practitioners Toward Homosexuals in the Netherlands Antilles Anita Radix MD MPH - PowerPoint PPT Presentation

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Attitudes of General Practitioners Toward Homosexuals in the Netherlands Antilles Anita Radix MD MPH

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Title: Attitudes of General Practitioners Toward Homosexuals in the Netherlands Antilles Anita Radix MD MPH


1
Attitudes of General Practitioners
TowardHomosexuals in the Netherlands
AntillesAnita Radix MD MPHGerard van Osch
MDCarl Buncamper
AIDS SUPPORT GROUP Saba
2
PAHO 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)
4
How 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

5
But..
  • 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)

6
Gender Distribution of Reported Adult AIDS Cases
1982 1998CARICOM member countries (CAREC)
MF ratio 21
33 Female
67 Male
7
Categories of Transmission in Reported AIDS Cases
in CMC 1982-2000
MSM 11
Unknown 17
Heterosexual 64
8
Categories of transmission in men Jamaica 1998
(CAREC)
7
???
46
47
9
HIV incidence per 1000 tested ADC-LAB
Curacao, Netherlands Antilles
Epidemiology Research Unit Curaçao
10
Why 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

11
Andwhat 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?

12
Impact 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

13
Homophobia 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)

14
GLMA 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.

16
Study 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?

17
Investigation
  • Focus groups with Gay men and lesbians in the
    Netherlands Antilles
  • Questionnaire to General Practitioners in the
    Windward islands to gauge level of homophobia

18
Focus 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.

19
Results 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

20
GP 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

21
International 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

22
Index 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

23
Results
  • 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

24
Results 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)

25
Results (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)

26
Results (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)

27
Tolerance Scores (ISSP)
28
Conclusions
  • 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

29
Barriers 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

30
What 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
32
Thank You
Saba, Netherlands Antilles
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