Attitude of medical and nursing students towards lesbian, gay, bisexual and transgender people: A cross-sectional study

INTRODUCTION

Diverse sexual orientations and gender identities are normal. Lesbian, gay, bisexual and transgender (LGBT) people are often known as sexual and gender minorities. ¹ There is limited public information about the total LGBT population in India. According to the LGBT+ Pride 2021 global survey, 3% of the Indian population is homosexual (including gay and lesbian), 9% are bisexual, 1% are pansexual and 2% are asexual. Overall, 17% identified as not heterosexual (excluding ‘do not know’ and ‘prefer not to answer’).² Data regarding the total exclusively transgender population are not available. However, as per the Census 2011 of the Government of India, 487 803 people were listed as the ‘other’ gender, which might include the transgender population.³

The Indian LGBT community has seen many favourable judicial verdicts including th2e scrapping of section 377 of the Indian Penal Code which criminalized consensual sexual acts between same-sex individuals and passage of the Transgender Persons (Protection of Rights) Act, 2019.^4,5 However, members of the sexual minority face intolerance even today. LGBT people are exposed to poor health and social outcomes because of marginalization, stigma and normative pressure on sexual and gender minorities.^6,7 They confront personal and interpersonal issues resulting from the ‘coming out’ process, which includes several challenging milestones. They are particularly vulnerable since, unlike other minorities, they do not always have the support of their parents or relatives. LGBT persons are subjected to both verbal and physical abusse.⁷ As a result, they have higher levels of psychological discomfort, including depression, anxiety, body image and eating disorders than the general population.⁸

The inadequate knowledge and sensitivity of healthcare professionals towards LGBT individuals, and active discrimination and perpetuation of violence may be contributing to healthcare barriers for this community.^9,10 Healthcare providers are untrained or uninterested in LGBT people’s health problems.^11,12 Furthermore, professionals find it challenging to discuss sexuality in general, especially sexual orientation or gender identity.^13,14 As a result of a lack of detailed information and heterosexist attitudes on the part of healthcare providers, LGBT patients face barriers to adequate healthcare.

The WHO identified poor health of LGBT persons as an area for improvement.¹⁵ Providers must be sensitive to and be aware of stigmatization, ongoing hurdles to care access and specific risk factors and health conditions these groups face in order to deliver optimal healthcare and preventive services to sexual and gender minorities. Furthermore, each subgroup has unique healthcare needs that healthcare practitioners must be aware of to provide quality care.

Studies done abroad show medical students lack knowledge and preparedness in LGBT healthcare, with discomfort in discussing sexual history due to inadequate training.^11,16,17 However, there are few studies on this topic in India, as the majority of the studies done on sexual and gender minorities in India focus mainly on homosexuality, and not the LGBT community.^18–20 Hence, we assessed the attitudes of medical and nursing students towards LGBT people at a tertiary care centre.

METHODS

RESULTS

A total of 155 students completed the survey, with a mean (SD) age of 23.2 (3.6) years, ranging from 19 to 37 years (Table 2). Overall, 96.1% (149/155) of students believed that it is the responsibility of all healthcare providers to care for LGBT people/patients, and 89.7% (139/155) of students tend to agree that LGBT people/patients deserve the same quality of care from the health services as heterosexuals (Fig 1). However, 30.3% (47/155) of students tend to agree that they would prefer not to treat any LGBT patients, and 14.8% (23/155) tend to agree that LGBT persons should seek healthcare from LGBT health clinics.

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FIG 1.

Distribution of survey response from all respondents (This figure uses statement number of survey items: see Table 1 for full survey items.) LGBT lesbian, gay, bisexual and transgenders

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DISCUSSION

We assessed the attitudes of medical and nursing students towards LGBT individuals, and the results showed mixed responses among the study participants. Students had a supportive view towards same-sex attraction, as most participants agreed that same-sex attraction is a natural expression of sexuality. Other studies done outside India also showed a mixed response from participants.^22,23 Most participants believed that an LGBT person deserves the same level of care as a heterosexual person. This finding was consistent with earlier studies.^16,21 Among the study participants, 14.8% tended to agree that LGBT persons should seek healthcare from LGBT health clinics, which was in contrast to the previous studies.^16,21 Though most of the study participants believed that it is the responsibility of healthcare providers to care for LGBT, 30.3% of participants would prefer not to treat any LGBT patients. The possible explanations for this disparity and this disinterest could be due to the lack of knowledge regarding LGBT health issues. Additionally, it may be because the LGTB community is still stigmatized and considered taboo in Indian society, as attitudes are shaped by knowledge, social impact, formal education, and observation.^19,24,25 Some previous studies show that knowledge regarding LGBT health issues improves students’ attitudes towards LGBT.^17,26

The gender and sexual orientation of the study participants influenced the responses in this study. For example, responses to ‘LGBT people/patients should only seek healthcare from LGBT health clinics’ were varied across gender, and more females tended to disagree with this statement than males. In addition, most females tended to agree that they can empathise with the life experience of an LGBT person. While our data cannot explain these differences, it is possible that females have a more personal experience with the impact of gender on health and therefore, recognise the importance of LGBT-specific health issues.^27–30

There is a scarcity of Indian literature that investigates topics concerning the LGBT population, and this is an attempt to assess medical and nursing students’ attitudes towards LGBT people.^18–20 Most studies have been done abroad and aimed to determine the attitudes of medical and nursing students towards LGBT individuals, using various scales and analysis plans.^16,21,22

Although we did not assess the participants’ knowledge, the possible reason for a poor attitude in a few areas could be due to a lack of knowledge, as seen in some previous studies where short lectures improved attitudes.^17,26 The undergraduate medical and nursing curriculum of India is not gender-inclusive.³¹ The Madras High Court took cognisance of the ‘queerphobic’ information in standard textbooks used by medical students throughout their undergraduate courses in September 2021.³² In response, the National Medical Commission (NMC) issued rules requiring any such unscientific assertions to be removed from textbooks.³³ While NMC has started promoting LGBT inclusivity in medical education by revising books, there is still a long way to go.