Abstract
Purpose: The aims of this study were (1) to evaluate current physician attitudes toward homosexuality and homosexual, transgender, and HIV-positive individuals and (2) to compare current attitudes of those from prior surveys of the same population, the San Diego County medical community.Methods: An online survey was conducted during November–December 2017 to assess general attitudes toward homosexuality and medically focused items that addressed homosexual orientation, transgender identity, and HIV. Responses were weighted for nonresponse. Predictors of stigma were assessed using generalized linear models. Trends across three surveys of the same population in 1982, 1999, and 2017 using common items were assessed using unweighted responses.Results: Of 4418 eligible physicians, 491 (11.1%) responded (median age 55 years, 38% female and 8.7% gay or bisexual). Regarding admission to medical school, 1% opposed admitting a homosexual applicant, 2% a transgender applicant, and 5% an HIV-positive applicant. Regarding consultative referral to a pediatrician, 3% would discontinue referral to a homosexual pediatrician, 5% to a transgender pediatrician, and 10% to an HIV-positive pediatrician. Regarding discomfort treating patients, 7% reported discomfort treating homosexual patients, 22% transgender patients, and 13% HIV-positive patients. Earlier year of graduation from medical school, male gender, and heterosexual orientation were significant predictors of stigma-associated responses. Compared with the results from surveys in 1982 and 1999, the current results suggest substantively less stigma associated with homosexuality and HIV.Conclusion: There have been substantive declines over a 35-year period in the prevalence of stigmatizing attitudes toward sexual minorities and HIV-positive people among physician respondents in three survey waves of the San Diego County medical community.
Highlights
Compared with the results from surveys in 1982 and 1999, the current results suggest substantively less stigma associated with homosexuality and HIV
Self-identified homosexual or bisexual respondents, and women endorsed responses associated with less stigma
No doubt, important differences in regional, cultural, and religious attitudes that limit generalizability of the findings, the current results provide some reassurance to physicians and patients who are themselves members of sexual minorities or HIV positive that stigma associated with these characteristics has declined markedly in a major urban medical community in California
Summary
Recent research has documented important health disparities experienced by LGBT persons in the United States across several health conditions, health behaviors, healthcare access, and utilization characteristics. Stigma has emerged prominently as a potent contributor to at least some of the documented health disparities and may causally relate to disparities both through enactments of stigma by healthcare workers or through consequences of internalized homonegativity. Stigma can have detrimental effects on both healthcare access and quality. self-reported attitudes of healthcare providers do not necessarily predict professional or clinical behavior, they are measurable indicators that can inform evaluations of cultural competence to treat patients and to interact with colleagues who are at risk for prejudice.A recent comparative effectiveness review concluded that the term cultural competence is not well defined for LGBT populations and that most cultural competence intervention studies did not ‘‘measure the downstream effect of changing provider beliefs on the care delivered to patients.’’9 there is theoretical support in Ajzen’s theory of planned behavior for the premise that clinician attitudes a Robert Marlin et al 2018; Published by Mary Ann Liebert, Inc. Recent research has documented important health disparities experienced by LGBT persons in the United States across several health conditions, health behaviors, healthcare access, and utilization characteristics.. Stigma has emerged prominently as a potent contributor to at least some of the documented health disparities and may causally relate to disparities both through enactments of stigma by healthcare workers or through consequences of internalized homonegativity.. Stigma can have detrimental effects on both healthcare access and quality.. Self-reported attitudes of healthcare providers do not necessarily predict professional or clinical behavior, they are measurable indicators that can inform evaluations of cultural competence to treat patients and to interact with colleagues who are at risk for prejudice.
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