Stigma Toward Men Who Have Sex with Men Among Future Healthcare Providers in Malaysia: Would More Interpersonal Contact Reduce Prejudice?
I was very fortunate to work with outstanding MPH students, including Harry Jin, when I was a postdoc at Yale. Harry received funding from the Downs Fellowship to collect data on stigma among medical and dental students in Malaysia. He was interested in the extent to which these students stigmatize people living with HIV as well as people at risk of HIV. This was important to do because these students will soon be healthcare providers and stigma among healthcare providers has been shown to be a significant problem: Providers who are more prejudiced toward and stereotype certain groups also discriminate against members of those groups, including by giving them worse care.
Harry worked with Rick Altice at Yale and other collaborators in the U.S. and Malaysia to collect these data in 2012. Students from 7 Malaysian universities received the link to our online study, and 1296 ultimately filled it out. Not bad!
Harry’s initial work with these data compared prejudice toward four groups: patients in general, patients living with HIV, patients who are men who have sex with men (whom I’ll refer to as gay men in this article, even though the two aren’t necessarily the same), and patients who inject drugs. We used a feelings thermometer, which generally captures how positively vs. negatively people feel toward groups of people and is sometimes used as a measure of prejudice. Our findings were pretty striking: As expected, students felt positively toward patients in general. They felt rather neutral toward patients living with HIV. But then, they felt negatively toward patients who inject drugs and gay male patients.
I was surprised by just how negatively the students reported feeling toward gay men: They reported the most negative feelings, or the most prejudice, toward this group. Although we didn’t collect data from the US or other places to compare to these data, I would expect less prejudice toward gay men among students in other places.
In retrospect, I really shouldn’t have been so surprised: Malaysia is one of a few countries wherein same-sex sexual acts are forbidden by law. Malaysian Penal Code Section 377 is a remnant of British colonial-era law that punishes “carnal intercourse against the order of nature.” These punishments include imprisonment, fines, and whipping. So, the structural stigma toward gay men is pretty strong in Malaysia. We can expect that students who live in this socio-cultural context would absorb this stigma and be prejudiced toward gay men.
We dug a little bit deeper into these data to try to understand if any students felt less prejudice toward gay men. By understanding why some students are less prejudiced, we may eventually be able to develop ways to reduce prejudice among the other students who are prejudiced. We pulled on Gordon Allport’s Contact Hypothesis, which suggests that prejudice toward outgroup members is reduced with interpersonal contact (although the contact does have to involve pretty specific circumstances).
Only 14% of students said that they knew one or more gay men! That seems really low until you consider the laws that force gay men to conceal their identities. It’s possible that some students had met a gay man without knowing it. Older, male, and Buddhist students were more likely to have had contact with gay men than younger, female, and Muslim students.
We found that students who had had previous interpersonal contact with gay men were less prejudiced toward, held fewer stereotypes regarding, and were less fearful of gay men. They also intended to discriminate less against gay men in healthcare settings.
We have a bit of a “chicken and the egg” problem with this study: Because of the way that we collected the data, we don’t know if more contact leads to less prejudice or less prejudice leads to more contact. Research in other countries with other stigmatized groups suggests that both processes are at play. And so, this gives us hope that interpersonal contact between Malaysian medical and dental students with gay men could reduce prejudice toward gay men.
Which brings us to our next problem: How can this interpersonal contact happen if gay men could be arrested, whipped, or fined if they disclose that they are gay in a public setting to a group of students? There’s some evidence that virtual contact can reduce prejudice, and so introducing books, television, and radio that include gay men could help. Ultimately, however, structural change is needed. Prejudice among students is going to persist as long as laws are on the books that prohibit “carnal intercourse against the order of nature.”
– Valerie Earnshaw
- Earnshaw VA, Jin H, Wickersham JA, Kamarulzaman A, John J, Lim SH, Altice FL. Stigma toward men who have sex with men among future healthcare providers in Malaysia: Would more interpersonal contact reduce prejudice? AIDS Behav. In Press. [PubMed]
Other papers from this dataset:
- Jin H, Earnshaw VA, Wickersham J, Kamarulzaman A, Desai MM, John J, Altice FL. An assessment of healthcare students’ attitudes towards patient with or at high risk for HIV: Implications for education and cultural competency. AIDS Care 2014;26:1223-1228. PMCID: PMC4089975. [PubMed]
- Earnshaw VA, Jin H, Wickersham J, Kamarulzaman A, John J, Altice FL. Exploring intentions to discriminate against patients living with HIV/AIDS among future healthcare providers in Malaysia. Trop Med Int Health 2014;19:672-679. PMCID In process. [PubMed]