“Zami, Macumeres and Bulla men”; enhancing the delivery of competent health care services to sexual minorities in the Caribbean – experiences from St Lucia
A. Radix1,2,3, J. Didier2,4, V. Cenac2,4
1Columbia University, Mailman School of Public Health, New York, United States, 2Caribbean Vulnerable Communities, Kingston, Jamaica, 3Callen Lorde Community Health Center, New York, United States, 4AIDS Action Foundation, Castries, Saint Lucia
Issues: The Caribbean has the second highest prevalence of HIV/AIDS worldwide. A significant, but hidden epidemic occurs in MSM, however targeted HIV prevention interventions are often impeded by societal homophobia and legislation criminalizing sexual activity between men. In St. Lucia same-gender sexual contact is highly stigmatized resulting in difficulty evaluating behavioral risks and HIV prevalence among MSM. In addition, sexual minorities may avoid or delay medical services due to fear of discrimination, causing missed opportunities to diagnose and treat STIs and HIV. Improving healthcare access to sexual minorities is an essential component of HIV prevention, treatment and care services.
Description: The AIDS Action Foundation in partnership with the Ministry of Health designed a workshop for public-sector healthcare workers (HCWs) to improve delivery of healthcare services to sexual minorities. This was the first such program held in the English-speaking Caribbean. The workshop encouraged participants to explore the cultural interplay of sexual minorities with the medical system and adverse health outcomes related to stigma and discrimination. Through case reports, group exercises, lectures and role plays HCWs identified challenges and solutions to delivery of culturally competent healthcare services, increased knowledge of LGBT health issues and improved sexual history taking skills. Pre and post workshop surveys evaluated HCW attitudes and acceptance of training.
Lessons learned: HCWs identified multiple barriers to healthcare access including personal and institutional-level homophobia, inadequate knowledge of LGBT-specific health issues, roles of religion, Caribbean culture, taboos, legislation and lack of confidentiality. 100% of HCWs “strongly agreed” or “agreed” that the workshop enhanced their capacity to obtain sexual histories and offer welcoming, competent healthcare to sexual minorities.
Next steps: The original workshop and program materials are available to other Caribbean countries facing similar issues of LGBT stigma and discrimination in healthcare settings. A follow-up workshop “Prevention for Positives” focusing on HIV-positive MSM is currently underway.