AIDS and Behavior

, Volume 20, Issue 1, pp 98–106

Stigma Toward Men Who Have Sex with Men Among Future Healthcare Providers in Malaysia: Would More Interpersonal Contact Reduce Prejudice?

  • Valerie A. Earnshaw
  • Harry Jin
  • Jeffrey A. Wickersham
  • Adeeba Kamarulzaman
  • Jacob John
  • Sin How Lim
  • Frederick L. Altice
Original Paper

Abstract

Men who have sex with men (MSM) living in countries with strong stigma toward MSM are vulnerable to HIV and experience significant barriers to HIV care. Research is needed to inform interventions to reduce stigma toward MSM in these countries, particularly among healthcare providers. A cross-sectional survey of 1158 medical and dental students was conducted at seven Malaysian universities in 2012. Multivariate analyses of variance suggest that students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM. Path analyses with bootstrapping suggest stereotypes and fear mediate associations between contact with prejudice and discrimination. Intervention strategies to reduce MSM stigma among healthcare providers in Malaysia and other countries with strong stigma toward MSM may include facilitating opportunities for direct, in-person or indirect, media-based prosocial contact between medical and dental students with MSM.

Keywords

Contact hypothesis Discrimination HIV Malaysia MSM Stigma 

Resumen

Los hombres que tienen sexo con hombres (HSH) y viven en países en los cuales el estigma contra los HSH es marcado son vulnerables a la infección por el VIH y encuentran barreras importantes a la hora de recibir atención para esta infección. Se necesitan investigaciones que inspiren intervenciones para reducir el estigma contra los HSH en estos países, en particular entre los profesionales de la salud. En 2012 se realizó en siete universidades de Malasia un estudio transversal en el que participaron 1158 estudiantes de medicina y odontología. Los análisis multivariantes de la varianza indican que los estudiantes que tenían contacto interpersonal con HSH albergaban menos prejuicios contra ellos y tenían menos intenciones de discriminarlos. Los análisis de cadenas causales con el método de bootstrapping (remuestreo aleatorio con reemplazo) indican que los estereotipos y el temor actúan como intermediarios en las asociaciones entre el contacto en condiciones de prejuicio y la discriminación. Entre las estrategias de intervención para reducir el estigma contra los HSH entre los profesionales de la salud de Malasia y de otros países en los que dicho estigma es marcado se podrían facilitar oportunidades para que haya contacto prosocial directo (en persona) o indirecto (a través de medios de comunicación) entre los estudiantes de medicina y odontología y los HSH.

Palabras clave

Hipótesis del contacto Discriminación VIH Malasia HSH Estigma 

References

  1. 1.
    Beyrer C, Baral SD, van Griensven F, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380:367–77.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Beyrer C, Sullivan P, Sanchez J, et al. The increase in global HIV epidemics in MSM. AIDS. 2013;27:2665–78.PubMedCrossRefGoogle Scholar
  3. 3.
    Beyrer C, Sullivan PS, Sanchez J, et al. A call to action for comprehensive HIV services for men who have sex with men. Lancet. 2012;380:424–38.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Altman D, Aggleton P, Williams M, et al. Men who have sex with men: stigma and discrimination. Lancet. 2012;380:439–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Goffman ES. Notes on the management of spoiled identity. 1st ed. New York: Simon & Schuster; 1963.Google Scholar
  6. 6.
    Beyrer C. Pushback: the current wave of anti-homosexuality laws and impacts on health. PLoS Med. 2014;11:e1001658.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Itaborahy LP, Zhu J. A world survey of laws: criminalization, protection and recognition of same-sex love. Geneva: ILGA—International Lesbian Gay Bisexual Trans and Intersex Association; 2014. www.ilga.org.
  8. 8.
    Beyrer C, Baral SD. MSM, HIV and the law: the case of gay, bisexual and other men who have sex with men (MSM). Working paper for the third meeting of the Technical Advisory Group of the Global Commission on HIV and the Law, 7–9 July 2011.Google Scholar
  9. 9.
    Poteat T, Diouf D, Drame FM, et al. HIV risk among MSM in Senegal: a qualitative rapid assessment of the impact of enforcing laws that criminalize same sex practices. PLoS One. 2011;6:e28760.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Anderson JE, Kanters S. Lack of sexual minorities’ rights as a barrier to HIV prevention among men who have sex with men and transgender women in Asia: a systematic review. LGBT Health. 2015;2:16–26.CrossRefGoogle Scholar
  11. 11.
    Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68:225–36.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Allport GW. The nature of prejudice. Cambridge: Perseus Books; 1954.Google Scholar
  13. 13.
    Tajfel H, Billig MG, Bundy RP, Flament C. Social categorization and intergroup behaviour. Eur J Soc Psychol. 1971;1:149–78.CrossRefGoogle Scholar
  14. 14.
    Pettigrew TF, Tropp LR. A meta-analytic test of intergroup contact theory. J Pers Soc Psychol. 2006;90:751–83.PubMedCrossRefGoogle Scholar
  15. 15.
    Pettigrew TF, Tropp LR. How does intergroup contact reduce prejudice? Meta-analytic tests of three mediators. Eur J Soc Psychol. 2008;38:922–34.CrossRefGoogle Scholar
  16. 16.
    Brewer MB. The social psychology of intergroup relations: social categorization, ingroup bias, and outgroup prejudice. In: Kruglanski AW, Higgins ET, editors. Social psychology: handbook of basic principles. New York: The Guilford Press; 2007.Google Scholar
  17. 17.
    Ngadiman S, Suleiman A, Taib SM, Yuswan F. Malaysia 2014: country responses to HIV/AIDS. HIV/STI Section of Ministry of Health Malaysia; 2014. http://www.unaids.org/sites/default/files/country/documents//MYS_narrative_report_2014.pdf.
  18. 18.
    Kanter J, Koh C, Razali K, et al. Risk behaviour and HIV prevalence among men who have sex with men in a multiethnic society: a venue-based study in Kuala Lumpur, Malaysia. Int J STD AIDS. 2011;22:30–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Lim SH, Bazazi AR, Sim C, Choo M, Altice FL, Kamarulzaman A. High rates of unprotected anal intercourse with regular and casual partners and associated risk factors in a sample of ethnic Malay men who have sex with men (MSM) in Penang, Malaysia. Sex Transm Infect. 2013;89:642–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Williams WL. Islam and the politics of homophobia: the persecution of homosexuals in Islamic Malaysia compared to secular China. In: Harib S, editor. Islam and homosexuality. 1st ed. Santa Barbara: ABC-CLIO; 2010.Google Scholar
  21. 21.
    Baharom H. Najib: LGBTs, liberalism, pluralism are enemies of Islam. Malays Insid; 2012. http://www.themalaysianinsider.com/malaysia/article/najib-lgbts-liberalism-pluralism-are-enemies-of-islam. Accessed 3 Jan 2015.
  22. 22.
    Profile: Anwar Ibrahim. BBC news Asia. http://www.bbc.com/news/world-asia-16440290. Accessed 6 Nov 2014.
  23. 23.
    Stein JA, Li L. Measuring HIV-related stigma among Chinese service providers: confirmatory factor analysis of a multidimensional scale. AIDS Behav. 2007;12:789–95.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Kline RB. Principles and practice of structural equation modeling. 2nd ed. New York: The Guilford Press; 2005.Google Scholar
  25. 25.
    Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2013.Google Scholar
  26. 26.
    Janke R. Effects of mentioning the incentive prize in the email subject line on survey response. Evid Based Libr Inf Pract. 2014;9:4–13.Google Scholar
  27. 27.
    Paluck EL, Green DP. Prejudice reduction: what works? A review and assessment of research and practice. Ann Rev Psychol. 2009;60:339–67.CrossRefGoogle Scholar
  28. 28.
    Paluck EL. Reducing intergroup prejudice and conflict using the media: a field experiment in Rwanda. J Pers Soc Psychol. 2009;96:574–87.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Valerie A. Earnshaw
    • 1
    • 2
  • Harry Jin
    • 3
  • Jeffrey A. Wickersham
    • 4
    • 5
  • Adeeba Kamarulzaman
    • 4
    • 5
    • 6
  • Jacob John
    • 7
  • Sin How Lim
    • 5
  • Frederick L. Altice
    • 4
    • 5
    • 8
    • 9
  1. 1.Division of General Pediatrics, Department of MedicineBoston Children’s HospitalBostonUSA
  2. 2.Department of PediatricsHarvard Medical SchoolBostonUSA
  3. 3.ICON Clinical ResearchSan FranciscoUSA
  4. 4.AIDS Program, Section of Infectious Diseases, Department of Internal MedicineYale School of MedicineNew HavenUSA
  5. 5.Centre of Excellence for Research in AIDS (CERiA)University of MalayaKuala LumpurMalaysia
  6. 6.Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  7. 7.Department of Diagnostic and Integrated Dental Practice, Faculty of DentistryUniversity of MalayaKuala LumpurMalaysia
  8. 8.Yale School of Public HealthNew HavenUSA
  9. 9.Center for Interdisciplinary Research on AIDSNew HavenUSA

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