Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students

ABSTRACT

Purpose

International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education.

Methods

This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression.

Results

Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly.

Conclusion

Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

KEYWORDS:

• LGBTQ+ health
• medical education
• healthcare stigma
• healthcare discrimination
• medical training

Acknowledgments

The authors would like to thank all their interviewees from the various non-governmental organisations in Singapore for contributing their time, experiences, and insight to this study.

The authors would also like to thank the clinical year medical students for their participation in the survey component of this study, as well as the student medical societies for assisting in dissemination of the survey to their medical student members.

Thirdly, the authors would like to thank the medical students Elizabeth Teo Min and Andrew Wong Yew Wei for their kind assistance in data cleaning for this study.

Lastly, the authors would like to thank the psychiatrist, obstetrician-gynaecologist, infectious disease physician and endocrinologist from Singapore who contributed their expertise in reviewing the knowledge segment of the medical student survey.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The work was supported by the Department of Infectious Diseases, Tan Tock Seng Hospital [NIL]; National University of Singapore [NIL].