While majority of health care providers agree that men who have sex with men (MSM) and transgender people should receive the same level of attention and care, homophobia, misconceptions and value-driven stigma does impact the quality of care provided to them.

This is according to a formative assessment, the health ministry carried out with support from UNDP in 2014.

The assessment also found that health care providers lack experience and skills in dealing with and managing MSM and transgender clients.

Public health consultant, Dechen Wangmo, yesterday during a media engagement programme to strategise on sexual education and sexual health awareness, said that a significant number of healthcare providers haven’t received any training or orientation on HIV and male sexual health.

“So, it is left up to the individual providers to be nice or mean because there was no formal training,” she added.

The assessment on stigma and discrimination impacting universal access to HIV and health services for MSM and transgender people in Bhutan found that there are few opportunities to build the health workers’ capacity on HIV/AIDS or male sexual health.

Of the 887 health care providers from six dzongkhags, 317 responded to the questionnaire.

The six dzongkhags, Thimphu, Chukha, Sarpang, Samdrupjongkhar, Bumthang, and Wangdue were selected for the study based on the population size. Bumthang has the highest respondent at 83 percent and Thimphu the lowest at 25 percent. The overall response rate was 36 percent.

Dechen Wangmo said this is the only study that looks at sexual behaviours.

The assessment found that more than half of healthcare providers reported a poor understanding of MSM and transgender issues and do not feel comfortable to discuss sexuality with their patients.

About 47 percent said they were comfortable discussing sexuality while 30 percent said they are somewhat comfortable and 16 percent said they are not comfortable.

About 38 percent said they understand the MSM issues well while 29 percent said their understanding on MSM issues is reasonable poor. About 27 reported their understanding as very poor.

“As a health care provider, we want the respondents’ level of understanding MSM issues very well. However, only about seven percent said they have a high level of understanding the issue,” she said.

According to the assessment, comfort in discussing sexuality and understanding MSM and transgender are negatively correlated with homophobia and attitude towards people living with HIV (PLWH), but not with compounded stigma.

The study also found that 80 percent of the health workers never had MSM or transgender client and three percent said they had those clients.

“They have never heard about this behaviour and the community, so it’s also a lot to do with ignorance,” she said. “Only few reported seeing such cases.”

Some nurses who have clients with an anal tear or infection said they felt uncomfortable to discuss the case even with a doctor, she added.

“This shows that there is a lot that needs to be done in the institution itself where the health workers are trained. It shouldn’t matter who it is, it is the issue that should be of the interest,” she said.

The study revealed that half of the health workers were identified with a low to moderate level of HIV knowledge, and with a moderate and high level of HIV contamination fears through health practices.

Dechen Wangmo said if health workers have fear of contamination then they would have a high reservation in talking to PLWH. She said it is also important to look at the institution itself whether they follow universal precaution or not.

“We thought that a majority of the health workers would have a positive attitude towards HIV-related health practices. However, negative and intermediate were quite high,” she said. “Even within the health care system where health workers are taught about transmission, there was a lot of reservation.”

The assessment’s findings validate that health care providers with a good understanding of the issues have fewer misconceptions and may be less likely homophobic.

Dechen Tshomo