Reducing discrimination faced by MSM and Transgender Women in public hospitals: preliminary efficacy of a pilot workshop-delivered intervention among healthcare providers in India

Title

Reducing discrimination faced by MSM and Transgender Women in public hospitals: preliminary efficacy of a pilot workshop-delivered intervention among healthcare providers in India

Presenter

Sudharshini S

Authors

S. S * (1), S. Nair (2), K. Ranade (2), R. Nelson (3), M. Shunmugam (3), B. Mohan (4,3), S. Rawat (4), U. Das (5), A. Nuken (6), V. Verma (5), C. Das (5), V. Chakrapani (3)

Institutions

(1) Madras Medical College, Community medicine, Chennai, India, (2) Tata Institute of Social Sciences, School of Social Work, Mumbai, India, (3) C-SHaRP, Research, Chennai, India, (4) The Humsafar Trust, Research, Mumbai, India, (5) National AIDS Control Organisation, New Delhi, India, (6) International Centre for Research on Women, New Delhi, India

BACKGROUND: Indian government is aiming at 'zero discrimination' in public healthcare settings. Studies have documented discrimination experiences of men who have sex with men (MSM) and Transgender Women (TGW) in public healthcare settings, hindering access to health/HIV services.To contribute to scalable interventions, we developed and tested the efficacy of a theory-based pilot intervention to reduce stigma/discrimination faced by MSM and TGW in public healthcare settings.
METHODS: In November 2021, we conducted two half-day workshops for clinical (n=24) and non-clinical staff (n=28) of a government hospital in Chennai. The sessions aimed to improve knowledge and attitude towards MSM/TGW through interactive sessions, speeches by role models (popular opinion leader strategy), exercises, and discussions with MSM/TGW activists ('contact' hypothesis). A self-administered questionnaire assessed knowledge, attitude, practices, and comfort level before and after workshop. Paired t-tests and chi-square tests were conducted.
RESULTS: Participants' mean age was 39.1, and mean years of practice was 12.5.The majority (86.5%) reported no prior friends/colleagues who are MSM/TGW, and none had prior training on MSM/TGW. There was no significant difference in the mean attitude score (7 items) before and after the intervention among clinical/non-clinical staff, although attitude in relation to certain items improved; e.g.,13% of clinical staff endorsed the statement 'sex between two men is just plain wrong' before training, which reduced to 7.7% after the training.Among non-clinical staff, there was a significant increase in the proportion who reported being comfortablein providing care to MSM/TGW (pre-training=46.4%; post-training=81.8%, p<.01). Post-training, a higher proportion of clinical (65.2% to 91.7%, p=.02) endorsed the statement that healthcare providers should challenge misinformation about MSM/TGW. Similarly, clinical (95.8%) and non-clinical staff (81.0%) endorsed the need for a hospital non-discrimination policy to protect MSM/TGW.
CONCLUSIONS: This pilot intervention shows preliminary evidence for improving certain aspects of attitude and comfort level. COVID-19 pandemic prevented having an intervention of longer duration. As part of the intervention, we also shared four videos and text messages after the training to promote acceptance, and follow-up data are being collected. The intervention will be replicated in another site to further evaluate its effectiveness before potential scale up.

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