A central tenet of the health professions is that of equitable access to health care. However, disparities in equitable healthcare provision continues to be a challenge in many societies due to prejudices against the LGBTQ community. This study was aimed at exploring the attitudes of medical students toward LGBTQ patients in Malaysia. A qualitative approach was adopted to seek depth of understanding of clinical year medical students' perceptions and attitudes toward LGBTQ patients. Data were collected in 2018 through individual interviews and focus group discussions with a total of 29 participants, using a semi-structured question guideline. Purposive sampling comprised representation from the three major ethnic groups in Malaysia. Thematic analysis using NVivo highlighted three main themes i.e., neutrality, in compliance with the Professional Code of Conduct; implicit biases and tolerance of an Odd Identity; explicit biases with prejudices and stereotyping. The lack of knowledge and understanding of the nature and issues of sexuality is problematic as found in this study. They are primarily biases and prejudices projected onto marginalized LGBTQ patients who must contend with multiple jeopardies in conservative societies such as in Malaysia. With some state policies framed around Islam the concern is with the belief among Malay/Islamic students for LGBTQ individuals to go through conversion 'therapies' to become cisgender and heterosexual.
There are scant LGBT+ studies in Southeast Asia exploring mental health differences across multiple social identities. Using data from the Malaysian KAMI Survey (n = 718), we conducted bivariate regression analyses to investigate the association between sociodemographic backgrounds and the prevalence of depression, anxiety, non-suicidal self-injury, and suicidality. Results showed that younger participants, those questioning their sexual orientation (compared to gay or lesbian), cisgender women, trans men, and non-binary individuals (compared to cisgender men) reported significantly higher levels of mental ill-health. Our intercategorical analysis builds a foundation for future intersectional-based research in response to public health challenges for vulnerable LGBT+ groups.
Despite growing international criticism of actions and efforts to change sexual orientation and gender identity, such efforts remain prevalent in Malaysia. Using data from a nationwide community-based survey, this study examined the prevalence of these efforts amongst LGBT+ adults and the association between exposure to them and mental health outcomes. Participants (n = 521) completed an online survey assessing exposure to efforts to change their sexual orientation and/or gender identity, internalised LGBT-phobia, negative future expectations, and several mental health variables. Just under sixty-four percent (n = 333) of participants reported having experienced change efforts, with the most common perpetrators being family members, friends and religious organisations or people. Recent (past year) and past exposure to change efforts (over one year ago) were each associated with significantly higher odds of suicidal ideation, non-suicidal self-injury, and suicide attempts. Participants with recent exposure to change efforts also reported elevated internalised LGBT-phobia and negative future expectations compared to those who lacked such experience. A content analysis of participants' open-ended responses documented the perceived impact of change efforts on proximal stressors and mental health and wellbeing. Recommendations are made for national authorities and healthcare bodies to ban efforts to change sexual orientation and gender identity in Malaysia.