Provider Attitudes: Overcoming Biases and Improving Comfort

Sexuality is an important element of reproductive health and should be an integral aspect of reproductive health care. Yet many health providers are uncomfortable discussing sexuality with clients, may not even perceive the need to do so, or are judgmental about certain sexual behaviors that differ from their own.

In recent years, as providers have been faced with the realities of the HIV epidemic and the critical role of sexual behavior in reducing risk, it has become ever clearer that STIs and HIV cannot be addressed effectively without a frank and direct dialogue about sexuality and sexual practices. Indeed, obtaining information about clients’ feelings and attitudes about sexuality forms a core component of assessing need for appropriate health services.

While a frank and sensitive discussion of sexual practices in a nonjudgmental environment can best meet clients’ needs, this ideal can be difficult to achieve for many reasons, including:

• Cultural taboos: In most cultures, explicit discussions of sexual practices and sexuality are generally taboo, and great stigma surrounds infection by STIs such as HIV. Experience in many settings has indicated, however, that such taboos can be overcome, and when discussed with sensitivity, most clients are willing to talk about these issues and are grateful for the opportunity to discuss their concerns in a safe environment.
• Discomfort: Providers are often inhibited or uncomfortable and frequently lack the information that would support them in discussing sexuality and STI issues (including HIV) with clients.
• Biases: Providers bring personal biases and perceptions about the “sort of clients” who are infected with an STI, including HIV.
• Personal values: Providers may allow their own personal attitudes and values to interfere with their professional obligation to provide nonjudgmental and respectful services to clients. For example, providers may find it especially difficult to remain objective when they personally disapprove of a client’s behavior or lifestyle.
• Lack of knowledge: Providers may not always be familiar with local beliefs, preferences, and customs, as well as the local terminology for sexual anatomy, sexual behaviors, or STIs/RTIs.

Providers can improve their interactions with clients by becoming aware of their own personal biases, values, and attitudes, and working to prevent them from interfering with the ability to provide nonjudgmental services. Special training techniques can help providers feel more comfortable addressing sexuality with clients and become aware of their own biases and judgments about clients. Improving the interaction between providers and clients will ultimately help clients to reduce their risk of infection and will result in better quality service.

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