In November 1994, an Association of Canadian Medical Colleges (ACMC) meeting on HIV/AIDS education called for interdisciplinary teaching models after a survey found that medical schools didn't make the grade in preparing students for the psychosocial aspects of AIDS.
A review of literature on attitudes among health care professionals also revealed an array of fears in dealing with AIDS patients and widespread bias against stigmatized groups, especially gay men and intravenous drug users. By the same token, the meeting reported, studies showed that attitudes improved with experience and contact.
Those findings, plus results from the Gay and Lesbian Medical Association's survey on antigay discrimination in medicine, "gave me the ammunition to go ahead," says Dr. Jocelyn Rowe, head of the Sex, Drugs & HIV project.
Rowe, an assistant professor in family medicine at McGill University, and a team of experts from medicine, social work, government and the AIDS community designed Sex, Drugs & HIV to deal with discrimination, discomfort and other attitudes.
The program has three modules:
Rowe says the modules begin with videotapes and/or panel presentations. The videos feature stand-up comedy, dramatization and interviews with patients, health care providers and medical students.
"Everybody in medicine goes in with the best of intentions and the highest of ideals, and it's kind of hard to hear that people have had bad experiences at the hands of health care," Rowe says. "You need to have people who say, 'This really happened. I wasn't allowed to see my lover on the day that he died because I'm not a family member.' Or a transsexual person saying they came out of the OR and overheard the staff saying, 'What are we going to do with that thing?'"
Rowe says participants then form small groups to explore issues through case studies, role-playing exercises or discussion. Some of the exercises help students develop communication skills in areas such as taking a sexual history.
Rowe says the program has received consistently high (85%-95%) ratings at nearly all pilot sites, including several national meetings and three medical schools: McGill, Memorial University and the University of Ottawa.
"It's quite well done," says Dr. Andrew Chalmers, associate dean of undergraduate education (curriculum) at the University of British Columbia (UBC). He is seeking funding for UBC's own response to the 1994 ACMC meeting. Next spring, he hopes to pilot an HIV/AIDS elective in which students from different disciplines and from across the country spend several weeks in Vancouver working in teams to define and respond to a community need. He says students will get a good grounding in attitudes and values before they head out into the community. Meanwhile, Chalmers says, the UBC medical school plans to incorporate Rowe's materials in second year. But he has one concern. "It links sexuality with disease," he says of Sex, Drugs & HIV. "It's sort of a mixture of human sexuality, which is one thing, and HIV/AIDS, which is another thing, and it's an unfortunate juxtaposition."
Dr. Pierre-Paul Tellier, director of student health and undergraduate medical education at McGill, praises the modules for presenting "very difficult" social issues. But he understands Chalmers' reservation.
"Obviously, HIV is very much stigmatized, being gay and lesbian is very much stigmatized, and putting both together makes a whopping big negative." He says Sex, Drugs & HIV may "continue that picture" if it "is the only place where students are exposed to gay and lesbian issues." "I would look at it the other way," counters McGill's Dr. Deborah Danoff, who chaired the 1994 ACMC meeting and is a member of the project's advisory committee. "HIV/AIDS has forced people to recognize the fact that sexuality is a central issue in medical care as opposed to, 'I don't really need to know what your sexual preference is or what your sexual activities are because that's outside the problem I'm dealing with.'
"The project was developed to deal with sexuality in the context of HIV/AIDS because there was a very specific mission," she adds. "You could easily take about 50% of the material in those tapes and re-edit it and it would provide an excellent opportunity to talk about issues of sexuality and sexual identity and it would have nothing to do with HIV.
"The next step is getting the information to medical schools. "The degree to which gay and lesbian issues and the psychosocial aspects of HIV are incorporated into curricula across the country is really dependent on local champions, local leaders, people with specific interests and skills," she says. "For me, these modules are an attempt to provide a knowledge base and skill base so that faculty don't necessarily have to have experience in dealing with AIDS or sexuality or homosexuality. They've got a resource to use."