You ever see something ridiculous and think ‘Really? Is this still happening in 2020?’. Like, men still can’t say the word ‘two’. . . in 2020? Hanover still doesn’t have a Burger King. . . in 2020? Jamaica still doesn’t have a sexual harassment bill. . . in 2020? We still gonna argue about climate change. . . in 2020?

Jamaica is light years behind the rest of the Western world when it comes to LGBTQ+ rights and inclusivity. The closest we get is when the national HIV programme focuses on sexual risk reduction among key populations (as determined by international donors) like men who have sex with men and transwomen. In the past the government hasn’t put much effort put into understanding the lives of these individuals beyond getting them tested at workshops and lymes and ensuring they took their meds if diagnosed positive. This service gap encouraged the development of civil society groups like Equality Jamaica and Transwave, which advocate for the rights of LGBTQ-identifying folks in a holistic way, not just zooming in on their sexual practices.

The habit of defining people by their sexual practices has always rubbed me the wrong way. The intellectual defense put forward by many in my field is that not every man who has sex with men identifies as gay or bisexual. Which, fine, I understand that, but many more of them do identify that way. Or are afraid to identify as gay/bisexual because of the possible repercussions. And that’s important to acknowledge too. It is awkward as hell to have a conversation about sexuality with someone you’ve just met, and for most patients the revelation happens after building the therapeutic relationship, if it happens at all. But regardless of who my patients choose to have sex with, I try to create a space where they can feel accepted.

I’ve always taken the position of affirming people’s identities and respecting their life choices, while the rest of my colleagues politely tolerate the ‘alternative lifestyles’ of the people we work with. Do I wish we could all be a little more open-minded and accepting? Yes, but I’m also grateful that I haven’t heard any complaints from patients (yet) about being treated poorly by staff members based on their perceived sexual orientation. For the most part health care workers are getting better at customer service and professional behaviour, whatever their personal beliefs. And that’s major progress.

There’s still much more work to be done in erasing stigma and discrimination due to homophobia. A lot of it is systemic, related to our laws and policies. But so much more of it is cultural and community based. Recently my supervisor exhorted the team to see MSM as individuals, not just patients with high risk behaviours. At first I was annoyed because, Obviously. They. Are. People. That’s what I’ve been saying this whole time! But then I was grateful. Because this was the same supervisor who two years ago had advised me to refuse care to a transman seeking advice on transitioning. And if that isn’t progress I don’t know what is.

Our healthcare system has a lot of catching up to do. When I look at models of healthcare in other countries, I recognize the outdated practices and policies that are holding us back. Some of it is a broader cultural mindset of paternalism and individualism but who is to say which came first? What I hope for is a cultural and psychological revolution, what I work toward is effecting a little change every day in my circle of influence. The progress is heartening, a reassurance that we are moving in the right direction, however slowly. Huge changes don’t happen overnight, but they happen. Through the dedicated effort of committed people, change starts somewhere and then spreads across the world.