Original Research Article 263

ACCESSIBILITY TO MEDIA AND ITS RELATION TO

STIGMATIZATION TOWARD LESBIAN-GAY-BISEXUAL
AND TRANSGENDER (LGBT) INDIVIDUALS: A STUDY
AMONG 2ND YEAR MIDWIFERY STUDENTS IN
YOGYAKARTA, INDONESIA
Dhesi Ari Astuti1, *, Asri Hidayat1, Rezka Zahra Humaira1,
Dyah Anantalia Widyastari2, Doni Marisi Sinaga3
1
Universitas Aisyiyah Yogyakarta, Yogyakarta, Indonesia
2
Institute for Population and Social Research, Mahidol University, Thailand
3
International Program in Hazardous Substance and Environmental Management, Graduate School, Chulalongkorn University,
Bangkok, 10330, Thailand

ABSTRACT:
Background: Stigmatization and discrimination toward lesbian, gay, bisexual, and transgender (LGBT)
people are regularly reported. Both, in urban and in rural areas, LBGT individuals experience
marginalization and detachment from the community. The media plays a major role in providing
information related to LGBT people and HIV-AIDS since stigmatization and discrimination toward LBGT
people are largely caused by inadequate knowledge related to HIV and AIDS transmission. The study aimed
to examine the relationship of accessibility to media and the midwifery students’ attitudes toward LBGT.
Methods: The study employed a descriptive analytic method with a cross sectional approach. A total of 120
postgraduate midwifery students in Yogyakarta, Indonesia, who agreed to be involved in the study were
recruited as participants.
Results: The vast majority of respondents (92.5%) lived in urban boarding homes and had no difficulty
accessing media and obtaining reliable information related to LGBT people. Respondents expressed
negative attitudes toward LGBT people; the data shows 28% unwilling to be in close proximity to LGBT
people; and 90% agreed that parents should keep their children away from LGBT people because they are
considered to be very dangerous. Although respondents’ access to media information is relatively good,
their attitudes toward LGBT people are distorted based on their roles as health providers and as a family
member. When it comes to their children, respondents perceived that it is important to protect their
children from LGBT people for safety reasons; whilst in the working place, the vast majority of respondents
agreed that LGBT people should not be discriminated.
Conclusion: The misconception towards LGBT people highlights the urgent need for providing correct
health education for lay people and health providers. Inconsistence and ambiguous attitudes toward LGBT
people provides excellent evidence that the existing knowledge is not sufficient. With the role of media as a
double edged-sword, there is a need for government and health providers to accurately and continuously
provide health education for the general population in order to reduce stigmatization and discrimination
toward LGBT people.

Keywords: Accessibility to media; Mass media; Stigmatization; LGBT; Health provider; Indonesia

DOI: 10.14456/jhr.2017.33 Received: October 2016; Accepted: January 2017

INTRODUCTION
*
Stigmatization and discrimination toward Correspondence to: Dhesi Ari Astuti
lesbian, gay, bisexual, and transgender (LGBT) have E-mail: dhesi_stikesayo@yahoo.co.id

Astuti DA, Hidayat A, Humaira RZ, Widyastari DA, Sinaga DM. Accessibility to media and its relation to
Cite this article as: stigmatization toward lesbian-gay-bisexual and transgender (LGBT) individuals: a study among 2nd year
midwifery students in Yogyakarta, Indonesia. J Health Res. 2017; 31(4): 263-9. DOI: 10.14456/jhr.2017.33

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264

been reported continuously. Either in urban or rural and unreliable information for its users. Cultivation
areas, LBGT becomes marginalized and detached theory posited, viewers tend to believe media-
from the community [1]. Ministry of Health of directed version of reality than the reality itself [15].
Republic Indonesia reported, the number of same- Thus, media may also increase the level of
sex partners increased significantly from 7 percent stigmatization and discrimination by repeating the
in 2009 to 12.8 percent in 2013. The number of male information which viewers store in their memory,
who have sex with male are also increasing from 5.3 form their perception and turn it to attitudes.
percent to 12.4 percent in 13 cities of the survey Nonetheless, this study aimed to only focus on the
settings [2]. With an increasing number of populations midwifery students’ attitudes toward LBGT, and
at risk, the need to reduce stigmatization and their accessibility to media. It is expected that the
discrimination becomes necessary; therefore, HIV finding of this study may provide evidences for
and AIDS prevention and control should be taken the government and policy makers in improving
into account. the programs to combat stigmatization and
Stigmatization and discrimination have been discrimination toward LBGT particularly, and
acknowledged as the greatest barrier in the HIV and people at risk to HIV-AIDS in general.
AIDS prevention and control [3, 4]. In a country
with heterosexual mainstream such as Indonesia, METHODOLOGY
LGBT is seen as a deviant sexual practice; because The present study employed a descriptive
homosexual is believed against cultural and analytic method with a cross sectional approach. It
religious norms. Those who have same-sex explored the stigmatization towards LGBT as
relationship are usually hide to a certain extent phenomenon and observed it in one point at a time
behind the layers of public silence on sexuality [5, [16]. A total population of 120 second-year
6]. midwifery diploma students who have completed
Midwife as a health provider who’s responsible the basic course works was recruited as participants.
for maternity care actually plays many roles in Data was collected through self-administered
service delivery point. Preliminary study among questionnaires, distributed by researcher at the end
midwifery students related to LBGT revealed only of reproductive health course. Prior to data
few students understood the meaning of LGBT. collection, validity and reliability study were
Most of them were informed through news channel conducted to test the instruments. The result showed
on the television. The midwifery students’ that out of 50 attitude questions, 42 questions were
perceptions and attitudes toward LBGT become valid; whilst of 30 stigma questions, 26 were
important because in many cases, health provider’s validated.
attitudes and behaviors toward people at risk to Stigmatization and discrimination in the present
HIV-AIDS become a major boundary for marginal study were measured in attitudinal scales, ranged
population to access health services [7-9]. Studies from strongly agree to strongly disagree including
among health providers in Indonesia showed that 21 questions related to respondents’ perception
level of stigmatization and discrimination toward towards LGBT. Stigma was implied in respondent’s
marginalized group were quite high; and health care personal responses toward social relationship with
provider’s stigmatized attitudes increased with the LGBT either in working place or community.
increment of irrational fear of HIV transmission [10, Accessibility to media was measured as types of
11]. media that respondents have accessed to obtain
In addition, media plays a major role in information related to LGBT and frequency of
providing information related to LGBT and HIV- access ranged from never to more than 5 hours per
AIDS. In many different settings, stigmatization and day. The present study obtained its approval from
discrimination toward LBGT are partly caused by Ethical Committee Board of Universitas Aisyiyah
inadequate knowledge related to HIV and AIDS Yogyakarta with reference number 01/KEP-
transmission. Scholars found that when people’s UNISAYOGYA/IX/2016, dated September 2nd,
knowledge to HIV-AIDS transmission and LGBT is 2016.
improved, the stigmatization and discrimination
tend to be decreased [12-14]. Media is one of the RESULTS
sources of information yielding a double-edged Of 120 respondents, all were female who
sword with its possibility to provide both reliable currently studying at the second year of postgraduate

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Table 1 Respondents’ attitudes toward LGBT

Attitudes
No Statements Strongly Strongly
Agree Disagree Total
agree disagree
1 I am not afraid to make friends with LGBT although 21.7 9.2 53.3 15.8 100.0
many people said their sexual disorder may infect me
2 If one of my family is an LGBT, I will disgrace and 8.3 2.5 61.7 27.5 100.0
avoid him
3 LGBT is not a sexual disorders and I don’t have to 27.5 9.2 50.8 12.5 100.0
avoid them
4 I think LGBT’s presence will not harm anyone 9.2 2.5 58.3 30.0 100.0
5 I will not refuse to visit LGBT’s house 42.5 5.0 44.2 8.3 100.0
6 LGBT will have some difficulties in finding jobs 55.0 17.5 21.7 5.8 100.0
7 I don’t want to have any relationship with LGBT 28.3 16.7 51.7 3.3 100.0
8 When I am working at hospital, I will not put LGBT 4.2 3.3 42.5 50.0 100.0
patient at the bottom of the line for the service
9 People with different sexual orientation such as 32.5 7.5 47.5 12.5 100.0
LGBT should be given freedom to live and socialize
in the community
10 People with different sexual orientation such as 12.5 3.3 69.2 15.0 100.0
LGBT should be excluded from the community
11 LGBT should have equal right to obtain any health 5.8 5.0 57.5 31.7 100.0
service
12 LGBT should have equal rights to in the workplace 41.7 10.8 40.0 7.5 100.0
13 When I am working at the hospital, I will ignore 4.2 5.0 60.0 30.8 100.0
LGBT complaints
14 LGBT needs support to prevent them from sexually 40.8 45.8 7.5 5.8 100.0
transmitted disease
15 I will avoid LGBT because they are very dangerous 29.2 15.0 50.8 5.0 100.0
and related to sexual abuse
16 I would think LGBT contribute largely in HIV AIDS 47.5 36.7 13.3 2.5 100.0
infection
17 Before stigmatizing and discriminating LGBT, 51.7 42.5 3.3 2.5 100.0
people should find accurate information
18 LGBT is a dangerous group because many murder 50.0 28.3 18.3 3.3 100.0
and violence were related to them
19 Government should reduce the information related to 28.3 27.5 33.3 10.8 100.0
sexually transmitted infections for LGBT so they will
change their behavior
20 I will never come to an event if the host is an LGBT 28.3 16.7 50.0 5.0 100.0
21 Parents should keep their children away from LGBT 50.8 40.0 6.7 2.5 100.0
because they are very dangerous

midwifery program in Yogyakarta, Indonesia, and that most of respondents (92%) were easily accessed
aged 20 years old in average. All respondents were any media related to HIV-AIDS; it is not surprising
full-time students and unemployed. Nevertheless, if the vast majority (99 %) ever heard about LGBT.
38 percent of respondents received allowance more Respondents in this study can be categorized as
than IDR 1,000,000 (equal to $77) per month. medium users of media because more than half spent
about 1-3 hours per day; whilst 26% spent a longer
Accessibility to media duration up to 5 hours per day. Considering
Since the vast majority of respondents (92.5%) respondents are students; most of them prefer
lived in urban boarding home, they had no difficulty accessing information related LGBT from the
accessing media and obtaining reliable information internet and their mobile phones (94 and 84 percent,
related to LGBT. Only a few of them (7.5%) respectively), whilst other media such as television,
experienced a barrier in accessing media books, magazines, newspaper and other printed
information due to remote residential area. Given media were rarely accessed.

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Table 2 Accessibility to media and attitudes toward LGBT

Accessibility to media
Attitudes toward LGBT Difficult Easy Total
F % F % F %
Positive attitudes 0 0 6 5 6 5
Less positive attitudes 0 0 64 53.3 64 53.3
Negative attitudes 9 7.5 41 34.2 50 41.7

Stigma toward LGBT any workplace because of their status. Although

The present study found that the vast majority generally positive, the respondents’ responses
of respondents have negative attitudes toward toward equal rights for LGBT in the workplace were
LGBT. Stigmatization to LGBT was shown from the also diverted into two groups, agree (41%) and
respondents’ unwillingness to have proximate disagree (40%).
distance to LGBT and tends to build a social- Association between accessibility to media and
distance. Table 1 shows 28% respondents refused to stigma toward LGBT
have any contact with LGBT and perceived LGBT Studies found that media helps to shape
group as the biggest contributor in HIV-AIDS people’s perception toward a phenomenon [17].
transmission. Nevertheless, 61% of respondents Several theories posited that media plays a great role
showed their positive support if one of their family in building community’s awareness. In its relation to
member happened to be an LBGT. stigma, media may influence people by providing
Respondents’ attitudes toward LGBT seem to information or inflicting fear to its users. The nature
be inconsistent, as shown in the Table 1. Although of media as information source may improve
about half of respondents disagreed to the statement people’s knowledge which in turn will affect their
“I will avoid the LGBT group because they have attitudes and behaviors toward LGBT [18-20].
risky sexual behavior”, negative stigma toward Table 2 shows the cross tabulation between
LBGT also shown by 50% of respondents who attitudes toward LGBT and accessibility to media.
considered that being an LBGT means having sexual The cut of points defining less positive and negative
disorder; and therefore should be avoided. Although was set based on respondents’ scores compared to
more than half (69%) of respondents perceived that total attitudes score. Respondents who scored less
LGBT should not be excluded from the community than 60% of total expected scores were categorized
and stated not afraid of HIV transmission just by as negative; whilst those who scored 60-80% were
becoming friends; 58% believed that this group of considered to have less positive attitudes. Midwifery
people would be dangerous. The reluctance of students who have favorable (more than 80%)
respondents in having a close relationship with responses toward LGBT were regarded as having
LGBT was also shown by 51% who do not want to positive attitudes.
have any relationship with LGBT, and refused to The findings of the present study revealed that
attend an event that is hosted by an LGBT. those who have better access to media information
Respondents seemed that they did not only hesitate are less likely to have positive attitudes toward
but also confused. The data shows 44% willing and LGBT. Among those who have better access, the
42% not willing to visit LGBT house. About 40% proportion of midwives who have positive attitudes
agreed that LGBT should have equal rights in the was at the lowest compared to those who have
workplace; whilst 41% disagreed toward the negative or less positive attitudes. Statistical
statement. analysis by chi-square showed that access to media
A clearer picture of negative stigma depicted by information is associated to respondents’ attitudes
90% of respondents who agreed that parents should toward LGBT, a p-value <0.01.
keep their children away from LGBT because they
are considered to be very dangerous. More than 70% DISCUSSION
perceived that LGBT can be very dangerous because Stigma has been studied widely across different
many violence and murder case reports were done settings. Since many scholars have their own
by this group. Stigma in the workplace was definition of “stigma”, there are many definitions of
portrayed by more than half of respondents who the word. Therefore, most of them relied on
believed that LGBT will not be easily accepted in Goffman’s initial definition “tribute that is deeply

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discrediting" and that reduces the bearer "from a found them in service delivery points. Although the
whole and usual person to a tainted, discounted percentage of respondents who openly admitted the
one” [21, 22]. Stigma can also be seen as a intention to discriminate LGBT seemed to be low,
relationship between an attribute and a stereotype to the actual practice might be higher than it is
produce a definition of stigma as a "mark" (attribute) reported; because attitudes are unobserved; and
that links a person to undesirable characteristics some respondents were silent or in doubt [25].
[23]. The study confirmed that accessibility to media
Midwife is one of health providers that are has an association to respondents’ attitudes toward
expected to provide an equal service to anyone, LGBT. Respondents who have better access to any
regardless their sexual preference and HIV status. media were more likely to have better attitudes and
Unfortunately, stigmatization and discrimination by less stigmatized. As Cultivation theory posited,
health providers are continuously reported in many exposure to mass media creates and cultivates
settings. LGBTs are less likely to visit health attitudes more consistent with a media-directed
services and tend to disclose themselves from the version of reality than with reality itself [17, 26].
community. This is because not only they attached Media portrayals and messages affect the behavior
to LGBT themselves; stigma also creates a social of young persons over time by enabling them to
barrier for their family. Social seclusion to LGBT acquire new attitudes and behaviors, or by changing
and their family has put this group under a social the likelihood that they will perform new, or
distressed [18]. previously learned responses [27]. Those who have
Interestingly, respondent’s attitudes toward higher exposure to media are more likely to have
LGBT in this study were diverted based on their more permissive attitudes compared to their
roles as health provider and as a family member. counterparts who have less exposure [28].
When it comes to their children, respondents Internet is found as the most preferred media of
perceived that it is important to protect their children the respondents. It can be understood since the
from LGBT because of safety reason. It should be internet is accessed through laptop, computer or
noted that parents’ perception in this case was mobile phone; and it is the most convenient to be
perhaps influenced by media. Back to 1996, when accessed at a very low cost compared to other media
many media channels broadcasted the Robot Gedek such as book, magazine or DVD/VCD. The finding
case, parents were exposed with excessive reports of of the study corresponds to several media studies
an adult male who forced male children for sodomy conducted among young people. The anonymity of
and ended up by murdering them. Robot Gedek was the internet as a new medium has made it as the most
just an example of a case which was blown up by the preferred media to be accessed by the youngsters,
media; unfortunately, he was a same-sex oriented replacing television and printed media that have no
person [24]. Other than Robot Gedek, Ryan was longer been a favorite source of information. With a
another example of how media in 2012 overstated lowered cost, the internet nowadays has become a
homosexual person as murderer. It is true that Ryan highly accessible medium for its users; where they
was a homosexual man; and he was also proven can obtain the information needed at their most
guilty by the court as a murderer of his boyfriend; convenient time [17, 26].
but media’s overexposure has inflicting fear to Not only the frequency and adequacy of media
community and thus, increasing stigma towards exposure to community, the contents that media
LGBT. provided are also influencing people’s attitude and
Unlike for family case, health providers showed behavior related stigma. With the nature of media as
more positive attitude in the working place. The vast double-edge swords, it cannot be denied that it plays
majority of respondents agreed that LGBT should a great role in shaping community’s perception and
not be discriminated. Ascribing a role as health awareness. Exposure to media representations of
provider, midwives are already vowed to provide LGBT may help cultivate viewers’ own attitudes
treatment to everyone equally. Nevertheless, further about homosexuality [28]. In Robot Gedek and
attention should be addressed to health education Ryan cases, excessive media exposures on the
curriculum for health provider in Indonesia, since sodomy and murder by homosexual men were
7.5% of midwifery postgraduate students were injecting fear to its viewer and contributing to the
having negative attitudes toward LGBT; and they negative attitudes toward LGBT.
intend to discriminate LGBT when respondents Of course the media’s role in shaping

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community’s perception was not only in negative it did not specify purpose of access. Further research
manners. Although it existed, media representation and future studies therefore should include motive
of a successful LGBT in Indonesia unfortunately of access; and it should be specified each content of
was not as strong as the negative image. Dorce media.
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