Abstract
Background:
India has made significant strides in recognizing the rights of the LGBTQ+ community by repealing Article 377 of the erstwhile Indian Penal Code. Despite that, societal attitudes toward the LGBTQ+ community have not undergone a substantial transformation. The current study was conducted to ascertain the knowledge and attitudes of the general population about homosexuality and to investigate the association between spirituality and the knowledge and attitudes toward same-sex relationships.
Methods:
The study employed a cross-sectional design, and an inter-group comparison was made between respondents of various sexual orientations. The three instruments used were the Attitudes Toward Homosexuals Questionnaire (AHQ) to study attitudes, the Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ) to assess the knowledge base, and the Centrality of Religiosity Scale (CRS) to quantify the religiosity of the respondents.
Results:
We obtained responses from 419 participants. The asexual respondents scored significantly higher on AHQ, signifying a more negative attitude (analysis of variance [ANOVA] = 5.502; P < .01). The homosexual or bisexual respondents had a better knowledge profile than others (ANOVA = 20.159; P < .001). Asexual respondents tended to have a higher score on the intellect and ideology subscale of CRS. In multiple linear regression, we found that scores on SEKHQ, CRS, and expressed sexual orientation were predictive of the attitude toward homosexuality.
Discussion:
Overall, this study addresses an important area of the role of religiosity in the attitude of the public toward homosexuality. It can be very useful in developing an intervention that is scientifically sound, culturally sanctioned, and acceptable to the patients and society.
Introduction
Indian literature demonstrates a significant paucity of comprehensive discourse on matters related to homosexuality. 1 Despite the historic repeal of Article 377 of the Indian Penal Code in 2018, societal attitudes toward the lesbian, gay, bisexual, transgender and queer (or “questioning”) (LGBTQ) community have not undergone a substantial transformation, and the stigma associated with non-heterosexual identities remains deeply entrenched. Moreover, there exists a notable deficiency in scholarly inquiries addressing the legal enforcement and societal acceptance of the queer population in the post-decriminalization era. This study aims to evaluate the awareness, perceptions, and religiosity of the general Indian population in relation to these issues.
Although the term “LGBTQ stigma” is utilized in this context, it is important to recognize the extensive body of academic literature that specifically addresses the prejudices and societal discrimination faced by individuals with diverse sexual orientations, including lesbian, gay, bisexual, and queer identities. 2 Additionally, there is an expanding field of research that examines stigma directed at transgender individuals. 3 Ilan Meyer further developed this theoretical framework by defining LGBTQ stigma as a persistent and profound psychosocial stressor that significantly compromises the well-being of gay men. 4 Moreover, empirical findings indicate that key sociocultural factors, such as peer acceptance of homosexuality, adherence to just-world beliefs, maternal educational background, and affinity toward LGBTQ public figures, serve as significant predictors of attitudes toward homosexuality among participants (P < .05). 5 The study underscores that knowing about homosexuality is the primary factor linked to favorable attitudes toward homosexuals. This reinforces the idea that increasing knowledge might be effective in reducing bias and discrimination against sexual minorities. This is not intended to advocate for homosexuality but to expose people to differing perspectives on sexuality, challenge their beliefs, and promote inclusivity. 6
The relationship between religiosity and outlook toward non-heterosexual orientations has been somewhat less studied. In an article by Adamczyk and Pitt, religion was found to be an important predictor of attitude toward homosexuality. The study used statistical modeling from large community-based data to derive that religion had a macro-level effect on the outlook toward homosexuality. 7 Another study by Jäckle and Wenzelburger used data from 79 countries to find that the attitude showed significant variance across the various countries. While in some countries, such as the United States, the attitude has gradually been more accepting toward homosexuality, other countries, such as Turkey and China, have not shown any changes over the recent years. 8 The study also found that the religious affiliations of the respondents may be linked to their attitudes. These findings were further supported by the study conducted on Chinese respondents by Xie and Peng, which showed a conservative outlook of the majority toward homosexuality. However, the study reported that “modernizing factors” such as education, access to the internet, and others led to a more accepting outlook. 9 Similar outlook about the complex interplay of religion and homosexuality could also be obtained from other cultural backgrounds, such as the African countries. 10
Barringer et al. in their study, further studied the role of identified spirituality in the context of religious affiliations and outlook toward homosexuality. This study, conducted in the United States in a community-representative sample, found that male respondents who identified themselves as spiritual but not religious tended to have a more accommodative outlook than the male respondents who considered themselves religious and spiritual. 11 This study provides us with a background to investigate whether a person’s spiritual inclination may affect the person’s attitude toward non-heterosexual orientations. To achieve this, the study utilized a cross-sectional method involving a survey developed from validated questionnaires and scales to assess participants’ knowledge and attitude toward homosexuality, as well as its correlation with their spirituality. The objectives of the current study were to first ascertain the knowledge and attitudes of the general population of India toward same-sex relationships and second, to investigate the association between spirituality and knowledge and attitudes toward same-sex relationships among these participants.
Methodology
This research was designed as a cross-sectional study and was conducted over one year in India, targeting the general population. The Institute Ethics Committee approved the study. The study utilized three standardized and validated instruments: the Attitudes Toward Homosexuals Questionnaire (AHQ), the Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ), and the Centrality of Religiosity Scale (CRS). The AHQ comprised 20 items addressing various aspects of homosexuality, including lifestyle and societal acceptance. Responses were recorded using a five-point Likert scale, ranging from “strongly agree” (one) to “strongly disagree” (five), with specific items requiring reverse scoring. The total possible AHQ score ranged from 20 to 100, where higher scores indicated more negative attitudes toward homosexuality. The scale has been used in prior studies and has good psychometric properties (Cronbach’s alpha = 0.8).6,12 The SEKHQ consisted of 32 statements, requiring participants to classify each statement as “true,” “false,” or “undecided.” Correct responses were assigned a score of one point, whereas incorrect or undecided responses were scored zero. A higher SEKHQ score represented a better knowledge profile among the respondents. The scale has been used extensively in previous studies with good psychometric properties (Cronbach’s alpha = 0.724).6,12 The CRS is an instrument used to measure the importance or salience of religious meanings in personal reflections. It is important to state that the scale was developed after obtaining responses from cross-cultural backgrounds across 25 countries. It tends to evaluate the importance and influence of religiosity in participants’ lives, incorporating five subscales: intellect, ideology, public practice, private practice, and religious experience. 13
Given the exploratory nature of the research, a formal sample size calculation was not performed. A purposive sampling technique was employed to recruit participants; however, measures were taken to ensure diverse representation. The respondents were recruited from the community. The respondents were apprised of the study’s purpose and nature, and responses were obtained from individuals who voluntarily provided informed consent. Respondents were instructed not to disclose personally identifiable information to ensure anonymity and confidentiality. The collected data were systematically recorded in a preformatted, structured Excel sheet for further statistical evaluation.
For statistical analysis, descriptive statistics were utilized to summarize the socio-demographic characteristics of the participants, along with the scores obtained from the AHQ, SEKHQ, and CRS. The Kolmogorov-Smirnov test was conducted to assess data normality. To analyze variations in AHQ, SEKHQ, and CRS scores across different study years, analysis of variance (ANOVA) was employed, followed by Tukey’s post-hoc test for multiple comparisons. Furthermore, Pearson’s correlation coefficient was used to examine the relationships between AHQ, SEKHQ, and CRS scores, providing insights into the potential interdependencies among attitudes toward homosexuality, knowledge about sex education, and religious beliefs.
Results
Overall, in the study, we obtained responses from 419 participants. Table 1 depicts the basic socio-demographic and clinical parameters of the recruited sample. The majority of participants identified as male (52%), and the average age of participants was 20.71 years. The most common religious affiliation was Hinduism (90%). The predominant sexual orientation of the sample was heterosexual (65.9%), while almost 84% of them were single.
Basic Socio-demographic or Clinical Parameters.
Since our study was an exploratory study, we did not conduct an a priori sample size calculation. However, we conducted a post-hoc power calculation of the study using an online resource (
Table 2 depicts the results of the ANOVA (with post-hoc Tukey’s test) on the scores of SEKHQ, AHQ, and CRS across the various sexual orientations. It was found that the attitude toward homosexuality, as assessed by AHQ, tended to significantly differ among the groups, with respondents identifying as asexual tending to have a more negative attitude. There was also a significant difference in the knowledge profile among the groups, with respondents identifying as homosexual or bisexual tending to have a better knowledge profile. In our study, it was also found that the respondents who identified themselves as asexual tended to have a higher score on the intellect and ideology subscale of CRS. This can be interpreted as the asexual respondents having a higher knowledge of religion and a stronger belief in transcendent reality and the relation between transcendence and humans. However, the groups did not differ in the total score and other subscales of CRS, namely public practice, private practice, and religious experience.
Results of ANOVA (with Post-hoc Tukey’s test) on the Scores of SEKHQ, AHQ, and CRS Across the Various Sexual Orientations.
Multiple linear regression analysis was done using the scores on AHQ to look for statistically independent predictors. The model was found to be statistically viable, and it was found that the scores on SEKHQ, the total scores of CRS, and identified sexual orientation were all predictive of the attitude toward homosexuality (Table 3).
Results of Linear Regression of Factors Predicting the Attitude Toward Sexual Orientation as Measured by the Scores of AHQ.
Discussion
Our study was a cross-sectional study of a community-based sample that aimed to ascertain the knowledge and attitudes of the general population of India toward same-sex relationships and, second, to investigate the association between spirituality and knowledge and attitudes toward same-sex relationships among these participants. The results of our study showed that respondents who identified themselves as homosexual or bisexual tended to have a higher knowledge base about same-sex relationships as compared to heterosexual or asexual respondents. This result is on expected lines and can be attributed to the lived experiences of the respondents who have had same-sex partners. It has been established that heteronormative hegemony has been the norm in most societies, including Indian societies. 15 This attitude can be detrimental to the knowledge of even the most trained cadres of the healthcare setup. However, lived experiences can be very useful in changing the knowledge base and, hence, also in changing people’s attitudes. 16
In our sample, attitude toward homosexuality was found to be the most negative among the asexual respondents as compared to the other groups. The respondents identifying as asexual also scored higher in the ideology and intellect subscale of the CRS. This finding is very interesting when we evaluate it through the complex interplay between sexuality and religiosity. It needs to be understood that the theological approach toward sexuality has been very conservative, and most religion seems to have blurred lines regarding the boundary between morality (which is essential in this context) and non-heterosexual relationships. 17 Literature also pointed out that curriculum training for future religious leaders has been avoidant toward the complex issues of morality, sexuality, and ethics. 18 In our sample, we feel that the orthodox outlook of the asexual respondents toward homosexuality and their higher scores in the ideology and intellect subscale of the CRS could be linked to their preference for identifying as asexual and considering sexuality-related issues as anathema. Due to the cross-sectional nature of our investigation, it is difficult to attribute any causal directions to this association. Still, we believe this gives us a background to form a hypothesis that can be pursued in further research. Further research on this topic should include qualitative studies, which would be appropriate to capture the inherent complexities of this potential association.
We also conducted a multiple linear regression to study the factors that can predict the attitude of the respondents to homosexuality. We found three predictors that assumed statistical significance. We found that scientific knowledge of the nuances of homosexuality, religiosity, and expressed sexual orientation was predictive of attitudes toward homosexuality. These findings are well supported by the literature, which suggests that an increase in knowledge and lived experience of homosexuality or bisexuality can help develop a more conforming attitude. However, the relationship between religiosity and the attitude toward sexuality needs to be discussed in some detail. In our sample, we refrained from comparing respondents across various religions because of the disproportionate representation of the various faiths. However, in many religions, homosexuality is looked at as an “unnatural” practice and is condemned, though, with time, various religious subsects have gradually expressed a more accepting view. 19 However, the complexities in this interplay go beyond just the interpretation of religious doctrines. The conflict can stem at a personal level, and individuals identifying themselves as homosexuals may find their sexual orientation in conflict with their religious beliefs, which can be a source of constant stress. These people also have to deal with attacks from religious sects, or they have to live under a constant fear of suffering from that. They often end up being marginalized and discriminated against, even on matters that are not related to sexual orientation. Religious leaders often end up in a position to offer intervention to persons in conflict between religion and sexuality. This gives rise to a philosophical contradiction because evidence-based gender-affirmative care lies in stark contrast to religious endorsements of sexual behavior. 19
Overall, this study addresses an important area of the role of religiosity in the attitude of the public toward homosexuality. According to our literature search, this is the first study of its kind from India, the world’s most populous country. The religious and cultural heritage of the country has often been a matter of interest to scholars, and this study details the prospective role of religiosity in the attitudinal development of the general public toward homosexuality. The strength of our study has been the use of structured tools with good psychometric properties and wide previous use. Though we did not perform an a priori sample size assumption, we still obtained data from a sizable population recruited from the community, and the power of our study on post-hoc analysis was robust. Our study’s major limitation was that although the tools have been widely used, we could not obtain any literature about their validation. Since we used a cross-sectional design, we could not ascribe a causal direction to any of the hypotheses we could generate. Moreover, the domains tested in the study may not apprehend the adroit and subtle aspects of sexuality and the deeply rooted stigma affecting LGBTQ people efficiently. Since sexual minorities are stigmatized, some people who identify as LGBT+ may be unwilling to acknowledge their gender identity in the survey.
Future studies in this direction can use a stratified random sampling method, where we can have a closer look at the respondents’ religious affiliation and attitude toward homosexuality. The study can be conducted as multicentric research so that the generalizability of the data can improve. Such research can help understand the close interplay of religion and sexuality. It can be very useful in developing an intervention that is scientifically sound yet culturally sanctioned and hence, acceptable to the patients and society at large.
Footnotes
Authors’ Contribution
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by all authors, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Consent to Publish
Not applicable.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethics Approval
Ethical approval was obtained from the Research Cell of AIIMS Raebareli (Letter no: AIIMS/RBL/IRC/NF036/136/2023 dated: 21/08/2023).
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Patient Consent
Not applicable.