Editor,—We read with interest the article by Fethers and colleagues on STIs and risk behaviours in women who have sex with women (WSW) and the accompanying editorial by Marrazzo.^{1, 2} It is gratifying to see our own results³ replicated in a larger and more complete study. Marrazzo highlights many of the methodological difficulties and deficiencies in research into WSW and comments specifically on “ lack of interest” or homophobia contributing to the paucity of interest into STI risk among WSWs. Homophobia is recognised as a barrier to accessing health care.⁴ We wish to report encouraging attitudes among the majority of medical students but forewarn colleagues of the potential for difficulties with attitudes in a minority of medical students.

Over the past 3 years we have administered the “Attitudes to lesbians and gay men” questionnaire⁵ to final year medical students at St Bartholomew's and the London Medical School as part of core teaching on “sexuality and sexual health,” in order to promote discussion. This consists of two 10 item subscales for assessing heterosexual attitudes to homosexual men and lesbians. The 20 statements are presented in Likert format with a nine point scale ranging from “strongly disagree” to “strongly agree,” therefore scores range from 20 (extremely positive attitudes) to 180 (extremely negative attitudes). We have analysed the responses to 217 questionnaires: 41% of the sample were male and the median age was 23 (range 21–34 years). The results are presented in table 1. The majority of the sample displayed positive attitudes to lesbians and homosexual men with female students exhibiting statistically more positive views especially in relation to homosexual men. However, a significant minority of men (11.8%) exhibited extremely negative attitudes to homosexual men.

We are encouraged by these results which are contrary to much of the published data on attitudes among physicians, nurses, and medical and non-medical students. However, we must continue to challenge negative attitudes as studies show that teaching and promoting tolerance can result in change.⁶ Otherwise difficulties with disclosure in medical settings will continue to impact on provision of health care to WSW and homosexual men and further hamper research in this area.