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Unlike the recent global trend of a decline in the prohibition of the use of Cannabis sativa for recreational and medical uses, Barbados and other small island states in the Caribbean have maintained their prohibitive legislation and policies on the use of the herb. A negative social construct of the use of cannabis and its effects in the consciousness of many in the Caribbean have contributed to the maintenance of the prohibitive policies towards the use of the herb. This article highlights the negative societal construct of the herb and its impact on the youth as two critical factors limiting the implementation of medical marijuana laws. It conceptualises a possible policy framework that would address this issue by enabling a phased implementation of the use of medicinal products from marijuana in the management of selected conditions from an evidence-based vantage point. Barbados would need to evaluate the mechanisms under current prohibitive legislation and create amendments to allow for an incremental approach on the use of the plant or products thereof for medicinal purposes in light of societal concerns. The policy framework should result in discreet enforceable mechanisms to facilitate and monitor the importation and development of efficacious and safe medicinal products for prescribing to authorised patients throughout the island's healthcare system.

Purpose A consensus in the literature is that anti-gay prejudice has a negative impact on HIV programming for men who have sex with men (MSM). This paper aims to analyse the prevalence and predictors of anti-gay prejudice in Barbados, an island in the Caribbean, and possible impacts on the full recognition of the right to health care. Design/methodology/approach The study used nationally representative data obtained from the Caribbean Development Research Services capturing anti-gay prejudice in Barbados in 2004, 2013 and 2019. The data were analysed using logit models and ordinary least squares regression. Findings The share of persons who expressed feelings of hatred towards gays and lesbians did not change significantly over the period. Social distance attitudes improved between 2004 and 2013 but have not changed since. Men generally expressed more prejudice than women and male sexual prejudice could be localised to three groups – men without tertiary education, men under 51 and members of non-Christian religions. Meanwhile, there was little consistency in the predictors of women’s attitudes over the period. Originality/value This study provides insights into the trends in attitudes towards sexual minorities in a developing country. The main conclusion is that although health care is provided as a universal right to all Barbadians, a strictly medical approach to HIV prevention among MSM in countries with high levels of anti-gay prejudice is insufficient.