Category: AIDS/HIV

NARTH pulls the Melonakos article

Recently, I took some exception to the outdated article, “Why Isn’t Homosexuality Considered A Disorder On The Basis Of Its Medical Consequences?” by Kathleen Melonakos. It was posted on the NARTH website and reprinted at Lifesite News but has now been pulled from the site. You can still read it at the Lifesite News page. I commend Dave Pruden and the NARTH leaders who are taking seriously these concerns for accuracy.

UPDATE: 1/5/06 – A commenter pointed out that the Melonakos article has now been pulled from the Lifesite News site. So this link does not work. For future reference, one can find it on other sites around the web.

CDC, anal sex, and risk

Related to a couple of previous posts, I thought it would be helpful to review what The Centers for Disease Control (CDC) has to say about anal sex and risk.

Can I get HIV from anal sex?

Yes. In fact, unprotected (without a condom) anal sex (intercourse) is considered to be very risky behavior. It is possible for either sex partner to become infected with HIV during anal sex. HIV can be found in the blood, semen, pre-seminal fluid, or vaginal fluid of a person infected with the virus. In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions, or open sores on the penis.

Not having (abstaining from) sex is the most effective way to avoid HIV. If people choose to have anal sex, they should use a latex condom. Most of the time, condoms work well. However, condoms are more likely to break during anal sex than during vaginal sex. Thus, even with a condom, anal sex can be risky. A person should use generous amounts of water-based lubricant in addition to the condom to reduce the chances of the condom breaking.

Working with clients, I provide this information and accentuate the risks involved. This is true for men and women, no matter what their erotic orientation.

For information purposes, Laumann et al found that 25% of men and 20% of women reported anal sex. Among gay and bisexual men, 76% of the survey respondents had experienced insertive anal intercourse and 82% receptive. This was in 1994, I suspect the numbers are higher among straights now.

To me, this means that straights need the CDC information and some gays do not engage in anal sex (although they need the information as well). Assumptions that all gay males do this routinely, while often correct, are not always true. Frequency of such activities and with whom are important factors for health care professionals to ask about and they are the determinants of disease, not sexual attractions per se. My view is that sexual promiscuity in gay men owes more to being male than being attracted to the same sex. Of course, this is not proven but it fits my clinical experience and observations better than assuming the reverse.

There are people of both sexes and all sexual orientations who are at high risk for acquiring and spreading STDs. These individuals often have significant emotional needs and profit from interventions that are individually suited to their needs.

Take away point: People who do not manage their intimate lives well are at higher risk for disease and emotional distress than those who do.

NARTH article asking why homosexuality isn’t a disorder.

This article by Kathleen Melonakos from the NARTH website was recently reprinted by Lifesite News.

While I think it is important to advocate for healthy sexual conduct, I do question the sources and some of the conclusions of this article. I did not check everything but a few things seem important to note.

First, the article quotes the discredited work of Paul Cameron and relies on his conclusions based on questionable assumptions. One popular response to his work notes the problems with sampling and inference in his articles.

Also, Ms. Melonakos says: As far as I know, there is no other group of people in the United States that dies of infectious diseases in their mid-forties except practicing homosexuals. The evidence for this statement is in a footnote that leads to the 1997 article by Hogg et al that has been widely reported. The finding often quoted that is generalized to homosexuals as a group is:

In a major Canadian centre, life expectancy at age 20 years for gay and bisexual men is 8 to 20 years less than for all men. If the same pattern of mortality were to continue, we estimate that nearly half of gay and bisexual men currently aged 20 years will not reach their 65th birthday.

Rarely do sources that cite the Hogg et al study or that simply assume a mid-40s life expectancy then cite the follow up letter from Hogg et al where the authors provide context for their research. It is important to read this letter to understand the significance of their findings. In this note, they state:

In contrast, if we were to repeat this analysis today the life expectancy of gay and bisexual men would be greatly improved. Deaths from HIV infection have declined dramatically in this population since 1996. As we have previously reported there has been a threefold decrease in mortality in Vancouver as well as in other parts of British Columbia.

and

It is essential to note that the life expectancy of any population is a descriptive and not a prescriptive mesaure. Death is a product of the way a person lives and what physical and environmental hazards he or she faces everyday. It cannot be attributed solely to their sexual orientation or any other ethnic or social factor. If estimates of an individual gay and bisexual man’s risk of death is truly needed for legal or other purposes, then people making these estimates should use the same actuarial tables that are used for all other males in that population. Gay and bisexual men are included in the construction of official population-based tables and therefore these tables for all males are the appropriate ones to be used.

Ms. Melonakos then notes the psychiatric criteria for viewing a syndrome as a diagnosis. The behavior or syndrome must cause subjective distress and/or negative social/life consequences. She asserts that homosexuality satisfies these criteria because many gays are unhappy with their sexual orientation and being gay is a “lethal addiction.” First, the DSM does include a diagnosis for those who are in distress over their sexual orientation (302.90). Second, the evidence is not clear that simply having same-sex attraction or taking on a gay identity requires one to pursue practices that do indeed lead to shortened life or disabling disease. I have previously addressed this issue relating to mental health morbidity.

In short, I do not believe the article makes the case for considering homosexual attraction per se to be a psychiatric disorder. Disordered sexuality of any sort (many partners, risky behavior, comcommitant drug usage, etc.) can be treated under several diagnostic headings, whether the person is gay, straight or bisexual.

More on this article. In it, Ms. Melonakos asks: “Can anyone refute that increased morbidity and mortality is an unavoidable result of male-with-male sex–not to mention the increased rates of alcoholism, drug abuse, depression, suicide and other maladies that so often accompany a homosexual lifestyle?[v] People with this whole cluster of behavior patterns are somehow “normal”?”

This is pretty easily refuted by observing people who engage in male-to-male sex but do not have these disorders. Even in studies showing an increased risk of the disorders cited here, the majority of people studied do not have them. Somewhat, and in some cases, very minor, elevated risk, yes, but “unavoidable” incidence? No. Research does not show that increased morbidity and mortality is an unavoidable result of male-with-male sex.

To better understand the issues in anal cancer, see this National Cancer Institute article. HPV (against which condoms do not protect well) seems to be the major culprit. Men and women who engage in anal sex are at risk as are those who have had other STDs. The 4000% number quoted in the NARTH article seems pretty amazing until you consider that anal cancer is about unheard of in the general population. So instead of less than 1 case per 100,000, the rate is 35 per 100,000 in men who engage in anal sex. The risk is substantially elevated but the cancer is pretty rare. Even though the incidence is rare, I do think health professionals should provide this information to patients and in schools as well.

UPDATE (12/19/06) – NARTH Board member Dave Pruden tells me that the NARTH Scientific Advisory Committee is reviewing this article for accuracy.

1/4/07 -This article has been pulled from both the NARTH and Lifesite News websites.

Rick Warren’s AIDS conference dust up

The last several days, a fuss has erupted about an AIDS conference at Rick Warren’s (Purpose Driven Life) Saddleback church hosting an AIDS conference. Pro-life groups are upset that Barack Obama is speaking (he favors partial-birth abortion) and the new AIDS Truth Coalition wants more time at the conference on gay promiscuity. Saddleback has responded and the conference goes on.

Given our discussion of gay culture, is there something to the idea that gay leaders should be more vocal about promiscuity? That sounds provocative but I mean it to be a serious question. Feel free to comment on any aspect of this controversy.

Mental health status and homosexuality

Since the LA Times article appeared in October, I have received several emails asking about various aspects of my views that were reported in the article. Some ask about my view that same-sex attraction does not always stem from poor parenting, others ask about my views on homosexuality and increased risk for pathology. I have covered the parenting issues in prior posts and want to address briefly the matter of risk for pathology.

Some wrote to say that when I was characterized by reporter Stephanie Simon as believing homosexuals can have a “fulfilling life” that I ignore research documenting a higher level of mental health problems among homosexuals.

I disagree that the reporter’s characterizations of my views ignore social science research. On the contrary, my views are quite consistent with what we know about homosexual adjustment. While there are consistent reports of elevations of various mental health problems among homosexuals, there are many homosexually identified people who are untroubled by diagnosable conditions.

For instance, the most recent published comparison of gays and straights on suicidality found that homosexuals were more likely to feel suicidal than heterosexual participants, even with psychiatric history considered. However, the effect sizes on dimensions of self-injurious thoughts and behaviors were small to modest (2-4%). For women, when psychiatric history was considered, the relationships disappeared for all indicators except the contemplation of self-harm. Even for men, the modest effect sizes indicate there is much overlap between straight and gay groups; the results cannot be accounted for by sexual orientation differences alone. (Archives of Sexual Behavior, June 2006).

To withhold “even the possibility” (quote from the LA Times article) of homosexuals experiencing happiness is not warranted by the research we have. In all studies of psychiatric problems among homosexuals, large numbers of homosexuals report no psychiatric distress. In the study of suicidality noted above, the majority of homosexuals reported no indication of difficulty. While rates are frequently elevated among homosexual men, and sometime among lesbians, such elevations do not preclude the possibility of a satisfying life. If so, then we would need to extend such thinking to other groups (both essential human categories and those socially constructed as well) where elevated risks are found. For instance, other groups who have elevated risk for depression include the elderly, women, people of low socioeconomic class, people who smoke, people living in high stress situations, and people with chronic medical conditions. Suicide risk is elevated among Native American teens compared to all youth (2.5 times). Higher rates of psychiatric disorders and substance abuse problems have been reported among physicians. Evidence from a large study of physician suicide indicates that the suicide rate among male doctors is twice that of men in general. The rate among female doctors is four times higher than for all women. (South Med J 93(10):966-972, 2000). Women in general are about three times more likely to attempt suicide than men. Would one deny the possibility of a rewarding life to members of these groups? Surely not.

Thus, it would be inconsistent with the research on psychiatric risk to deny members of at-risk groups “even the possibility” of a “fulfilling life,” whether partnered or not. Higher risk, yes; inevitable mental health maladjustment for all members of a group of people? No.

PS – I want to note that some of the correspondence about the LA Times came via a coordinated effort from NARTH to my college with the intent to appear that the effort was not coordinated.