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Note: "The Health
Risks of Gay Sex" is also available in pdf format here. Contents
Levels of Promiscuity The Health Risks of Gay Sex I. Differences between homosexual and heterosexual
relationships A. Promiscuity a. Anal-genital 1. Psychiatric Illness D. Life span II. Cultural Implications of Promiscuity Executive
Summary Sexual
relationships between members of the same sex expose gays, lesbians and bisexuals
to extreme risks of Sexually Transmitted Diseases (STDs), physical injuries,
mental disorders and even a shortened life span. There are five major
distinctions between gay and heterosexual relationships, with specific
medical consequences. They are:
Common
sexual practices among gay men lead to numerous STDs and physical injuries,
some of which are virtually unknown in the heterosexual population. Lesbians
are also at higher risk for STDs. In addition to diseases that may be
transmitted during lesbian sex, a study at an Australian STD clinic found
that lesbians were three to four times more likely than heterosexual women to
have sex with men who were high-risk for HIV.
It
is well established that there are high rates of psychiatric illnesses,
including depression, drug abuse, and suicide attempts, among gays and
lesbians. This is true even in the Netherlands, where gay, lesbian and
bisexual (GLB) relationships are far more socially acceptable than in the
U.S. Depression and drug abuse are strongly associated with risky sexual
practices that lead to serious medical problems.
The
only epidemiological study to date on the life span of gay men concluded that
gay and bisexual men lose up to 20 years of life expectancy.
Monogamy,
meaning long-term sexual fidelity, is rare in GLB relationships, particularly
among gay men. One study reported that 66 percent of gay couples reported sex
outside the relationship within the first year, and nearly 90 percent if the
relationship lasted five years. Encouraging
people to engage in risky sexual behavior undermines good health and can
result in a shortened life span. Yet that is exactly what employers and
governmental entities are doing when they grant GLB couples benefits or
status that make GLB relationships appear more socially acceptable.
Introduction
Back in the early
1980s, while working at Beth Israel Hospital, I vividly remember seeing
healthy young gay men dying of a mysterious disease that researchers only
later identified as a sexually transmitted disease — AIDS. Over the years,
I've seen many patients with that diagnosis die. As a physician,
it is my duty to assess behaviors for their impact on health and wellbeing.
When something is beneficial, such as exercise, good nutrition, or adequate
sleep, it is my duty to recommend it. Likewise, when something is harmful,
such as smoking, overeating, alcohol or drug abuse, it is my duty to
discourage it. When sexual
activity is practiced outside of marriage, the consequences can be quite
serious. Without question, sexual promiscuity frequently spreads diseases,
from trivial to serious to deadly. In fact, the Centers for Disease Control
and Prevention estimates that 65 million Americans have an incurable sexually
transmitted disease (STD).1 There are
differences between men and women in the consequences of same-sex activity.
But most importantly, the consequences of homosexual activity are distinct
from the consequences of heterosexual activity. As a physician, it is my duty
to inform patients of the health risks of gay sex, and to discourage them
from indulging in harmful behavior.
The current media
portrayal of gay and lesbian relationships is that they are as healthy,
stable and loving as heterosexual marriages — or even more so.2
Medical associations are promoting somewhat similar messages.3
Nevertheless, there are at least five major areas of differences between gay
and heterosexual relationships, each with specific medical consequences.
Those differences include: A. Levels of
promiscuity A. Promiscuity Gay author
Gabriel Rotello notes the perspective of many gays that "Gay liberation
was founded . . . on a 'sexual brotherhood of promiscuity,' and any
abandonment of that promiscuity would amount to a 'communal betrayal of
gargantuan proportions.'"4 Rotello's perception of gay
promiscuity, which he criticizes, is consistent with survey results. A
far-ranging study of homosexual men published in 1978 revealed that 75
percent of self-identified, white, gay men admitted to having sex with more
than 100 different males in their lifetime: 15 percent claimed 100-249 sex
partners; 17 percent claimed 250- 499; 15 percent claimed 500-999; and 28
percent claimed more than 1,000 lifetime male sex partners.5By
1984, after the AIDS epidemic had taken hold, homosexual men were reportedly
curtailing promiscuity, but not by much. Instead of more than 6 partners per
month in 1982, the average non-monogamous respondent in San Francisco
reported having about 4 partners per month in 1984.6 In more recent
years, the U.S. Centers for Disease Control has reported an upswing in
promiscuity, at least among young homosexual men in San Francisco. >From 1994
to 1997, the percentage of homosexual men reporting multiple partners and
unprotected anal sex rose from 23.6 percent to 33.3 percent, with the largest
increase among men under 25.7 Despite its continuing incurability,
AIDS no longer seems to deter individuals from engaging in promiscuous gay
sex.8 The data relating
to gay promiscuity were obtained from self-identified gay men. Some advocates
argue that the average would be lower if closeted homosexuals were included
in the statistics.9 That is likely true, according to data obtained
in a 2000 survey in Australia that tracked whether men who had sex with men
were associated with the gay community. Men who were associated with the gay
community were nearly four times as likely to have had more than 50 sex
partners in the six months preceding the survey as men who were not
associated with the gay community.10 This may imply that it is
riskier to be "out" than "closeted." Adopting a gay
identity may create more pressure to be promiscuous and to be so with a
cohort of other more promiscuous partners. Excessive sexual
promiscuity results in serious medical consequences — indeed, it is a recipe
for transmitting disease and generating an epidemic.11 The
HIV/AIDS epidemic has remained a predominantly gay issue in the U.S.
primarily because of the greater degree of promiscuity among gays.12
A study based upon statistics from 1986 through 1990 estimated that
20-year-old gay men had a 50 percent chance of becoming HIV positive by age
55.13 As of June 2001, nearly 64 percent of men with AIDS were men
who have had sex with men.14 Syphilis is also more common among
gay men. The San Francisco Public Health Department recently reported that
syphilis among the city's gay and bisexual men was at epidemic levels.
According to the San Francisco Chronicle: "Experts believe syphilis is on the rise
among gay and bisexual men because they are engaging in unprotected sex with
multiple partners, many of whom they met in anonymous situations such as sex
clubs, adult bookstores, meetings through the Internet and in bathhouses. The
new data will show that in the 93 cases involving gay and bisexual men this
year, the group reported having 1,225 sexual partners."15 A study done in
Baltimore and reported in the Archives of Internal Medicine found that gay
men contracted syphilis at three to four times the rate of heterosexuals.16
Promiscuity is the factor most responsible for the extreme rates of these and
other Sexually Transmitted Diseases cited below, many of which result in a
shortened life span for men who have sex with men. Promiscuity among
lesbians is less extreme, but it is still higher than among heterosexual
women. Overall, women tend to have fewer sex partners than men. But there is
a surprising finding about lesbian promiscuity in the literature. Australian
investigators reported that lesbian women were 4.5 times more likely to have
had more than 50 lifetime male partners than heterosexual women (9 percent of
lesbians versus 2 percent of heterosexual women); and 93 percent of women who
identified themselves as lesbian reported a history of sex with men.17
Other studies similarly show that 75-90 percent of women who have sex with
women have also had sex with men.18
Unhealthy sexual
behaviors occur among both heterosexuals and homosexuals. Yet the medical and
social science evidence indicate that homosexual behavior is uniformly
unhealthy. Although both male and female homosexual practices lead to
increases in Sexually Transmitted Diseases, the practices and diseases are
sufficiently different that they merit separate discussion. 1. Male Homosexual Behavior Men having sex
with other men leads to greater health risks than men having sex with women19
not only because of promiscuity but also because of the nature of sex among
men. A British researcher summarizes the danger as follows: "Male homosexual behaviour is not simply
either 'active' or 'passive,' since penile-anal, mouth-penile, and hand-anal
sexual contact is usual for both partners, and mouth-anal contact is not
infrequent. . . . Mouth-anal contact is the reason for the relatively high
incidence of diseases caused by bowel pathogens in male homosexuals. Trauma
may encourage the entry of micro-organisms and thus lead to primary
syphilitic lesions occurring in the anogenital area. . . . In addition to
sodomy, trauma may be caused by foreign bodies, including stimulators of
various kinds, penile adornments, and prostheses."20 Although the
specific activities addressed below may be practiced by heterosexuals at
times, homosexual men engage in these activities to a far greater extent.21
a. Anal-genital Anal intercourse
is the sine qua non of sex for many gay men.22 Yet human
physiology makes it clear that the body was not designed to accommodate this
activity. The rectum is significantly different from the vagina with regard
to suitability for penetration by a penis. The vagina has natural lubricants
and is supported by a network of muscles. It is composed of a mucus membrane
with a multi-layer stratified squamous epithelium that allows it to endure
friction without damage and to resist the immunological actions caused by
semen and sperm. In comparison, the anus is a delicate mechanism of small
muscles that comprise an "exit-only" passage. With repeated trauma,
friction and stretching, the sphincter loses its tone and its ability to
maintain a tight seal. Consequently, anal intercourse leads to leakage of
fecal material that can easily become chronic. The potential for
injury is exacerbated by the fact that the intestine has only a single layer
of cells separating it from highly vascular tissue, that is, blood.
Therefore, any organisms that are introduced into the rectum have a much
easier time establishing a foothold for infection than they would in a
vagina. The single layer tissue cannot withstand the friction associated with
penile penetration, resulting in traumas that expose both participants to
blood, organisms in feces, and a mixing of bodily fluids. Furthermore,
ejaculate has components that are immunosuppressive. In the course of
ordinary reproductive physiology, this allows the sperm to evade the immune
defenses of the female. Rectal insemination of rabbits has shown that sperm
impaired the immune defenses of the recipient.23 Semen may have a
similar impact on humans.24 The end result is
that the fragility of the anus and rectum, along with the immunosuppressive
effect of ejaculate, make anal-genital intercourse a most efficient manner of
transmitting HIV and other infections. The list of diseases found with
extraordinary frequency among male homosexual practitioners as a result of
anal intercourse is alarming: Anal Cancer Sexual
transmission of some of these diseases is so rare in the exclusively
heterosexual population as to be virtually unknown. Others, while found among
heterosexual and homosexual practitioners, are clearly predominated by those
involved in homosexual activity. Syphilis, for example is found among
heterosexual and homosexual practitioners. But in 1999, King County,
Washington (Seattle), reported that 85 percent of syphilis cases were among
self-identified homosexual practitioners.26 And as noted above,
syphilis among homosexual men is now at epidemic levels in San Francisco.27
A 1988 CDC survey
identified 21 percent of all Hepatitis B cases as being homosexually
transmitted while 18 percent were heterosexually transmitted.28 Since
homosexuals comprise such a small percent of the population (only 1-3
percent),29 they have a significantly higher rate of infection
than heterosexuals.30 Anal intercourse
also puts men at significant risk for anal cancer. Anal cancer is the result of
infection with some subtypes of human papilloma virus (HPV), which are known
viral carcinogens. Data as of 1989 showed the rates of anal cancer in male
homosexual practitioners to be 10 times that of heterosexual males, and
growing. 30 Thus, the prevalence of anal cancer among gay men is of great
concern. For those with AIDS, the rates are doubled.31 Other physical
problems associated with anal intercourse are: hemorrhoids b. Oral-anal There is an
extremely high rate of parasitic and other intestinal infections documented
among male homosexual practitioners because of oral-anal contact. In fact,
there are so many infections that a syndrome called "the Gay Bowel"
is described in the medical literature.33 "Gay bowel syndrome
constitutes a group of conditions that occur among persons who practice
unprotected anal intercourse, anilingus, or fellatio following anal
intercourse."34 Although some women have been diagnosed with
some of the gastrointestinal infections associated with "gay
bowel," the vast preponderance of patients with these conditions are men
who have sex with men.35 "Rimming"
is the street name given to oralanal contact. It is because of this practice
that intestinal parasites ordinarily found in the tropics are encountered in
the bodies of American gay men. Combined with anal intercourse and other
homosexual practices, "rimming" provides a rich opportunity for a
variety of infections. Men who have sex
with men account for the lion's share of the increasing number of cases in
America of sexually transmitted infections that are not generally spread
through sexual contact. These diseases, with consequences that range from
severe and even life-threatening to mere annoyances, include Hepatitis A,36
Giardia lamblia, Entamoeba histolytica,37 Epstein-Barr virus,38
Neisseria meningitides,39 Shigellosis, Salmonellosis, Pediculosis,
scabies and Campylobacter.40 The U.S. Centers for Disease Control
(CDC) identified a 1991 outbreak of Hepatitis A in New York City, in which 78
percent of male respondents identified themselves as homosexual or bisexual.41While
Hepatitis A can be transmitted by routes other than sexual, a preponderance
of Hepatitis A is found in gay men in multiple states.42
Salmonella is rarely associated with sexual activity except among gay men who
have oral-anal and oral-genital contact following anal intercourse.43
The most unsettling new discovery is the reported sexual transmission of
typhoid. This water-borne disease, well known in the tropics, only infects
400 people each year in the United States, usually as a result of ingestion
of contaminated food or water while abroad. But sexual transmission was
diagnosed in Ohio in a series of male sex partners of one male who had
traveled to Puerto Rico.44 In America, Human
Herpes Virus 8 (called Herpes Type 8 or HHV-8) is a disease found exclusively
among male homosexual practitioners. Researchers have long noted that men who
contracted AIDS through homosexual behavior frequently developed a previously
rare form of cancer called Kaposi's sarcoma. Men who contract HIV/AIDS
through heterosexual sex or intravenous drug use rarely display this cancer.
Recent studies confirm that Kaposi's sarcoma results from infection with
HHV-8. The New England Journal of Medicine described one cohort in San
Francisco where 38 percent of the men who admitted any homosexual contact
within the previous five years tested positive for this virus while none of
the exclusively heterosexual men tested positive. The study predicted that
half of the men with both HIV and HHV-8 would develop the cancer within 10
years.45 The medical literature is currently unclear as to the
precise types of sexual behavior that transmit HHV-8, but there is a
suspicion that it may be transmitted via saliva.46 c. Human Waste Some gay men sexualize
human waste, including the medically dangerous practice of coprophilia, which
means sexual contact with highly infectious fecal wastes.47 This
practice exposes the participants to all of the risks of anal-oral contact
and many of the risks of analgenital contact. d. Fisting "Fisting"
refers to the insertion of a hand or forearm into the rectum, and is far more
damaging than anal intercourse. Tears can occur, along with incompetence of
the anal sphincter. The result can include infections, inflammation and,
consequently, enhanced susceptibility to future STDs. Twenty-two percent of
homosexuals in one survey admitted to having participated in this practice.48
e. Sadism The sexualization
of pain and cruelty is described as sadism, named for the 18th Century
novelist, the Marquis de Sade. His novel Justine describes repeated rapes and
non-consensual whippings.49 Not all persons who practice sadism
engage in the same activities. But a recent advertisement for a sadistic
"conference" included a warning that participants might see
"intentional infliction of pain [and] cutting of the skin with bleeding
. . . ." Scheduled workshops included "Vaginal Fisting" (with
a demonstration), "Sacred Sexuality and Cutting" with "a
demonstration of a cutting with a live subject," "Rough Rope,"
and a "Body Harness" workshop that was to involve
"demonstrating and coaching the tying of erotic body harnesses that
involve the genitals, male and female."50 A similar event
entitled the "Vicious Valentine" occurred near Chicago on Feb.
15-17, 2002.51 The medical consequences of such activities range
from mild to fatal, depending upon the nature of the injuries inflicted.52
As many as 37 percent of homosexuals have practiced some form of sadism.53
f. Conclusion The consequences
of homosexual activity have significantly altered the delivery of medical
care to the population at-large. With the increased incidence of STD organisms
in unexpected places, simple sore throat is no longer so simple. Doctors must
now ask probing questions of their patients or risk making a misdiagnosis.
The evaluation of a sore throat must now include questions about oral and
anal sex. A case of hemorrhoids is no longer just a surgical problem. We must
now inquire as to sexual practice and consider that anal cancer, rectal
gonorrhea, or rectal chlamydia may be secreted in what deceptively appears to
be "just hemorrhoids."54 Moreover, data shows that rectal
and throat gonorrhea, for example, are without symptoms in 75 percent of
cases.55 The impact of the
health consequences of gay sex is not confined to homosexual practitioners.
Even though nearly 11 million people in America are directly affected by cancer,
compared to slightly more than three-quarters of a million with AIDS,56
AIDS spending per patient is more than seven times that for cancer.57
The inequity for diabetes and heart disease is even more striking.58
Consequently, the disproportionate amount of money spent on AIDS detracts
from research into cures for diseases that affect more people.
Lesbians are also
at higher risk for STDs and other health problems than heterosexuals.59
However, the health consequences of lesbianism are less well documented than
for male homosexuals. This is partly because the devastation of AIDS has caused
male homosexual activity to draw the lion's share of medical attention. But
it is also because there are fewer lesbians than gay men,60 and
there is no evidence that lesbians practice the same extremes of same-sex
promiscuity as gay men. The lesser amount of medical data does not mean,
however, that female homosexual behavior is without recognized pathology.
Much of the pathology is associated with heterosexual activity by lesbians. Among the
difficulties in establishing the pathologies associated with lesbianism is
the problem of defining who is a lesbian.61 Study after study
documents that the overwhelming majority of self-described lesbians have had
sex with men.62 Australian researchers at an STD clinic found that
only 7 percent of their lesbian sample had never had sexual contact with a
male.63 Not only did
lesbians commonly have sex with men, but with lots of men. They were 4.5
times as likely as exclusively heterosexual controls to have had more than 50
lifetime male sex partners.64 Consequently, the lesbians' median
number of male partners was twice that of exclusively heterosexual women.65
Lesbians were three to four times more likely than heterosexual women to have
sex with men who were high-risk for HIV disease-homosexual, bisexual, or IV
drug-abusing men.66 The study "demonstrates that WSW [women
who have sex with women] are more likely than non- WSW to engage in
recognized HIV risk behaviours such as IDU [intravenous drug use], sex work,
sex with a bisexual man, and sex with a man who injects drugs, confirming
previous reports."67 Bacterial
vaginosis, Hepatitis B, Hepatitis C, heavy cigarette smoking, alcohol abuse,
intravenous drug use, and prostitution were present in much higher
proportions among female homosexual practitioners.68 Intravenous
drug abuse was nearly six times as common in this group.69In one
study of women who had sex only with women in the prior 12 months, 30 percent
had bacterial vaginosis.70 Bacterial vaginosis is associated with
higher risk for pelvic inflammatory disease and other sexually transmitted
infections.71 In view of the
record of lesbians having sex with many men, including gay men, and the
increased incidence of intravenous drug use among lesbians, lesbians are not
low risk for disease. Although researchers have only recently begun studying
the transmission of STDs among lesbians, diseases such as "crabs,"
genital warts, chlamydia and herpes have been reported.72 Even women who have
never had sex with men have been found to have HPV, trichomoniasis and
anogenital warts.73 C. Mental Health 1. Psychiatric Illness Multiple studies
have identified high rates of psychiatric illness, including depression, drug
abuse and suicide attempts, among selfprofessed gays and lesbians.74
Some proponents of GLB rights have used these findings to conclude that
mental illness is induced by other people's unwillingness to accept same-sex
attraction and behavior as normal. They point to homophobia, effectively
defined as any opposition to or critique of gay sex, as the cause for the
higher rates of psychiatric illness, especially among gay youth.75
Although homophobia must be considered as a potential cause for the increase
in mental health problems, the medical literature suggests other conclusions.
An extensive
study in the Netherlands undermines the assumption that homophobia is the
cause of increased psychiatric illness among gays and lesbians. The Dutch
have been considerably more accepting of same-sex relationships than other
Western countries — in fact, same-sex couples now have the legal right to
marry in the Netherlands.76 So a high rate of psychiatric disease
associated with homosexual behavior in the Netherlands means that the
psychiatric disease cannot so easily be attributed to social rejection and
homophobia. The Dutch study,
published in the Archives of General Psychiatry, did indeed find a high rate
of psychiatric disease associated with same-sex sex.77 Compared to
controls who had no homosexual experience in the 12 months prior to the
interview, males who had any homosexual contact within that time period were
much more likely to experience major depression, bipolar disorder, panic
disorder, agoraphobia and obsessive compulsive disorder. Females with any
homosexual contact within the previous 12 months were more often diagnosed
with major depression, social phobia or alcohol dependence. In fact, those
with a history of homosexual contact had higher rates of nearly all psychiatric
pathologies measured in the study.78 The researchers found
"that homosexuality is not only associated with mental health problems
during adolescence and early adulthood, as has been suggested, but also in
later life."79 Researchers actually fear that methodological
features of "the study might underestimate the differences between
homosexual and heterosexual people."80 The Dutch
researchers concluded, "this study offers evidence that homosexuality is
associated with a higher prevalence of psychiatric disorders. The outcomes
are in line with findings from earlier studies in which less rigorous designs
have been employed."81 The researchers offered no opinion as
to whether homosexual behavior causes psychiatric disorders, or whether it is
the result of psychiatric disorders. 2. Reckless Sexual Behavior Depression and
drug abuse can lead to reckless sexual behavior, even among those who are
most likely to understand the deadly risks. In an article that was part of a
series on "AIDS at 20," the New York Times reported the risks that
many gay men take. One night when a gay HIV prevention educator named Seth
Watkins got depressed, he met an attractive stranger, had anal intercourse
without a condom — and became HIV positive. In spite of his job training, the
HIV educator nevertheless employed the psychological defense of
"denial" in explaining his own sexual behavior: "[L]ike an increasing number of gay men in
San Francisco and elsewhere, Mr. Watkins sometimes still puts himself and
possibly other people at risk. 'I don't like to think about it because I
don't want to give anyone H.I.V.,' Mr. Watkins said."82 Another
gay man named Vince, who had never before had anal intercourse without a
condom, went to a sex club on the spur of the moment when he got depressed,
and had unprotected sex: "I was definitely in a period of depression .
. . . And there was just something about that particular circumstance and
that particular person. I don't know how to describe it. It just appealed to
me; it made it seem like it was all right."83 Some
of the men interviewed by the New York Times are deliberately reckless. One
fatalistic gay man with HIV makes no apology for putting other men at risk: "The prospect of going through the rest of
your life having to cover yourself up every time you want to get intimate
with someone is an awful one. . . . Now I've got H.I.V. and I don't have to
worry about getting it," he said. "There is a part of me that's
relieved. I was tired of always having to be careful, of this constant
diligence that has to be paid to intimacy when intimacy should be
spontaneous."84 After
admitting to almost never using condoms he adds: "There is no such thing as safe sex. . . . If
people want to use condoms, they can. I didn't go out and purposely get
H.I.V. Accidents happen."85 Other reports
show similar disregard for the safety of self and others. A1998 study in
Seattle found that 10 percent of HIV-positive men admitted they engaged in
unprotected anal sex, and the percentage doubled in 2000.86
According to a study of men who attend gay "circuit" parties,87
the danger at such events is even greater. Ten percent of the men surveyed
expected to become HIV-positive in their lifetime. Researchers discovered
that 17 percent of the circuit party attendees surveyed were already HIV
positive.88 Two thirds of those attending circuit parties had oral
or anal sex, and 28 percent did not use condoms.89 In addition, drug
use at circuit parties is ubiquitous. Although only 57 percent admit going to
circuit parties to use drugs, 95 percent of the survey participants said they
used psychoactive drugs at the most recent event they attended.90 There was a
direct correlation between the number of drugs used during a circuit party
weekend and the likelihood of unprotected anal sex.91 The
researchers concluded that in view of their findings, "the likelihood of
transmission of HIV and other Sexually Transmitted Diseases among party
attendees and secondary partners becomes a real public health concern."92
Good mental
health would dictate foregoing circuit parties and other risky sex. But
neither education nor adequate access to health care is a deterrent to such
reckless behavior. "Research at the University of New South Wales found
well-educated professional men in early middle age — those who experienced
the AIDS epidemic of the 1980s — are most likely not to use a condom."93
D. Shortened Life Span The greater
incidence of physical and mental health problems among gays and lesbians has
serious consequences for length of life. While many are aware of the death toll
from AIDS, there has been little public attention given to the magnitude of
the lost years of life. An
epidemiological study from Vancouver, Canada of data tabulated between 1987
and 1992 for AIDS-related deaths reveals that male homosexual or bisexual
practitioners lost up to 20 years of life expectancy. The study concluded
that if 3 percent of the population studied were gay or bisexual, the
probability of a 20-year-old gay or bisexual man living to 65 years was only
32 percent, compared to 78 percent for men in general.94 The
damaging effects of cigarette smoking pale in comparison -cigarette smokers
lose on average about 13.5 years of life expectancy.95 The impact on
length of life may be even greater than reported in the Canadian study.
First, HIV/AIDS is underreported by as much as 15-20 percent, so it is likely
that not all AIDSrelated deaths were accounted for in the study.96
Second, there are additional major causes of death related to gay sex. For
example, suicide rates among a San Francisco cohort were 3.4 times higher
than the general U.S. male population in 1987.97 Other potentially
fatal ailments such as syphilis, anal cancer, and Hepatitis B and C also
affect gay and bisexual men disproportionately.98 E. "Monogamy" Monogamy for
heterosexual couples means at a minimum sexual fidelity. The most extensive
survey of sex in America found that "a vast majority [of heterosexual
married couples] are faithful while the marriage is intact."99
The survey further found that 94 percent of married people and 75 percent of
cohabiting people had only one partner in the prior year.100 In
contrast, long-term sexual fidelity is rare among GLB couples, particularly
among gay males. Even during the coupling period, many gay men do not expect
monogamy. A lesbian critic of gay males notes that: "After a period of optimism about the
longrange potential of gay men's one-on-one relationships, gay magazines are
starting to acknowledge the more relaxed standards operating here, with
recent articles celebrating the bigger bang of sex with strangers or
proposing 'monogamy without fidelity'-the latest Orwellian formulation to
excuse having your cake and eating it too."101 Gay men's sexual
practices appear to be consistent with the concept of "monogamy without
fidelity." Astudy of gay men attending circuit parties showed that 46
percent were coupled, that is, they claimed to have a "primary
partner." Twenty-seven percent of the men with primary partners
"had multiple sex partners (oral or anal) during their most recent circuit
party weekend . . . ."102 For gay men, sex outside the
primary relationship is ubiquitous even during the first year. Gay men
reportedly have sex with someone other than their partner in 66 percent of
relationships within the first year, rising to approximately 90 percent if
the relationship endures over five years.103 And the average gay
or lesbian relationship is short lived. In one study, only 15 percent of gay
men and 17.3 percent of lesbians had relationships that lasted more than
three years.104 Thus, the studies reflect very little long-term
monogamy in GLB relationships.
"Don't tear down a fence until you know why
it was put up." ~ African proverb The societal
implications of the unrestrained sexual activity described above are
devastating. The ideal of sexual activity being limited to marriage, always
defined as male-female, has been a fence erected in all civilizations around
the globe.105 Throughout history, many people have climbed over
the fence, engaging in premarital, extramarital and homosexual sex. Still,
the fence stands; the limits are visible to all. Climbing over the fence,
metaphorically, has always been recognized as a breach of those limits, even
by the breachers themselves. No civilization can retain its vitality for
multiple generations after removing the fence.106 But now social
activists are saying that there should be no fence, and that to destroy the
fence is an act of liberation.107 If the fence is torn down, there
is no visible boundary to sexual expression. If gay sex is socially
acceptable, what logical reason can there be to deny social acceptance of
adultery, polygamy, or pedophilia? The polygamist movement already has
support from some of the advocates for GLB rights.108 And some in
the psychological profession are floating the idea that maybe pedophilia is
not so damaging to children after all.109 Lesbian social
critic Camille Paglia observes, "history shows that male homosexuality,
which like prostitution flourishes with urbanization and soon becomes
predictably ritualized, always tends toward decadence."110
Gay author Gabriel Rotello writes of the changes in homosexual behavior in
the last century: "Most accounts of male-on-male sex from the
early decades of this century [20th] cite oral sex, and less often
masturbation, as the predominant forms of activity, with the acknowledged
homosexual fellating or masturbating his partner. Comparatively fewer
accounts refer to anal sex. My own informal survey of older gay men who were
sexually active prior to World War II gives credence to the idea that anal
sex, especially anal sex with multiple partners, was considerably less common
than it later became."111 Not
only has the practice of anal sex increased, condom use has declined 20
percent and multi-partner sex has doubled in the last seven years,112
despite billions of dollars spent on HIV prevention campaigns. "In many
cases, the prevention slogans that galvanized gay men in the early years of
the epidemic now fall on deaf ears."113 As should be
expected, the health-care costs resulting from gay promiscuity are
substantial.114 Social approval
of gay sex leads to an increase in such behavior. As early as 1993, Newsweek
reported that the growing media presence and social acceptance of homosexual
behavior was leading to teenager experimentation to the extent that it was
"becoming chic."115 A more recent report stated that
"the way gays and lesbians appear in the media may make some people more
comfortable acting on homosexual impulses."116 In addition,
one of the goals of GLB advocates' quest for domestic partner benefits from
employers is to motivate more gays and lesbians "to come out of the
closet."117 If, as suggested above, being "out"
results in a greater incidence of promiscuity, employer decisions to provide
domestic partner benefits may have a negative impact on employee health.
Indeed, giving gays and lesbians the social approval they desire may
ultimately lead to an early death for employees who otherwise might have
restrained their sexual behavior. Research designed
to prove that gays and lesbians are "born that way" has come up
empty — there is no scientific evidence that being gay or lesbian is
genetically determined.118 Even researcher Dean Hamer, who once
hoped he had identified a "gay gene," admits "there is a lot
more than just genes going on."119
It is clear that
there are serious medical consequences to same-sex behavior. Identification
with a GLB community appears to lead to an increase in promiscuity, which in
turn leads to a myriad of Sexually Transmitted Diseases and even early death.
A compassionate response to requests for social approval and recognition of
GLB relationships is not to assure gays and lesbians that homosexual
relationships are just like heterosexual ones, but to point out the health
risks of gay sex and promiscuity. Approving same-sex relationships is
detrimental to employers, employees and society in general.
Definitional
Impediments to Research Unfortunately,
endeavors to assess the actual practices and the health consequences of male
and female homosexual behavior are hampered by imprecise definitions. For
many, being gay or lesbian or bisexual is a political identity that does not
necessarily correspond to sexual behavior. And investigators find that sexual
behavior fluctuates over time: "[P]eople often change their sexual behavior
during their lifetimes, making it impossible to state that a particular set of
behaviors defines a person as gay. A man who has sex with men today, for
example, might not have done so 10 years ago."120 Defining
the terms becomes even more difficult when people who identify as gay or
lesbian enter heterosexual relationships. Joanne Loulan, a well-known
lesbian, has talked openly about her two-year relationship with a man:
"'I come from this background that sex is an activity, it's not an
identity,' says Loulan. 'It was funny for a while, but then it turned out to
be something more connected, more deep. Something more important. And that's
when my life started really going topsy turvy.'" While critics complain
that "You can't be a lesbian and be having sex with men," Loulan
sees no contradiction in the fact that she "adamantly refuses to call
herself a bisexual, to give up the lesbian identity."121 Several
high-profile lesbian media stars that have abandoned lesbianism further
illustrate the difficulty in defining homosexuality. An article about the now
defunct couple, Anne Heche and Ellen Degeneres, said, "Although the pair
never publicly discussed the reason for their breakup, it has been heavily
rumored that Heche decided to go back to heterosexuality."122
Heche married a man on Sept. 1, 2001.123 As recently as
June 2000, pop-music star Sinead O'Connor said, "I'm a lesbian . . .
although I haven't been very open about that, and throughout most of my life
I've gone out with blokes because I haven't necessarily been terribly
comfortable about being a lesbian. But I actually am a lesbian."124
Then, shocking the gay world that applauded her "coming out,"
O'Connor's sexual identity fluctuated again when she withdrew from
participating in a lesbian music festival because of her marriage to British
Press Association reporter Nick Sommerlad.125 Although women
get most of the press coverage of fluctuating between same-sex and
heterosexual relationships, men can experience similar fluidity. Gay author
John Stoltenberg has lived with a lesbian, Andrea Dworkin, since 1974.126 And
a 2000 survey in Australia found that 19 percent of gay men reported having
sex with a woman in the six months prior to the survey.127 This
fluctuation in sexual "orientation" inhibits the creation of a
fixed definition of homosexuality. As one group of researchers stated the
problem: "Does a man who has homosexual sex in prison
count as a homosexual? Does a man who left his wife of twenty years for a gay
lover count as a homosexual or heterosexual? Do you count the number of years
he spent with his wife as compared to his lover? Does the married woman who
had sex with her college roommate a decade ago count? Do you assume that one
homosexual experience defines someone as gay for all time?"128 Despite the
difficulty in defining homosexuality, the one thing that is clear is that
those who engage in same-sex practices or identify themselves as gay, lesbian
or bisexual constitute a very small percentage of the population. The most
reliable studies indicate that 1-3 percent of people — and probably less than
2 percent — consider themselves to be gay, lesbian or bisexual, or currently
practice same-sex sex.129
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