ST Forum: Aids and gays: A flawed response (May 28, 2007)

ST Forum

May 28, 2007

Aids and gays: A flawed response

I REFER to the letter written by Mr Wong Suan Yin, 'Aids: Stop the spread of misinformation' .

The letter misrepresents what I have said. It is not true that I made the statement that homosexuality leads to the spread of Aids and therefore criminalising homosexual sex will prevent the spread of Aids.

My article only mentioned that there is an increased risk of homosexuals engaging in anal intercourse in contracting the HIV virus. The reasons given for this is that anal intercourse is inherently unhealthy and studies have shown that homosexuals are more promiscuous.

Mr Wong has missed the point made by me in the letter and has gone off tangent with his own argument.

Unfortunately his argument is flawed. Let me clarify.

HIV virus is spread in three main ways.

1. From mother to child during birth
2. Sexual contact during intercourse, oral, vaginal and anal
3. Via blood either through contaminated blood, contaminated blood products, contaminated donor organs, tattooing and intravenous drug abuse

According to WHO statistics, there is a higher incidence of HIV in women and children in Third World countries compared to the rest of the world.

It is just as true that in Singapore and in the United States, there is a high incidence of HIV among homosexual men who engage in anal sex.

How do we reconcile this? Obviously there must be environmental factors involved that lead to differences between the two. Unfortunately WHO statistics from most Third World countries do not show the mode of infection.

There are so many unanswered questions. We do not know how many of the mothers contracted HIV because of drug abuse or how many of their husbands were drug abusers.

We do not know how many of their husbands had intercourse with high-risk individuals. We do not know the incidence of bisexual men who are married.

In some African cultures, bisexual behaviour is rampant. Culturally, in some countries, young men are sent by their fathers to prostitutes for their first sexual experience.

Some studies have shown that the incidence of HIV among young children is higher than that of mothers in Africa. This implies that children are getting HIV from sources other than their mothers. Contaminated needles? Contaminated dental equipment?

How many adults are infected through contaminated medical equipment due to poor health care? All these cultural, social and environmental factors affect the behaviour and sexual practices of individuals and therefore account for the different figures seen in different countries.

We cannot apply these figures to the situation in Singapore because the environment is different.

Let me illustrate with an example.

We know that poverty leading to malnutrition and starvation is statistically one of the leading causes of death among children in the world. Obviously it is illogical to put all our resources in eradicating malnutrition and starvation to lower the death rate of children in Singapore. This will not help at all as it is not a leading cause of death in Singapore.

Similarly for the case of HIV infection, we have to look at the local context, what the local statistics are and what the risk factors for our population are. As I have previously stated, our local statistics and those of the US show that the group with the highest risk of being infected by the HIV virus is that of individuals who indulge in anal intercourse.

Currently anal intercourse is a criminal offence. The argument put forward that decriminalisation will make it easier to educate those who engage in such practices and lower the risk of HIV needs to be examined carefully.

As a doctor I wrote in to highlight the public health issues involved in this matter. As for public policy issues, this is not an appropriate forum. Parliament will consider all these issues in due course.

Dr Alan Chin Yew Liang

ST Forum: Irresponsible to suggest treatment based on one study (May 22, 2007)

ST Forum

May 22, 2007
Irresponsible to suggest treatment based on one study

I AM writing in response to Dr Alan Chin's letter, 'Figures speak for themselves: Practising gays have higher risk of HIV'.

He went to great lengths to provide statistical data that male-to-male sexual activities have resulted in a disproportionately high incidence of HIV transmission.

Considering this with his other key point that homosexuality is not an immutable trait and that we should not deny anyone the right to change, Dr Chin seems to suggest that gay men should exercise the right to change their sexual orientation in view of the health risks they face.

With discrimination faced by gay people in many societies, it is interesting that not more gay men have exercised the right to change their orientation by evidence that most self-identified gay men remain gay.

One wonders who in their right mind would choose to suffer societal rejection if there was a way out. If reparative therapy to change one's sexual orientation is so pervasively successful as Dr Chin claims (he has not provided any statistical evidence though), why is it not adopted by most medical practioners as a treatment for homosexuality?

It is irresponsible for a medical doctor to suggest a treatment based on one study. Dr Chin has conveniently ignored the comments made by the author of the study, Dr Robert Spitzer himself, in response to misuse of his study results as published in the Wall Street Journal May 21, 2001 (verbatim).

'In reality, change should be seen as complex and on a continuum. Some homosexuals appear able to change self-identity and behavior, but not arousal and fantasies; others can change only self-identity; and only a very few, I suspect, can substantially change all four.

'I suspect the vast majority of gay people would be unable to alter by much a firmly established homosexual orientation.

'I did not conclude that all gays should try to change, or even that they would be better off if they did.

'The issue here is not about the right to change one's sexual orientation. Since when has that right been denied?

As a medical doctor communicating his views in a public forum, Dr Chin should have presented a more robust analysis of a scientific study done by someone else, especially when there already exists a wide spectrum of professional opinions on the study in question.

Peter Goh Kok Yong

ST Forum: Figures speak for themselves: Practising gays have higher risk of HIV (May 15, 2007)

ST Forum

May 15, 2007

Figures speak for themselves: Practising gays have higher risk of HIV

I REFER to Mr Siew Meng Ee's letter, 'Doctor using selective material to justify own conclusion' which was written in response to my letter, 'Homosexuality: disease or immutable trait?'. I thank him for his views that he has expressed.

Let me clarify what I have written. It is true that not all people who contract Aids are homosexuals and not all homosexuals have Aids.

Let's look at the statistics from the US' Communicable Diseases Centre (CDC) - in the year 2005, there were 45,669 cases of newly-diagnosed Aids cases of which 18,938 were from male-to-male sexual contact.

This means that 41.5 per cent of cases of Aids were transmitted by male-to-male sexual contact.

The estimated number of cases diagnosed through 2005 (this means the number of people at the end of 2005 having HIV) is 988,376.

The estimated number of this same group of people having Aids through male-to-male sexual contact is 454,106. This means that of the 988,376 diagnosed cases of Aids in the US, 45.94 per cent of these cases were contracted through male-to-male sexual contact.

The number of homosexuals in the US has been estimated to be 2.8 per cent ('the most widely accepted study of sexual practices in the United States is the National Health and Social Life Survey which found that 2.8 per cent of the male, and 1.4 per cent of the female, population identify themselves as gay, lesbian or bisexual.

See Laumann, et al, The Social Organization of Sex: Sexual Practices in the United States (1994).

This amounts to nearly four million openly gay men and two million women who are identified as lesbian.

This means that 2.8 per cent of the population in the US accounts for 41.5 per cent of the new cases and of the number of HIV cases in the States, 2.8 per cent of the population accounts for the 45.94 per cent of the people having Aids. When relative risk is calculated, this means that a person who engages in male-to-male sexual contact has a 2,400 per cent higher chance of getting Aids.

If we look at the Singapore figures for 2005, 2.8 per cent of the population accounted for 31 per cent of the new cases of HIV infection, 2.8 per cent of the population accounted for 22 per cent of the number of people diagnosed with HIV.

I believe the figures speak for itself, that practising homosexuals have a far higher risk of HIV with its numerous complications and increased mortality.

There are two main reasons for this.

1) The rectum is physiologically unsuitable for anal intercourse. Its fragility leads to increased risks of trauma during anal intercourse, accounting for the increased risks of infection, both bacterial and viral including HIV.

2) Homosexuals are sexually more promiscuous.

A 1978 study found that 75 per cent of homosexual white males claimed to have 100 male sex partners, 15 per cent 100-249 male sex partners, 17 per cent 250-499 male sex partners, 15 per cent 500-999 male sex partners and 28 per cent more than 1,000 male sex partners (Alan P. Bell et al, Homosexuality: A Study of Diversity among Men & Women pg 308 Table 7. New York 1978).

In a local publication, People Like Us: Sexual Minorities In Singapore, gay activist Alex Au Wai Pang wrote frankly about homosexual sexual values being different from that of heterosexual males. Both of Mr Au's articles in the book talk frankly about how many homosexuals are more promiscuous than their heterosexual counterparts.

With regard to whether homosexuals can change their sexual orientation, this is an issue that arouses the emotions of all concerned. As gay activists see it, if someone can change his or her sexual orientation, then homosexuality can be considered a lifestyle choice and thus does not qualify to be considered as a protected class under the law.

As why Dr Robert Spitzer's study was quoted, some background information as how this study came about is useful. Dr Spitzer is one of the most renowned psychiatrists in the US, who is called the father of DSM.

In fact, he was one of the key psychiatrists in deciding that homosexuality should be removed from the DSM. However, in the early 2000s, during an APA meeting, Dr Spitzer met some picketers who claimed that they had changed their sexual orientation.

Intrigued, he decided to do a study as, at that time, his view was that homosexuals could not change their behaviour.

He genuinely wanted to know if some homosexual men and women could change from homosexual to heterosexual, and that he wanted science to guide him. Certainly, with more than 275 publications to his credit, this esteemed scientist at Columbia University was more than able to conduct such a study.

With the limitations that are inherent to all such studies, Dr Spitzer employed the best rigours available for such research protocols.

His sample size was larger than those in previous studies. He was very detailed in his assessment and carefully considered the affective components of the homosexual experience.

Any bias in interview coding was virtually eliminated by near-perfect interrater scores. He limited his pool of applicants to those reporting at least five years of sustained change from a homosexual to a heterosexual orientation.

His structured interview clearly described how the participants were evaluated. His entire set of data is available for scrutiny by other researchers.

If his study methods are considered flawed, then all the original research material used by APA to justify the original change in classification is also flawed using the same argument.

Dr Spitzer's conclusions are simply this: Based on his study, there is evidence to suggest that some gay men and lesbians are not only able to change self-identity, but are also able to modify core features of sexual orientation, including fantasies.

His study was not designed to give the percentage of homosexuals that have changed. Dr Spitzer felt the percentage was low as it was difficult to find subjects willing to be interviewed.

One of the few rational, scientific commentaries on the Spitzer study was offered by Scott L. Hershberger. Dr Hershberger, a distinguished scholar and statistician, elected to respond in a Commentary to the Spitzer research (Hershberger' s article was published in the same issue of the Archives of Sexual Behavior as the Spitzer study was) by conducting a Guttman scalability analysis. This is a scalogram to determine whether or not reported changes occur in a cumulative, orderly fashion.

Dr Hershberger' s conclusion: 'The orderly, law-like pattern of changes in homosexual sexual behaviour, homosexual self-identification , and homosexual attraction and fantasy observed in Dr Spitzer's study is strong evidence that reparative therapy can assist individuals in changing their homosexual orientation to a heterosexual orientation.

'Now it is up to those sceptical of reparative therapy to provide comparably strong evidence to support their position. In my opinion, they have yet to do so.'

The Schidlo and Schroeder study, funded by the National Lesbian & Gay Health Association, was originally titled 'Homophobic Therapies: Documenting the Damage.'

The title was later changed to 'Changing Sexual Orientation: Does Counseling Work?' because they found that some people reported benefits to reorientation therapy including a change of sexual orientation. Biasness will be an issue as the aim of the National Lesbian & Gay Health Association is to prove that homosexuals are normal and healthy and reparative therapy is harmful.

There are thousands of testimonies of homosexuals who have changed their orientation. Even in Singapore there are testimonies of homosexuals who have changed their sexual orientation.

The point is that even if one person can change, then homosexuality is not an immutable trait and we should not deny anyone the right to change.

Dr Alan Chin Yew Liang

Singapore AIDS Candlelight Memorial - 20 May 2007, 7pm

Singapore AIDS Candlelight Memorial

• Leading the way to a World without AIDS
• Date: 20 May 2007
• Time: 7.00pm
• Venue: SMU Conference Hall, Level 2
  School of Accountancy, School of Law
  60 Stamford Road, Singapore 178900