One of the issues that has arisen here in Australia in the last week of debate over homosexuality has been the question of health outcomes for homosexuals compared to the population at large.

Before I begin a review of the topic and then move to some arguments of my own I thought it important to state something right up front:

Arguments about the health effects of homosexual behaviour in the wider homosexual community are not good arguments against “gay marriage”.

That’s an important thing to get our heads around right at the start. Consider this – the argument about gay health and lifestyle is derived, in part, from the widely-recognised higher prevalence of promiscuity and non-permanence of sexual relationships within certain segments of the gay population. These stats then, naturally, whilst deriving in part from that segment nevertheless influence the consideration of the statistics when considering the entire population.

The argument for “gay marriage”, however, is an argument grounded in the claim by some that there are monogamous permanent sexual relationships which ought to be recognised as “marriage”. You can’t logically argue against this “gold standard” of gay relationships with data from non-monogamous non-permanent relationships. Yes, they’re part of a wider population but to use the stats in that way is to misunderstand the “gay marriage” argument. We complain when the “gay marriage” lobby don’t take our arguments seriously or treat them fairly – let’s not respond in kind.

With that said, onto the specifics of the debate…

It all kicked off last week when Jim Wallace, Managing Director of the Australian Christian Lobby, suggested at their annual conference that in the future Australia might come to view homosexual behaviour as it did smoking – a harmful lifestyle that we ought to persuade others not to take up. This was seized upon by opponents and the ACL were forced to issue a press release where they defended their position.

Australian Christian Lobby Managing Director Jim Wallace says gay activists have misrepresented his comments about smoking in a deliberate attempt to demonise and to shut down debate.

“I was not comparing homosexuality with smoking at all. What I was saying is that on one hand we are vocal on our discouragement of people to smoke and on the other we are suppressing public dialogue about the health risks associated with homosexuality.

In his answer to a student’s question at UTAS, Mr Wallace was referring to Canadian gay activists who in 2009 said years of legal gay marriage had not solved the health crisis in their community.  http://www.xtra.ca/public/National/Canadas_healthcare_system_is_homophobic_says_group-6314.aspx

“By the activists’ own admission in this submission gay marriage did not solve the mental and other chronic physical health problems associated with the gay lifestyle,” Mr Wallace said.

“Far from being out of date information we know that every year over 80 per cent of newly acquired HIV infections are the result of male homosexuality and this is verified in the 2011 report of the Kirby Institute at UNSW,” Mr Wallace said.

Whether or not you think Wallace handled it all as well as he could, the issue was out and became a question at last week’s Q&A. Here’s the initial answering of the question by Peter Jensen:

TONY JONES: What about this very specific statement where Jim Wallace suggests that homosexuality poses the same kind of health risk to the community as smoking does?

PETER JENSEN: It needs to be observed that he has been somewhat quoted out of context in some reports. I’m not sure about that one but in some reports he’s been somewhat quoted out of context. But what he has done for us, rightly or wrongly, what he has done is given us an opportunity to talk about something significant, namely the question of health risks. Now, I think it is true to say – I think it is true to say – it’s very hard to get all the facts here because we don’t want to talk about it and in this country censorship is alive and well, believe me. So what I’m about to say, I don’t want to say because I know I’m going to be hit over the head for the next 100 years about it so – and it’s a virulent censorship. Now, I will still go ahead. What I want to say is that as far as I can see by trying to get to the facts, the lifespan of practising gays is significantly shorter than the ordinary, so called, heterosexual man. I think that seems to be the case. Now what we need to do is to look at why this may be the case and we need to do it in a compassionate and objective way. Some people say it’s because of the things I say and the position I take and that creates, for example, a spate of suicides. That may be true but how can we get at the facts if we’re never willing to talk about it? Now, there may be other things as well.

And it developed from there. On teh intarwebs the first response, already mentioned by the ACL in the quote above, was to challenge the application of the studies initially relied upon by Wallace. The authors themselves have moved to challenge similar applications by commentators in their own country of Canada.

The aim of our research was never to spread more homophobia, but to demonstrate to an international audience how the life expectancy of gay and bisexual men can be estimated from limited vital statistics data. In our paper, we demonstrated that in a major Canadian centre, life expectancy at age 20 years for gay and bisexual men is 8 to 21 years less than for all men. If the same pattern of mortality continued, we estimated that nearly half of gay and bisexual men currently aged 20 years would not reach their 65th birthday. Under even the most liberal assumptions, gay and bisexual men in this urban centre were experiencing a life expectancy similar to that experienced by men in Canada in the year 1871. 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.4

The argument picked up by activists basically goes like this – yes, mortality rates were much higher initially as HIV (in particular) swept through the gay community in cities such as Vancouver but now with better safe-sex education we have the problem cracked. A similar point was made in the Q&A discussion by an audience member

 If we’re going to talk about the facts, we’re going to talk about something in between homosexuality and illness which is basically condom use. If you’re looking at the rates of HIV necessarily with the whole gay physiology thing, it’s that if you’re going to talk blatantly about it, the anus is much more a problem area with HIV than the vagina, okay? So really we’re talking about condom use and people not using condoms when they should. So really you can condemn an HIV positive man for not using a condom as much as you can condemn a teenage mother and really one gets life and the other gets death in a way so there appears to be a greater condemnation of gay men

We’ll return to this argument as we begin to outline a response as I think it’s both incorrect and self-defeating.

A similar strain of arguments has been made in the smh letters page,

These authors advise that their figures relate only to the city of Vancouver in the late 1980s and early 1990s, at the height of the AIDS crisis. They then state, ”In contrast, if we were to repeat this analysis today the life expectancy of gay men would be greatly improved”. The third hit was an article on statistics by an associate professor at Columbia University. In it, the author debunks the other of the two studies quoted by the Christian website, finding that the study had used, ”an unrepresentative sample that includes only those who died; gay men of the same generation who live longer aren’t in the sample at all!”

So, we have two studies claiming gay men’s life expectancy is shorter than heterosexual men. One of those, according to its original authors, is out of date. The other, according to independent analysis, is irredeemably flawed. These are the facts. They were not difficult to find and they have not been censored. They do not come from the publications of gay rights groups or other activist organisations, but from the research of professional scientists and statisticians.

Unfortunately, these facts do not conform to the opinions of anti-gay Christian activists, who will continue to ignore the truth, spout bigotry and cry that they are being censored.

Lots to deal with, so let’s get to it.

Turning first to the Vancouver research and subsequent movements in the data. Remember what the researchers stated:

 In our paper, we demonstrated that in a major Canadian centre, life expectancy at age 20 years for gay and bisexual men is 8 to 21 years less than for all men. If the same pattern of mortality continued, we estimated that nearly half of gay and bisexual men currently aged 20 years would not reach their 65th birthday. Under even the most liberal assumptions, gay and bisexual men in this urban centre were experiencing a life expectancy similar to that experienced by men in Canada in the year 1871. 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.4

All well and good but does it adequately counter the argument being made by Wallace, Jensen et. al.? Consider:

  1. Like it or not, it is incontrovertible that mortality rates amongst homosexual men in Vancouver (and, indeed, all over the western world) were tragically high as HIV/AIDS spread when compared to the general population. This was tied directly to homosexual behaviour and a high rate, as we’ve noted, of promiscuity in that population. Of course, no-one is claiming that all gay men are promiscuous – that would be absurd (and also absurd to suggest that that is what is being argued) – but nevertheless there it is. Setting aside the issue of safe-sex (which we will come to) we should have to face the hard truth that this was a particularly (but not exclusively) homosexual problem due to recognised homosexual behavioural traits.
  2. The follow-up study that they refer to may indeed show a massive reduction in death rates but the study’s title is “Decline in deaths from AIDS due to new antiretrovirals” and it demonstrates that the usage of new antiretrovirals is helpful in reducing death rates. But this is an argument about the benefits of good pharmacology! You can hardly use it to argue another point since it doesn’t address it – it’s seeking to find out whether the drugs worked and that’s what the data set is all about.

Even if improved safe-sex practice is a factor in reduced mortality it doesn’t actually do away with the main point being made since this is more than an argument about HIV (as we will develop below). Consider again the audience comment:

…with the whole gay physiology thing, it’s that if you’re going to talk blatantly about it, the anus is much more a problem area with HIV than the vagina…

So let’s talk about it blatantly for a minute, because this is an important issue. Wikipedia is as good a place as anywhere to get some basic facts.

Take care, some of this material might make some readers a little uncomfortable.

Anal sex can expose participants to two principal dangers: infections due to the high number of infectious microorganisms not found elsewhere on the body, and physical damage to the anus and the rectum due to their fragility.

Unprotected anal sex, colloquially known as “barebacking“, carries an elevated risk of passing on sexually transmitted diseases because the anal sphincter is delicate, easily-torn tissue; a tear can provide an entry for pathogens. The high concentration of white blood cells around the rectum, together with the risk of tearing and the rectum’s function to absorb fluid, places those who engage in unprotected anal sex at high risk of sexually transmitted infection.

Anal sex alone does not cause anal cancer; the risk of anal cancer through anal sex is attributed to HPV infection, which is often contracted through unprotected anal sex. The incidence of the disease has jumped 160% in men and 78% in women in the last thirty years, according to a 2004 American study. The increase is attributed to changing trends in sexual behavior (such as a history of multiple sex partners, fifteen or more, or receptive anal sex) and smoking. … studies also indicate that gay or bisexual sex among men is on the rise, which may account for the increase in anal cancer.[97]

Physical damage to the rectum and anus can manifest as generalized ano-rectal trauma, anal fissures,[17]rectal prolapse, and exacerbating hemorrhoids.

Not pretty. But then what are we expecting? The anus, as opposed to the vagina, is an orifice designed (or evolved, if you like) for the “outward” movement of softer fecal matter. Inserting harder objects in the other way is contrary to its purpose and results in damage. You end up with fecal matter passing by open wounds.

Of course, using a condom and lubrication can reduce these risks and that is certainly a good thing but it doesn’t actually answer the challenge since what should be apparent is that it is the nature of anal sex itself that is the health risk – a risk that can be minimised but not eliminated completely. We also ought to note that it is simplistic to reduce this matter of homosexual sex simply to anal sex but nevertheless it is an important factor in the discussion. And the gay man who made comment from the audience in Q&A recognised exactly what the issues were – he raised the specifics.

As the issues being discussed move outwards from HIV to the nature of male homosexual practice we begin to see that the discussion cannot be cast aside with the quick rejection of one set of results from Canada in the 1980s. On the contrary, the truth of the matter is that there are many studies showing similar results across the board. So, a number of examples,

  • A 2010 report by the US Centre for Disease Control (ie an official government body) stated that:
 the rate of new HIV diagnoses among men who have sex with men (MSM) is more than 44 times that of other men and more than 40 times that of women.
and
The rate of primary and secondary syphilis among MSM is more than 46 times that of other men and more than 71 times that of women
Now this is important to get our heads around. Another audience comment in the Q&A show observed:
…the rates of HIV among the heterosexual community is actually raising faster than the rates of HIV within the homosexual community.
Quite possibly. But that is hardly relevant. The real question is the absolute rates which are staggeringly disproportionately skewed towards homosexuals. In 2009 65% of new diagnoses of HIV were amongst MSM (men who have sex with men). If we are generous with the estimate of homosexuality rates (the figure of 5% would probably be too high) that means that the rate of HIV diagnoses in homosexual men is an incredible 35 times the rest of the population. (Check my maths – I make the sum to be (65/5)/(35/95)  Rates may be increasing at a greater rate amongst heterosexuals but they will have to rocket for a very long time to balance out that awful disparity. No, the tragic fact is that the commentor’s outrage was misplaced – and since she works in the field she would have known about it. It was a dishonest answer to give for it utterly failed to be honest about the real situation.
  • I’ve written before about mental health outcomes for homosexuals and that even in places like the Netherlands which have general societies that are far more supportive of homosexuals there are still adverse mental health outcomes.

As anticipated, prevalent HIV infection among gay men was a critical factor for this greater morbidity. When men who reported prevalent HIV infection were excluded from our analyses, many of the health differences between gay men and exclusively heterosexual men disappeared. Thus, it appears to be HIV infection rather than sexual orientation that increases health risks among gayidentified men. Nevertheless, because approximately one fifth of the gay men in this study reported prevalent HIV infection, our results highlight the ongoing need for models of general health care for homosexually active men that are cognizant of how HIV infection shapes general health risks among gay men.

Consider what is being argued here. First, like it or not HIV has had a massive effect upon the gay population. But does that mean it is, as they claim, “HIV infection rather than sexual orientation that increases health risks among gayidentified men”? They’ve already noted that being gay massively increases your risk of HIV infection but now they want to limit that out. Surely the argument is, more realistically, “being gay massively increases your risk of HIV infection which, in turn, massively increases mortality rates”? There is a concession to exactly this simple logic in their last sentence.

But there’s more:

Second, consistent with previous studies, we observed elevated levels of psychological distress among individuals who identified as gay, lesbian, or bisexual or who reported same-gender sexual histories compared with exclusively heterosexual individuals. Although explicating the reasons for this distress were beyond the scope of our study, when psychological distress was treated as a confounder of associations between sexual orientation and health, differences associated with sexual orientation among lesbians and bisexual women nearly disappeared.

By “when psychological distress was treated as a confounder” they mean “if we assume that psychological distress naturally brings worse physical health then we can assign those worse health reports to psychological reasons, not purely “being gay”. But again this is obfuscation to the point of being disingenuous for it does not follow through the implications of the simple causal chain “being gay -> higher rate of psychological disorder -> higher distress at health impairment” that their logic might very well imply.

Their basic conclusion,

Our findings indicate that minority sexual orientation alone is not associated with poorer physical health

aren’t sustained by their figures unless they choose to, essentially, control for HIV infection and psychological disorders. But to do so is to set aside the possibility that these might be directly related to homosexual orientation in the first place. While the statistics can never be read independently of some discussion and understanding, they can’t be explained away as they are here without also conceding the assumptions in those explanations. As they themselves concede:

Clarification of the ways in which sexual orientation is associated with health outcomes, and the mechanisms by which this occurs, are critical for developing appropriate and efficacious health interventions for lesbians, gay men, bisexual individuals, and homosexually experienced heterosexual persons.

And that, surely, is the point! The better we understand these issues the better care and help we can provide for people. But the real problem is that there are many who cannot countenance the possibility, despite the evidence, that being homosexual is itself the chief cause of increased health risks for homosexuals. Ultimately this is not a matter of evidence and logic but ideology – an ideology that requires that homosexual orientation and practice be only affirmed.

As Christians we’re called to love all those around us and seek their best. God Himself causes the rain to fall bountifully upon the righteous and the unrighteous (Matt. 5:45) and loves the whole rebellious world enough to send His Son to die (John 3:16). So we in turn are motivated (or should be) by this same love.

This is the point that Jensen sought to make on Monday night,

What I want to say is that as far as I can see by trying to get to the facts, the lifespan of practising gays is significantly shorter than the ordinary, so called, heterosexual man. I think that seems to be the case. Now what we need to do is to look at why this may be the case and we need to do it in a compassionate and objective way.

I would like to know see, people tell me that it is and they produce literature on the subject. I can’t get a discussion going on this because it’s a forbidden subject. Now, I’m open on this. I hope it’s not true, Tony. I don’t want to see my friends dying and I’ve seen my friends dying. I don’t want to see that. I don’t want to hear stories like that. But, dear friends, sorry, when do we get to the point where we can talk about this without shouting at each other and hurting each other?

As Christians, we’re well aware that the ultimate solution for this dying world is Jesus and the forgiveness and new life that He brings. But our mandate is not simply gospel, it is Creation as well. We don’t simply bring the gospel but we also seek to bring about restoration of good created order. Even while we recognise that it is only the return of Jesus that will make all things new (Rev. 21:5) we note that Jesus Himself sought the best physical outcomes for those around Him – something which caused many to also seek after the spiritual healing that He brought. Consider this, then, the pursuit of the welfare of homosexuals is, in part, a gospel issue for it demonstrates a holistic care for the person. Perhaps, like me, you know the great joy of someone coming to Christ as a result of you first attending to their physical needs and distress (whatever that might have been). So it was for Jesus Himself and so it is for us. So on this issue we also ought to not be unconfident in the same strategy. Let’s keep having a great concern for homosexuals and the documented and demonstrated risks they face – so that they might know both the physical and the spiritual freedom that only the truth can bring.

image source: Dana Warner Fisher via Qualia Folk – pink triangle quilt memorialising gay AIDS victims

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12 comments on “(Re)Visiting the Discussion on Homosexual Health

  1. Thanks for the references and discussion David. I agree that we need to be pursuing truth when discussing homosexual health, however I am a bit confused as to the practical conclusion of this reasoning. Assuming we reach the point where society understands and accepts the special physical and psychological needs of the homosexual community should the church then be searching for and supporting research into a medical solution for these needs?

    • hi Peter,

      I think it’s a 2-strand approach. Yes, we want to be helping with medical care. Work like that of ACET is important.
      But it’s not a solution. The solution to a damaging behaviour is cessation of the behaviour.
      But it goes beyond that because part of the question is whether there is an associated psychological disorder too. Of course when you say that you won’t be popular. But it’s it’s true then 2 things are our ultimate conclusion:
      1. we care as much as we can for anyone afflicted in this way – as I trust we would care for pretty much anyone afflicted by anything
      2. we lovingly point out that pursuit of this way of life is only compounding something harmful

  2. Hi David,

    Great post. Fascinating reading.

    I want to take issue with one small point (which you end up doing yourself by the end of your post, but it’s unclear when it first comes up). You say:

    The follow-up study that they refer to may indeed show a massive reduction in death rates but the study’s title is “Decline in deaths from AIDS due to new antiretrovirals” and it demonstrates that the usage of new antiretrovirals is helpful in reducing death rates. But this is an argument about the benefits of good pharmacology! You can hardly use it to argue another point since it doesn’t address it – it’s seeking to find out whether the drugs worked and that’s what the data set is all about.

    That seems to me to be a reasonable thing for them to say. Their first study, from the bits you’ve written about it, seemed to say basically that the danger was from high rates of HIV/AIDS. If the second study is about reducing the morbidity of that disease, then it’s dealing with that specific danger and rendering it less valid as a factor. If that danger is dealt with, then the lifestyle is not a factor any more.

    As I say, you go on to outline the further effects that affect the community in various ways… I just thought it was less clear earlier on in the post.

    Also, xkcd.

    • hi Sam,

      Yes, I move through the piece developing the ideas but I don’t think I want to change my argument at the specific point you mention.

      While HIV/AIDS is quite obviously one of the biggest impacters upon homosexual health it’s not the only one. Putting on a condom doesn’t actually remove the risks, it only mitigates one of them – the basic risk is the behaviour itself.

      I think I can also see a natural law argument flowing from this too in terms of “natural” behaviour but I’m very wary of where that goes and whether it can be sustained in anything like a careful way.

      and yes, that xkcd cartoon makes the point beautifully

  3. The HPV discussion, while true, is a bit one sided. HPV does not discriminate based on gender, sexuality or location. The HPV virus causes cell changes in areas where there is a junction, or change, in cell types. In the case of HPV this is most commonly the vaginal/cervical junction or in the case of anal intercourse the anal/rectal junction. If these medical facts are used against homosexual anal sex then they should likewise tell us that heterosexual vaginal sex is a health risk and only lesbians are therefore safe. Also regarding prolapse of the anus, women can also experience prolapse of the uterus post childbirth. Childbirth in women is also a risk. My argument here is most activities we are involved in have risk associated with them. That in itself is not an argument to stop those behaviours and more an argument about risk management.

    • hi Dean, thanks for commenting here.

      I’m with you to a point but surely we ought to concede that there is some activity which is more dangerous than others? So yes, different forms of intercourse all have risk but some are more risky than others.

      I’m wary, as well, of segmenting the argument in this way – there’s an issue of overall health outcomes which needs to be addressed and which the figures point towards. Individual discussion over particular risks, while, helpful, masks this greater issue.

      Nevertheless, thanks for the comment. It’s good for us to be able to discuss these critical issues.

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