Sunday, October 23, 2011

Homosexuality In Judeo-Christian Religion

(11) HOMOSEXUALITY IN JUDEO-CHRISTIAN RELIGION:

What is this webpage about?

This post is sub-section 11 of the main essay on this blog, which is entitled "Countering Heterosexist Arguments". The vast majority of the post is directed towards the analysis of scripture in order to demonstrate that whether or not religiously motivated heterosexism has a sound biblical basis is debatable.



CONTENTS

THOUGH SHALT NOT JUDGE
SCRIPTURAL ARGUMENTS
OLD TESTAMENT
          Genesis
          Leviticus
NEW TESTAMENT
          Romans
          Corinthians and Timothy
          Jude
          Jesus
          General Biblical Counters
          Summary
LOGICAL ARGUMENTS




THOUGH SHALT NOT JUDGE:

Numerous biblical verses condemn judgement in far clearer terms than any condemnation of homosexuality. Romans 2:1;
"You, therefore, have no excuse, you who pass judgment on someone else, for at whatever point you judge another, you are condemning yourself". Other verses include; 1 Corinthians 5:11-13, Luke 6:37, Luke 6:41, John 8:7, Romans 14:10 & James 4:11.



SCRIPTURAL ARGUMENTS; OLD TESTAMENT:

Genesis:

Heterosexists frequently use the rhetoric "Adam and Eve not Adam and Steve" to try to suggest that their depiction in the Bible demonstrates the exclusion of same sex partnership as a morally valid variant of human relationships:

- The assumption that what is described is the only legitimate variant is unjustified.
- According to the bible, humans were also created naked and it appears likely that the human race was founded on incest.
- Genesis 4:25-26 seems to suggest that Seth (Adam and Eve's son) had a child by Eve for instance.
- There is also no mention in Genesis of any miraculous creation of women from men's ribs after Eve.


One verse commonly used by heterosexists is Genesis 2:24:
"24 Therefore a man shall leave his father and mother and be joined to his wife, and they shall become one flesh.
25 And they were both naked, the man and his wife, and were not ashamed."
- It is highly unsurprising, if God wished for humans to become a whole race, that he would choose to make Adam and Eve, not Adam and Steve.
- Likewise, it is unsurprising that in a chapter about a heterosexual relationship, references to relationships (Genesis 2:24) would refer to a heterosexual one, rather than a homosexual one.
- It therefore seems quite clear that God could easily have chosen Adam and Eve, and not Steve, (and allowed incest) simply to allow for procreation, not as a condemnation of homosexuality.


God created man naked, and man only made and wore clothes after becoming sinful via eating the forbidden fruit:

- Genesis 2:25 explicitly states that man was made naked and unashamed of this.
- In Genesis 3:10, after eating the fruit, Adam hid himself from God apparently due to fear of being seen naked.
- According to heterosexist reasoning (that which was created in the beginning is the only morally legitimate form of existence), all Christians should therefore renounce the evils of clothing and live naked for the rest of their lives.
- An incestuous heterosexual relationship is also likely the only morally legitimate one.
- The sanctioning of polygamy in the OT in particular irrefutably demonstrates that Adam and Eve were a general template, not the only legitimate form a relationship could take.


The Genesis account of the destruction of the cities of Sodom and Gomorrah is often attributed by religious heterosexists to anal sex:

- The sins of Sodom and Gomorrah are not all clearly stated in the bible. Ezekiel 16:49-50:
"Now this was the sin of your sister Sodom: She and her daughters were arrogant, overfed and unconcerned; they did not help the poor and needy. They were haughty and did detestable things before me."
- Many people consider it probable that the sin punished was a lack of hospitality/the mistreatment of foreigners/strangers.
- This is particularly the case as there are many biblical commandments to avoid the mistreatment of strangers.
- In the New Testament, Mathew 10:14-15 and Luke 10:10-12, it is implied that Sodom and Gomorrah were destroyed due to inhospitality.
- In the Book of Judges, 19-21, The battle of Gibeah that is described greatly resembles S&G and arises from inhospitality and (heterosexual) gang-rape.
- Aside from the peculiarity of assuming that in a story of attempted gang-rape, homosexuality, rather than rape is the sin, a number of other aspects of the story of S&G may be difficult for Christians to explain. These include;
a) How "all the men from every part of the city of Sodom—both young and old" (Gen 19:4) were homosexual.
b) How Lot, who offered his two very young virginal daughters to the mob of men to be gang-raped, saying "do what you like with them" (Gen 19:8) is considered to be righteous (2 Peter 2:7).
c) The contradiction between the command not to murder and the mass murder allegedly perpetrated by the biblical deity at S&G, which would of course include numerous infants/babies.



Leviticus:

The TV show, "The West Wing", points out some Biblical teachings, many from Leviticus. 2:32


Other things condemned in Leviticus 18-22, that are all located around 2 supposed anti-gay quotations from the bible, include:

- Shaving, - haircuts, - tattoos,
- interbreeding animals,
- wearing mixed fabrics,
- mixing seed in a field,
- sex during a womans period,
- eating meat with blood in it,
- picking up fallen grapes during a harvest,
- eating fruit from a tree during its first 4 years.

Leviticus also repeatedly endorses the death penalty, for a variety of actions, including insolent children, Leviticus 20:9:
"For every one that curseth his father or his mother shall be surely put to death: he hath cursed his father or his mother; his blood shall be upon him."

- Leviticus 11:12 and the surrounding verses condemn eating shellfish as an "abomination".
- Leviticus 25:44  and the surrounding verses endorse slavery.
- Leviticus may not be the best source for enlightened moral guidance.
- Some translators claim that Leviticus simply condemns male homosexual acts in a women's bed.  Culturally, a women's bed was not to be used by anybody except her and her husband.



NEW TESTAMENT:

Romans:

Romans 1:26-27, KJV:
"For this cause God gave them up unto vile affections: for even their women did change the natural use into that which is against nature: And likewise also the men, leaving the natural use of the woman, burned in their lust one toward another; men with men working that which is unseemly, and receiving in themselves that recompence of their error which was meet."
- Paul wrote this in a letter to the Christians of Rome, as stated in Romans 1:7.
- In 1st century Rome, bisexuality was considered to be the cultural norm and was especially practiced in orgies as part of Pagan fertility rituals.
- Some translators argue that verses 26 and 27 actually refer to heterosexuals who behave homosexually in accordance with their culture and pagan rituals, despite being heterosexual, rather than actual to homosexuals.
- By doing this they defy ("exchange") their God-given nature, where as a homosexual behaving homosexually would not be doing so.
- This is particularly the case because the preceding and proceeding verses, such as 1:25, below, are geared towards criticizing Roman paganism and so 1:26-27 is simply part of a list of practises associated with paganism.
Romans 1:25, KJV:
"Who changed the truth of God into a lie, and worshipped and served the creature more than the Creator, who is blessed for ever. Amen."
- Religioustolerance gives credence to this possibility with it's analysis of the translation of certain terms in Romans.

As Rev. Dr. Lewis B. Smedes, a distinguished Christian author and ethicist, explains in his essay "Like the Wideness of the Sea?" 01/01/1998;
"The people Paul speaks of had turned from "natural" heterosexual practices to homosexual practices. The Christian homosexuals that I am talking about have not given up heterosexual passions for homosexual lusts. They have never been heterosexual. They have been homosexual from the moment of their earliest sexual stirrings."
"The homosexual people I am talking about do not lust after each other any more than heterosexual people lust after each other. They seek abiding personal companionship, enduring love, shared intimacy and complete trust from each other just as heterosexual people, at their best, do. Their love for one another is likely to be just as spiritual and personal as any heterosexual love can be."


Another line of criticism of Romans 1:26-27 is to point out that in 1 Corinthians 11:14-15 Paul asserts that gender-appropriate hair lengths can be determined by looking at nature:
"Does not even nature itself teach you that if a man has long hair, it is a dishonour to him, but if a women has long hair, it is a glory to her?"
- Paul's concepts regarding what nature stipulates are clearly incorrect, as most likely, is his supposed assertion that homosexuality is wrong due to it being unnatural.
- Sikh men for instance demonstrate that a man's hair naturally grows just as long as a woman's.
- In 2 Corinthians 11:17, Paul admits that he does not always speak the word of God but sometimes expresses his own opinion, therefore casting further doubt upon the validity of his claims.
- Given that humans are born with a "sinful nature" according to the bible, acting contrary to nature as described in Romans 1:26 would seem to be a very spiritually rewarding thing to do.

As described by religioustolerance (contents of the brackets were added by this author):
"Many religious liberals reject Paul's condemnation of homosexual behavior, particularly when Paul's support for the oppression of women (1 Corinthians 14:34-35, 1 Timothy 2:12-13), and his acceptance of slavery as a normal social practice in (Philemon 1:15-16, Titus 2:9) are considered. They might feel that this passage in 1 Romans should be (similarly) rejected as immoral and outside the will of God.



Corinthians and Timothy:

Paul shares more of his views on sexuality in 1 Corinthians 7 (NIV):
"3 The husband should fulfill his marital duty to his wife, and likewise the wife to her husband."
"5 Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer.  6 I say this as a concession, not as a command.  7 I wish that all of you were as I am. But each of you has your own gift from God; one has this gift, another has that.  8 Now to the unmarried and the widows I say: It is good for them to stay unmarried, as I do."
"12 To the rest I say this (I, not the Lord)"

- 1 Cor 7:3 and 5 Seem to mandate that sex is for mutual pleasure, not just procreation.
- In 1 Cor 7:6-8 Paul shares his own views again, rather than always speaking for God. He then claims that he wishes all were celibate, just as both he himself and Jesus were, further weakening any heterosexist proclamations of the sacrality or essentiality of procreation.
- Matthew 19:12 similarly endorses celibacy and may additionally recognise the legitimacy of homosexuality: "For there are some eunuchs, which were so born from their mother's womb... and there be eunuchs, which have made themselves eunuchs for the kingdom of heaven's sake."
- 1 John 2:5-6 further undermines procreation by imploring adherents to "live as Jesus did".
- Yet again in 1 Cor 7:12, Paul shares his own views, rather than God's.  The bible itself therefore repeatedly claims that Paul does not always speak for God, making it hard to decipher when he actually is.
- In a chapter 1 Corinthians 12:4-5, there is a reference once more to the "gifts" Paul mentions in 1 Corinthians 7:7, when he was discussing relationships and marriage:
"4 There are different kinds of gifts, but the same Spirit distributes them. 5 There are different kinds of service, but the same Lord."


1 Corinthians 6:9-10, KJV:
"9 Know ye not that the unrighteous shall not inherit the kingdom of God? Be not deceived: neither fornicators, nor idolaters, nor adulterers, nor effeminate (malakoi), nor abusers of themselves with mankind (arsenokoitai),
10 Nor thieves, nor covetous, nor drunkards, nor revilers, nor extortioners, shall inherit the kingdom of God."

Religioustolerance:
"The original Greek text describes the two behaviors as "malakoi". -- some sources quote "malakee" -- and "arsenokoitai".
"Malakoi" is translated in both Matthew 11:8 and Luke 7:25 as "soft" (KJV) or as "fine" (NIV) in references to clothing.
"Although "homosexual" is a very common translation, it is almost certain to be inaccurate:
If Paul wanted to refer to homosexual behaviour, he would have used the word "paiderasste." That was the standard Greek term at the time for sexual behaviour between males.
The second term is "arsenokoitai" in Greek. The exact meaning of this word is lost. It seems to have been a term created by Paul for this verse. "Arsen" means "man" in Greek. So there is no way that "arsenokoitai" could refer to both male and female homosexuals. It seems that the translators gave in to the temptation to widen Paul's condemnation to include lesbians as well as gay males."

Religioustolerance:
"Homosexual offenders:" The NIV contains this phrase.  Suppose for the moment that Paul had attacked "heterosexual offenders" or "heterosexual sexual offenders." We would not interpret this today as a general condemnation of heterosexuality."
"At the time of Martin Luther, "arsenokoitai" was universally interpreted as masturbator. But by the 20th century, masturbation had become a more generally accepted behavior. So, new translations abandoned references to masturbators and switched the attack to homosexuals. The last religious writing in English that interpreted 1 Corinthians 6:9 as referring to masturbation is believed to be the [Roman] Catholic Encyclopaedia of 1967."
- 1 Timothy 1:9-10 is also regarded as a heterosexist verse by some but it simply uses the word "arsenokoite" again, so it's true meaning is unknown.
- Arsenokoite is used without malakoi in Timothy, suggesting that the two words may not even be connected.


The link below cites many ancient texts to provide a detailed exposition of the word "malakoi":
- It does mean "effeminate" but according to the ancient Greek understanding, not the modern one.
- It is a misogynistic term and refers to a broad range of characteristics which would not be considered effeminate today.  According to Dale Martin, Yale University Professor of Religious Studies:
"In fact, malakos more often referred to men who prettied themselves up to further their heterosexual exploits."

- It is sometimes argued that arsenokoite is derived from the Levitical condemnation of homosexuality, which includes the words arsene (male) and koite (beds).
- The link above also provides an example of how the logic employed to associate arsenokoite with the Levitical condemnations of homosexuality is flawed:
"To "understand" does not mean to "stand under."  In fact, nothing about the basic meanings of either "stand" or "under" has any direct bearing on the meaning of "understand.""
- Ladybirds or even ladybugs are another example of words which have a meaning not derived from their constituent term's literal meanings.  They are not all female, not birds and not even technically true bugs.
- The word "ladykiller" is an example where a literal interpretation would almost reverse it's meaning.

Another usage of the word Arsenokoitai:
"A revealing use of it appears around 575 A.D.; Joannes Jejunator (John the Faster), the Patriarch of Constantinople, used the word in a treatise that instructed confessor priests how to ask their parishioners about sexual sin. Here it appears in the context of a paragraph dealing with incestuous relations, and if translated as ‘homosexuality,’ the sentence containing it would read “In fact, many men even commit the sin of homosexuality with their wives.” (Patrologiae cursus completus, Series Graeca, 88:1893-96) Though at the time it apparently referred to anal or oral sex or to sex forced upon a woman, it pretty clearly had nothing to do with homosexuality."
- The reality is that the meaning intended by "arsenokoite" is unknown, which is why there tends to be great variation in how it is translated in the various versions of the bible.



Jude:

Another verse sometimes used against homosexuals is Jude 1:7, KJV:
"Even as Sodom and Gomorrha, and the cities about them in like manner, giving themselves over to fornication, and going after strange flesh, are set forth for an example, suffering the vengeance of eternal fire."

However, as ReligiousTolerance points out:
"Jude might have been referring to:
The intent of the mob to rape the angels. Rape is a clear perversion of God-given sexuality.
The fact that the angels were non-human. This would have made their sin of rape even worse; bestiality would have been involved."
- The term "strange flesh" in particular could refer to the flesh of strangers.
- "Strange" is derived from the Greek word "heteras", which is used in Hebrews 7:13 to refer to those of "another tribe", I.E. strangers.



Jesus:

- Jesus never actually mentioned homosexuality at all, making it very hard to see how it could be considered to be a particularly terrible sin.
- Christian heterosexists sometimes take Mathew 19 to be indicative of Jesus's views about it but it doesn't refer to homosexuality at all.
- In Matthew 19:3, the Pharisees ask Jesus if it is "lawful for a man to divorce his wife".
- Jesus responds by reiterating genesis and explaining that "what God has joined together, let no one separate".
- Unsurprisingly, Jesus refers to a man and women in his response because he is asked about a man and a woman.
- As the CEV and NIV titles for this section describe, it is about divorce, nothing else.



Counters to the Bible in General:

Deuteronomy 22:20-21 commands the stoning to death of non-virgin brides, NIV:
"20 If, however, the charge is true and no proof of the young woman’s virginity can be found, 21 she shall be brought to the door of her father’s house and there the men of her town shall stone her to death."
Deuteronomy 22:28-29 commands raped women to marry their rapist and never divorce, NIV:
"28 If a man happens to meet a virgin who is not pledged to be married and rapes her and they are discovered, 29 he shall pay her father fifty shekels of silver. He must marry the young woman, for he has violated her. He can never divorce her as long as he lives".
- Note that the 10 commandments are also found in Deuteronomy.
Matthew 25-32 describe how the wife of a man who dies is to become his brother's wife and so on, repeatedly, even for as many as seven brothers. Verse 30 additionally makes the supposedly vital role of marriage seem questionable; "For in the resurrection they neither marry, nor are given in marriage, but are as the angels of God in heaven".
- Using the bible to regulate marriage would in reality be quite an unsettling prospect for most modern-day Christians, given the above and the fact that it claims that you should be of the same religion to marry (2 Corinthians 6:14).


According to the bible, we all sin (Rom 3:23), though redemption can be found via faith in Jesus.  The modern Christian heterosexist's justification for their overzealous criticism of homosexuality, relative to other perceived sins, is often that homosexuals are "living in sin".  This implies repeated sexual relations outside of marriage:
- The only difference between having sinned and "living in sin" appears to be that the sin is repeatedly performed, therefore seemingly negating the possibility that the sinner is seeking or finding redemption.
- Applying this criterion consistently would therefore mean that any "sin" that is repeatedly performed would make the perpetrator just as morally deficient as a homosexual.
- Gluttony, remarriage and lust (Matthew 5:28) are all examples where most of the population are repeatedly sinning, with about 68% of the U.S. population being gluttonous and over 18% of first marriages leading to remarriage within five years. These people are effectively living in sin.
- Both the above and minority stress make Matthew 23:13 perfectly applicable to heterosexists; "Woe to you, teachers of the law and Pharisees, you hypocrites! You shut the door of the kingdom of heaven in people’s faces. You yourselves do not enter, nor will you let those enter who are trying to."

Remarriage and Gluttony Condemned:

Divorce and remarriage is adultery according to Mark 10:11-12:
"11 He answered, “Anyone who divorces his wife and marries another woman commits adultery against her. 12 And if she divorces her husband and marries another man, she commits adultery.”"

Gluttony is repeatedly condemned within the bible, such as in Philippians 3:18-19 (see below), Proverbs 23:2, Proverbs 23:21 and Deuteronomy 21:20:
"For, as I have often told you before and now tell you again even with tears, many live as enemies of the cross of Christ. Their destiny is destruction, their god is their stomach, and their glory is in their shame. Their mind is set on earthly things."


Remarriage and Gluttony's Prevalence:

The CDC, "Cohabitation, Marriage, Divorce, and Remarriage in the United States. Series Report 23, Number 22. 103pp" found that:
"After 10 years, the probability of a first marriage ending is 33 percent".
"The probability of remarriage among divorced women was 54 percent in 5 years".

The CDC, "Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960–1962 Through 2007–2008" found that:
"Percent of adults age 20 years and over who are obese: 33.9% (2007-2008)
Percent of adults age 20 years and over who are overweight (and not obese): 34.4% (2007-2008)"


1 John 4:7 appears to indicate that ultimately, all love is divinely inspired and worthy of recognition and appreciation, with no suggestion that this excludes homosexual love:
"Beloved, let us love one another: for love is of God; and every one that loveth is born of God, and knoweth God".


This video is highly recommended viewing for religiously motivated heterosexists, who are likely to find most of it very agreeable. 2:52



One of a 7 part lecture, which particularly tackles Catholic arguments against homosexuality. 9:24



Rev. Mel White, an evangelical Christian, relates his journey of coming to understand homosexuality as a gift from God. 2:49



Summary:

- Genesis provides a generic template for relationships, not stringent restrictions, as evidenced by the sanctioning of polygamy and incest.
- The sin(s) of Sodom are not clearly stated.
- Leviticus condemns benign activities and sanctions and commands abhorrent ones.  Many Christians claim that it refers to culturally rather than morally condemned practices.
- All supposed NT condemnations of homosexuality except Romans use malakoi and arsenokoite.  Arsenokoite appears to be translated in numerous different ways because it's meaning is unknown.
- Romans seems to be a condemnation of Paganism and it's associated practices, rather than homosexuality as it exists today.
- Jesus did not mention homosexuality at all.



LOGICAL ARGUMENTS:

Theism can not justifiably be used in a rational debate because it is itself unjustified:

- This is why Abrahamic religions typically have the requirement of having "faith".
- If this were not true then God's existence and nature would be demonstrable to anybody.
- This fact alone is entirely sufficient to refute any attempts to use religious conviction alone as a justified argument against homosexuality or anything else.
- To construct a sound argument involving a god, a theist must 1) Prove that a god exists, 2) Prove that it has the nature/will that they ascribe to it, 3) Prove that we should capitulate to it, 4) Prove that we can do this.


God himself feels that he should not interfere with free will:

- Despite this meaning that he lets people sin, and allows all human evil to occur.
- It is difficult to understand why some theists feel that they have more right than their God to interfere with the free will of his creation using anti-LGBT legislation.
- Homosexuality is after all a victimless "crime".
- Other victimless crimes, such as drink/drug driving, revolve around the principal of potentially harming non-consenting individuals, which is not a factor with homosexuality.


There is no universal factor in religious teachings that defines the specific distinction between what is moral, amoral or immoral:

- There are only arbitrary, unjustified condemnations.
- All things that are morally bad should have at least one principal in common.
- This thing would encompass the essence of what it is to be immoral (or virtuous).
- Murder, rape and theft all involve deliberately harming others, while homosexuality does not.
- If the unifying factor of sin is that it is condemned in the bible then a believer would have to concede that they would consider murder, rape and torture etc of first-born infants to be a moral prerogative, if these things had happened to be biblically endorsed.
- To disagree with this would mean the believer was being inconsistent and therefore using a fraudulent, incorrect definition of morally good/bad/sin.


Monday, July 04, 2011

Lesbian Health Disparities

CONTENTS:

INTRODUCTION
1) BACTERIAL INFECTIONS
          - Bacterial Vaginosis
          - Chlamydia
          - Gonorrhea
          - Syphilis
2) VIRAL INFECTIONS
          - Human Immunodeficiency Virus
          - Hepatitis C
          - Herpes Simplex Virus
          - Human Papilloma Virus
3) CANCERS
          - Cervical Cancer
          - Breast Cancer
4) OTHER GENERAL HEALTH DISPARITIES
          - Life Expectancy
          - Obesity
5) LESBIANS HAVING SEX WITH MEN
6) CONCLUSION




INTRODUCTION

LGBT people are known to suffer from higher levels of distress and some associated mental illnesses due to the heterosexism/minority stress they suffer at the hands of heterosexists (see section 1 of the following link).  In turn, this increases the probability that some will abuse both legal and illegal drugs, likely as a coping mechanism.

Obesity, alcohol and smoking are general risk factors for some cancers, and all three of these disproportionately affect lesbians due to heterosexism (see section 2 of the following link).  Section 3 of the following URL demonstrates the well established link between substance abuse and risky sexual behaviour.  This may place some WSW at increased risk for STIs, though a low biological predisposition towards STI transmission may offset this, as demonstrated in this essay.
http://homoresponse.blogspot.com/2011/06/mental-health-and-substance-abuse.html

Note that the many of the studies below were carried out at STI clinics and were on WSW (women who have had sex with women), rather than lesbians.  This clearly skews the findings towards a higher STI prevalence, both in that those attending STI clinics are far more likely to have an STI than the general population and in that WSW excludes any members of the population that have not yet had sex, unlike general population statistics.  Furthermore, WSW and MSM definitions are often based upon sexual activity within the last year or even 6 months, therefore further excluding less promiscuous participants.  Finally, given that lesbian sexual interactions do likely present a lower risk for STI transmission than heterosexual ones, WSW who have also had heterosexual interactions are likely to be over-represented in STI clinic populations.




1) BACTERIAL INFECTIONS

BACTERIAL VAGINOSIS (BV)

BV is usually the only (supposed) STIs that heterosexists even attempt to suggest is more prevalent among lesbians than the general population.  It appears though that much of this can be explained in terms of the higher smoking prevalence among lesbians that is induced by minority stress.  BV can arise spontaneously in virgins and smoking is a known risk factor.

The CDC:
"It is not clear what role sexual activity plays in the development of BV."
"Women who have never had sexual intercourse may also be affected."
http://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm

Fethers et al. 2000, Sex Transmitted Infection, 76:345-349:
"Abnormalities on cervical cytology were equally prevalent in both groups, except for the higher cytological BV detection rate in WSW (OR 5.3, p=0.003)."
http://sti.bmj.com/content/76/5/345.abstract

Evans et al. 2007, Sexually Transmitted Infection, 83:470-475:
"Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking."
http://sti.bmj.com/content/83/6/470.abstract


Furthermore, the minority stress imposed upon WSW by heterosexists likely also plays a significant role, given that very similar stressors appear to explain the severely heightened prevalence of BV among black women.  It therefore becomes nothing more than a great hypocrisy for any heterosexist to criticise lesbian BV prevalence as it appears to be a direct result of heterosexism itself.

Paul et al. 2008, Social Science and Medicine, 67(5), 824-33:
"A higher number of stressful life events was significantly associated with higher BV prevalence among both African American and White American women."
http://www.ncbi.nlm.nih.gov/pubmed/18573578

Culhane et al. 2002, American Journal Obstetrics and Gynecology, 187(5), 1272-6:
"Black women had significantly higher rates of bacterial vaginosis (64%) compared with white women (35%). Exposure to chronic stressors at the individual level differed by race (eg, 32% of the black women reported threats to personal safety compared with 13% of white women). There were significant racial differences in exposure to stress at the community level (eg, 63% of the black women lived in neighborhoods with aggravated assault rates that were above the citywide mean compared with 25% of the white women)."
http://www.ncbi.nlm.nih.gov/pubmed/12439519



CHLAMYDIA AND GONORRHOEA

Skinner et al. 1996, Genitourinary Medicine, 72(4), 277-80:
"Gonorrhoea and chlamydia infection were infrequent diagnoses in both groups, occurring in four (2%) lesbians and 14 (7%) heterosexuals."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195678/

Robertson et al. 1981, Sexually Transmitted Diseases, 8(2), 75-6:
"A screening of 148 sexually active lesbians revealed no cases of syphilis, cervical gonorrhea, herpes simplex virus, or Chlamydia trachomatis infections."
http://www.ncbi.nlm.nih.gov/pubmed/6894808



SYPHILIS

Bailey et al. 2004, Sexually Transmitted Infections, 80(3):244-246:
"There were no cases of HIV, syphilis, or hepatitis B. However, while most subjects were tested for syphilis, a minority were tested for HIV or hepatitis, so we cannot estimate prevalence rates."
http://sti.bmj.com/content/80/3/244.abstract




2) VIRAL INFECTIONS

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Centers for Disease Control and Prevention, 2005:
"To date, there are no confirmed cases of female-to-female sexual transmission of HIV in the United States database."
http://www.cdc.gov/hiv/topics/women/resources/factsheets/wsw.htm

Petersen et al. 1992, Journal of Acquired Immune Deficiency Syndromes, 5(9), 853-5:
A study on "960,000 female blood donors at 20 large U.S. blood centers during 1990... identified no woman who was infected with HIV from sexual contact with another woman."
http://www.ncbi.nlm.nih.gov/pubmed/1512683



HEPATITIS C (HCV)

Though higher risk of hepatitis is not documented among lesbians, one study did find a higher prevalence but attributed it directly to increased IDU, rather than sexual contact:

Fethers et al. 2000, Sexually Transmitted Infections, 76:345-349:
"The prevalence of hepatitis C was significantly greater in WSW (OR 7.7, p<0.001), consistent with the more frequent history of injecting drug use in this group (OR 8.0, p<0.001)."
http://sti.bmj.com/content/76/5/345.abstract

According to the CDC:
"HCV is not efficiently transmitted sexually".
http://www.cdc.gov/hepatitis/HCV/index.htm



HERPES SIMPLEX VIRUS (HSV)

In the following study, table 2 shows that HSV primary infection was 5 times more prevalent among heterosexuals than lesbians:

Skinner et al. 1996, Genitourinary Medicine, 72(4), 277-80:
"Genital herpes (p = 0.05) and genital warts (p = 0.005) were more common in the heterosexual women."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195678/



HUMAN PAPILLOMA VIRUS (HPV)

Genital warts are caused by HPV, as are several cancers (CDC, 2009):
"HPV infections are highly prevalent in the United States, especially among young sexually active women."
http://www.cdc.gov/std/stats09/womenandinf.htm

Fethers et al. 2000, Sexually Transmitted Infections, 76(5), 345-349:
"Genital herpes and genital warts were common in both groups, although warts were significantly less common in WSW (OR 0.7, p=0.001)."
http://sti.bmj.com/content/76/5/345.abstract

In the 1996 Skinner et al. study, table 2 shows that genital warts were 14 times more prevalent among heterosexual women than the lesbians:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195678/?page=2


A study on HPV transmission also suggests that lesbians sex is less risky than penile-vaginal sex for HPV infection and that smoking is a risk factor for HPV contraction, which we would expect to result in higher smoking-related HPV risk for WSW:

J. M. Marrazzo, 2004, AIDS Patient Care and STDs, 14(8), 447-451:
"In a pilot study of 149 WSW in Seattle, Washington, prevalence of HPV as detected by DNA amplification assay was 30%, and was 19% among women reporting no prior sex with men."
http://www.liebertonline.com/doi/abs/10.1089/108729100416669

CDC 2003-4 statistics show an HPV prevalence of about 30% in the general population around the age range of the above study's participants:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5633a5.htm

Marrazzo et al, 1998 The Journal of Infectious Diseases, 178(6), 1604-9:
"We also found, as have other investigators [17], that current cigarette smoking was associated with an increased risk of HPV DNA detection."


Another study found that exclusive lesbians were again at much lower risk of HPV/cervical cancer and the risk factors it notes as being associated with cervical cancer are predominantly heterosexual:

Bailey et al. 2000, British Journal of General Practice, 50(455), 481–482:
"Cytological abnormalities (borderline, mild, moderate or severe dyskaryosis) were significantly more common in women who had been sexually active with men than in ‘exclusively lesbian’ subjects".
"Early age of first intercourse with a man, number of male partners, smoking, and the presence of cervical HPV infection are all acknowledged factors associated with cervical pre-malignant and malignant change ."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313729/




3) CANCERS

CERVICAL CANCER

There are currently no studies known to this author that indicate a greater prevalence of cervical cancers among lesbians.  Given the seemingly lower prevalence of HPV (which causes almost all cervical cancer), it is probably that lesbians have a lower incidence of cervical cancer than heterosexuals.  However, some studies indicate that reduced uptake of Pap tests (which detect cervical cancer) by lesbians due, at least in part, to heterosexism, may put lesbians at greater risk of late detection of cervical cancer.

Mcintre et al. 2010, Culture, Health & Sexuality, DOI: 10.1080/13691058.2010.508844:
"Lesbians are said to feel excluded by sexual health messages that presume heterosexuality, a finding linked to lower levels of Papanicolaou (Pap) testing."
http://www.informaworld.com/smpp/content~db=all~content=a925913140

Tracy et al. 2010, Journal of Women's Health, 19(2), 229-237:
"Many lesbians do not screen for cervical cancer at recommended rates. Nonroutine screeners perceive fewer benefits, more barriers, and more discrimination".
http://www.liebertonline.com/doi/abs/10.1089/jwh.2009.1393



BREAST CANCER

As with cervical cancer, no studies are currently known to this author showing a higher prevalence of breast cancer among lesbians.  However, again, studies indicate a lower uptake of preventative medical care by lesbians, again, due to heterosexism.  Lesbians higher smoking, drinking and obesity rates may also put them at higher risk for various cancers.  Obesity and alcohol intake are risk factors for breast cancer, while smoking may be.  Other risk factors that are incidentally related to lesbianism include; being female, not having children and not breast feeding.  These apply all childless women and it would be insane to advocate having children purely in order to reduce the risk of a specific cancer.  http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors

Lauver et al. 1999, Women's Health Issues, 9(5), 264-274:
"Lesbians face unique barriers to health care... some issues identified were particular to lesbians; many issues were common to those identified by general samples of women (which include lesbians)."
http://www.sciencedirect.com/science/article/pii/S1049386799000249




4) OTHER GENERAL HEALTH DISPARITIES

LIFE EXPECTANCY

Women in general have higher life expectancies than men.  MSM life expectancy is only thought to be negatively impacted by HIV and suicide, relative to heterosexuals.  HIV risk appears to be lower in lesbians than heterosexuals, suggesting a potentially higher mean life expectancy.  Suicide rates are still likely higher among WSW than the general population though, due to heterosexism.  The only lifespan studies performed on homosexuals include a massively discredited one, by anti-gay activist Paul Cameron and one that was on MSM, not WSW.  Overall, heterosexism-induced suicide is the only obvious factor that may impact upon WSW mean life expectancy.



OBESITY

Some sources allegedly indicate a higher rate of obesity among lesbians than the general female population, although the specific studies are not currently known to this author.  As with mental illness and substance abuse, obesity is linked to the stress, depression and anxiety such as that caused by heterosexism.

Zigman et al. 2011, Journal of Clinical Investigation, DOI:10.1172/JCI57660:
"The popular media and personal anecdotes are rich with examples of stress-induced eating of calorically dense “comfort foods.” Such behavioral reactions likely contribute to the increased prevalence of obesity in humans experiencing chronic stress or atypical depression."
http://www.jci.org/articles/view/57660

M F Dallman, 2010, Trends in Endocrinology & Metabolism, 21(3), 159–165:
"Stress also induces secretion of both glucocorticoids, which increases motivation for food, and insulin, which promotes food intake and obesity."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831158

Richardson et al. 2003, Archives of Pediatric & Adolescent Medicine, 157(8), 739-745:
"Depressed late adolescent girls were at a greater than 2-fold increased risk for obesity in adulthood compared with their nondepressed female peers.  A dose-response relationship between the number of episodes of depression during adolescence and risk for adult obesity was also observed in female subjects."
http://archpedi.ama-assn.org/cgi/content/full/157/8/739


At least one study finds no correlation between sexual orientation and BMI, though this study was on a Dutch population, where heterosexism is not as abundant, therefore diminishing the effects of minority stress that we might expect to see in less accepting cultures.

Sandfort et al. 2006, American Journal of Public Health, 96(6), 1119–1125:
"Obesity was not related to sexual orientation, suggesting that gay/lesbian and bisexual people are not at greater risk than heterosexual people for obesity-related health problems."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470639/




5) LESBIANS HAVING SEX WITH MEN

The heterosexist draws attention to lesbian's who have sex with men 1) in an attempt to undermine the legitimacy of their sexual orientation and perhaps 2) to distract from the fact that the WSW STI studies show that WSW generally derive far more of their risk for STI infection from their heterosexual than their homosexual interactions.  The high incidence of lesbian and WSW having at least one lifetime male partner has a couple of explanations:

- The WSW studies include bisexuals and in some cases, heterosexual women who have ever experimented with women.
- Conformity to family and societal expectations and pressure likely explain the bulk of self-identified lesbians who have had sex with men.
- The predominance of heterosexuality in society likely also leaves even the less-pressured lesbians more open to experimentation, at some point in their lives, than the average heterosexual.
- The above two points are particularly probable in that women do not have to get aroused to have sex, unlike men.
- Women are additionally culturally portrayed as not being lustful, far more than men, which likely further contributes to phases of self-denial in young lesbians about their sexual orientation.
- In such cases of self-denial, heterosexual sex may even be used as a means of self-affirmation that "I can't be lesbian because I have had sex with a man".
- Bisexuality can have some additional associated stigma attached to it, even occasionally among homosexuals (bisexuals may be considered "greedy", "confused" or more prone to infidelity) and this may lead some bisexual women, particularly those who lean strongly towards same-sex attraction, to classify themselves as lesbian.
- Even those who were not afraid of bisexuality-associated stigma may have identified as lesbian under the belief that they were primarily lesbian (ignorance of terminology) or purely for simplicity (if you're rarely attracted to men, "lesbian" may be a more pragmatic description).


What we would expect to see, were the above explanations correct (particularly ones such as teenage experimentation, self-denial and conformation to societal pressure), would be a relatively high lifetime incidence of lesbians having sex with men and a very small percentage continuing to do so, even after identifying as lesbian and therefore, presumably, having accepted their sexuality.  This is exactly what we do see:


WSW STUDIES (These include bisexual women):

Note: The Audre Lorde Clinic, which has now closed, was a WSW clinic, not exclusive to lesbians, as confirmed by this author via contact with staff at The Ambrose King Centre, where the Skinner et al. 1996 study was conducted.  Sexual health clinics are also likely to cater to a population that is on average substantially younger than the national mean or median age because the majority of STI transmission occurs among younger people.

Skinner et al. 1996, Genitourinary Medicine, 72(4), 277–280:
"Of the lesbians, 218 (91%) had experienced heterosexual intercourse but in only four (2%) had this occurred in the lst 90 days and none within the last 60 days.  In 34 (14%) of the lesbians, heterosexual intercourse had not occurred within the last 10 years."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195678/

Baley et al. 2003, Sexually Transmitted Infections, 79(2), 147-150:
"85% of the sample reported sexual activity with men; for most (70%) this was 4 or more years ago."
http://sti.bmj.com/content/79/2/147.abstract


SELF-IDENTIFIED LESBIAN STUDIES (These exclude bisexual women):

Diamant et al. 1997, Archives of Internal Medicine, 159(22), 2730-2736:
"Our data showed that 5.7% of respondents reported having had 1 or more male sexual contacts within the preceding year."
"Younger women were more likely to have had a male sexual partner during the preceding year. By contrast, older women were more likely than younger women to have engaged in vaginal intercourse".
"Data suggest that individuals who answer surveys about sexual issues tend to hold more liberal sexual attitudes and be more sexually active than nonrespondents."
http://archinte.ama-assn.org/cgi/content/full/159/22/2730

In Koh et al. 2005, (Sexually Transmitted Diseases, 32(9), 563-569), only 3% of the lesbians reported sex with men in the last year (see table 2). 
http://journals.lww.com/stdjournal/Fulltext/2005/09000/Sexual_Risk_Factors_Among_Self_Identified.8.aspx


Only a tiny portion (~4%) of the self-identified lesbians have had recent (past year) sex with men.  These 4% are likely made up of those predominantly bisexual women who identify as lesbian and those young members of the study populations who only recently accepted their sexual orientation.  That the older women in the Diamant 1997 study were more likely to have had lifetime vaginal intercourse is consistent with the point that heterosexism, which used to be even more prevalent, is the cause behind a lot of the lesbian heterosexual interactions.  Studies on the prevalence of homosexuality and bisexuality repeatedly show more people claiming to have engaged in homosexual interactions than the number that identify as something other than heterosexual.  This does not undermine heterosexuality.




6) CONCLUSION

BV and obesity appear to both be linked quite closely with stress.  Substance abuse may put lesbians at increased risk of STIs and some cancers, with fears of discrimination and feelings of exclusion also potentially contributing to lack of preventative medical care.  However, current research does not generally indicate a higher incidence of STIs among lesbians, except for BV, the sexual transmission of which is controversial and the prevalence of which is linked to (minority) stress.

One study showed a markedly higher prevalence of hepatitis C, though the study was not representative, did not have a properly matched control population and the study authors attributed the HCV prevalence to injecting drug usage (IDU), which correlated with it.  All of these disparities are clearly established as being caused by heterosexism, rather than homosexuality itself.

The potential for HIV transmission is known to be significantly lower between two women than WSM or MSM.  There is insufficient research on nationally representative populations to draw firm conclusions about the prevalence of other STIs, though current studies appear suggestive of a lower prevalence of many STIs among WSW than WSM.

In a study on 708 WSW patients attending two London-based STI clinics, Bailey et al. (2004, Sexually Transmitted Infections, 80(3):244-246) found that:
"Bacterial vaginosis and candida species were commonly diagnosed (31.4% and 18.4% respectively). Genital warts, genital herpes, and trichomoniasis were infrequently diagnosed (1.6%, 1.1%, and 1.3% respectively). Chlamydia, pelvic inflammatory disease, and gonorrhoea infections were rare (0.6%, 0.3%, and 0.3% respectively) and diagnosed only in women who had histories of sex with men."
http://sti.bmj.com/content/80/3/244.full

Cochran et al. 2007, American Journal of Public Health, 97(11), 2048–2055:
"Our findings indicate that minority sexual orientation alone is not associated with poorer physical health."
"Lesbians and bisexual and homosexually experienced heterosexual women reported a greater variety of health conditions and limitations compared with exclusively heterosexual women; however, these differences mostly disappeared when distress levels were taken into account."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2040376

Note that Candida (mentioned in Bailey, 2004) causes yeast infection/thrush, which affects the majority of women at least once in their lifetime and is similar to BV.  An analogous quotation to the above one can be found at the end of the "African American Health Disparities" conclusion:
http://homoresponse.blogspot.com/2011/06/african-american-health-disparities.html#5

Saturday, June 25, 2011

African American Health Disparities

Just as higher rates of some STIs among Black Americans are not "because they are black", neither are the higher rates of some STIs among gay men or MSM (men who have sex with men) simply "because they are gay".  Black people comprise approximately 13.5% of the American population.  Note that the information below is not intended to provide a balanced perspective of black people's health (sexual or otherwise) but is designed to demonstrate the absurdity of using STI or general health disparities to claim that a certain subpopulation is either pathological, immoral or deserving of mistreatment or fewer rights.  All points made are facts, quoted from reputable scientific sources.  Clicking on any of sections 1-5 will take you directly to that section.




CONTENTS:

1) BACTERIAL INFECTIONS
          - Bacterial Vaginosis
          - Chlamydia
          - Gonorrhea
          - Syphilis
          - Tuberculosis
2) VIRAL INFECTIONS
          - Human Immunodeficiency Virus
          - Hepatitis A,B,C
          - Herpes Simplex Virus
          - Human Papiloma Virus
3) CANCERS
          - Anal Cancer
          - Cervical Cancer
          - Breast Cancer
          - Prostate Cancer
4) OTHER GENERAL HEALTH DISPARITIES
          - Life Expectancy
          - Trichomoniasis
          - Obesity
          - Infant Mortality
          - Asthma
5) CONCLUSION





BACTERIAL VAGINOSIS (BV)

Bacterial vaginosis is a largely inconsequential STI, especially in comparison to various other ones.  However, it is the only one that heterosexists are able to even slightly demonstrate as being more prevalent among lesbians (or women who have sex with women).  It is far more prevalent among black women than lesbians and is believed to arise from stress.  It can arise in virgins and there is limited evidence for it's sexual transmission.  The stress described in the third study below in particular is exactly the kinds of stress that lesbians may suffer at the hands of heterosexists, therefore making any criticism of lesbians based upon BV prevalence high hypocritical.

Koumans et al. 2007, Sexually Transmitted Diseases, 34(11), 864-869:
"Prevalence was 51.4% among non-Hispanic blacks, 31.9% among Mexican Americans, and 23.2% among non-Hispanic whites."
http://journals.lww.com/stdjournal/Fulltext/2007/11000/The_Prevalence_of_Bacterial_Vaginosis_in_the.6.aspx

Paul K et al. 2008, Social Science and Medicine, 67(5), 824-33:
"A higher number of stressful life events was significantly associated with higher BV prevalence among both African American and White American women."
http://www.ncbi.nlm.nih.gov/pubmed/18573578

Culhane JF et al. 2002, American Journal Obstetrics and Gynecology, 187(5), 1272-6:
"Black women had significantly higher rates of bacterial vaginosis (64%) compared with white women (35%). Exposure to chronic stressors at the individual level differed by race (eg, 32% of the black women reported threats to personal safety compared with 13% of white women). There were significant racial differences in exposure to stress at the community level (eg, 63% of the black women lived in neighborhoods with aggravated assault rates that were above the citywide mean compared with 25% of the white women)."
http://www.ncbi.nlm.nih.gov/pubmed/12439519



CHLAMYDIA

According to the CDC, in 2004:
"African-American women are also disproportionately impacted by chlamydia. In 2004, the rate of reported chlamydia among black females (1,722.3) was more than 7.5 times that of white females (226.6)."
http://www.cdc.gov/std/stats04/trends2004.htm

According to the CDC, in 2007:
"The rate of chlamydia among blacks was over eight times higher than that of whites (1,398.7 and 162.3 cases per 100,000, respectively)."
http://www.cdc.gov/std/stats07/chlamydia.htm

According to the CDC, in 2009:
"African Americans had 8.7 times the reported chlamydia rates of whites".
http://www.cdc.gov/std/health-disparities/race.htm



GONORRHEA

According to the CDC, in 2004:
"In 2004, the gonorrhea rate among African-Americans was 19 times greater than the rate for whites, down from 28 times greater in 2000."
http://www.cdc.gov/std/stats04/gonorrhea.htm

According to the CDC, in 2007:
"In 2007, approximately 70% of the total number of reported cases of gonorrhea occurred among blacks."
http://www.cdc.gov/std/stats07/minorities.htm

According to the CDC, in 2009:
African Americans had 20.5 times the reported gonorrhea rates of Whites".
http://www.cdc.gov/std/health-disparities/race.htm



SYPHILIS

The CDC:
"Racial gaps in syphilis rates are narrowing, with rates in 2004 5.6 times higher among blacks than among whites, a substantially lower differential than in 2000, when the rate among blacks was 24 times greater than among whites."
http://www.cdc.gov/std/stats04/trends2004.htm

According to the CDC, in 2009:
"African Americans had 9.1 times the reported syphilis rates of whites".
http://www.cdc.gov/std/health-disparities/race.htm



TUBERCULOSIS (TB)

According to the CDC, in 2008:
"83% of all reported TB cases occurred in racial and ethnic minorities (29% in Hispanics, 26% in Asians, 25% in non-Hispanic blacks or African-Americans, 1% in American Indians or Alaska Natives, and <1% in Native Hawaiians or Other Pacific Islanders), whereas 17% of cases occurred in non-Hispanic whites."
http://www.cdc.gov/tb/statistics/surv/surv2008/slides/surv10.htm





HUMAN IMMUNODEFICIENCY VIRUS (HIV)

According to the CDC, in 2006:
"The rate of new HIV infection for black women was nearly 15 times as high as that of white women and nearly 4 times that of Hispanic/Latina women".
http://www.cdc.gov/hiv/topics/aa/

AVERT - International AIDS Charity:
"Despite comprising less than 1% of the total UK population, Black-Africans accounted for one third of all new HIV diagnoses in 2009."
http://www.avert.org/uk-race-age-gender.htm

AVERT's statistic is based upon The Health Protection Agency:
"In 2009, there were 23,288 diagnosed HIV-infected black-Africans and 1,932 diagnosed HIV- infected black-Caribbeans seen for  HIV care in the UK, which accounted for 36% (23,288/64,378) and 3% (1,932/64,378) of all HIV-infected persons accessing care."
http://tinyurl.com/HPAStat

The Centers for Disease Control:
"In 2009, blacks/African Americans made up approximately 13% of the population of the 40 states (surveyed) but accounted for 52% of diagnoses of HIV infection." (See slide 5).
http://cdc.gov/hiv/topics/surveillance/resources/slides/race-ethnicity/index.htm



HEPATITIS A,B,C

The CDC regarding Hepatitis A:
"HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease".
"Antibody produced in response to HAV infection persists for life and confers protection against reinfection".
http://www.cdc.gov/hepatitis/HAV/index.htm

Until very recently, Hepatitis A has been astronomically more prevalent among American Indians than any other race:
http://www.cdc.gov/hepatitis/Statistics/2008Surveillance/Slide5a.htm

Acute hepatitis B infection is 2-3 times more prevalent among black Americans than white Americans:
http://www.cdc.gov/hepatitis/Statistics/2008Surveillance/Slide5b.htm

In the year 2000, acute hepatitis C infection was approximately twice as prevalent among black Americans compared to white Americans:
http://www.cdc.gov/hepatitis/Statistics/2008Surveillance/Slide4c.htm



HERPES SIMPLEX VIRUS (HSV)

The CDC (MMWR 2010, 59(15);456-459) found in a study on herpes simplex virus type 2 that:
"By race/ethnicity, HSV-2 seroprevalence was approximately three times greater among non-Hispanic blacks (39.2%) as among non-Hispanic whites (12.3%) (p<0.001)".
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5915a3.htm

Kaposi's Sarcoma is a form of cancer that only occurs after infection with Human Herpes virus 8.  A 2004 publication of cancer statistics for 2001, by the CDC and National Cancer Institute claimed that:
"Among men aged 35–44, Kaposi’s sarcoma is 1.6 times higher for black men than for Hispanic men and 3 times higher for black men than for white men."
http://wonder.cdc.gov/wonder/help/cancer/USCS_2001.pdf



HUMAN PAPILOMA VIRUS (HPV)

HPV (particularly types 16 and 18) are oncogenic and can lead to a variety of cancers:
"Black and Hispanic women had higher rates of HPV-associated cervical cancer than white women. Black women also appeared to have higher rates of HPV-associated vaginal cancer. Black men and women appeared to have higher rates of HPV-associated cancers of the oropharynx and oral cavity."
http://www.cdc.gov/cancer/hpv/what_cdc_is_doing/qa.htm





ANAL CANCER

The CDC:
"More black men get anal cancer than men of other races."
http://www.cdc.gov/cancer/hpv/statistics/anal.htm



CERVICAL CANCER

American Cancer Society, 2011-2012:
"African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers."
"The incidence rate of cervical cancer remains 39% higher in African American women".
http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027765.pdf



BREAST CANCER

Smigal et al. 2006, A Cancer Journal for Clinicians, 56,168-183:
Breast cancer "death rates in African American women remain 37% higher than in Whites".
http://caonline.amcancersoc.org/cgi/content/full/56/3/168
DOI: 10.3322/canjclin.56.3.168



PROSTATE CANCER

According to the CDC:
"Men have a greater chance of getting prostate cancer if they are 50 years old or older, are African-American, or have a father, brother, or son who has had prostate cancer."
http://www.cdc.gov/Features/ProstateCancer/

B. Walker et al. 1995, Environmental Health Perspectives, 103(8), 275-81:
"During the years 1987 to 1991, African Americans experienced higher incidence and mortality rates than whites for multiple myeloma and for cancers of the oropharynx, colorectum, lung and bronchus, cervix, and prostate."
http://www.ncbi.nlm.nih.gov/pubmed/8741798





LIFE EXPECTANCY

The CDC, 2007 statistics, (MMWR 2009 / 58(42);1185):
"Life expectancy for white males in 2007 (75.8 years) was 5.6 years greater than for black males (70.2) and 3.7 years greater for white females (80.7) than black females (77.0)".
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5842a7.htm

The CDC, 2006 statistics:
"In 2006, African Americans had the highest age-adjusted all-causes death rate of all races/ethnicities.  In addition, African Americans had the highest age-adjusted death rate for heart disease, cancer, diabetes, and HIV/AIDS."
http://www.cdc.gov/omhd/Highlights/Highlight.htm



TRICHOMONIASIS

Trichomoniasis is a protozoan parasite STI that can increase the chances of HIV transmission.

CDC 2001-2004 National Health and Nutritional Examination Survey data:
"NHANES data from 2001–2004 indicated an overall prevalence of 3.1% (95% CI: 2.3–4.3), with the highest prevalence observed among blacks (13.3%)"
http://www.cdc.gov/std/stats09/other.htm



OBESITY

The CDC, 2008 statistics:
"In 2008, African American Adults were almost 4 times as likely to be obese*  as Asian Adults, (African American: 36.1%, White: 26.5%, Asian American: 9.4%).  African American women were particularly impacted, with 42.1% of African American women 18 years of age and over obese in 2008."
http://www.cdc.gov/omhd/Highlights/Highlight.htm



INFANT MORTALITY

According to the CDC (MMWR, 2011 / 60(01);49-51), 2006 statistics show that:
"The highest infant mortality rate was for non-Hispanic black women (13.35), with a rate 2.4 times that for non-Hispanic white women (5.58)."



ASTHMA

According to the CDC (MMWR, 2011 / 60(01);84-86), 2006-2008 statistics show that:
"Current asthma prevalence was higher among the multiracial (14.8%), Puerto Rican Hispanics (14.2%), and non-Hispanic blacks (9.5%) than among non-Hispanic whites (7.8%)."
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6001a18.htm?s_cid=su6001a18_w





Epidemiology is highly complex, involving a range of different variables, with no one factor the sole cause of a higher disease prevalence.  Black people appear to be at high risk of almost every STI that MSM are at high risk for as well as suffering from various other health disparities.  There are a range of reasons for this in both cases, not all of which are accurately quantified or perhaps even known and none of which indicate that being black or MSM is immoral or pathological.  Attempts to suggest otherwise are typically malicious attempts to legitimize and provide excuses for prejudice and discrimination.

According to the American Academy of Family Physicians:
"The USPSTF recommends that physicians be aware that in some communities black and Hispanic men and women (including pregnant women) may be at increased risk of chlamydia, gonorrhea, and syphilis, irrespective of age or sexual behaviors, and may need to be screened."

"Research has documented that many social-contextual factors contribute to varying STI prevalence rates within communities. Through a variety of direct and indirect mechanisms, factors in a community (e.g., poverty, discrimination, illicit drug use, male-to-female ratio, incarceration rate, racial segregation) influence sexual behaviors and networks, subsequently affecting the spread of infection."
http://www.aafp.org/afp/2008/0315/p819.html

A review of racial/ethnic discrimination and health studies by Williams et al. (2008, American Journal of Public Health, 98(S1), S29–S37) found that:
"Perceptions of discrimination appear to induce physiological and psychological arousal, and, as is the case with other psychosocial stressors, systematic exposure to experiences of discrimination may have long-term consequences for health."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518588/

Wednesday, June 22, 2011

Love & Lust

Below is a simplified schematic of how love/lust can be directed towards distinct parts of the spectrums of two key traits that influence attraction. A person's attraction could be represented on the diagram by drawing a double-headed/forked arrow from the central circles (either green, blue or where they overlap) in opposite directions. One arrow would head towards the scale at the top and the second towards the scale at the bottom. Click to enlarge the diagram.

Sunday, June 19, 2011

Homosexual Health Disparities

CONTENTS:

INTRODUCTION
1) MENTAL HEALTH
2) SUBSTANCE ABUSE
3) HIGH RISK SEXUAL BEHAVIOUR
4) SUICIDALITY
5) VICTIMISATION
6) CONCLUSION




INTRODUCTION

What is this page about?

Each section below presents extensive scientific evidence for the link between heterosexism/minority stress and a key LGBT health disparity which it impacts. These same disparities are frequently cited by heterosexists to demonstrate that the "homosexual lifestyle" is risky, unhealthy or dangerous. Ironically, given that heterosexism itself causes these disparities, rather than homosexuality, such criticisms are not only flawed but additionally, hypocritical and counter-productive.


What is heterosexism?

Heterosexism refers to an ideology centred around the concept that heterosexuality is the default or normal sexual orientation and that any other variants are therefore inferior. It is similar to homophobia, though homophobia is a stigmatized term, the use of which may therefore inhibit discussion. Heterosexism can arise in many sources, including parents, peers and social/legal institutions and may be particularly prolifically directed towards people with atypical gender-expression. This can lead to a pervasive climate of prejudicially motivated discrimination for LGBT individuals and minority stress results from these factors, as elaborated upon below.


What is minority stress?

I.H. Meyer, 1995, Journal of Health and Social Behavior, 36(1), 38-56:
"The concept of minority stress is based on the premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization. Minority stressors were conceptualized as: internalized homophobia, which relates to gay men's direction of societal negative attitudes toward the self; stigma, which relates to expectations of rejection and discrimination; and actual experiences of discrimination and violence."
http://www.chssp.columbia.edu/events/ms/year4/pdf/sh_Meyer%20IH.pdf

Other facets of sexual minority stress include failure to live up to parental expectations, the strain of concealing one's minority status and romantic relationship formation in an environment that demands inconspicuousness or invisibility. The image below contains further examples. The various impacts of minority stress, as described in the proceeding sections, interact synergistically, as will be elucidated in the conclusion.


PLEASE NOTE;
- Studies appear in reverse chronological order.
- Please click any of the contents sections to be taken to that section.
- Links and DOIs for each study are provided at the end, in the same numerical order as the studies.
- Some studies have (DUTCH) in their citations because heterosexists occasionally use LGBT mental health disparities in the "gay-friendly" Netherlands to insinuate that minority stress can't be the cause.
- All studies cited below include LGBT sample populations unless stated otherwise.






Numerous studies actually link increased mental health issues, among sexual minorities, with internalized heterosexism/ minority stress etc:

01) Gevonden et al. 2014, Psychological Medicine, 44(2), 421-33 (DUTCH):
"The finding that LGB orientation is associated with psychotic symptoms adds to the growing body of literature linking minority status with psychosis and other mental health problems, and suggests that exposure to minority stress represents an important mechanism."

02) Bockting et al. 2013, American Journal of Public Health, 103, 5, 943-951:
"Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Our findings support the minority stress model."

03) Kuyper & Fokkema, 2011, Journal of Counseling Psychology, 58(2), 222-233 (DUTCH):
"Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems".

04) Chakraborty et al. 2011, The British Journal of Psychiatry, 198(2), 143-148:
"This study corroborates international findings that people of non-heterosexual orientation report elevated levels of mental health problems and service usage, and it lends further support to the suggestion that perceived discrimination may act as a social stressor in the genesis of mental health problems in this population".

05) Nemoto et al. 2011, American Journal of Public Health, 101(10), 1980-1988:
"Transphobia, suicidal ideation, and levels of income and education were significantly and independently correlated with depression."

06) Vanden Berghe et al. 2010, Journal of Applied Social Psychology, 40(1), 153–166:
"Hierarchical regression shows that LGB-specific unsupportive social interactions have the greatest direct effect on mental well-being of LGB youth, followed respectively by stigma consciousness, internalized homonegativity, and confidant support".

07) Ryan et al. 2010, Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205-213:
"Family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors".

08) Chae et al. 2010, International Journal of Health Services, 40(4), 589-608:
"Linear regression analyses revealed that reports of racial/ethnic discrimination and sexuality discrimination were associated with higher levels of psychological distress among sexual minority participants".

09) McLaughlin et al. 2010, American Journal Of Public Health, 100(8), 1477–1484:
"Psychiatric disorders are more prevalent among individuals reporting past-year discrimination experiences".

10) Toomey et al. 2010, Developmental Psychology, 46(6), 1580-1589:
"We found that victimization due to perceived or actual LGBT status fully mediates the association between adolescent gender nonconformity and young adult psychosocial adjustment (i.e., life satisfaction and depression)."

11) Roberts et al. 2010, American Journal of Public Health, 100(12), 2433-2441:
"Profound sexual orientation disparities exist in risk of PTSD (posttraumatic stress disorder) and in violence exposure, beginning in childhood. Our findings suggest there is an urgent need for public health interventions aimed at preventing violence against individuals with minority sexual orientations and providing follow-up care to cope with the sequelae of violent victimization."

12) Rosser et al. 2008, Journal of Homosexuality, 55(2), 185-203:
"Negative attitudes towards homosexuality, not homosexuality itself, are associated with both poorer mental and sexual health outcomes seen in sexual minorities".

13) Hatzenbuehler et al. 2008, Health Psychology,  27(4), 455-462:
"The results provide evidence for the predictive validity of minority stress".

14) Poteat & Espelage, 2007, The Journal of Early Adolescence, 27(2), 175-191:
"Homophobic victimization significantly predicted increased anxiety and depression, personal distress, and lower sense of school belonging in males and higher levels of withdrawal in females".

15) Mays & Cochran, 2001, American Journal of Public Health, 91(11), 1869-1876:
"Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity in the total sample".

16) D'Augelli & Grossman, 2001, Journal of Interpersonal Violence, 16(10), 1008-1027:
"Participants who had been physically attacked reported lower self-esteem, more loneliness, and poorer mental health than others. More suicide attempts were reported among those older adults who were physically attacked."

17) Safren & Heimberg, 1999, Journal of Consulting and Clinical Psychology, 67(6), 859-866:
"These results suggest that environmental factors associated with sexual orientation... play a major role in predicting distress in this population".

18) Otis & Skinner, 1996, Journal of Homosexuality, 30(3), 93-121:
"Results indicate that victimization has a significant positive effect on depression for both lesbians and gay men when controlling for other variables".

19) Ilan H. Meyer, 1995, Journal of Health and Social Behaviour, Vol. 36(1), 38-56:
"Men who had high levels of minority stress were twice to three times as likely to suffer also from high levels of distress".

20) Ritch C. Savin-Williams, 1994, Journal of Consulting and Clinical Psychology, 62(2), 261-269:
"A common theme identified in empirical studies and clinical reports of lesbian, gay male, and bisexual youths is the chronic stress that is created by the verbal and physical abuse they receive from peers and adults".

21) Michael W. Ross, 1990, Journal of Clinical Psychology, 46(4), 402-411:
"Data suggest that the impact of life events may be amplified by stigmatization and that the degree of life change is associated closely with psychological dysfunction".


Other, non-LGBT studies attest to the impact of minority stress upon other minorities and to the importance of family relationships in mitigating risky of psychopathy, a factor which could be particularly critical for LGBT youth:

22) Chou et al. 2011, Cultural Diversity & Ethnic Minority Psychology, 18(1), 74-81:
"The results suggest that the perception of racial discrimination is associated with psychopathology in the three most common U.S. minority groups."

23) Grant et al. 2006, Clinical Psychology Review, 26(3), 257-283:
"There is substantial evidence for the mediating role of family relationship in the relation between stressors and child and adolescent psychological symptoms"


01) http://tinyurl.com/Gevonden2014 DOI: 10.1017/S0033291713000718
02) http://tinyurl.com/Bockting2013 DOI: 10.2105/AJPH.2013.301241
03) http://tinyurl.com/Kuyper2011 DOI: 10.1037/a0022688.
04) http://tinyurl.com/Chakraborty2011 DOI: 10.1192/bjp.bp.110.082271
05) http://tinyurl.com/Nemoto2011 DOI: 10.2105/AJPH.2010.197285
06) http://tinyurl.com/VandenBerghe2010 DOI: 10.1111/j.1559-1816.2009.00567.x
07) http://tinyurl.com/CRyan2010 DOI: 10.1111/j.1744-6171.2010.00246.x
08) http://tinyurl.com/Chae2010 DOI: 10.2190/HS.40.4.b
09) http://tinyurl.com/McLaughlin2010 DOI: 10.2105/AJPH.2009.181586
10) http://tinyurl.com/Toomey2010 DOI: 10.1037/a0020705
11) http://tinyurl.com/ARoberts2010 DOI: 10.2105/AJPH.2009.168971
12) http://tinyurl.com/Rosser2008 DOI: 10.1080/00918360802129394
13) http://tinyurl.com/Hatzenbuehler2008 DOI: 10.1037/0278-6133.27.4.455
14) http://tinyurl.com/Poteat2007 DOI: 10.1177/0272431606294839
15) http://tinyurl.com/Mays2001 DOI: 10.2105/AJPH.91.11.1869
16) http://tinyurl.com/DAugelli2001 DOI: 10.1177/088626001016010003
17) http://tinyurl.com/Safren1999 DOI: 10.1037/0022-006X.67.6.859
18) http://tinyurl.com/Otis1996 DOI:10.1300/J082v30n03_05
19) http://tinyurl.com/Meyer1995 DOI:
20) http://tinyurl.com/SavinWilliams1994 DOI: 10.1037/0022-006X.62.2.261
21) http://tinyurl.com/Ross1990 DOI: 10.1002/1097-4679(199007)46:4<402
22) http://tinyurl.com/Chou2011 DOI: 10.1037/a0025432
23) http://tinyurl.com/Grant2006 DOI: 10.1016/j.cpr.2005.06.011






Multiple Studies indicate that increased discrimination suffered also correlates with increased substance abuse:

01) Peacock et al. 2015, Journal of Urban Health, DOI: 10.1007/s11524-014-9930-3:
"Among MSM, high self-stigma was associated with binge drinking at least weekly. These findings support multiple pathways linking stigma-related stress to alcohol use. Specifically, those with high self-stigma and identity concealment may be using alcohol as a maladaptive coping and emotion regulation strategy".

02) Rowe et al. 2015, Drug and Alcohol Dependence, 147, 160–166:
"We conducted a secondary data analysis of a study on HIV risk and resilience among trans female youth. Those who experienced gender-related discrimination had increased odds of drug use.., drug use concurrent with sex... and use of multiple drugs. Those with psychological distress had increased odds of using multiple heavy drugs."

03) O’Cleirigh et al. 2015, Journal of Psychosomatic Research:
"Adjusted logistic regression analysis revealed a significant dose effect of number of sexual minority stressors/traumas with odds of ever smoking."

04) Reisner et al. 2015, Journal of Sex Research, 52(3), 243-256:
"Gender minority youth disproportionately experienced bullying and harassment in the past 12 months, and this victimization was associated with increased odds of all substance use indicators. Bullying mediated the elevated odds of substance use for gender minority youth compared to cisgender adolescents."

05) Goldbach et al. 2014, Prevention Science, 15(3), 350-363:
"Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status."

06) Mereish et al. 2014, Psychology, Health & Medicine, 19(1), 1-13:
"Substance use problems were a significant partial mediator between LGBT-based victimization and suicidal ideation and between LGBT-based victimization and suicide attempts for sexual and gender minorities. Substances might be a temporary and deleterious coping resource in response to LGBT-based victimization, which have serious effects on suicidal ideation and behaviors."

07) Hatzenbuehler et al. 2011, Drug and Alcohol Dependence, 115(3), 213-220:
"Results indicated significant indirect effects from discrimination to alcohol-related problems through negative affect and coping motives".

08) Keyes et al. 2011, Psychopharmacology, 218(1), 1-17:
"Both perceptions of discrimination and objective indicators of discrimination are associated with alcohol use and alcohol use disorders among racial/ethnic and sexual minorities."

09) Blosnich & Horn, 2011, Nicotine & Tobacco Research, 13(12), 1284-1295:
"After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors."

10) Hatzenbuehler et al. 2011, Archives of Pediatrics and Adolescent Medicine. 165(6), 527-532:
"A more supportive social environment for LGB youth was significantly associated with reduced tobacco use".

11) Lehavot & Simoni, 2011, Journal of Consulting and Clinical Psychology, 79(2), 159-170:
"Direct links emerged between victimization and substance use and between internalized homophobia and substance use".

12) McCabe et al. 2010, American Journal of Public Health, 100(10), 1946-1952:
"The odds of past-year substance use disorders were nearly 4 times greater among LGB adults who reported all 3 types of discrimination prior to the past year than for LGB adults who did not report discrimination".

13) Hughes et al. 2010, Social Science & Medicine, 71(4), 824-831:
"Findings implicate stress as an important predictor of substance use and emphasize the need for research that more systematically examines the relationships between minority stress and substance use in sexual minority women".

14) Wilsnack et al. 2010, Addiction, 105(12), 2130–2140:
"Results showed strong associations between victimization and any past-year SUDs (Substance use disorders) and confirmed findings from several previous studies indicating that, compared with heterosexuals, sexual minority women and men are at heightened risk for life-time victimization".

15) Rosario et al. 2009, Psychology of Addictive Behaviors, 23(1), 175-184:
"The number of rejecting reactions to disclosure (of sexual identity) was associated with current and subsequent alcohol, cigarette, and marijuana use".


Non-LGBT specific studies demonstrate similar influences of minority stress upon other minorities as well as the interconnectedness of the resultant health disparities:

16) Otiniano et al. 2014, Cultural Diversity and Ethnic Minority Psychology, 20(1), 43-51:
"(Racial/Gender) Discrimination was significantly associated with increased risk of alcohol abuse for women and increased risk of drug abuse for men. These data indicate that discrimination is associated with different substance abuse outcomes between genders."

17) Sung et al. 2011, Nicotine & Tobacco Research, 13(12), 1183-1192:
"Adults with SPD (serious psychological distress) were more likely to be current smokers and to smoke heavily and less likely to quit than those without SPD".

18) Khoury et al. 2010, Depression and Anxiety, 27(12), 1077–1086:
"Exposure to traumatic experiences, especially those occurring in childhood, has been linked to substance use disorders (SUDs), including abuse and dependence... The level of substance use, particularly cocaine, strongly correlated with levels of childhood physical, sexual, and emotional abuse as well as current PTSD symptoms."

19) Bowden et al. 2010, Australian and New Zealand Journal of Psychiatry, 45(4), 325-331:
"People with a mental illness, particularly severe mental illness displayed higher measures of tobacco dependence."


01) http://tinyurl.com/Peacock2015 DOI: 10.1007/s11524-014-9930-3
02) http://tinyurl.com/Rowe2015 DOI: 10.1016/j.drugalcdep.2014.11.023
03) http://tinyurl.com/OCleirigh2015 DOI: 10.1016/j.jpsychores.2015.02.004
04) http://tinyurl.com/Reisner2015 DOI:10.1080/00224499.2014.886321
05) http://tinyurl.com/Goldbach2014 DOI: 10.1007/s11121-013-0393-7
06) http://tinyurl.com/Mereish2014 DOI: 10.1080/13548506.2013.780129
07) http://tinyurl.com/Hatzenbuehler2011 DOI: 10.1016/j.drugalcdep.2010.11.002
08) http://tinyurl.com/Keyes2011 DOI: 10.1007/s00213-011-2236-1
09) http://tinyurl.com/Blosnich2011 DOI: 10.1093/ntr/ntr183
10) http://tinyurl.com/2Hatzenbuehler2011 DOI: 10.1001/archpediatrics.2011.64
11) http://tinyurl.com/Lehavot2011 DOI: 10.1037/a0022839
12) http://tinyurl.com/McCabe2010 DOI: 10.2105/AJPH.2009.163147
13) http://tinyurl.com/Hughes2010 DOI: 10.1016/j.socscimed.2010.05.009
14) http://tinyurl.com/Wilsnack2010 DOI: 10.1111/j.1360-0443.2010.03088.x
15) http://tinyurl.com/Rosario2009 DOI: 10.1037/a0014284
16) http://tinyurl.com/Otiniano2014 DOI: 10.1037/a0034674
17) http://tinyurl.com/Sung2011 DOI: 10.1093/ntr/ntr148
18) http://tinyurl.com/Khoury2010 DOI: 10.1002/da.20751
19) http://tinyurl.com/Bowden2010 DOI: 10.3109/00048674.2010.536904






Substance abuse significantly mediates the link between heterosexism/ minority stress, sexual risk behaviour and STI prevalence, as demonstrated by a range of studies, with other consequences of minority stress likely also playing a role:

01) Hladik et al. 2012, PLoS One, 7(5), e38143:
"Those reporting ever having been exposed to homophobic abuse (verbal, moral, sexual, or physical abuse; AOR 5.38, 95% CI 1.95–14.79) were significantly more likely to be HIV infected."

02) Mizuno et al. 2012, AIDS and Behavior, 16(3), 724-735:
"Men exposed to both homophobia and racism were more likely than men exposed to neither form of discrimination to report unprotected receptive anal intercourse with a casual sex partner (AOR = 1.92, 95% CI, 1.18-3.24) and binge drinking (AOR = 1.42, 95% CI, 1.02-1.98)."

03) Parsons et al. 2012, American Journal of Public Health, 102(1), 156-162:
"We found strong positive interrelationships among syndemic factors including sexual compulsivity, depression, childhood sexual abuse, intimate partner violence, and polydrug use. In bivariate analyses, all syndemic health problems except for childhood sexual abuse were positively related to HIV seropositivity and high-risk sexual behavior."

04) O’Cleirigh et al. 2011, Annals Of Behavioral Medicine, 42(2), 227-234:
"Experiencing HIV-related stigma may increase risk for sexual transmission risk behavior and mental health problems."

05) Martin & Alessi, 2010, American Journal of Orthopsychiatry, 80(3), 293–301:
"The findings provide evidence that American gay and bisexual men may experience a variety of stressful life events, including a surprising amount of victimization, and that at least some episodes of UAS (unprotected anal sex) may be associated with attempts to cope with distress associated with such events".

06) Mansergh et al. 2010, PLoS Medicine 7(8), e1000329:
"Substance use during sex is associated with sexual risk behavior among men who have sex with men (MSM)".

07) Yi Huso et al. 2010, Health Psychology, 29(2), 205–214:
"Gay men who reported UAI (unprotected anal intercourse), compared to the men without UAI, reported significantly higher levels of internalized homophobia."

08) Johnson et al. 2008, Journal of Consulting and Clinical Psychology, 76(5), 829-839:
"Results supported the hypothesized model in which IH (Internalized heterosexism) was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART (HIV antiretroviral therapy) non-adherence indirectly via increased negative affect and more regular stimulant use."

09) Ross et al. 2008, AIDS and Education Prevention, 20(6), 547-557:
"For those with higher IH (internalized homonegativity), two significant paths led to unsafe sexual behavior: first, to serodiscordant unprotected anal intercourse (SDUAI) through being less “out”—thus disclosing serostatus to secondary partners less frequently, and second, to lower condom self-efficacy and SDUAI through lower sexual comfort".

10) Choi et al. 2008, AIDS and Behavior, 12(1), 71-77:
"We found significant positive direct associations of experiences of homophobia and financial hardship with having unprotected anal sex with men".

11) Neilands et al. 2008, Archives of Sexual Behavior, 37(5), 838-844:
"Enacted stigma measured direct personal experiences of stigmatizing behaviors. Enacted stigma... was associated with HIV sexual risk behavior."

12) Celentano et al. 2006, Sexually Transmitted Diseases, 33(4), 265-71:
"Report of unprotected receptive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol, cocaine, amphetamines or marijuana during sex".

13) Shoptaw & Reback, 2006, Journal of Urban Health, 83(6), 1151-7:
"Methamphetamine use is associated with high rates of HIV prevalence and sexual risk behaviors".

14) Diaz et al. 2004, Cultural Diversity and Ethnic Minority Psychology, 10(3), 255-267:
"Men who reported more instances of social discrimination and financial hardship were more psychologically distressed and more likely to participate in "difficult" sexual situations, as predicted. Participation in difficult sexual situations mediates the effects of social oppression and psychological distress on sexual risk behavior".

15) O'Connell et al. 2004, AIDS and Behavior, 8(1), 17-23:
"MSM/IDU reported more casual sexual partners and in multivariate analyses were twice as likely to report unprotected receptive anal intercourse with casual partners (than non-injection-drug using MSM)."

16) Colfax et al. 2004, American Journal of Epidemiology, 159(10), 1002-1012:
"Heavy alcohol use and use of poppers, amphetamines, or sniffed cocaine in general, as well as specifically just before or during sex, were significantly associated with increased risk of having unprotected anal sex with an HIV-positive or unknown-serostatus partner".

17) Rusch et al. 2004, Sexually Transmitted Diseases, 31(8), 492-8:
"UAI was significantly associated with sexual situation-specific use of marijuana (OR, 1.43), crystal methamphetamine (OR, 1.75), ecstasy (OR, 1.88), and ketamine (OR, 2.17); global use associations were similar".

18) Stall et al. 2003, American Journal of Public Health, 93(6), 939–942:
"We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM). Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection."

19) Stueve et al. 2002, AIDS Education and Prevention, 14(6), 482-95:
"Being high was associated with unprotected receptive anal intercourse with nonmain partners (odds ratio = 1.66, p = .02)".

20) Mansergh et al. 2001, The American Journal of Public Health, 91(6), 953-958:
"Consistent with other studies, 17, 21 we found drug use to be associated with sexual risk behavior".

21) Stone et al. 1999, Journal Of AIDS and Human Retrovirology, 20(5),495-501:
"Multivariate analysis of reported failures found more frequent condom use to be associated with a decreased per condom failure rate, and amphetamine and heavy alcohol use with increased rates in both models".  (Amphetamine and heavy alcohol use resulted in increased condom failure rate).


Non-LGBT-specific studies likewise identify the interrelatedness of substance abuse, psychopathy, high risk sexual behavior and STI contraction:

22) National Institute on Drug Abuse:
"Drug and alcohol intoxication affect judgment and can lead to risky sexual behaviors that put people in danger of contracting or transmitting HIV".
"NIDA has established that drug abuse treatment is HIV prevention".

23) Semple et al. 2010, Journal of Sex Research, 47(4), 355-363:
"Negative life events were positively associated with total number of unprotected sex acts, whereas positive life events were not associated with sexual risk-taking."

24) Fisher et al. 2007, Sexually Transmitted Diseases, 34(11), 856-863:
"Alcohol use was associated with HIV infection in Africa and alcohol-related interventions might help reduce further expansion of the epidemic".

25) Colfax er al. 2006, Clinical Infectious Diseases 42(10), 1463-1469:
"Most epidemiological data support the role of club drugs in increasing sexual risk behavior, with some studies demonstrating an independent association between use of certain club drugs and HIV infection".

26) Lehrer et al. 2006, Pediatrics, 118(1), 189-200:
"Depressive symptoms predicted sexual risk behavior in a national sample of male and female middle and high school students over a 1-year period".

27) Cook & Clark, 2005, Sexually Transmitted Diseases, 32(3), 156-64:
"The literature supports an overall association between problematic alcohol consumption and STDs".


01) http://tinyurl.com/Hladik2012 DOI: 10.1371/journal.pone.0038143
02) http://tinyurl.com/Mizuno2012 DOI: 10.1007/s10461-011-9967-1
03) http://tinyurl.com/JParsons2012 DOI: 10.2105/AJPH.2011.300284
04) http://tinyurl.com/OCleirigh2011 DOI: 10.1007/s12160-011-9275-z
05) http://tinyurl.com/Alessi2010 DOI: 10.1111/j.1939-0025.2010.01032.x
06) http://tinyurl.com/Mansergh2010 DOI: 10.1371/journal.pmed.1000329
07) http://tinyurl.com/YiHuso2010 DOI: 10.1037/a0017786
08) http://tinyurl.com/Johnson2008 DOI: 10.1037/0022-006X.76.5.829
09) http://tinyurl.com/Ross2008 DOI: 10.1521/aeap.2008.20.6.547
10) http://tinyurl.com/Choi2008 DOI: 10.1007/s10461-008-9394-0
11) http://tinyurl.com/Neilands2008 DOI: 10.1007/s10508-007-9305-x
12) http://tinyurl.com/Celentano2006 DOI: 10.1097/01.olq.0000187207.10992.4e
13) http://tinyurl.com/Shoptaw2006 DOI: 10.1007/s11524-006-9119-5
14) http://tinyurl.com/Diaz2004 DOI: 10.1037/1099-9809.10.3.255
15) http://tinyurl.com/OConnell2004 DOI: 10.1023/B:AIBE.0000017522.64063.ec
16) http://tinyurl.com/Colfax2004 DOI: 10.1093/aje/kwh135
17) http://tinyurl.com/Rusch2004 DOI:
18) http://tinyurl.com/Stall2003 DOI:
19) http://tinyurl.com/Stueve2002 DOI: 10.1521/aeap.14.8.482.24108
20) http://tinyurl.com/Mansergh2001 DOI: 10.2105/AJPH.91.6.953
21) http://tinyurl.com/Stone1999 DOI:
22) http://www.drugabuse.gov/ResearchReports/hiv/hiv.html
23) http://tinyurl.com/Semple2010 DOI: 10.1080/00224490903015843
24) http://tinyurl.com/Fisher2007 DOI: 10.1097/OLQ.0b013e318067b4fd
25) http://tinyurl.com/Colfax2006 DOI: 10.1086/503259
26) http://tinyurl.com/Lehrer2006 DOI: 10.1542/peds.2005-1320
27) http://tinyurl.com/Cook2005 DOI:






Mental health disorders, especially depression, are a major predictor of suicidality. This provides an obvious route via which heterosexism may induce increased suicidality in LGBT people. Heterosexism itself may also directly elevate suicidality:

01) Van Bergen et al. 2013, American Journal of Public Health, 103(1), 70-72 (DUTCH):
"The data showed that victimization at school was associated with suicidal ideation and actual suicide attempts. Homophobic rejection by parents was also associated with actual suicide attempts."

02) Burton et al. 2013, Journal of Youth and Adolescence, 42(3), 394-402:
"Sexual minority-specific victimization significantly mediated the effect of sexual minority status on depressive symptoms and suicidality."

03) Schneider et al. 2012, American Journal of Public Health, 102(1), 171-177:
"Victimization was higher among nonheterosexually identified youths."  "Distress was highest among victims of both cyberbullying and school bullying (adjusted odds ratios [AORs] were from 4.38 for depressive symptoms to 5.35 for suicide attempts requiring medical treatment)."

04) Hightow-Weidman et al. 2011, AIDS Patient Care and STDs, 25(S1), S39-S45:
"There was a significant association between experiencing a high level of sexuality-related bullying and depressive symptomatology (p=0.03), having attempted suicide (p=0.03), and reporting parental abuse (p=0.05)."

05) Hong et al. 2011, Journal of Adolescence, 34(5), 885–894:
"Sexual minority youth frequently struggle with rejection from their parents, peers, and teachers, as well as homophobia in society, which put them at risk for depression that can lead to self-destructive behavior such as suicide. It is imperative that bullying prevention programs are expanded to include a discussion about sexual orientation and how homophobic language creates unsafe environments".

06) Needham & Austin, 2010, Journal of Youth and Adolescence, 39(10), 1189-1198:
"Compared to heterosexual women, lesbian and bisexual women have higher odds of suicidal thoughts and recent drug use; bisexual women also have higher odds of elevated depressive symptomatology and heavy drinking. Gay men have higher odds of suicidal thoughts than heterosexual men. With the exception of heavy drinking, parental support either partially or fully mediates each of the observed associations."

07) Birkett et al. 2009, Journal of Youth and Adolescence, 38(7), 989-100:
"LGB and sexually questioning youth were more likely to report high levels of bullying, homophobic victimization, and various negative outcomes than heterosexual youth. Students who were questioning their sexual orientation reported the most bullying, the most homophobic victimization, the most drug use, the most feelings of depression and suicidality, and more truancy than either heterosexual or LGB students. A positive school climate and a lack of homophobic victimization moderated the differences among sexual orientation status and outcomes."

08) Almeida et al. 2009, Journal of Youth and Adolescence, 38(7), 1001-1014:
"Perceived discrimination accounted for increased depressive symptomatology among LGBT males and females, and accounted for an elevated risk of self-harm and suicidal ideation among LGBT males."

09) Walls et al. 2008, Social Work, 53(1), 21-29:
"The findings suggest that risk factors related to suicidality include hopelessness, methamphetamine use, homelessness, and in-school victimization."

10) Friedman et al. 2006, Journal of Adolescent Health, 38(5), 621-623:
"This study hypothesized that gender-role nonconformity is associated with suicidality, and bullying mediates this relationship."  "Support for the hypotheses was found."

11) de Graaf et al. 2006, Archives of Sexual Behavior, 35(3), 253-262:
"Among homosexual men, perceived discrimination was associated with suicidality."

12) Hidaka & Operario, 2006, Journal of Epidemiology and Community Health, 60(11), 962-967: 
"Independent correlates of attempted suicide were psychological distress, history of being verbally harassed, history of sex with a woman...and not having a university degree."

13) Goodenow et al. 2006, Psychology In The Schools, 43(5), 573-589:
"Sexual minority adolescents in schools with LGB support groups reported lower rates of victimization and suicide attempts than those in other schools. Victimization and perceived staff support predicted suicidality."

14) D'Augelli et al. 2005, Suicide & Life Threatening Behavior, 35(6), 646-60:
"Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males."

15) Warner et al. 2004, The British Journal of Psychiatry, 185(6), 479-485:
"Out of the whole sample, 361 (31%) had attempted suicide. This was associated with markers of discrimination such as recent physical attack (OR=1.7, 95% CI 1.3-2.3) and school bullying."

16) Bontempo & D'Augelli, 2002, Journal of Adolescent Health, 30(5), 364-374:
"LGB youths reporting low levels of at-school victimization reported levels of substance use, suicidality, and sexual-risk behaviors that were similar to heterosexual peers who reported low at-school victimization."

17) Russell & Joyner, 2001, American Journal of Public Health, 91(8), 1276–1281:
"The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization."

18) Bagley & Tremblay, 2000, Crisis, 21(3), 111-7:
"Reasons for these elevated rates of suicidal behavior include a climate of homophobic persecution in schools, and sometimes in family and community--values and actions that stigmatize homosexuality and that the youth who has not yet "come out" has to endure in silence."

19) Garofalo et al. 1999, Archives of Pediatrics and Adolescent Medicine, 153(5), 487-493:
"Female gender (odds ratio [OR], 4.43), GLBN orientation (OR, 2.28), Hispanic ethnicity (OR, 2.21), higher levels of violence/victimization (OR, 2.06), and more drug use (OR, 1.31) were independent predictors of suicide attempt (P<.001)."

20) Hershberger et al. 1997, Journal of Adolescent Research, 12(4), 477-497:
"In comparison to youth who made no suicide attempts, attempters reported that they had disclosed more completely their sexual orientation to others, had lost more friends because of their disclosures, and had experienced more victimization due to their sexual orientation."

21) Rotheram-Borus et al. 1994, Journal of Adolescent Research, 9(4), 498-508:
"Gay-related stressors were significantly more common among suicide attempters as compared to nonattempters".


Non-LGBT-specific studies highlight similar risk factors for suicide, including other minority stress sequelae:

22) Turecki et al. 2012, Trends in Neurosciences, 35(1), 14-23:
"Recent animal and human data have suggested that early-life adversity leads to epigenetic regulation of genes involved in stress-response systems. We review this evidence and suggest that early-life adversity increases risk of suicide in susceptible individuals by influencing the development of stable emotional, behavioral and cognitive phenotypes... involved in responses to stress."

23) Windfuhr & Kapur, 2011, British Medical Bulletin, 100(1), 101-121:
"Suicide risk is most commonly associated with mental illness."

24) Bruffaerts et al. 2010, The British Journal of Psychiatry, 197(1), 20-27:
"Childhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours."

25) Gradus et al. 2010, International Journal of Epidemiology, 39(6), 1478-1484:
"Those diagnosed with acute stress reaction had 10 times the rate of completed suicide compared with those without this diagnosis. Persons with acute stress reaction and depression, or acute stress reaction and substance abuse, had a greater rate of suicide than expected based on their independent effects."

26) Masocco et al. 2010, Psychiatric Quarterly, 81(1), 57-71:
"These findings support the notion that marital status may play a central role in influencing suicide."

27) Qin et al. 2003, The American Journal of Psychiatry, 160(4), 765-772:
"Suicide risk is strongly associated with mental illness, unemployment, low income, marital status, and family history of suicide."

28) Aharonovich et al. 2002, The American Journal of Psychiatry, 159(9), 1600-1602:
"All three types of depression increased the risk for making a suicide attempt."


01) http://tinyurl.com/vanBergen2013 DOI: 10.2105/AJPH.2012.300797
02) http://tinyurl.com/Burton2013 DOI: 10.1007/s10964-012-9901-5
03) http://tinyurl.com/Schneider2012 DOI: 10.2105/AJPH.2011.300308
04) http://tinyurl.com/HightowWeidman2011 DOI: 10.1089/apc.2011.9877
05) http://tinyurl.com/Hong2011 DOI: 10.1016/j.adolescence.2011.01.002
06) http://tinyurl.com/Needham2010 DOI: 10.1007/s10964-010-9533-6
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10) http://tinyurl.com/Friedman2006 DOI: 10.1016/j.jadohealth.2005.04.014
11) http://tinyurl.com/deGraaf2006 DOI: 10.1007/s10508-006-9020-z
12) http://tinyurl.com/Hidaka2006 DOI:10.1136/jech.2005.045336
13) http://tinyurl.com/Goodenow2006 DOI: 10.1002/pits.20173
14) http://tinyurl.com/DAugelli2005 DOI: 10.1521/suli.2005.35.6.646
15) http://tinyurl.com/Warner2004 DOI: 10.1192/bjp.185.6.479
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18) http://tinyurl.com/Bagley2000 DOI: 10.1027//0227-5910.21.3.111
19) http://tinyurl.com/Garofalo1999 DOI: 10.1001/archpedi.153.5.487
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LGBT people undoubtedly experience a greater degree of lifetime victimisation on average than heterosexuals. Unsurprisingly, this lowers quality of life (Kerr et al. 2011, DOI: 10.1007/s12187-010-9078-y):

01) Katz-Wise & Hyde, 2012, Journal of Sex Research, 49(2-3), 142-67, DOI: 10.1080/00224499.2011.637247
"LGB individuals experienced greater rates of victimization than heterosexual individuals."

02) Marieka Klawitter, 2011, Journal of Policy Analysis and Management, 30(2), 334–358, DOI: 10.1002/pam.20563
"The results suggest that gay men face an earnings penalty that varies significantly (though not sizably) across local areas, and that state antidiscrimination policies may decrease that penalty in private sector employment."

03) Berlan et al. 2010, Journal of Adolescent Health, 46(4), 366–371, DOI: 10.1016/j.jadohealth.2009.10.015
"Mostly heterosexual males... and gay males... were more likely to report being bullied. Similarly, mostly heterosexual females..., bisexual females..., and lesbians... were more likely to report being bullied than were heterosexual females."

04) Baral et al. 2009, PLoS ONE, 4(3), e4997, DOI: 10.1371/journal.pone.0004997
"Human rights abuses, including blackmail and denial of housing and health care was prevalent with 42.1% (222/527) reporting at least one abuse."

05) Nick Drydakis, 2009, Labour Economics, 16(4), 364–372, DOI: 10.1016/j.labeco.2008.12.003
"Mailing pairs of curriculum vitae, distinguished only by the sexual orientation of the applicants, led to the observation that gay men faced a significantly lower chance of receiving an invitation for an interview."

06) Anthony D’augelli, 2002, Clinical Child Psychology & Psychiatry, 7(3), 433-456, DOI: 10.1177/1359104502007003010
"More than three-quarters had been verbally abused because of their sexual orientation, and 15 percent reported physical attacks. More than one-third said they had lost friends because of their sexual orientation. Youths who had experienced more victimization and who had lost friends reported more mental health symptoms."

07) Rosario et al. 2001, American Journal of Public Health, 91(6), 903-906, DOI: 10.2105/AJPH.91.6.903
"Youths who report same-sex or both-sex romantic attraction are more likely to experience extreme forms of violence than youths who report other-sex attraction."





THE DISPARITIES ARE INTERRELATED

Stall et al. 2003, American Journal of Public Health, 93(6), 939–942:
"This analysis of these data supports the view that additive psychosocial health problems—otherwise known collectively as a syndemic—exist among urban MSM and that the interconnection of these problems functions to magnify the effects of the HIV/AIDS epidemic in this population."

The studies above are referenced below to evidence the health disparities' interconnectedness, using the format 2.14, where 2 corresponds to section 2 and 14 corresponds to study 14 in that section. Other studies, referenced for the first time, will appear below. The health disparities described above can interact synergistically to accentuate or cause one another. This can arise from a range of possible mechanisms, including;
  • Substance abuse (2.01, 2.07) and risky sexual behaviour (3.05) may both result directly from victimisation, as attempts to cope, or, in the latter case, discomfort with discussing serostatus or condom use (3.08),
  • Substance abuse is strongly associated with sexual risk behaviour via a range of mechanisms, such as reduced condom use, higher condom failure rate (slippage/breakage) and more sex with serodiscordant partners (3.06, 3.12-13, 3.16-17, 3.19-21, 3.22, 3.09),
  • Mental illness, such as depression, can be a route in to substance abuse, likely as an attempt to self-medicate, both among LGBT people (2.17-19) and the general population (3.03). These two factors can in turn lead to suicidality (2.06, 4.17, 4.19),
  • Homelessness may also represent a significant route for LGBT youth to these health disparities (Bruce2014, Clatts2005, 4.09).

Bruce et al. 2014, Journal of Urban Health, 91(3), 568-580, DOI: 10.1007/s11524-014-9876-5:
"Sexual minority youth are more likely to experience homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one’s home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one’s home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use."

Clatts et al. 2005, Journal of Adolescence, 28(2), 201–214, DOI: 10.1016/j.adolescence.2005.02.003:
"A prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk."



THE GENERAL POPULATION RESPONDS SIMILARLY

These health disparities can be ameliorated by a more supportive/less hostile environment (2.10, 4.07, 4.13, 4.16). Additionally, far from being unique to sexual minorities, these patterns of response to stress/victimisation and their interrelatedness appear integral to human nature;
  • Negative life events correspond to more unprotected sex (3.23),
  • Substance abuse is associated with higher STI rates (3.24, 3.27),
  • Depression increases sexual risk behaviour (3.26),
  • Mental illnesses, especially those entailing stress/depression, drastically increase suicidality (4.23, 4.25, 4.27-8).



PARENTAL REJECTION SETS LGBT APART

Other minorities, such as racial minorities also appear to be affected by minority stress too (Inzlicht2006, Jackson2004, 1.22, 2.08, 2.16), though one key distinction between these and LGBT people, aside from the considerably more antiquated nature of racism, is parental support or rejection (1.07, 1.23, 4.01, 4.04-6, 4.13, 4.18, Pachankis2008, Ryan2009). Racial minorities have daily shining examples of those who exhibit their stigmatised trait. They can look up to their parents and be open with and supported by them. In contrast, LGBT people have no such support and even fear rejection by their parents, ranging from disapproval to physical assault, homelessness and murder.

Inzlicht et al. 2006, Psychological Science, 17(3), 262-269, DOI: 10.1111/j.1467-9280.2006.01695.x:
"These results suggest that (a) stigma is ego depleting and (b) coping with it can weaken the ability to control and regulate one's behaviors in domains unrelated to the stigma."

Jackson et al. 2004, International Journal of Methods in Psychiatric Research, 13(4), 196-207:
"Several studies indicate that racial discrimination adversely affects the emotional wellbeing and physical health of African-Americans and other ethnic groups (Harrell, Merritt and Kalu, 1998; Clark, Anderson, Clark and Williams, 1999; Krieger, 1999; Williams and Williams-Morris, 2000; Williams, Neighbors and Jackson, 2003)."

Pachankis et al. 2008, Journal of Consulting and Clinical Psychology, 76(2), 306-317, DOI: 10.1037/0022-006X.76.2.306:
"After establishing a reliable and valid measure of the gay-related rejection sensitivity construct, the authors use this to test the mediating effect of internalized homophobia on the relationship between parental rejection of one's sexual orientation and sensitivity to future gay-related rejection. The present data support this mediational model and also establish rejection sensitivity's unique contribution to unassertive interpersonal behavior in the context of internalized homophobia and parental rejection."

Ryan et al. 2009, Pediatrics, 123(1), 346 -352, DOI: 10.1542/peds.2007-3524:
"Lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers (other LGBT people) from families that reported no or low levels of family rejection."



THE DISPARITIES ARE NOT UBIQUITOUS

Finally, it is important to keep in mind when referring to these disparities that we are still typically only referring to small minorities within minorities that are affected by them, rather than them being universal among LGBT people. HIV for example is far more prevalent among MSM in some countries, such as the U.S., than among the general population. It still only affects ~10% of MSM in the U.S., meaning that ~90% are uninfected, while lesbian's transmission risk is vastly below that of heterosexuals.

Fujie et al. 2010, Sexually Transmitted Diseases, 37(6), 399-405, DOI: 10.1097/OLQ.0b013e3181ce122b
"The prevalence of HIV was 0.2%... in non-MSM, 9.1% (95% CI, 4.8–16.4) in MSM-Ever, and 11.8% (95% CI, 6.0–21.9) in MSM-Past Year".