The first time I came face to face with homosexuality was when I visited Washington, USA, in November 1991 to attend a USAID/HIV/Aids prevention conference. I had gone to present data on HIV testing at the Aids Information Centre. This centre, together with Taso, was the first to start HIV counselling and testing in 1990. The meeting was attended by the Rev Sam Mulindwa from Taso. As part of entertaining us, a lady from the educational academy picked us from the hotel to take us to JF Kennedy Theatre to watch live Barry dance. There had been too much talk at the conference of gays and HIV prevalence.
On the way to the theatre, we asked her what lesbians do. We had an idea what homosexual men do. She laughed and thought we were joking or teasing her. We told her frankly that we did not know. We were so alarmed by what she explained. Initially, we thought this was something for the Western world. But here we are! There are few people who have come up in Uganda and said they are gays, they have rights, they are minorities and that they need protection. The widely debated Anti-homosexuality Bill has now been signed into law by the President. So we must now face it.
First, let us ask: What is homosexuality? It is sexual attraction, expressing sexual orientation towards people of the same sex. It is not a disturbance of gender identity. Research points to various causes:
• The influence of educational and environmental factors has been linked to homosexuality. However, no study has demonstrated that these factors cause homosexuality.
• Some studies have linked organic neuro-hormonal, prenatal and postnatal factors in the development of homosexuality. This “organicistic neurohormal theory” might find support in the study of particular situations in which the human foetus is exposed to an abnormal hormonal environment in utero. The relationship of sexual orientation to hormonal exposure in a number of older siblings in Finland (where the population is found to be genetically relatively homogeneous); and many previous studies show that heterosexual men had lower hormonal (2D:4D) than non-heterosexual men, which supports the notion that non-heterosexual men experience higher androgen levels in utero. However, this and other studies are not conclusive whether these factors actually cause homosexuality.
• A number of studies have also shown patterns of sex atypical cerebral dimorphism in homosexual subjects. Although the crucial question, namely how such complex functions as sexual orientation and identity are processed in the brain, remains unanswered.
• Emerging data point at a key role of specific neuronal circuits involving the hypothalamus.
• It has been shown that there are people who are sexually attracted to both sexes even though they may prefer one sex to the other. Further clinical studies also show that normal human sexual orientation contains both homosexual and heterosexual components even when one orientation clearly dominates the other. It has also been shown that heterosexual prisoners will often exhibit homosexual behaviour while incarcerated but, when returned to society, these same individuals will revert back to exclusive heterosexual behaviour. These studies are also not conclusive on the occurrence of such sexual behaviour and the transition.
Homosexuality, of course, has consequences. In the USA, of all new HIV infections in 2010, 80 per cent were among men, of which 78 per cent were among men who have sex with men (MSM).
Men who have sex with men have unique healthcare needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes.
Despite the above account, since 1973, the American Psychiatric Association, the American Psychological Association, the American Academy of Paediatrics and the National Association of Social Workers all agree that homosexuality is not a disorder or a mental illness.
Therefore, since many studies are not conclusive on the causes of homosexuality and yet it is not a mental disorder, the best way to handle it is through good parenting and reducing social deprivation and vulnerability.
Dr Mbonye is an associate professor and Commissioner of Health Services, Ministry of Health. firstname.lastname@example.org