Learning From AIDS
Those currently infected with the virus that causes AIDS are probably destined to die before their time. Many have AIDS now, and many of the rest will eventually get AIDS. Even many of those who do not contract AIDS will die first from other causes, but still prematurely. Given the tremendous efforts our public health establishment has put into studying and treating HIV/AIDS, and the fact that AIDS was first documented in homosexuals almost 20 years ago, what have our public health officials learned about homosexuality after all this time? A new study of the HIV+ offers some glimpes.
About 230,000 people are currently living with HIV infection in the U.S. Their living conditions, health, and the costs associated with them are of interest to everyone in the nation. So many researchers are trying to answer these and related questions. In fact, a cooperative effort between 11 researchers at Brown University, UCLA, the RAND corporation, Rutgers University, and Jefferson Medical College was recently published in the American Journal of Public Health. The research itself was sponsored by the National Institute for Mental Health, the National Institute on Drug Abuse, and other governmental and private agencies, including the Robert Wood Johnson Foundation and Merck corporation.
Sexual Identity Crisis
Not surprisingly, most (131,000 or 57%) of those infected with HIV were men who said that they had engaged in sex with men. Very recently, these men might have been called ‘homosexuals.’ But ‘homosexuals’ has almost disappeared from the scientific literature on AIDS. Why? Because the term isn’t very descriptive of men who have sex with men. And, similarly, ‘lesbians’ isn’t very descriptive of women who have sex with women.
So how were these men labeled? These researchers from the heart of the public health establishment, apparently aware of the uncertainty of terms like ‘homosexual’ or ‘gay,’ and also aware that people on the sexual fringe change their sexual orientations from time to time, put them under the heading “Current sexual orientation.” Then, under ‘Current sexual orientation’ were the subcategories “Gay/lesbian/bisexual,” “Heterosexual,” and “Celibate/transexual, other.”
The most interesting and perhaps most important thing to look at here is the authors’ choice of “Current sexual orientation.” As it turns out, 88% of those men who presumably got their HIV infection via sex with other men currently called themselves “gay or bisexual,” 7% said that they were currently “Celibate/transexual, other,” and another 4% said that they were currently “heterosexual.”
The terms ‘homosexual’ and ‘gay’ were used for a time in the medical literature. But then the evidence slowly built up that many men who had sex with men were married or had girlfriends. The psychiatric notion that ‘homosexuals are people who can only have sex with members of their sex’ was accepted at first, but the cold clear reality of empirical findings has quashed it. So the rather awkward ‘men who have sex with men’ has often taken its place.
As to ‘sexual identity,’ consider the results above. We don’t know whether some of the men once considered themselves ‘gay’ and now consider themselves ‘heterosexual,’ or whether we are just looking at ‘heterosexuals’ who included sex with men in their sexual repertoire. Likewise, one might think that the “celibates” decided upon celibacy after their HIV infection (but you never know). Further, more men were living with their wives or female partners than claimed to be ‘heterosexual’ - and there were even a few men who reported not having sex with men, but who lived with a man. One thing is clear: scientists will be in much better shape concentrating on behavior than in concentrating on ‘sexual orientation labels.’
Violence and HIV
A large sample of the HIV+ were asked, “Since your HIV diagnosis, have you ever been physically hurt by your partner or someone important to you?” 11.5% of the men who had engaged in homosexuality, but only 7.5% of the men who said they had not, responded ‘yes.’ 20.5% of the women said they had been “physically hurt.”
The question does not specify who did the ‘hurting,’ but if we assume that the partner with whom the HIV+ person lived was the most likely culprit, we can construct Figure 3.
Again assuming that the bulk of the physical hurt was delivered by their living partner, it was worse to cohabit with a member of the opposite sex than to be married to them. On the other hand, women living with a woman reported only one-third the frequency of having been subjected to physical hurt than women ‘shacking up’ with a man. But men who lived with a man were more apt to report physical hurt than men who lived with a wife.
In national random surveys, about 6% of younger women with lower incomes report having been physically hurt by someone in the past 12 months. So it seems likely that women who are HIV infected are considerably more apt to be hurt than those who are not infected. Comparable figures for men or for those who engage in homosexuality are not available.
Reference:
Zierler S, Cunningham WE et al Violence victimization after HIV infection in a U.S. probability sample of adult patients in primary care. American Journal of Public Health 2000;90:208-215.