tag:theconversation.com,2011:/us/topics/assaf-report-17763/articlesASSAF report – The Conversation2015-06-12T04:27:10Ztag:theconversation.com,2011:article/430072015-06-12T04:27:10Z2015-06-12T04:27:10ZScience alone can’t shift anti-gay prejudice in Africa<figure><img src="https://images.theconversation.com/files/84640/original/image-20150611-6823-lefw5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Uganda has come under pressure over its anti-homosexual laws.</span> <span class="attribution"><span class="source">Reuters/Edward Echwalu</span></span></figcaption></figure><p><em>This article is part of a series The Conversation Africa is running on issues related to LGBTI in Africa. You can read the rest of the series <a href="https://theconversation.com/africa/topics/lgbti-africa">here</a>.</em></p>
<p>South Africa was the first country in the world to include protection on the grounds of sexuality in its constitution. It remains a marked contrast to many of its African neighbours, which have either retained colonial laws against homosexual behaviour or, in some cases, introduced or strengthened such laws. </p>
<p>Thus it is not surprising that a report such as the <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">Diversity of Human Sexuality, Implications for Policy in Africa</a> should come from the Academy of Science South Africa. </p>
<p>The report provides a clear and rigorous summary of the current state of the science on diverse sexuality. But given the strength of anti-gay sentiment in Africa, whether it will be able to influence politicians is far from certain.</p>
<h2>The science of sexuality</h2>
<p>The idea that homosexuality may be biologically determined is hardly new. For more than a century there has been tension between the ideas that our sexuality is essential, and the idea that, in Freudian terms, we have the potential to act out a far greater range of sexual desires and identities than we do in practice. </p>
<p>In the end, how much does it matter? If people are convinced that homosexuality is bad, the claim for genetic cause is rather like finding the genetic basis for, say, haemophilia. There will be pressure to discover the causal gene and modify or eliminate. </p>
<p>Sexuality is a complex mix of desire, behaviour and identity. Many people may have strong desires without behaviour, like celibate clergy, while others have considerable homosexual behaviour without much desire and no identity (as is true for many who sell sex). </p>
<h2>Sexuality and identity</h2>
<p>In most societies, across most of history, the contemporary notions of “master identities” based on sexuality have not existed. </p>
<p>There are considerable examples throughout Africa of both homosexual acts and non-conformist gender identities. There are fewer examples of people adopting particular identities because of this. </p>
<p>The current rhetoric of “LGBTI” people is both liberatory and exclusive. The term lumps together different categories, and assumes a “community” whereas the majority of people who experience conflicted gender identity or same-sex desire almost certainly have no sense of a collective identity. </p>
<p>Nor is gender non-conformity always treated in the same way as homosexuality. In a world that is increasingly connected through travel and social media, it is not surprising that terms imported from the west are applied across the world. As <a href="http://www.markgevisser.com/essays.html">Mark Gevisser</a> wrote more than a decade ago: </p>
<blockquote>
<p>The internet, satellite TV and video rental stores are all key elements in the development of gay consciousness in Africa. As this happens nerves become raw, as is clearly evidenced from the anger unleashed in African political and clerical leaders. </p>
<p>For the first time, severely repressed societies are forced to talk about sex, a conversation which ends, logically, at a new analysis of gender, and the roles that men and women play in both the bedroom and in society. </p>
</blockquote>
<h2>Homosexuality and the law</h2>
<p>Meanwhile, Western countries have experienced rapid change in attitudes towards homosexuality, symbolised by the legal recognition of same sex marriage across Western Europe and most of the US. </p>
<p>Both the <a href="http://eeas.europa.eu/human_rights/lgbt/index_en.htm">European Union</a> and the <a href="http://www.hrc.org/blog/entry/with-executive-order-obama-takes-his-place-in-history">Obama administration</a> increasingly speak of sexuality in terms of human rights. This allows many leaders in the rest of the world to depict “gay rights” as neocolonial attacks on traditional culture and religion.</p>
<p>The past decade has seen both increasing visibility of both homosexual and trans people, and a growing gulf between societies which are moving towards greater acceptance and those in which there is increasing hostility, often fuelled by political and religious leaders. </p>
<p>Against the images of Catholic Ireland <a href="https://theconversation.com/another-ireland-is-born-its-a-big-yes-to-marriage-equality-42298">voting for same-sex marriage</a>, we need set those of men being thrown from rooftops by <a href="http://www.independent.co.uk/news/world/middle-east/isis-executes-three-gay-men-by-dangling-them-from-top-of-100ft-building-and-letting-go-10294966.html">Islamic State forces</a>, of <a href="http://www.slate.com/blogs/outward/2014/01/30/gay_russia_under_putin_brutal_bloody_and_horrifying.html">brutal bashings in Putin’s Russia</a>, of considerable numbers of <a href="http://www.nytimes.com/interactive/2013/07/26/opinion/26corrective-rape.html?_r=0">“corrective rapes”</a> of women perceived to be lesbian in parts of Africa. </p>
<h2>Human rights and homosexuality</h2>
<p>Homosexuality has become a marker of Western modernity, scorned by leaders who are increasingly using it to denounce the broader human rights rhetoric of western governments. </p>
<p>Just why homosexuality has become so central in this dispute is uncertain. Although it is worth remembering that <a href="http://sgwiki.com/wiki/Lee_Kuan_Yew%27s_views_on_homosexuality">Lee Kuan Yew</a> and <a href="http://www.nytimes.com/2001/11/02/world/mahathir-s-malaysia-no-gays-allowed.html">Mohammed Mahathir</a> deployed similar language in their framing of “Asian values” in the 1990s.</p>
<p>Anti-colonial resentments and religious fundamentalism, both Christian and Islamic, come together in Africa to bolster the image of homosexuality as imported and alien to existing norms and cultures. </p>
<p>Sometimes these abuses receive international attention, as in the case of the Ugandan gay activist, David Kato, who was <a href="http://www.nytimes.com/2011/01/28/world/africa/28uganda.html">murdered in 2011</a> shortly after winning a lawsuit against a local magazine which had outed him and called for his execution. </p>
<p>Since then there have been various attempts to strengthen anti-homosexual legislation. This has led to considerable US and European pressure on the <a href="http://www.africanglobe.net/africa/pressure-donors-uganda-compromises-anti-sodomy-law/">Ugandan authorities</a>.</p>
<p>When US President Barack Obama visited Senegal in 2012 he called for greater tolerance. But Senegalese President Macky Sall responded that Senegal was <a href="http://www.bbc.com/news/world-africa-23078655">“not yet ready”</a> to decriminalise homosexuality. Nigeria outlawed same-sex marriage in the absence of any local movement calling for its introduction.</p>
<h2>The role of activism</h2>
<p>At the same time, small groups of activists are working to create communities and defend rights, even in the most hostile of environments. Some of them have been forced into exile; others face daily threats to their lives, as the film <a href="http://www.bornthiswaydocumentary.com/">Born This Way</a> from Cameroon graphically depicts. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_z85DTV3WKc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Opinion poll data suggests a <a href="http://www.pewglobal.org/files/2014/05/Pew-Global-Attitudes-Homosexuality-Report-REVISED-MAY-27-2014.pdf">vast gap between countries</a>, predominately in the Atlantic world and Latin America, where homosexuality is accepted, and those, above all in Africa and the Middle East, where the spectre of Western style homosexuality – and same-sex marriage – is being used to bolster political and religious authority.</p>
<p>As the US and the EU are becoming more aggressive in
demanding recognition of “LGBTI rights”, there is an equal mobilisation of opposition which has been played out in bitter battles within international fora. </p>
<p>More than 70 countries retain criminal sanctions against homosexual behaviour. In most countries, sexual or gender non-conformity means the risk of discrimination, violence, even death. </p>
<p>Legal change is essential, but legal change by itself is not sufficient. Nor does hectoring from Western countries, or appeals to human rights, have much chance of changing either government policies or local attitudes. </p>
<p>Only organising at a local level, and using language appropriate to African conditions, rather than the international rhetoric of human rights, is likely to succeed. </p>
<p>I applaud this report, but unfortunately deeply held prejudices are not easily changed by appeals to science and reason.</p><img src="https://counter.theconversation.com/content/43007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dennis Altman has been funded in past for research on globalisation and sexuality through the ARC; Ewans Grawmeyer; University Chicago.</span></em></p>For more than a century there has been tension between the ideas that our sexuality is essential, and the idea that we have the potential to act out a far greater range of sexual desires and identities than we do in practice.Dennis Altman, Professorial Fellow in Human Security, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/430502015-06-12T04:26:44Z2015-06-12T04:26:44ZAfrican scientists recognise that diverse sexuality is the norm<p><em>This article is part of a series The Conversation Africa is running on issues related to LGBTI in Africa. You can read the rest of the series <a href="https://theconversation.com/africa/topics/lgbti-africa">here</a>.</em></p>
<p>The Academy of Science in South Africa (ASSAf), in collaboration with the Uganda National Academy of Sciences, has just released a comprehensive <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">“consensus report”</a> on human sexual diversity. </p>
<p>This is a significant contribution in a continent in which gay relationships are criminalised in 38 out of 55 countries, four of which impose the death penalty. </p>
<p>The study used a panel of non-partisan volunteer experts to assess the considerable and often contradictory literature on biological, social and environmental factors in sexual diversity. It is one of the most clear-sighted evaluations that I have encountered, and it deserves to be taken very seriously in Africa and elsewhere.</p>
<h2>A range of sexuality</h2>
<p>The nub of the report is its conclusion that diversity in human sexuality is:</p>
<blockquote>
<p>… a range of human variation, very little of which can justifiably be termed abnormal.</p>
</blockquote>
<p>The source of this variation has been contentious for decades, despite the accumulating evidence that nature (“born gay”) is overwhelmingly more significant than nurture (“lifestyle choice”). </p>
<p>The report has a large and readable section on biological factors in homosexuality, including neurohormone effects on the fetus, and “epigenetic” influence on the activity of genes by chemical modifications that can be modified by the environment and are transmitted to all the cells of the individual, and sometimes even between generations.</p>
<p>As the report summarises, family studies over decades show that gay men are more likely than average to have gay brothers, and lesbian women more likely to have lesbian sisters. </p>
<p>Many twin studies showing that identical twins are twice as likely as non-identical twins to be concordant (both straight or both gay) imply a clear genetic component, but the 70% concordance leaves room for considerable non-genetic effect. This is true whether or not the twins were raised together. </p>
<p>A 1993 report of a gay gene on the X chromosome has been recently confirmed by a larger study, with the addition of another one or two gay genes.</p>
<p>To me, the most compelling argument that homosexuality is just one end of a normal spectrum is its prediction by evolutionary theory, which I have <a href="https://theconversation.com/born-this-way-an-evolutionary-view-of-gay-genes-26051">explored in detail previously</a>. </p>
<p>Knowing about the wide variety of sexual behaviours in the animal kingdom, we can understand human sexuality in a broader context than our own society. It would be truly remarkable if humans had evolved without strong selection for mate choice genes. </p>
<p>Mate choice is one of the most highly selected traits in any animal. Just ask a fruitfly, which devotes a large share of its genes to choosing and attracting a mate.</p>
<h2>Not gay genes, but male-loving variants</h2>
<p>As <a href="https://theconversation.com/born-this-way-an-evolutionary-view-of-gay-genes-26051">I wrote previously</a>, I think there will turn out to be many – maybe hundreds – of gay genes. But these should be considered “male-loving” variants of mate choice genes. In a female, a male-loving variant will induce her to mate earlier and have more children, making up for her gay brother. Makes sense. </p>
<p>I was happy to see in the report a discussion of data showing that the female relatives of gay males have more children than average women, thus preventing the gay gene from extincting itself. </p>
<p>There is so far no evidence for a “female-loving” variant that induces the brothers of lesbians to have more children, but it would be surprising if there weren’t many of them too. </p>
<p>We know of many “sexually antagonistic” genetic variants like this, which have opposite effects on the “genetic fitness” (that is, numbers of children) of males and females.</p>
<p>So, everyone has a grand mixture of male- and female-loving variants. This explains why there is such a broad spectrum of mate preference among both males and females. </p>
<p>It’s a bit like height, in which there are variants of many genes (estimates of more than 1000) predisposing to tall or short stature. Everyone – males and females – has a mixture. Some males and some females will be either very short or very tall, but most will be somewhere in the middle.</p>
<p>In the same way, I propose that there is a distribution from the very male-loving to the very female-loving among both males and females. Gays and lesbian people simply represent one extremes at one end of this distribution. Hypersexualised heterosexual males and females represent the other end.</p>
<p>Perhaps even more importantly, the report rejects the concepts that homosexuality is learned from, or results from behaviour of parents or peers, that it can rub off on others, and that it can be “treated”. </p>
<p>The report concludes that:</p>
<blockquote>
<p>Contemporary science increasingly recognises the wide range of natural variation in human sexuality, sexual orientations and gender identities.</p>
</blockquote>
<p>The report argues that it is important for countries to accept that sexual diversity is normal. There are severe consequences of persecuting and criminalising LGBTI, and not just directly for individuals and particular communities. </p>
<p>By persecuting, marginalising and criminalising whole sets of sexual behaviour, societies as a whole may quickly lose the public health battle against HIV-AIDS and other sexual health scourges, experience higher levels of social violence, and ignore other serious issues like violence against women and children.</p>
<h2>The politics of homosexuality and role of science academies</h2>
<p>It could be said that ASSAf has gone way beyond its scientific limitations by summarising its findings as:</p>
<blockquote>
<p>Sexual diversity has always been part of a normal society and there is no justification for attempts to eliminate people who are not heterosexual from society. Efforts should rather be focused on countering the stigmatisation that creates hostile and violent environments. </p>
</blockquote>
<p>Alternatively, this report may be criticised for not going far enough down the political path to removing criminal sanctions, stigma and persecution. However, every academy – including the Australian Academy of Science – must jealously guard its non-partisan reputation in order to be taken seriously. </p>
<p>ASSAf’s mandate is “to provide evidence-based science advice to government and other stakeholders on matters of critical national importance”. I believe ASSAf has done this. It is now up to other bodies to use the clearly stated scientific conclusions as a sharp-edged weapon to dispel myths and repel bigots. </p>
<p>It is often said that it is ineffective to fight illogical fears and hatreds with facts and logic, and it is sadly true that common sense and respect for data don’t always win out – think climate change and vaccination. But academies of science would risk their reputations, and mortgage their influence with governments of any persuasion, were they to go down the track of fighting irrational fear with emotive appeals.</p><img src="https://counter.theconversation.com/content/43050/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Graves works at La Trobe University and is affiliated with the University of Canberra, ANU and the University of Melbourne. She has received funding from ARC and NHMRC. She is a Fellow and past office-bearer of the Australian Academy of Science.</span></em></p>Mate choice is one of the most highly selected traits in any animal. Just ask a fruitfly, which devotes a large share of its genes to choosing and attracting a mate.Jenny Graves, Distinguished Professor of Genetics, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/426762015-06-10T17:16:52Z2015-06-10T17:16:52ZExplainer: tackling the stigma and myths around sexuality<figure><img src="https://images.theconversation.com/files/84565/original/image-20150610-6793-1q4r8q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Activists attend Uganda's first gay pride parade at the Entebbe Botanical Gardens in Kampala, Uganda, in August 2012.</span> <span class="attribution"><span class="source">Rachel Adams/EPA</span></span></figcaption></figure><p><em>This article is part of a series The Conversation Africa is running on issues related to LGBTI in Africa. You can read the rest of the series <a href="https://theconversation.com/africa/topics/lgbti-africa">here</a>.</em></p>
<p>Increasing anti-homosexuality sentiment across Africa has been based on the belief that homosexuality is “contagious” or that people can be “recruited” to it.</p>
<p>These sentiments are reflected by 38 countries in Africa outlawing same-sex relationships. Several others are thinking about new laws against “promoting homosexuality”.</p>
<p>These views are dispelled as baseless by a <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">report</a> from the Academy of Science South Africa released this week. The report, Diversity in Human Sexuality: Implications for Policy in Africa, is based on a consensus study of research from across the world. </p>
<p>The study set out to establish if there was scientific backing to same-sex orientation. The academy also looked at the negative impact of prejudices against gender diversity and human sexuality on broader communities.</p>
<p>The panel looked for evidence whether homosexuality was contagious and whether parenting determined someone’s sexual orientation. They reviewed therapeutic interventions such as corrective therapy and looked at whether same-sex orientations posed a threat to society. The panel also evaluated the public health consequences of criminalising same-sex orientations.</p>
<h2>How the study was done</h2>
<p>The study was done in collaboration with the Uganda National Academy of Sciences and followed discussions with the American Institute of Medicine of the Academy of Sciences and the Network of African Science Academies. </p>
<p>The panel was set up following Ugandan President Yoweri Museveni’s decision <a href="http://mg.co.za/article/2014-02-22-uganda-mps-falsified-gay-report">last year</a> to sign the Anti-Homosexuality Act into law. This prescribed life in prison for anyone found in a same-sex relationship in Uganda. </p>
<p>An ad-hoc panel of 13 scientists and scholars were chosen from several different disciplines including genetics, embryology, anthropology, psychology, public health, history, gender diversity, epidemiology and medical ethics. They evaluated the scientific understanding of gender and sexual diversity, reviewing more than 300 published and peer-reviewed scientific articles written over the last 50 years. </p>
<p>The report should contribute to a more informed debate about same-sex orientation, particularly in Africa. The hope is that this will lead to a change in attitudes as well as a review of policies, laws and health practices.</p>
<h2>Answers to the toughest questions</h2>
<p>The panel examined all the evidence through the lens of seven questions:</p>
<ul>
<li><p>What is the evidence that biological factors contribute to sexual and gender diversity?</p></li>
<li><p>Do environmental factors, such as upbringing, explain diversity?</p></li>
<li><p>Is there evidence of same-sex orientation being “acquired”?</p></li>
<li><p>What evidence is there that therapy can change sexual orientation?</p></li>
<li><p>What evidence is there that same-sex orientation poses a threat?</p></li>
<li><p>What are the public health consequences of criminalising same-sex orientation?</p></li>
<li><p>What are the critical unanswered scientific research questions about diversity of human sexualities and sexual orientations in Africa?</p></li>
</ul>
<p>In the preface to the report, the panel expresses deep concern about the considerable challenges against lesbian, gay, bisexual, trans-gender and intersex (LGBTI) individuals in Africa, including social stigma and homophobic violence such as corrective rape. This is targeted at lesbian women and includes a “gang” rape to “teach” them that heterosexuality is the preferred sexual mode.</p>
<p>After examining the biological factors, the panel found science did not support thinking of sexuality in a binary fashion of hetero/homosexual or normal/abnormal. Science has evolved and there is now substantial biological evidence for the diversity of human sexuality and sexual orientations.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=419&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=419&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84576/original/image-20150610-6804-12xtieo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=419&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An explanation of the diversity of human sexuality and sexual orientation.</span>
</figcaption>
</figure>
<p>Research also shows that the number of LGBTI people as a percentage of the population varies little between countries. African countries are no different. </p>
<p>The panel found no evidence that upbringing or socialisation influences sexual orientation. Parents cannot be “blamed” for their children’s sexual orientation although family environments can shape elements of sexuality, such as how it is expressed. There are also social and cultural factors in the construction of gender and sexual identities. </p>
<p>Therapeutic interventions or “sexual orientation change efforts” do not work. Instead, interventions – such as conversion therapy – have negative consequences, are ineffective, have questionable medical ethics and result in depression and suicide. They are also in direct conflict with medical ethics. </p>
<h2>Impact on public health</h2>
<p>There is also evidence that more repressive environments increase stress and have a negative impact on the health of LGBTI people. They are less likely to access health care for fear of using health services. They also lack educational material and access to community support channels. </p>
<p>The net effect of the repressive environments on a country’s health care system is that it reduces the effectiveness of campaigns around HIV and AIDS, tuberculosis and sexually transmitted infections. Infectious diseases spread more quickly and community solidarity is lost.</p>
<p>In many African countries, LGBTI people often suffer socioeconomic
discrimination. Adolescents and young adults face intense pressure to conform to gender roles and identities in school, at home, in places of worship and from their peers. Many also suffer from stress caused by social alienation, rejection by their family and community, bullying, violence and potential incarceration. </p>
<h2>The unanswered questions</h2>
<p>The academy’s study shows that there are still critical unanswered questions in science around gender and sexual diversity. Research across the continent is needed to analyse the prevalence and genetic patterns of gender and sexual diversity.</p>
<p>Research also needs to explore the effect that chemicals, insecticides and other toxins have on physical sex, gender identity and sexual orientation. One such insecticide is DDT (<a href="http://www.ncbi.nlm.nih.gov/pubmed/9143718">dichlorodiphenyltrichloroethane</a>), which is used for malaria prevention. It has been implicated in the high incidence of intersex individuals in South Africa’s <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2009.09003.x/pdf">Limpopo province</a>. </p>
<p>The linguistic and cultural distinctiveness of sexual and gender minorities in Africa need to be documented. And policy research must be done on birth certification and gender, especially intersex. </p>
<p>It is hoped that the report will trigger this research. More importantly, it is hoped that it is instrumental in normalising sexual diversity in Africa.</p>
<hr>
<p><em>This article draws from the <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">ASSAf report</a> which says that 38 African countries have laws that criminalise same-sex relationships. This figure was taken from the 2014 report by the International Lesbian Gay Bisexual Trans and Intersex Association (ILGA). In its 2015 report released in May, the association has <a href="http://old.ilga.org/Statehomophobia/ILGA_State_Sponsored_Homophobia_2015.pdf">revised the number to 35</a>.</em></p><img src="https://counter.theconversation.com/content/42676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glenda Gray is of the co-chairs on the Academy of Science South Africa's health committee and was the co-chair of the panel for the Diversity in Human Sexuality: Policy Implications for Africa study. </span></em></p><p class="fine-print"><em><span>Hoosen Jerry Coovadia receives funding from the Wellcome Trust in UK, the NIH in US and SAMRC in South Africa. He is on the National Research Health Committee, on the board of K-Rith and co-chair of the health committee at the ASSAf.
He was the co-chair of the panel for the Diversity in Human Sexuality: Policy Implications for Africa study.
</span></em></p>Science shows that thinking about sexuality in a binary fashion of hetero/homosexual is no longer accurate. Rather, evidence shows that there is a diversity of human sexuality and sexual orientations.Glenda Gray, President of the SAMRC and Research Professor, Perinatal HIV Research Unit, University of the WitwatersrandHoosen Jerry Coovadia, Director of the Maternal, Adolescent and Child Health Systems (Match) at the School of Public Health, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/426412015-06-10T17:16:42Z2015-06-10T17:16:42ZThe science behind a more meaningful understanding of sexual orientation<figure><img src="https://images.theconversation.com/files/84574/original/image-20150610-6817-1lmdhs5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sexual orientation is more complicated than X and Y chromosome. Epigenetics has a greater role to play. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>This article is part of a series The Conversation Africa is running on issues related to LGBTI in Africa. You can read the rest of the series <a href="https://theconversation.com/africa/topics/lgbti-africa">here</a>.</em></p>
<p>People who are attracted to others of the same sex develop their orientation before they are born. This is not a choice. And scientific evidence shows their parents cannot be blamed. </p>
<p>Research proving that there is biological evidence for sexual orientation has been available since the 1980s. The links have been emphasised by new scientific research. </p>
<p>In 2014, researchers confirmed the association between same-sex orientation in men and a <a href="http://news.sciencemag.org/biology/2014/11/study-gay-brothers-may-confirm-x-chromosome-link-homosexuality">specific chromosomal region</a>. This is similar to findings originally published in the 1990s, which, at that time, gave rise to the idea that a “gay gene” must exist. But this argument has never been substantiated, despite the fact that studies have shown that homosexuality is a heritable trait.</p>
<p>Evidence points towards the existence of a complex interaction between genes and environment, which are responsible for the heritable nature of sexual orientation.</p>
<p>These findings are part of a <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">report</a> released by the Academy of Science South Africa. The report is the outcome of work conducted by a panel put together in 2014 to evaluate all research on the subject of sexual orientation done over the last 50 years. </p>
<p>It did this against the backdrop of a growing number of new laws in Africa which discriminate against people attracted to others of the same sex. The work was conducted in conjunction with the Ugandan Academy of Science. </p>
<h2>Existing research</h2>
<p>The academy looked at several scientific studies with different focus areas that have all provided converging findings. These include family and twin studies. The studies have shown that homosexuality has both a heritable and an environmental component. </p>
<p>Family studies have shown that homosexual men have more older brothers than heterosexual men. Homosexual men are also more likely to have brothers that are also homosexual. Similarly, family studies show that lesbian women have more lesbian sisters than heterosexual women. </p>
<p>Studies on identical twins are important as identical twins inherit the same genes. This can shed light on a possible genetic cause. Studies on twins have established that homosexuality is more common in identical (monozygotic) twins than in non-identical (dizygotic) twins. This proves that homosexuality can be inherited. </p>
<p>However, the extent of the inheritance between twins was lower than expected. These findings contribute to the notion that although homosexuality can be inherited, this does not occur according to the rules of classical genetics. Rather, it occurs through another mechanism, known as <a href="http://www.whatisepigenetics.com/fundamentals/">epigenetics</a>.</p>
<h2>Epigenetics likely to be an important factor</h2>
<p>Epigenetics relates to the influence of environmental factors on genes, either in the uterus or after birth. The field of epigenetics was developed after new methods were found that identify the molecular mechanisms (epi-marks) that mediate the effect of the environment on gene expression. </p>
<p>Epi-marks are usually erased from generation to generation. But under certain circumstances, they may be passed on to the next generation.</p>
<p>Normally all females have two X-chromosomes, one of which is inactive or “switched off” in a random manner. Researchers have observed that in some mothers who have homosexual sons there is an extreme “skewing” of inactivation of these <a href="http://gaystudies.genetics.ucla.edu/UCLA%20Twin%20Sexual%20Orientation%20Study/Read%20More_files/Extreme%20Skewing%20Bocklandt%20et%20al.pdf">X-chromosomes</a>. The process is no longer random and the same X-chromosome is inactivated in these mothers.</p>
<p>This suggests that a region on the X-chromosome may be implicated in determining sexual orientation. The epigenetics hypothesis suggests that one develops a predisposition to homosexuality by inheriting these epi-marks across generations. </p>
<p>External environmental factors such as medicinal drugs, chemicals, toxic compounds, pesticides and substances such as plasticisers can also have an impact on DNA by creating epi-marks. </p>
<p>These environmental factors can also interfere with a pregnant woman’s hormonal system. This affects the levels of sex hormones in the developing foetus and may influence the activity of these hormones. </p>
<p>Future studies will determine whether these factors may have a direct impact on areas of the developing brain associated with the establishment of sexual orientation. </p>
<h2>Looking to evolution</h2>
<p>From an evolutionary perspective, same-sex relationships are said to constitute a “Darwinian paradox” because they do not contribute to human reproduction. This argument posits that because same-sex relationships do not contribute to the continuation of the species, they would be selected against.</p>
<p>If this suggestion were correct same-sex orientations would decrease and disappear with time. Yet non-heterosexual orientations are consistently maintained in most human populations and in the animal kingdom over time. </p>
<p>There also appear to be compensating factors in what is known as the “balancing selection hypothesis”, which accounts for reproduction and survival of the species. In this context, it has been demonstrated that the <a href="http://www.huffingtonpost.com/2012/06/12/why-are-there-gay-men_n_1590501.html">female relatives</a> of homosexual men have more children on average than women who do not have homosexual relatives.</p>
<h2>Future studies</h2>
<p>The academy found that a multitude of scientific studies have shown sexual orientation is biologically determined. There is not a single gene or environmental factor that is responsible for this – but rather a set of complex interactions between the two that determines one’s sexual orientation. </p>
<p>However, more evidence is leading investigators to a specific region on the X-chromosome, and possibly a region on <a href="http://www.independent.co.uk/news/science/largest-ever-study-into-the-gay-gene-erodes-the-notion-that-sexual-orientation-is-a-choice-9875855.html">another chromosome</a>. </p>
<p>The identification of these chromosomal regions does not imply that homosexuality is a disorder – nor does it imply that there are mutations in the genes in these regions, which still remain to be identified. Rather, for the first time, it suggests that there is a specific region on a chromosome that determines sexual orientation. </p>
<p>Although research has not yet found what the precise mechanisms are that determine sexual orientation – which may be heterosexual, homosexual, bisexual or asexual – the answers are likely to come to the fore through continued research. These findings will be important for the field of genetics and, more importantly, for those attracted to others of the same sex and society as a whole.</p>
<hr>
<p><em>This article draws from the <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">ASSAf report</a>.</em></p><img src="https://counter.theconversation.com/content/42641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Pepper was a member of the ASSAf panel that undertook the study which forms the basis of the Diversity in Human Sexuality report. He receives funding from the South African Medical Research Council, the National Research Foundation of South Africa and the National Health Laboratory Services Research Trust.</span></em></p><p class="fine-print"><em><span>Beverley Kramer was a member of Academy of Science South Africa panel that undertook the study which form the basis of the Diversity in Human Sexuality report.</span></em></p>Scientific evidence shows that same-sex orientation is determined before you are born.Michael Sean Pepper, Director of the Institute for Cellular and Molecular Medicine, University of PretoriaBeverley Kramer, Assistant Dean: Research and Postgraduate Support in the Faculty of Health Sciences, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/426772015-06-10T17:16:27Z2015-06-10T17:16:27ZWhy anti-gay sentiment remains strong in much of Africa<figure><img src="https://images.theconversation.com/files/84399/original/image-20150609-10726-12ejedk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Members of a breakaway faction of the Anglican Church in Zimbabwe protest against homosexuality.</span> <span class="attribution"><span class="source"> Reuters</span></span></figcaption></figure><p><em>This article is part of a series The Conversation Africa is running on issues related to LGBTI in Africa. You can read the rest of the series <a href="https://theconversation.com/africa/topics/lgbti-africa">here</a>.</em></p>
<p>Of the 76 countries that still criminalise same-sex relationships and behaviour, 38 are <a href="http://scholarlycommons.law.northwestern.edu/njihr/vol11/iss2/3/">African</a>.
Recent <a href="http://www.pewglobal.org/2013/06/04/the-global-divide-on-homosexuality/">surveys</a> also show that the overwhelming majority of people who live in Africa strongly disapprove of homosexuality. This is even the case in South Africa, the only country on the continent that has legalised same-sex marriage. </p>
<p>Last month, socially conservative Ireland <a href="http://www.theguardian.com/world/2015/may/23/gay-marriage-ireland-yes-vote">voted convincingly</a> to legalise same-sex marriage. It became the first country where the people, as opposed to the courts or parliament, decided to legalise same-sex marriage. Ireland is now one of 20 countries globally that permit gay marriage. Fifteen years ago, such marriage was not legal anywhere in the world. </p>
<h2>What the science is saying</h2>
<p>Africa’s strong anti-homosexuality sentiment, harsh laws and active discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) people warrant exploration.</p>
<p><a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">A report</a> by the Academy of Science of South Africa reviews recent science about human sexuality and sexual orientation and challenges attitudes that are common in many African countries. The report also provides some explanation about the attitudes and laws prevalent in Africa.</p>
<p>It outlines how global science has steadily demonstrated that gay people are not “sick” nor do they have “conditions” needing treatment. This research, from the 1950s to the 1990s in particular, encouraged professional organisations to remove homosexuality <a href="http://www.researchgate.net/profile/Jack_Drescher/publication/38019926_Queer_diagnoses_parallels_and_contrasts_in_the_history_of_homosexuality_gender_variance_and_the_diagnostic_and_statistical_manual/links/53e8cfeb0cf2fb74872467eb.pdf">from diagnostic manuals</a>.</p>
<p>Contemporary science does not support thinking about sexuality in a “binary opposition” of hetero/homosexual and normal/abnormal. Rather, it favours thinking about a wide range of variations in human sexuality.</p>
<p>The report finds that:</p>
<blockquote>
<p>Variation in sexual identities and orientations has always been part of a normal society, [and] there can be no justification for attempts to ‘eliminate’ LGBTI from society.</p>
</blockquote>
<p>A growing public appreciation of this new science has been important in shifting public attitudes and laws globally.</p>
<h2>The effect of colonialism</h2>
<p>An understanding of the moralities that appeared in 19th-century Europe, entailing missionary-driven assaults on African social and sexual customs and practices such as polygamy, and sex before or outside of marriage, is key to unpacking the current state of affairs in Africa.</p>
<p>Dozens of studies show that same-sex practices in pre-colonial Africa <a href="http://www.ahrlj.up.ac.za/tamale-s">were not generally taboo</a> in the way that colonial administrations codified them. Many traditional societies in Africa, and elsewhere, developed ways of ordering and tolerating [same-sex attractions and behaviour](http://www.amnestyusa.org/research/reports/making-love-a-crime-criminalization-of-same-sex-conduct-in-sub-saharan-africa “).</p>
<p>Many tolerated <a href="http://76crimes.com/2014/01/30/21-varieties-of-traditional-african-homosexuality/">some same-sex relationships</a> among men, particularly in age-related cohorts or military units. Large numbers of men practised some same-sex activities while asserting their heterosexuality in other spheres of life.</p>
<p>Among women, many different African societies record <a href="http://nai.diva-portal.org/smash/get/diva2:460914/FULLTEXT01.pdf">marriage</a> or other kinds of <a href="http://www.osisa.org/buwa/regional/female-husbands-without-male-wives-women-culture-and-marriage-africa">recognised relationships</a> between women, as well as different forms of cross-dressing and role-swapping. These include societies and cultures in Kenya, Sudan, Cameroon, Nigeria, Lesotho, South Africa and many others.</p>
<p>Only during the height of colonisation were precise definitions of sexual orientations developed and proscribed behaviours punished. The <a href="http://www.hrw.org/reports/2008/12/17/alien-legacy-0">British</a> in particular brought in legislation because they thought "native” cultures did not punish “perverse” sex enough. </p>
<p>Like so many other colonial era laws based on Victorian prejudices, these laws should have been repealed as part of the decolonisation process. But, on liberation, most English-speaking colonies did not repeal colonial-era “sodomy” or “crime/vice against nature” laws. </p>
<p>There has been some progress. For example, Mozambique, which celebrates 40 years of independence this month, will officially rescind “vice against nature” <a href="http://www.mambaonline.com/2015/06/01/homosexuality-become-legal-mozambique-problems-remain/">legislation</a> in a few weeks time. </p>
<h2>In more recent times</h2>
<p>But attitudes and laws about homosexuality are not purely a colonial import. Since independence, other factors, including political populism, have driven anti-LGBTI attitudes. More recently, some of the impetus behind new laws has come from conservative and often racist organisations <a href="http://www.alternet.org/story/153723/how_deep_is_the_republican_christian_right%27s_connection_to_the_anti-gay_bills_sweeping_sub-saharan_africa">based in the US</a>. </p>
<p>In the last 15 years, the Christian right, primarily charismatic right-wing churches from the US, has been <a href="http://www.theguardian.com/world/2012/jul/24/evangelical-christians-homophobia-africa">very active</a> in driving anti-homosexuality sentiment in parts of Africa, like Uganda.</p>
<p>These groups have supplied their African allies with discredited junk science to bolster what is ultimately a narrow, imported set of ultra-conservative values. Similarly, the growth of a more <a href="http://www.pewforum.org/2010/04/15/executive-summary-islam-and-christianity-in-sub-saharan-africa/">conservative set of Islamic customs</a> in some parts of Africa has seen the erosion of indigenous belief systems that have been historically more tolerant of non-heterosexual orientations. </p>
<p>Attempts in Uganda to impose new, tougher laws has drawn global attention and opprobrium. In 2014, President Yoweri Museveni ordered the establishment of a <a href="http://mg.co.za/article/2014-02-22-uganda-mps-falsified-gay-report">Presidential Scientific Committee on Homosexuality</a> to advise his government on whether on not to pass a controversial anti homosexuality law.</p>
<p>The medical academics involved <a href="http://cdn.mg.co.za/content/documents/2014/02/22/scientistconsensusstatementonhomosexuality.pdf">concluded</a> that:</p>
<ul>
<li><p>Homosexuality “is not a disease”;</p></li>
<li><p>Homosexuality is not an “abnormality”;</p></li>
<li><p>Specifically that “homosexual behaviour has existed throughout human history, including in Africa”; and</p></li>
<li><p>Homosexuality existed in Africa way “before the coming of the white man”.</p></li>
</ul>
<p>Despite receiving this report, Museveni signed a law that contained harsh new punishments for “homosexual acts” and for what it calls the “promotion” of homosexuality. Implementation of that law is currently suspended by the Ugandan Constitutional Court.</p>
<p>There are also new laws in <a href="http://76crimes.com/anti-lgbt-laws-nigeria/">Nigeria</a>, homophobic changes to the constitution in <a href="http://www.ijhssnet.com/journals/Vol_2_No_13_July_2012/24.pdf">Zimbabwe</a> and discussion about possible new laws in a number of countries, including Kenya. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=334&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=334&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=334&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=420&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=420&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84579/original/image-20150610-6810-1xyn18k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=420&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Countries where same-sex acts are criminalised.</span>
<span class="attribution"><span class="source">assaf</span></span>
</figcaption>
</figure>
<h2>Negative impacts</h2>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4068984/">impact</a> of this type of legislation is severe on LGBTI individuals and communities as well as on public health services.</p>
<p>A particularly dangerous aspect of new laws in some parts of Africa is that they are designed to <a href="http://scholarlycommons.law.northwestern.edu/njihr/vol11/iss2/3/">criminalise</a> those who advocate for LGBTI rights or campaign for better access to public health facilities. This impedes the work of NGOs and activists and wider dissemination of new science about sexual orientation.</p>
<p>The report aims to make recent science more accessible to African policymakers so that policy can be based on good evidence, not social prejudices. Same-sex attraction is neither “un-African” nor a colonial import. Between 350 million and 400 million people globally are not heterosexual, about 50 million of whom live in African countries.</p>
<p>It is time to transform the continent’s laws, and its societies, informed by a rapidly evolving, and ever more convincing, science of sexual orientation.</p>
<hr>
<p><em>This article draws from the <a href="http://www.assaf.co.za/wp-content/uploads/2015/06/8-June-Diversity-in-human-sexuality1.pdf">ASSAf report</a>, which says that 38 African countries have laws that criminalise same-sex relationships. This figure was taken from the 2014 report by the International Lesbian Gay Bisexual Trans and Intersex Association (ILGA). In its 2015 report released in May, the association has <a href="http://old.ilga.org/Statehomophobia/ILGA_State_Sponsored_Homophobia_2015.pdf">revised the number to 35</a>.</em></p><img src="https://counter.theconversation.com/content/42677/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Professor Harry Dugmore was the research coordinator and co-author, with the research panel, that produced the Academy of Science South Africa's report on Diversity in Human Sexuality: Implications for Policy in Africa.</span></em></p>Attitudes and laws about homosexuality are not purely a colonial import. Since independence, other factors, including right-wing evangelism, have driven anti-LGBTI attitudes.Harry Dugmore, Professor and Director of the Centre for Health Journalism, Rhodes UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/428872015-06-10T04:20:26Z2015-06-10T04:20:26ZWhy criminalising homosexuality is a public health hazard<figure><img src="https://images.theconversation.com/files/84328/original/image-20150609-27119-f5gz2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Criminalisation does little to change behaviour, while actively contributing to increased stigma.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-190933592/stock-photo-couple-holding-hands-by-the-sea-love-concept.html?src=vSAWitxpxKsQikLEkshr3A-1-23">KieferPix/Shutterstock</a></span></figcaption></figure><p>Homosexuality remains <a href="http://www.loc.gov/law/help/criminal-laws-on-homosexuality/african-nations-laws.php">illegal</a> in 38 of 55 African nations. Such a stance against homosexuality is concerning from ethical and human rights perspectives. It also poses serious risks from a public health perspective, not least of all because of the significant rates of <a href="http://www.avert.org/impact-hiv-and-aids-sub-saharan-africa.htm">HIV across Africa</a>.</p>
<p>Men who have sex with men account for a substantial minority of those affected by HIV, with their risk of infection more than double that of the <a href="http://www.aidsmap.com/HIV-prevalence-among-South-African-MSM-twice-as-high-as-general-population/page/1323795/">general population</a>. Many African countries also harbour homophobic cultures and attitudes. Together, this creates an environment where homosexuality is highly stigmatised, with homosexual people socially isolated and marginalised. </p>
<p>We know from decades of research across stigmatised and socially excluded groups, such as <a href="http://www.scarletalliance.org.au/library/unjust-counterproductive/file_view">sex workers</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/17981451">injecting drug users</a> and men who have sex with men, that criminalisation does little to change behaviour, while actively contributing to increased stigma and marginalisation of these groups. This amplifies the health risks by driving stigmatised communities underground, isolating them from health or support initiatives.</p>
<p>What does this mean for homosexual people across Africa?</p>
<h2>HIV</h2>
<p>One of the greatest health risks created through the criminalisation of homosexuality relates to the treatment and prevention of HIV. </p>
<p>The current situation in <a href="http://www.avert.org/hiv-aids-uganda.htm">Uganda</a> provides a striking case study of how the law can affect responses to HIV. Uganda was once considered a regional leader in HIV prevention. Just over 7% of the Ugandan population are HIV positive. This is significantly lower than the rate of 15%, which was projected two decades ago. <a href="http://pmj.bmj.com/content/81/960/615.full">Uganda’s success</a> in preventing HIV transmission is often attributed to an early, progressive, and ambitious government response.</p>
<p>However, in recent years the Ugandan government has taken an <a href="http://www.hrw.org/reports/2005/03/29/less-they-know-better">increasingly conservative approach</a> to HIV-prevention, supporting abstinence-only programs and refusing to promote condom use. </p>
<p>This has been accompanied by a major crack down on homosexuality in the form of the <a href="https://www.amnesty.org/download/Documents/.../afr590032010en.pdf">Anti-Homosexuality Bill</a>, signed into law in 2014, although it was later annulled. The Ugandan government plans to introduce further <a href="http://www.bbc.com/news/world-africa-29994678">anti-gay legislation</a>, and homosexuality remains illegal. Similar legislation has also been introduced in <a href="https://theconversation.com/gambia-becomes-the-latest-african-country-to-enact-hateful-anti-gay-laws-34617">The Gambia</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84329/original/image-20150609-27130-1awoagt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Where homosexuality has been criminalised, men are likely to avoid HIV testing.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-251585581/stock-photo-african-nurse-is-drawing-blood-from-an-african-male-for-blood-tests.html?src=Bu_4rpqBLm1f-g6UbZuXsA-1-59">Leonie Pauw/Shutterstock</a></span>
</figcaption>
</figure>
<p>Criminalisation of same-sex sexual practice cripples any initiatives aimed to prevent HIV transmission among this group or to provide treatment to HIV-positive men. Men are rightly afraid of disclosing their sexuality to service providers – who are required by law to report same-sex sexual practices. Anyone trying to organise a program around HIV prevention for men who have sex with men could be charged with “<a href="http://www.tandfonline.com/doi/abs/10.1080/17290376.2012.744177">promoting homosexuality</a>”. </p>
<p><a href="http://journals.lww.com/aidsonline/Fulltext/2015/06190/Hidden_from_health___structural_stigma,_sexual.15.aspx">Research has shown</a> that where homosexuality has been criminalised, men are likely to avoid HIV testing or seeking knowledge about safer sex if it risks exposing their sexual activities.</p>
<p>But beyond this, increased levels of stigma – which inevitably results from criminalisation – mean gay and bisexual men are actually <a href="http://journals.lww.com/aidsonline/Fulltext/2015/06190/Hidden_from_health___structural_stigma,_sexual.15.aspx">more likely</a> to engage in risky sexual behavior.</p>
<p>Criminalisation also decimates gay networks and communities. Gay and bisexual men in Western countries such as <a href="http://press.anu.edu.au//apps/bookworm/view/Movement,+Knowledge,+Emotion:+Gay+activism+and+HIV-AIDS+in+Australia/6291/Text/upfront.html">Australia</a> and the United States had the social capital needed to mobilise the community to initiate HIV information and prevention programs. Community-led prevention – and government support for community led prevention – has long been acknowledged as the most important element of <a href="http://www.publish.csiro.au/paper/HE13078.htm">Australia’s successful efforts</a> to reduce HIV transmission. </p>
<p>Criminalising homosexuality removes the capacity for gay communities to organise and to mobilise around HIV prevention by effectively making such initiatives a criminal offence. </p>
<h2>Mental health and well-being</h2>
<p>The decimation of homosexual communities and stigmatisation of homosexuality has further implications for health and well-being. </p>
<p>The criminalisation of homosexuality entrenches the stigma associated with it. There is a great deal of <a href="http://www.biomedcentral.com/1471-244X/8/70/">evidence</a> that many individuals who experience stigma or marginalisation also experience considerable stress. </p>
<p>Worldwide, lesbian, gay, and bisexual (LGB) men and women experience far higher rates of depression, anxiety, and other stress-related disorders compared to the rest of the population. Such stress may come from discrimination, rejection, and concealment, as well as internalised stigma that leads to feelings of shame and low self-worth. In countries where homosexuality is a criminal offence, a fear of persecution and living in secrecy only adds further stress. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84330/original/image-20150609-27084-1jna7rh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Criminalising homosexuality removes the capacity for gay communities to organise and to mobilise around HIV prevention.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-205401436/stock-photo-rainbow-flag.html?src=ztyN8zLxJYA2-DAebCnfmQ-1-9">oceanfishing/Shutterstock</a></span>
</figcaption>
</figure>
<p>According to <a href="http://www.apa.org/pi/aids/resources/exchange/2012/04/minority-stress.aspx">Minority Stress Theory</a>, living with stigma-related stress has direct repercussions on health. Not only does it place individuals at greater risk of mental health problems, but chronic stress is also linked with physical health outcomes, such as heart disease. </p>
<p>Self-medication through substance abuse is also a risk, with LGB populations also tending to have <a href="http://www.cdc.gov/msmhealth/substance-abuse.htm">higher rates</a> of alcohol consumption and drug dependence.</p>
<p>Conversely, LGB people with strong social networks and support tend to have <a href="http://www.tandfonline.com/doi/abs/10.1080/14623730.2014.903621">better mental and physical health outcomes</a>.</p>
<h2>The law as harm</h2>
<p>Criminalisation forces LGB men and women to live in stressful circumstances, and amplifies the stigma and marginalisation these groups experience. It renders LGB people invisible and creates significant barriers to openly accessing relevant health services and treatment. </p>
<p>In a continent that withstands the worst of the global HIV epidemic, the criminal regulation of homosexuality can only be viewed as an affront to the health of homosexual communities.</p><img src="https://counter.theconversation.com/content/42887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Lyons has previously received funding from beyondblue and the Movember Foundation. He currently receives funding from the Australian Research Council and works on projects funded by the Australian Commonwealth Government. </span></em></p><p class="fine-print"><em><span>Jennifer Power has previously received funding from the Australian Research Council, Relationships Australia, VicHealth and ACON. She currently works on a project funded by the Australian Commonwealth Government. </span></em></p><p class="fine-print"><em><span>Bianca Fileborn does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Homosexuality remains illegal in 38 of 55 African nations. This is concerning from ethical and human rights perspectives. It’s also a serious public health risk.Bianca Fileborn, Research Officer at the Australian Research Centre for Sex, Health & Society, La Trobe UniversityAnthony Lyons, Senior Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe UniversityJennifer Power, Research Fellow at Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.