Steps forward

How does someone become gay?

All available research is consistent with gay sexual orientation being inherent in the individual from a very early age, and there is increasing evidence of inheritance of the trait through the maternal side of the family. Indeed, the recent identification of a candidate for a possible 'gay gene' in the Xq28 region of the human genome, was facilitated by such inheritance studies[28].

Cohort studies have dispelled some of the myths that young men can be converted or seduced into becoming gay[29].

What is 'coming out'?

This is a term used in the gay community to describe the process whereby a gay man comes to terms with homosexuality and begins to disclose it to other people. In our social climate people are assumed to be heterosexual. Therefore for a gay man to have a strong self or social identity, he may 'come out'. A coming out process may involve his just telling close friends or may involve revealing his sexuality to colleagues, heath professionals, business representatives and others.

Why are gay men still at high risk of HIV transmission?

Owing to the high prevalence of HIV in the gay population, the same degree of risk activity is much more likely to lead to infection than in the heterosexual population.

Surveys have shown that gay men tend, on average, to have higher numbers of sexual partners than heterosexuals[30].

Epidemiology has shown that unprotected anal sex is riskier than vaginal sex. Additionally there is a higher risk of transmission from the insertive to the receptive partner than vice versa. Moreover, whereas penetrative sex can obviously only be from male to female amongst heterosexuals, there is more likelihood of chains of infection amongst gay men who may engage in anal sex both actively and passively.

What are the key features of the sexual behaviour of gay men?

Research has shown a great diversity of behaviours[31]. Some, for instance, never engage in anal intercourse at all. Some do so exclusively actively or passively. And some engage in anal sex both actively and passively. It is not possible to predict which of these patterns a particular man will fit without asking him.

By contrast with heterosexuals, condom use amongst gay men has developed only as a disease prevention measure.

Studies have shown that a large majority of gay men practise oral sex. Most gay men know that it is considered to be a very low HIV risk activity, and consequently very few use condoms for oral sex.

Just as, amongst heterosexual couples, alternative methods of contraception are used as an alternative to condoms, so too unprotected anal sex is most common amongst gay men in relationships rather than with casual partners. There is considerable evidence that some gay men abandon the use of condoms in an established relationship, but that this may be on the basis of assumed rather than tested HIV negative status for both partners.

However, although the majority of gay men practise safer sex most of the time, studies have shown that a significant number of gay men lapse from their own safer sex rules from time to time. This is of course far more risky in a population with high HIV prevalence.

Is homosexuality a disease?

No. Homosexuality was removed from the official list of mental disorders of the American Psychiatric Association in 1976 and thereafter from other registers, such as the International Classification of Diseases.

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