Thursday, November 02, 2006

Health perspective on homosexuality by Gynaecologist

Attention: Mr.M.Mangke
Parliament of South Africa Action

South Africa

Dear Mr.Mangke,

With regard to the proposed Bill legalizing Same sex marriage, I
respectfully submit for your perusal, some

important facts surrounding sexual activity of these relationships.
While much sexual activity between heterosexual couples can also produce
pathology, there are very safe guidelines

for this. Unfortunately, the same cannot be said particularly for anal sex
which is unsafe in any circumstance.

There are obvious natural boundaries between healthy experimentation and
high risk sexual behavior. The principle

of first do no harm however cannot be said for male homosexual
experimentation where anatomically, the use of the

rectum as a receptacle for sexual activity is clearly always unhealthy. The
rectum contains 1000 billion organisms

per gram of faeces and is designed very well for the storage and voluntary
expulsion of waste material. We teach our

children from an early age that this is its function and that they must
avoid contamination by hand washing and

basic hygiene. Indeed, as a surgeon, I am constantly mindful of the dangers
of damaging the intestinal tract and I am

aware of the devastating consequences of fecal contamination. Using the
anal canal as a sexual organ has produced

an explosion of pathology, with the rapid spread of HIV, herpes, Human
papilloma virus causing anal warts and anal

cancer and a host of other infective conditions.(1-5) In Alberta, Canada
over 1000 HIV +ve AIDS patients have been

treated to date, over 85% of them men who mostly acquired the disease
through anal intercourse.(6) Their treatment

is funded at taxpayers’ expense to the tune of about C$ 2500 per month per
person. How many South African

homosexuals have been treated for HIV disease and AIDS compared with those
who acquired the disease through

heterosexual contact? Those men living with HIV often continue to have
indiscriminate sex with other men with over

60% reporting not using condoms (8), and some having over 10 new partners
per month, many anonymous. Recent

studies indicate that 1 in 5 HIV+ve men will not inform their
“regular”HIV-ve partners of their HIV status and will

engage in unprotected anal sex with them (9) A man was recently charged
with murder for knowingly infecting two

women with HIV in Ontario.(10) Similar cases are widespread in South
Africa. It is little wonder that the blood

transfusion service regards anal sex as such a risky activity, they will
not use blood donated by men who indulge in

this practice (11) The emergence of super resistant HIV in a New York man
recently has alarmed public health

officials as the patient himself reported that over 3 months, had
“hundreds” of anonymous contacts, while under the

influence of crystal meth. (12)

Some activists would have us believe that sexual experimentation is merely
a wide spectrum of activities, none of

which are unnatural in themselves. One wonders what their attitude is to
the activities of fisting, rimming and

daubing (13,14)*occurring in bathhouses and backrooms of gay clubs all over
the world. This abandonment of

sexual restraint, and advocacy of anonymous sexual partnering sees
sexuality only as genital focused self

gratification. This is a far cry from healthy sex which is the ultimate
expression of intimacy, so exquisite, that out of

it, new life may emerge.

While anal sex has been used by heterosexual couples as a form of
contraception particularly in Africa, it is

associated with severe gynaecological infection, trauma, incontinence and
is generally reserved for those who would

degrade and injure their partners/victims rather than celebrate love (15).
It is also been implicated as a major factor

in the devastating spread of HIV in sub-Saharan Africa.(16)
The use of condoms does not guarantee safety for anal sex * condom breakage
has been reported at 36% and

condom slippage at 21% compared with 6 and 5% respectively for heterosexual
sex.(17) The trauma to the anus from

this activity is so great so as to leave 30% of recipients temporarily
incontinent of stool after their first encounter.
The pain and physical suffering incurred in dangerous sexual activity is
not confined to infections, cancer, infertility

and degenerative terminal diseases (19). There are numerous studies and
reports referring to the psychiatric and

psychosocial injury such as depression,(20,21) suicide (22,23), partner
violence (much greater than for heterosexual

couples) (24-27) and alcohol (28) and drug (29-31) abuse in homosexual

The sexual activity among lesbian women is also not without pathology, the
incidence of human papilloma virus

infection is some studies is higher than in the heterosexual population
(32,33) and cross contamination with

menstrual fluid is hardly hygienic with sex toy swapping (34,35) The
Boston Lesbian Health project 2005 report has

recommended yearly PAP smears and Sexually Transmitted Infection screening
yearly for lesbian women.(36)
Much opposition to homosexual lifestyles stems from knowledge of the end
point of sexual expression and is not

really homophobia (an irrational fear of homosexuals) but rather
homorevulsion, where they imagine the sexual

activity advocated and are repulsed by the concept of anal sex and other
related sexual activity. As a result,

discrimination against homosexuals usually begins once their behavior is
perceived as a sexual advance or a sexual

statement. There is a grey area between merely friendly gestures and subtle
to open sexual advances * sexual

predators and pedophiles exploit this zone and are overrepresented in the
homosexual group (37). Homosexual

advocates for reducing the age of sexual consent to 14 (38) help to lure
more confused and ambivalent teens (39)

into premature sexual activity and a hyper sexed lifestyle (40,41). Parents
who oppose the introduction of

homosexual promotion in schools are protecting their children from serious

It is time for an open discussion and public debate about homosexual
practice at a local, provincial and federal level.

Precedents have already been set with tobacco, alcohol and other dangerous
habits and lifestyles. Dietary

investigation, school cafeterias and exercise programs are now on the
political agenda. We cannot afford to sacrifice

our citizens on the altar of political correctness and ignore this issue.

Before this Liberal government should legislate regarding so called gay
unions, I think it is incumbent on politicians

to be fully informed about the nature, risks, consequences and public
safety of homosexual sexual practice. They

should seek advice from the SA College of Surgeons, gastroenterologists,
sexual disease specialists and others to

convene a Task Force for this purpose. If they do not and turn a blind eye
and a deaf ear to this issue, they will

endorse it by default, sending a message to the nation, and the world, that
South Africa regards homo and hetero

sexual practice as equal despite adequate evidence to the contrary. Should
one South African suffer the

consequences of anal sex and sue the government for not providing
appropriate health warning, this letter will serve

as evidence against them.

Like a car driven on the wrong side of the road, inevitably here will be
consequences both for the aberrant road user

and for others in their path- so will it be for those who engage in
unhealthy sexual practice. While you may be free

to jump off a building, the immutable laws of nature will not allow you to
avoid hitting the street below at terminal


We ignore the boundaries provided for healthy sexual expression at our own
(and eventually society’s) peril. It is not

hateful to honestly speak out against harmful sexual practice. We do it for
unsafe and dangerous heterosexual sex. I

would suggest that the hate crime is committed by those who would ignore,
or worse still, suppress the truth about

homosexual sex to the detriment of any individual or society’s health.


Harvey Ward

1. Chin-Hong PV et al Age-specific prevalence of anal HPV infection in HIV
-ve sexually active MSM: the EXPLORE

study J Infect Dis 2004 Dec 15, 190(12); 2070-2076.. “In the United
States, anal cancer in men who have sex with

men (MSM) is more common than cervical cancer in women. Human
papillomavirus (HPV) is causally linked to the

development of anal and cervical cancer”
2. Renzi et al . Herpes Simplex Virus 2 infection as a risk factor for HIV
acquisition in MSM . Sex Trans Diseases

2003 Jun 1, 187(1) 19-25
3. Sobhani I et al Anal carcinoma: incidence and effect of cumulative
infections. AIDS 2004 Jul 23. 18(11)

4. Goldberg GS et al Microbiology of HIV anorectal disease.Dis Colon
Rectum 1994 May 37(5) 439-443.
5. Centre for Disease Control. Lymphogranulosum venereum among MSM:
Netherlands 2003-4 Morb Mortal

Wkly Rep 2004 Oct 29. 53 (43) 985-8
6. HIV surveillance in Alberta. Website:

7. Krentz HB , Auld MC, Gill MJ The high cost of medical care for patients
who present late (CD4 <200 cells/
microl) with HIV infection. HIV Med 2004 Mar 5 (2) 93-98. The annual cost
of managing a patient with HIV ranges

between over C$ 9000 and up to over C$ 18000 if they present late. The
cost of treating an AIDS patient is probably

much higher but variable due to the nature of the AIDS defining illness. My
text should have read “up to C$ 1500 per

month for HIV treatment alone” to be more accurate.

8. Crosby R, Mettey A. A descriptive analysis of HIV risk behaviour among
men having sex with men attending a

large sex resort. J Acquir Immune Defic Syndr 2004 Dec 1;37(4) 1496-1499
9. Denning PH, Campsmith ML Unprotected anal intercourse among HIV *
positive men who have a steady male

sex partner with negative or unknown HIV serostatus. Am J Public Health
2005 Jan:95(1):152-158
10. Brown B, Hemsworth W. HIV infection draws murder charge. Toronto star
news service 25 Feb 2005. (Can we

expect lawsuits among men who have sex with men who knowingly infect a
11. Canadian Blood Services website: permanent deferrals “All men who have
had sex with another man, even once,

since 1977 are permanently deferred. This is based on current scientific
knowledge and statistical information that

shows that men who have had sex with other men are at greater risk for
HIV/AIDS infection than other people.”

12. Susman Ed A Case of Apparent Recent Infection With a
Multi-Drug-Resistant and Dual-Topic HIV-1 in

Association With Rapid Progression to AIDS. Abstract 793A]- March 1, 2005.

13. Richters J et al . Sex in Australia: autoerotic, esoteric and other
sexual practices engaged in by a representative

sample of adults. Aust NZ J Public Health 2003;27(2):180-190.
14. Van de Ven P, Mao L, Prestage G. Gay Asian men in Sydney resist
international trend: no change in rates of

unprotected anal intercourse, 1999-2002. AIDS Educ Prev; 2004

15. Cossa HA et al. Syphilis and HIV infection among displaced pregnant
women in rural Mocambique. Int J STD

AIDS. 1994 Mar-Apr;5(2):117-123
16. Brody S, Potterat JT Assessing the role of anal intercourse in the
epidemiology of AIDS in Africa. Int J STD AIDS

2003 Jul 14 (7) 431-436
17. Silverman BG et al. Use and effectiveness of condoms during anal
intercourse. Sex Transm Dis 1997;24 (1): 14
18. Miles AJ et al. Effect of anoreceptive intercourse on anorectal
function J Roy Soc Med 1993; 86:144-147. “*
Fourteen of the (40) anoreceptive (AR) subjects but only one of the (18)
non-AR subjects had symptoms of frequent

anal incontinence (P < 0.05)..”.
19. Rosser BR et al. Anodyspareunia: an unacknowledged sexual dysfunction:
a validation study of painful receptive

anal intercourse and its psychosexual concomitants in homosexual men. J Sex
Marital Ther. 1998 Oct-Dec;24(4):
20 Berg MB, Mimiaga MJ, Safren SA . Mental Health concerns of HIV infected
men and bisexual men seeking mental

health services: an observational study. AIDS Patient Care STDS 2004 Nov
18(11): 635-643
21. Warner J et al. Rates and predictors of mental illness in gay men,
lesbians and bisexual men and women:

Results from a survey based in England and Wales. Br J Psychiatry; 2004 Dec
22 McAndrew S, Warne T. Ignoring the evidence dictating the practice:
sexual orientation, suicidality and the

dichotomy of the mental health nurse. J Psychiatric Ment Health Nurs 2004
23 Mills TC et al. Distress and depression in men who have sex with men:
the Urban Men’s Health Study. Am J

Psychiatry 2004 Feb;161(2):278-285
24 Greenwood GL et al. Battering victimization among a probability based
sample of men who have sex with men.

Am J Public Health 2002 Dec;92(12):1964-1969. * a search on PUBMED using
the words “homosexual, partner

violence” yield more studies
25 Cameron P . Domestic Violence among homosexual partners. Psychol Rep.
2003 Oct 93(2):410-416.
26. Tjaden P, et al. Comparing violence over the life span in samples of
same sex and opposite sex cohabitants.

Violence Vict. 1999 Winter;14(4):413-425 “The study also confirms previous
reports that intimate partner violence is

more prevalent among gay male couples than heterosexual couples.”
27 Burke LK, Follingstad DR. Violence in lesbian and Gay relationships:
theory, prevalence and correlational

factors. Clin Psychol Rev. 1999 Aug 19(5):487-512
28. Roberts SJ et al. Health related behaviours and cancer screening of
lesbians: results from the Boston Lesbian

Health Project II .Women Health 2004;39(4):41-55 . “BLHP II data confirm
other findings that lesbians are more

likely to drink alcohol and to drink more heavily than other women.”
29. Logan TK, Leukefeld. HIV risk behaviour among bisexual and
heterosexual drug users. J Psychoactive drugs

2000 Jul-Sep 32(3):239-248
30. Romanelli F, Smith KM. Recreational use of sildenafil by HIV positive
and negative homosexual/bisexual males.

Ann Pharmacother. 2004 Jun;38(6):1024-1030
31.. Klitzman RL et al. MDMA (‘ecstasy”) use, and its association with high
risk behaviours, mental health and other

factors among gay/bisexual men in New York City. Drug Alcohol dependence
2002 Apr 1,66(2):115-125
32.. Marrazzo JM. Genital human papilloma virus infection in women who
have sex with women. A concern for

patients and providers. AIDS Patient Care STDS. 2000 Aug;14(8):447-451
33. Marrazzo et al. Papanicolaou test screening and prevalence of genital
human papilloma virus among women

who have sex with women. Am J Public Health 2001 Jun;91(6):947-952.

34. Marrazzo JM et al. Characterisation of vaginal flora and bacterial
vaginosis in women who have sex with

women. J Infect Dis 2002 May 1;185(9):1307-1313
35. Berger BJ et al. Bacterial vaginosis in lesbians: a sexually
transmitted disease. Clin Infect Dis 1995 Dec;21(6):
36. Roberts SJ, et al 2004 ibid.
37. Freund K, Watson RJ. The proportions of heterosexual and homosexual
pedophiles among sex offenders

against children: an exploratory study. J Sex Marital Ther 1992
Spring,18(1):34-43. “..the ratio of heterosexual to

homosexual pedophiles was calculated to be approximately 11:1”. But only

1.3% of men and 0.7% of women

considered themselves homosexual. 0.9% of women, compared with 0.6% of men,
said they were bisexual. On a

statistical basis, only 1 in 50-80 pedophiles should be

Source: Canadian Community Health Survey, June 2004. A Canadian government
survey of 83,000 people. Ref:

Statistics Canada. Click here.
38. Remafedi G, Resnick M, Blum R, Harris L. Demography of sexual
orientation in adolescents. Pediatrics v1992

Apr;89(4 Pt 2):714-721. 25.9% of 12 year olds were unsure whether they were
homo or heterosexual vs only 5% of

17 year olds (98.5% of all students were sure they were heterosexual)

40. Centre for Disease Control and Prevention (1991 January 4). Premarital
sexual experience among adolescent

women * United States 1970-1988. Morb Mort Wkly Rep 39(51), 929-932
41. Epidemic: How teen sex is killing our kids. Meeker M MD. 2002.
Lifeline press

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