Discrimination against homosexual people and their healthBMJ 2007; 335 doi: https://doi.org/10.1136/sbmj.0707260 (Published 01 July 2007) Cite this as: BMJ 2007;335:0707260
- Michael King, professor of primary care psychiatry1
Homosexual people are easy to hate. Men or women who are drawn emotionally and physically to others of the same sex face discrimination, harassment, and a denial of full human rights in most countries of the world. South Africa seems to be one of very few countries that has introduced full protection from discrimination on the grounds of sexual orientation in addition to a full marriage law for same sex couples.1
Meanwhile, homosexual behaviour is an offence punishable by a term of imprisonment in countries such as India, China, and Nigeria and the death sentence in Saudi Arabia, Sudan, and Iran. Even in the most liberal of Western countries jokes and slander about gay men, lesbians, and bisexual people abound in the media and ordinary conversation.
Why is this the case? Why, for example, do most Islamic and Christian traditions see homosexuality as a greater threat to human worth and dignity than urgent global problems such as war, poverty, political abuse of prisoners, and exploitation of women and children? Why is homophobic bullying one of the commonest forms of victimisation that we see in schools and colleges?23 Why might parents experience extreme distress or even reject their children when homosexuality is exposed?4 Why is homosexuality still regarded as a mental disorder requiring treatment or “spiritual healing” in many parts of the United States and Europe?5 Why do civil partnerships for gay couples provoke political hostility in many states of the US and Australia and in Italy?
Sexuality and human society
Sexual thoughts and behaviour are the most intimate and personal parts of our lives. Although sexual mores have varied greatly from era to era and culture to culture, people who stray from conventional paths have long been subject to disapproval and correction. The almost universal opposition to homosexuality seems to arise from a mix of fear of difference; male denigration of all that is female; and an intense fear on the part of men that they should notice another man let alone regard him as handsome or sexually attractive. It is possible that homophobia is simply part of a general intolerance of difference.6 However, the gender bias is obvious in the greater antipathy of men than women to homosexuality7; the fact that legal prohibition of homosexual acts throughout history has been aimed almost exclusively at men8; and that men have dominated state legislatures throughout most of history. One famous exception is Margaret Thatcher's introduction in the 1980s of a legal injunction against the promotion in schools of homosexuality as a “pretended family relationship” in the United Kingdom. This legislation, which was overturned only in 2003, would have been unthinkable had it been directed against any other social, cultural, or ethnic group. It owed its origins to the historical view of homosexuality as a sick and shameful state from which British youth required protection.9
If you are heterosexual and are beginning to find this all a bit tedious then try imagining that you grew up with every fleeting sexual thought repressed; that no comment about someone attractive could escape your lips; that there could be no thought of having an open relationship with someone you desired; that jokes about you were commonplace; that if you ever revealed your sexuality to others they would become embarrassed, pressurise you to change, or worse try to harm you; and that if you ever acted on your feelings you could be blackmailed, imprisoned, or worse. Although attitudes have become more liberal in North America, Australasia, and most parts of Europe, this is still the daily experience of most gay people around the world.
Are there grounds for this hostility? For example, are gay men and lesbians evil or a threat to organised religion? Religious interest and participation would indicate that if anything gay men are more spiritually inclined than their heterosexual counterparts, at least as regards Christianity.10 Is homosexuality a biological aberration? There is no evidence that homosexuality is a disease.11 Do gay men and lesbians abuse children? Despite vigorous efforts by antigay pressure groups to make a link between homosexuality and paedophilia, no evidence supports any such association.12 Are gay men and lesbians more inclined than heterosexual people to crime and violence? Research indicates that although most criminal activity is perpetrated by men, gay men are much less predisposed to violence than their heterosexual counterparts.13 Do gay relationships threaten the stability of marriage? There is no link between the development of same sex civil partnerships and the stability of heterosexual marriage, which has been declining steadily since the 1940s.14
Why this matters to health
Clear evidence shows that discrimination because of other human characteristics, such as race, has negative impacts on health.15 If your health professional is antagonistic to your sexuality you are much less likely to consult or risk being open about your sexual orientation when you do so, particularly in societies where homosexual behaviour is illegal. This disadvantage has been well recorded throughout the history of medical and governmental responses to medical treatments of HIV and AIDS in particular,16 but also in women's health services,17 mental health,18 and general practice.19 Access to adequate health care is a basic human right that is compromised when sexuality prevents full and open access. If you are subject to discrimination and abuse this is likely to have a grave impact on your mental health. Clear evidence shows that lesbians, gay men, and bisexual people are subject to greater mental distress and are more likely than heterosexual people to harm themselves.20
Discrimination and prejudice against gay men, lesbians, and bisexual people around the world urgently needs tackling-and not least among doctors.21 This requires action at governmental level to protect people's civil rights. South Africa is an exemplar for other nations to follow. Only through fundamental changes in people's attitudes, however, will homosexual people enter the mainstream and enjoy equal health and social care.
Responses published this month
(July 28th, 2007)
Undergraduate Student, University of Michigan (Ann Arbor),
As a heterosexual male in today's society, it is rather easy to turn a blind eye toward the incessant discrimination toward homosexuals on a day to day basis. However, this is a cruel injustice and this issue should be brought to light around the world. First, we must ask ourselves, “Who am I to pass any judgments against another individual, solely based on a person that identifies as homosexual?” To be homosexual means nothing more than just that, being homosexual. In professional fields all across the globe, this discrimination has denied perfectly qualified homosexuals job positions. I consider myself a friend to several homosexuals and I see no differences in them compared to my other friends. Homosexuals should be treated just as anybody else you come across in life: only pass judgment on a person after you have gotten to know them as an individual, rather than as a homo or hetero sexual.
True, some homosexuals may not be good people, but the same is definetely true for heterosexuals. Most of us have some innate preconceptions (and misconceptions) regarding homosexuals but I implore you all, as a society, to hold judgment until you experience the true nature of a person.
Originally published as: Student BMJ 2007;15:260