"Malaysia Prime Minister Mahathir Mohamad and the Sultan of Johor are seen in a blue Proton Saga... "When asked whether there is any tension with the sultan, Dr Mahathir said: “No, I don’t see anything because I went to see him and he drove me to the airport. I don’t want to comment on the sultans because if I say anything that is not good then it’s not nice because he is the sultan”"

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Thursday, February 13, 2014

How NOT to write an FAQ about LGBT health issues

In the Straits Times Forum 2 days ago:

HPB site too skewed towards gay issues

I WAS surprised by the content in the Health Promotion Board's Frequently Asked Questions on sexuality and the manner in which it was presented ("Health board tackles gay issues in FAQs"; last Wednesday).

More than half of the FAQs addressed sexual orientation issues.

Surely, sexuality encompasses more than a person's sexual orientation. What about more wide-ranging issues such as body image, anxiety about sex, unwanted sexual impulses or compulsions, impotence, lack of sexual desire, promiscuity, or recovery from sexual abuse or sexual assault? Why have these issues been overlooked?

Also, the FAQs on sexually transmitted infections and HIV were at the bottom of the page. It is more logical for them to be at the top as this issue affects anyone regardless of sexual orientation.

The webpage's content seems skewed towards gender identity issues.

This is incongruent with the HPB's stand of "encouraging heterosexual married couples to have healthy relationships and to build stable nuclear and extended family units".

Karen Liaw Soek Yin (Ms)

At first I thought the ruckus about the HPB FAQ was the usual liberal vs conservative tussle, but then I actually read the FAQ.

I am sure some people are already labelling her a "homophobe", but this is a very neutral letter which points out important issues with the HPB FAQ which is supposedly about "sexual health" (it is also true that this is incongruent with the HPB's stand - this is no judgment of whether this stand is a good one).

Of course, if one takes a broad view of "sexual health", anything related to what might possibly cause LGBTs mental distress could fall under that category. But then, we would be surprised if a Health FAQ on obesity talked about bullying and the fat acceptance movement and we might even suspect the writers of the FAQ of having a political agenda. And we might as well invent a new category called "racial health" and talk about the harms of racial discrimination.

It is instructive to compare the HPB FAQ with other LGBT Health FAQs. For example, the NHS's: Gay health: the issues - Live Well - NHS Choices which explicitly states (indeed, starts with):

"Research shows that people with same-sex partners may have a higher risk of contracting certain conditions, for instance lesbians may have a higher risk of breast cancer and gay men are at higher risk of HIV. They may also be less likely to take advantage of screening and other health checks so health problems are not picked up as early as they could be."

In contrast, HPB begins with:

"What is homosexuality/bisexuality?

Homosexuality is the emotional, romantic and sexual attraction to someone of the same sex. ‘Gay’ is commonly used to describe men who are attracted to men, and ‘lesbian’ for women who are attracted to women. Bisexuality is the attraction to both sexes.

Many people think that homosexuality and heterosexuality are on opposite ends of the sexuality spectrum, with bisexuality in the middle. In reality, human sexuality is much more complex. For example, some guys might consider themselves as heterosexual but have homosexual attraction towards men. And bisexuals might fi nd themselves attracted to guys and girls at diff erent times. For more information, check out the Kinsey Scale."

All of which is more or less true, but what does it have to do with sexual health?!

There are also misleading half-truths, like:

"Are homosexual and bisexual men more likely to get STIs/HIV?

Anyone who indulges in high-risk sexual behaviour (e.g. unprotected sex with multiple partners) is at high risk of being infected with a STI, including HIV... Correct and consistent use of condoms during any form of sex is the most e ective (sic) way of preventing STIs/HIV transmission"

It is well-known that gay men have more sexual partners than straight men, that a lot of gay men like to go bareback and that this is dangerous. Pretending that everyone's sexual behavior is the same can have disastrous consequences for sexual health (once again, a comparison with the NHS FAQ is instructive).

Also the most effective way of preventing STI transmission is not condom use but rather the ABC strategy: abstinence, being faithful and condom use (it is presumably relatively uncontroversial to state that not having sex is a virtually foolproof way of avoiding STIs/HIV).

As such, there are very valid concerns one should have about the HPB FAQ that are not motivated by religion or LGBT antipathy.

Footnote: The NHS pages on Trans health are arguably less neutral, but then gender dysphoria *is* a medical condition after all, and anyway they still read more neutrally than the HPB's FAQ.

Addendum: The Mayo Clinic has a similar approach to gay health: Health issues for gay men: Prevention first - Mayo Clinic

The Centers for Disease Control and Prevention is not too far off with their CDC - Gay and Bisexual Men's Health. There is a section on "Stigma and Discrimination" but this is both short compared to the rest of the sub-site and contextualised with respect to health. Also they state that:

"when compared with the general population, gay and bisexual men, lesbian, and transgender individuals are more likely to:

- Use alcohol and drugs
- Have higher rates of substance abuse
- Are less likely to abstain from alcohol and drug use
- Are more likely to continue heavy drinking into later life"

If you are a health authority, these are important facts to consider and address rather than promulgating politically correct claims that "LGBTs are exactly the same as straight people, kumbaya".
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