yes, i am inspired. i think my concluding statement kicks @$$.


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To the Editor

I refer to Dr Alan Chin Yew Liang's letter "Figures speak for themselves: Practising gays have higher risk of HIV dated 15 May 2007.

I am glad that he has rescinded his position that homosexuality is a disease that needs to be cured.

However, his statement that "homosexuality can be considered a lifestyle choice and thus does not qualify to be considered as a protected class under the law." I find it extremely ludicrous how a group of people can be protected by a law that states that their actions are illegal. The debate today is about the decriminalisation of homosexuality, and I have yet heard of a proposal to set up a "protected class under the law". In fact, the crux of the issue is equality - so that they are not to be treated differently from others.

The issue of practising gays having higher risk of HIV should be addressed, like practising heterosexuals, by the promotion of safe sex. Smoking increases the risk of lung cancer, and it is addressed by education - printing warning labels on the cigarette packs, and public education campaigns.

I am surprised yet again, that Dr Chin has referred to a specific study to justify his stand. His bias is clearly evident when he wrote "one of the few rational, scientific commentaries on the Spitzer study was offered by Scott L. Hershberger". He again failed to acknowledge the numerous other scientific commentaries that challenged the validity of Spitzer's study.

Bancroft mentioned in his commentary "Can Sexual Orientation Change? A Long-Running Saga (2003)" that the sample consists of men and women who principally sought treatment because of their religious beliefs and who were presenting themselves as evidence that such change was both possible and desirable for others (for 93%, religion was extremely or very important, and 78% had spoken in public about their "conversion," in many cases in their churches). Assessment of change was entirely based on their recall of how things were before treatment. Given their powerful agenda of promoting such treatment, it would be surprising if they did not overestimate the amount of change. A similar problem exists with the evaluation of any treatment for which the patient has a vested interest in proving its worth. Spitzer addresses this issue by pointing out that simple bias of this kind would have produced a more clear-cut picture of reorientation and no gender difference. He is partially right, but he cannot justifiably conclude that because there was not maximum distortion, that distortion did not occur.

In another commentary, "A Methodological Critique of Spitzer's Research on Reparative Therapy (2003)" by Helena M. Carlson it was stated that "participants in the study come from a very narrow stratification of the population: 97% were Christian, 95% were Caucasian, the mean age for males was 42 years, the mean age for females was 44 years, 76% of the males were married, and 47% of the women were married. Some participants were directors of ex-gay ministries and some had publicly spoken favorably of efforts to change sexual orientation, often at their church. Thus, this is a population of highly religious, White, Protestant, middle aged, and middle class men and women."

As a medical doctor, Dr Chin would agree with me that although the sample size was larger than those in previous studies, it is far from being a representative sample.

Finally, as I had mentioned in my earlier letter, "Dr Spitzer himself said in subsequent interviews "...the kinds of changes my subjects reported are highly unlikely to be available to the vast majority [of gays and lesbians... [only] a small minority -- perhaps 3% -- might have a "malleable" sexual orientation.". This statement, made in 2005, was totally glossed over by Dr Chin. Who better to judge Spitzer's study than Dr Spitzer himself?

Dr Chin stated that "the point is that even if one person can change, then homosexuality is not an immutable trait and we should not deny anyone the right to change." I think he has missed Dr Spitzer's point that only a small minority might have a "malleable" sexual orientation - one person can change does not mean that everyone else can.

I don't think the issue is denying anyone the right to change, but denying anyone the right not to change, especially if homosexuality is not decriminalised.



I REFER to Mr Siew Meng Ee's letter, 'Doctor using selective material to justify own conclusion' which was written in response to my letter, 'Homosexuality: disease or immutable trait?'. I thank him for his views that he has expressed.

Let me clarify what I have written. It is true that not all people who contract Aids are homosexuals and not all homosexuals have Aids.

Let's look at the statistics from the US' Communicable Diseases Centre (CDC) - in the year 2005, there were 45,669 cases of newly-diagnosed Aids cases of which 18,938 were from male-to-male sexual contact.

This means that 41.5 per cent of cases of Aids were transmitted by male-to-male sexual contact.

The estimated number of cases diagnosed through 2005 (this means the number of people at the end of 2005 having HIV) is 988,376.

The estimated number of this same group of people having Aids through male-to-male sexual contact is 454,106. This means that of the 988,376 diagnosed cases of Aids in the US, 45.94 per cent of these cases were contracted through male-to-male sexual contact.

The number of homosexuals in the US has been estimated to be 2.8 per cent ('the most widely accepted study of sexual practices in the United States is the National Health and Social Life Survey which found that 2.8 per cent of the male, and 1.4 per cent of the female, population identify themselves as gay, lesbian or bisexual.

See Laumann, et al, The Social Organization of Sex: Sexual Practices in the United States (1994).

This amounts to nearly four million openly gay men and two million women who are identified as lesbian.

This means that 2.8 per cent of the population in the US accounts for 41.5 per cent of the new cases and of the number of HIV cases in the States, 2.8 per cent of the population accounts for the 45.94 per cent of the people having Aids. When relative risk is calculated, this means that a person who engages in male-to-male sexual contact has a 2,400 per cent higher chance of getting Aids.

If we look at the Singapore figures for 2005, 2.8 per cent of the population accounted for 31 per cent of the new cases of HIV infection, 2.8 per cent of the population accounted for 22 per cent of the number of people diagnosed with HIV.

I believe the figures speak for itself, that practising homosexuals have a far higher risk of HIV with its numerous complications and increased mortality.

There are two main reasons for this.

1) The rectum is physiologically unsuitable for anal intercourse. Its fragility leads to increased risks of trauma during anal intercourse, accounting for the increased risks of infection, both bacterial and viral including HIV.

2) Homosexuals are sexually more promiscuous.

A 1978 study found that 75 per cent of homosexual white males claimed to have 100 male sex partners, 15 per cent 100-249 male sex partners, 17 per cent 250-499 male sex partners, 15 per cent 500-999 male sex partners and 28 per cent more than 1,000 male sex partners (Alan P. Bell et al, Homosexuality: A Study of Diversity among Men & Women pg 308 Table 7. New York 1978).

In a local publication, People Like Us: Sexual Minorities In Singapore, gay activist Alex Au Wai Pang wrote frankly about homosexual sexual values being different from that of heterosexual males. Both of Mr Au's articles in the book talk frankly about how many homosexuals are more promiscuous than their heterosexual counterparts.

With regard to whether homosexuals can change their sexual orientation, this is an issue that arouses the emotions of all concerned. As gay activists see it, if someone can change his or her sexual orientation, then homosexuality can be considered a lifestyle choice and thus does not qualify to be considered as a protected class under the law.

As why Dr Robert Spitzer's study was quoted, some background information as how this study came about is useful. Dr Spitzer is one of the most renowned psychiatrists in the US, who is called the father of DSM.

In fact, he was one of the key psychiatrists in deciding that homosexuality should be removed from the DSM. However, in the early 2000s, during an APA meeting, Dr Spitzer met some picketers who claimed that they had changed their sexual orientation.

Intrigued, he decided to do a study as, at that time, his view was that homosexuals could not change their behaviour.

He genuinely wanted to know if some homosexual men and women could change from homosexual to heterosexual, and that he wanted science to guide him. Certainly, with more than 275 publications to his credit, this esteemed scientist at Columbia University was more than able to conduct such a study.

With the limitations that are inherent to all such studies, Dr Spitzer employed the best rigours available for such research protocols.

His sample size was larger than those in previous studies. He was very detailed in his assessment and carefully considered the affective components of the homosexual experience.

Any bias in interview coding was virtually eliminated by near-perfect interrater scores. He limited his pool of applicants to those reporting at least five years of sustained change from a homosexual to a heterosexual orientation.

His structured interview clearly described how the participants were evaluated. His entire set of data is available for scrutiny by other researchers.

If his study methods are considered flawed, then all the original research material used by APA to justify the original change in classification is also flawed using the same argument.

Dr Spitzer's conclusions are simply this: Based on his study, there is evidence to suggest that some gay men and lesbians are not only able to change self-identity, but are also able to modify core features of sexual orientation, including fantasies.

His study was not designed to give the percentage of homosexuals that have changed. Dr Spitzer felt the percentage was low as it was difficult to find subjects willing to be interviewed.

One of the few rational, scientific commentaries on the Spitzer study was offered by Scott L. Hershberger. Dr Hershberger, a distinguished scholar and statistician, elected to respond in a Commentary to the Spitzer research (Hershberger's article was published in the same issue of the Archives of Sexual Behavior as the Spitzer study was) by conducting a Guttman scalability analysis. This is a scalogram to determine whether or not reported changes occur in a cumulative, orderly fashion.

Dr Hershberger's conclusion: 'The orderly, law-like pattern of changes in homosexual sexual behaviour, homosexual self-identification, and homosexual attraction and fantasy observed in Dr Spitzer's study is strong evidence that reparative therapy can assist individuals in changing their homosexual orientation to a heterosexual orientation.

'Now it is up to those sceptical of reparative therapy to provide comparably strong evidence to support their position. In my opinion, they have yet to do so.'

The Schidlo and Schroeder study, funded by the National Lesbian & Gay Health Association, was originally titled 'Homophobic Therapies: Documenting the Damage.'

The title was later changed to 'Changing Sexual Orientation: Does Counseling Work?' because they found that some people reported benefits to reorientation therapy including a change of sexual orientation. Biasness will be an issue as the aim of the National Lesbian & Gay Health Association is to prove that homosexuals are normal and healthy and reparative therapy is harmful.

There are thousands of testimonies of homosexuals who have changed their orientation. Even in Singapore there are testimonies of homosexuals who have changed their sexual orientation.

The point is that even if one person can change, then homosexuality is not an immutable trait and we should not deny anyone the right to change.

Dr Alan Chin Yew Liang