Dr Alan Chin Yew Liang
Dr Alan Chin is a family physician who graduated in NUS in 1982 (Update 16 Apr 2009, Article has been removed from sma.org.sg website. Click here for a screen shot of the article.). He is not a statistician. He is the person who helped in counting the votes.
He wrote 6 articles to Straits Times
1. Homosexuality: Neither a disease nor an immutable trait, ST Online Forum, May 8, 2007 Tuesday
2. Figures speak for themselves: Practising gays have higher risk of HIV, ST Online Forum, May 15, 2007 Tuesday
3. Aids and gays: A flawed response, ST Online Forum, May 28, 2007 Monday
4. Let’s conserve our marriage constitution as one between man and woman, ST Online Forum, July 16, 2007 Monday
5. Law and public education should go hand in hand in dealing with HIV, ST Online Forum, August 7, 2007 Tuesday
6. Beware the high-risk ‘gay lifestyle’, ST Forum, August 8, 2007 Wednesday
Homosexuality: Neither a disease nor an immutable trait
May 8, 2007 Tuesday
I WRITE with regard to the recent discussion on the issue of homosexuality. Homosexuality, until recently, was regarded as a disease.
A disease is defined as an impairment of health or condition of abnormal functioning.
Homosexuality certainly fits the definition of a disease as there is an increased mortality rate mainly from Aids; the life expectancy of a homosexual and bisexual male is up to 20 years shorter compared to a normal male (R.S. Hogg, et al, ‘Modelling the impact of HIV disease on mortality in Gay and Bisexual Men’ International Journal of Epidemiology 1997).
There is also an increased morbidity rate, with a greater risk of suffering from sexually transmitted diseases, including Aids, and increased risk of psychiatric illnesses such as depression, suicides and drug abuse.
Simply put, being a homosexual (statistically speaking) puts one at risk of suffering from poor health and dying early.
In 1973, homosexuality was removed from the Diagnostic And Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA).
The question we have to ask is: How did this come about? One would think that the APA would not have taken such a step unless there was strong scientific evidence to justify such a move.
A review of the history of events shows that the decision was not based on scientific evidence, but in fact was the response of an organisation under siege by gay activists. Ronald Bayer’s book, Homosexuality And American Psychiatry: The Politics Of Diagnosis, documents the political nature of this battle over DSM.
Dr Bayer defends this move by APA, saying: ‘Psychiatry may, under certain circumstances, act upon society, using its cultural influences to challenge social values and practices.’
It is clear from this that the removal of homosexuality from DSM was a political settlement and not due to scientific evidence. Thus, homosexuality should still be regarded as a disease.
The question is, if homosexuality is a disease, can it be treated?
There have been numerous documented cases of people who have changed their sexual orientation.
Dr Robert Spitzer, who was very much involved in the 1973 removal of homosexuality from DSM, found in a 2001 study, that ‘there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians’.
It follows from this that homosexuality is neither a fixed trait nor is it immutable.
Figures speak for themselves: Practising gays have higher risk of HIV
May 15, 2007 Tuesday
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.
Aids and gays: A flawed response
May 28, 2007 Monday
I REFER to the letter written by Mr Wong Suan Yin, ‘Aids: Stop the spread of misinformation’.
The letter misrepresents what I have said. It is not true that I made the statement that homosexuality leads to the spread of Aids and therefore criminalising homosexual sex will prevent the spread of Aids.
My article only mentioned that there is an increased risk of homosexuals engaging in anal intercourse in contracting the HIV virus. The reasons given for this is that anal intercourse is inherently unhealthy and studies have shown that homosexuals are more promiscuous.
Mr Wong has missed the point made by me in the letter and has gone off tangent with his own argument.
Unfortunately his argument is flawed. Let me clarify.
HIV virus is spread in three main ways.
1. From mother to child during birth
2. Sexual contact during intercourse, oral, vaginal and anal
3. Via blood either through contaminated blood, contaminated blood products, contaminated donor organs, tattooing and intravenous drug abuse
According to WHO statistics, there is a higher incidence of HIV in women and children in Third World countries compared to the rest of the world.
It is just as true that in Singapore and in the United States, there is a high incidence of HIV among homosexual men who engage in anal sex.
How do we reconcile this? Obviously there must be environmental factors involved that lead to differences between the two. Unfortunately WHO statistics from most Third World countries do not show the mode of infection.
There are so many unanswered questions. We do not know how many of the mothers contracted HIV because of drug abuse or how many of their husbands were drug abusers.
We do not know how many of their husbands had intercourse with high-risk individuals. We do not know the incidence of bisexual men who are married.
In some African cultures, bisexual behaviour is rampant. Culturally, in some countries, young men are sent by their fathers to prostitutes for their first sexual experience.
Some studies have shown that the incidence of HIV among young children is higher than that of mothers in Africa. This implies that children are getting HIV from sources other than their mothers. Contaminated needles? Contaminated dental equipment?
How many adults are infected through contaminated medical equipment due to poor health care? All these cultural, social and environmental factors affect the behaviour and sexual practices of individuals and therefore account for the different figures seen in different countries.
We cannot apply these figures to the situation in Singapore because the environment is different.
Let me illustrate with an example.
We know that poverty leading to malnutrition and starvation is statistically one of the leading causes of death among children in the world. Obviously it is illogical to put all our resources in eradicating malnutrition and starvation to lower the death rate of children in Singapore. This will not help at all as it is not a leading cause of death in Singapore.
Similarly for the case of HIV infection, we have to look at the local context, what the local statistics are and what the risk factors for our population are. As I have previously stated, our local statistics and those of the US show that the group with the highest risk of being infected by the HIV virus is that of individuals who indulge in anal intercourse.
Currently anal intercourse is a criminal offence. The argument put forward that decriminalisation will make it easier to educate those who engage in such practices and lower the risk of HIV needs to be examined carefully.
As a doctor I wrote in to highlight the public health issues involved in this matter. As for public policy issues, this is not an appropriate forum. Parliament will consider all these issues in due course.
Let’s conserve our marriage constitution as one between man and woman
July 16, 2007 Monday
I WRITE in response to Mr Janadas Devan’s article, ‘Can mum, mum and kids make a family?’ (ST, July 7) and Dr George D. Bishop’s letter, ‘Special-needs kids thrive, thanks to mum and mum’ (ST, July 11).
The main thrust of their letters are that lesbians and homosexuals can and are a normal family unit and can take care of children just as well as any other family unit and thus should be allowed to get married and be one.
The basic building block of society has always been the family which is defined as a married father and mother with children. Without strong family units, society will be fraught with problems. Our Prime Minister has rightly stated that the family unit is the core of our Singapore society.
Now homosexuals and lesbians want to redefine ‘marriage’ and ‘family’. Why so? There is an inherent need for them to be accepted by society that their sexual behaviour is not abnormal but just a variation of normal sexual activity.
Do we want a Singapore where same-sex marriage prevails? If so, one might ask why not incorporate the following as diverse families.
1. two brothers;
2. two sisters
3. a brother and sister (case in German courts)
4. a man and a horse (film ‘Zoo’ shown in Sundance Film Festival - bestiality)
5. why not a combination of three or more?
6. why bother have a marriage or a family?
All these questions are not too remote; because those pursuing a perverted lifestyle must have the endorsement of society to secure their very identity, and the only way to achieve this is to go down the slippery road to establish that perversion is normal like incest is normal; bestiality is normal.
It is an issue of self-autonomy. Self is god. The point made is not academic but it has already happened and will continue to happen. This may be seen in the case of the four legislators in Massachusetts who followed up ‘their success at legalising homosexual unions by pushing for softening laws against other forms of sexual deviance’ including bestiality viz reducing the penalty to a fine (See First Comes Gay Marriage then comes Bestiality in Massachusetts http://www.lifesite.net/ldn/2005/nov/05111703.html )
The four Democrat legislators ‘are all vocal supporters of abortion, homosexual unions, and are all endorsed by all three of Massachusetts’ gay lobby groups. Family lobbyists opposed to the re-definition of marriage were frequently ridiculed for their warnings that dissolving the natural basis of marriage in law would end with legalising and normalising a host of sexual perversions, including incest and bestiality. The case of the Massachusetts legislators is in point.
Following this, ‘the media has quickly picked up on the trend of acceptance for any and all sorts of conditions that before the 1960’s sexual revolution and the politicising of the psychiatric profession, were universally recognised as serious psychological disorders. New terminology has been established, calling those persons interested in having sexual relations with animals, ‘zoophiles’ or ‘zoos’ for short, and a campaign has been discretely under way for some time to reduce the public ’stigma’ against ‘zoos’.
We, in Singapore, want to conserve our marriage institution as one between a man and a woman so that the needs of our children for a father and a mother are catered for. We abhor any regression into perversity which, as history has shown, has led into the decline and fall of a society.
Law and public education should go hand in hand in dealing with HIV
August 7, 2007 Tuesday
I WRITE in response to the letter by Mr Paul Toh, ‘ ‘Bug chasers’ or ‘gift givers’ will not be let off lightly by the gay community’ (ST, Aug 2),
His statement that because of our laws, especially Penal Code Section 377A, the message of ’safe sex’ cannot be effectively communicated to those at risk is flawed.
Take the example of heroin drug abuse; laws prohibit its use. Using the same line of argument as Mr Toh’s, it would then not be possible to effectively communicate the message ‘Do not use drugs’.
However, the message against drug abuse has been effectively communicated to all segments of society. Everyone knows that it is wrong to use drugs and if you are caught you will be punished.
In the United States, 99 per cent of the population understands that you can get HIV through unprotected sex. In the United States’ CDC Mortality and Morbidity Weekly Report, June 24, 2005, Issue, a study of 1,767 MSM men showed that one in four men had HIV. The number of MSM men getting HIV continues to rise despite all efforts.
This shows that education and awareness of HIV by itself cannot bring down the infection rates of HIV. If it were so, then data from the US should show falling rates of infection rather than rising rates.
An example of the inadequacy of public education and awareness alone is the phenomenon of ‘bug chasing’ and ‘gift giving’ at ‘bug parties’.
This reckless behaviour is found among men who engage in anal penetrative coitus. Men, who knowing that they have HIV, yet still engage in unprotected anal penetrative coitus. This practice of having deliberate unprotected anal sex has the potential to cause widespread HIV infection. These men know that it is wrong and yet persist in doing it.
The number of MSM men having HIV in Singapore is about 1 in 20. It is still unacceptably high. However, compared to the US, we have a five times lower rate of infection.
It is our society’s stance against such immoral and socially irresponsible behaviour and our laws, especially Penal Code Section 377A, that account for this difference.
Evidence in point:
1) Some time ago, the then Senior Minister of State for Health, Dr S. Balaji, stated that the relaxation of our laws against ‘gay’ events led to a spike in the number of HIV cases among MSM men from 2003 to 2004.
2) We have the lowest rate of heroin and drug abuse in the world because of our strict laws and tough stance against drug abusers.
Sometimes tough love is needed for those who, despite their being aware of their irresponsible and reckless behaviour, do not want to change.
The law and public education should go hand in hand in dealing with this scourge of HIV.
Beware the high-risk ‘gay lifestyle’
August 8, 2007 Wednesday
IN THE article, ‘Most with Aids virus don’t know they have it’ (ST, July 18), Senior Minister of State Balaji Sadasivan announced that a study of 3,000 blood samples in government hospitals showed that 1 in 350 samples was positive for the human immunodeficiency virus (HIV) which causes Aids. The male to female ratio of these cases was 15:1.
What conclusions can we draw?
The 15:1 ratio means that the HIV epidemic is still confined mainly to the high-risk groups (concentrated epidemic) and has not spread to the general population (generalised epidemic). If it were already in the general population, the ratio would be much closer to 1:1.
Therefore we still have time to do something before the situation gets worse.
Who constitutes these high-risk groups?
Data released by the Ministry of Health on HIV last year showed two groups of men were responsible for approximately 83 per cent of HIV cases.
53 per cent of the cases were men who contracted HIV via unprotected high-risk heterosexual sex. This group was infected overseas or by local unlicensed prostitutes; our licensed prostitutes are screened for HIV.
30 per cent of the cases comprised men having sex with men (MSM). Based on the prevalence of 2.8 per cent of men being homosexual or bisexual, there are about 67,000 men in Singapore who engage in MSM.
I highlight this second high-risk group as it is a matter of public interest and concern, given the ongoing debate on the review of the Penal Code relating to Section 377A.
Extrapolating from the infection rate of 1 in 350 and 15:1 ratio of males to females, the conclusion is that among men who indulge in MSM, about one in 20 has HIV and does not know it.
This means that someone who indulges in MSM and has 20 sexual partners would have exposed himself to HIV.
A survey conducted in the United States has shown that 75 per cent of homosexual men have more than 100 sexual partners and 28 per cent of them have more than 1,000 partners.
I feel that not enough has been done to warn our youth that leading a ‘gay lifestyle’ is not cool. On the contrary, it is very unhealthy. There is a very high risk of contracting not only HIV but also a slew of other sexually transmitted diseases.
http://forums.delphiforums.com/sunkopitiam/messages?msg=27360.1
