Should Homophobia be Treated?

"Homophobia" may range from mild, private feelings of discontent to raging hatred affecting public policies and social institutions such as marriage. When homophobia is internalized, it can affect the behavior and decision-making of the homophobic person significantly.
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"Homophobia" refers to the fear of homosexual people. It may span a range of feelings from mild, private feelings of discontent to raging hatred affecting public policies and social institutions such as marriage.

When homophobia is internalized, it can affect the behavior and decision-making of the homophobic person significantly, so much so, that people may go to large extents to avoid being perceived as homosexual. While trying to separate out "metrosexuals" and "bromance" from homosexuality can at times seem defensive, the effects of this "turf battle" are usually not so glaringly detrimental. However, a recent study has shown that a fundamental trait of internalized homophobia can have disastrous consequences, leading to denial and disabilities that can profoundly affect their lives.

Shoptaw and colleagues recently published a study in the Journal of Urban Health, in which they examined how internalized homophobia correlated with sexual behavior and HIV status. Their findings were quite revealing and concerning. There were two major implications: (1) Men who identified as straight (they may have been bisexual) who looked down upon homosexuality had more sexual partners than those who did not; (2) Also, greater internalized homophobia was highest in a subgroup of men who had sex with men and women who had never tested themselves for HIV. Of these men, 26% - more than a quarter- were HIV positive. What are the implications of these findings?

This study shows that homophobia can be a barrier to HIV testing and may also lead to a false level of feeling protected against HIV, thereby leading to multiple sexual partners and a greater risk of AIDS. It is notable that this study did not include men who had sex exclusively with women, but it did include people who self-identified as straight. In fact, it is notable that men who self-identified as straight despite having had sex with men were in danger of denial of the adverse effects of their sexual practices. What are the possible reasons for this?

One obvious reason is that the "straight" men in this study were petrified of examining the complexity of their sexuality, and in an effort to "block off" a real part of their lives, also blocked off a real concern about their own health. Having more sexual partners may also be a way to avoid being boxed into a category of sexuality, but it does pose a greater risk for not being tested and then, actually having HIV. In part, because of the strong associations of HIV with homosexuality, these men may not take the risk of HIV seriously. This points to the terrible effect of the anxiety of homophobia and a reason to pay attention to this. Clearly, there is some exaggerated sense of immortality that is created as a defense against examining the real risks of promiscuous sex.

In the US, Puerto Rico, for example, had the second highest rate of HIV infection, and 37% of people were likely infected during high-risk heterosexual contact. Sexual behaviors among heterosexual men and women are also evolving. In fact, between 2001 and 2006 in a study done in Seattle, New Orleans and St. Louis, 37% of heterosexual adults had had anal intercourse with only 26% of women reporting condom use during the last anal intercourse and 45% of men reporting condom use. In this respect, women were less protected than men. These and other data point to the real risk of HIV infection in heterosexual contexts and the absence of safe sexual behavior in this population.

With that many people having unprotected sex, the dangers of promiscuity pose a real tension for the sexual explorer-homosexual or heterosexual. Furthermore, a false unconscious association between HIV and homosexuality may make people avoid HIV testing, or not even think of it. Unfortunately, when the infection strikes, it is too late to do anything about this.

Clearly, we cannot make assumptions about safe sexual practices in the heterosexual community either, despite appearances. While education about the risk of STDs and safe sexual practices could be helpful the problem seems to be more deeply rooted in denial, but even more so, in the perceived "need" for sex regardless of risk. Sex is notorious for blocking off thinking, and in fact its appeal is based on this very effect, but the answer to the ever-present public health hazards of HIV is not facilitated by homophobia-this fear and anxiety seems to paralyze self-preservation as well. One wonders how much of this homophobia is rooted in self-hatred.

While society has done well to remove some policy prejudices against groups such as women and people of color, with still more that has to be done, it is notable that people still feel protected by the fact that they cannot "become" a woman (unless they go through several conscious procedures) or a black person, for example. However, this same level of assurance does not appear to exist for homosexuality and the resulting homophobia clearly sets up an irrational set of thoughts and beliefs that have a huge impact on health.

With homophobia therefore affecting quality of life in terms of HIV awareness, the question arises: how different is this from social phobia or spider phobia or any other phobia? I would argue that homophobia, like these other phobias, can reach proportions where it is disabling to a person's health, and should be addressed by primary care physicians or psychiatrists so as to protect people from their own fears and beliefs.