The Sexual Continuum

American Psychological Association says, “Don’t tell patients they can change their sexual orientation.”

Brian Mustanski, Ph.D. — Tue, 01 Sep 2009 20:05:02 +0000

The American Psychological Association's (APA) governing Council of Representatives recently adopted a resolution stating that mental health professionals should avoid telling clients that they can change their sexual orientation through therapy or other treatments. The resolution also advises that parents, young people and their families avoid sexual orientation treatments that falsely portray homosexuality as a mental illness or developmental disorder. If a family or individual is struggling with acceptance, the resolution advises seeking services "that provide accurate information on sexual orientation and sexuality, increase family and school support, and reduce rejection of sexual minority youth."

APA appointed the six-member Task Force on Appropriate Therapeutic Responses to Sexual Orientation in 2007. The task force examined the peer-reviewed journal articles in English from 1960 to 2007, which included 83 studies. The group also reviewed the recent literature on the psychology of sexual orientation. Some of the major conclusions of this literature review were:

1) Sexual stigma is a major source of stress for LGBT people. This stress, also known as minority stress, is a factor in mental health disparities found in some sexual minorities (i.e. LGBT people). We have found evidence in our studies of LGBT youth in Chicago that support this idea. LGBT stigma and victimization were significant predictors of psychological distress and depression symptoms. Family and peer support reduced psychological distress, but did not eliminate the negative effects of victimization.

2) Same-sex sexual attractions, behavior, and orientations are normal and positive variants of human sexuality. They concluded this based on the fact that homosexuality is not a mental or developmental disorder.

3) "Gay, lesbian, and bisexual individuals form stable, committed relationships and families that are equivalent to heterosexual relationships and families in essential respects." See my blog on the Iowa Supreme Court decision for more about this.

4) The major conclusions of the report focused on if therapy can change a person's sexual orientation, if it is harmful, and if it has any benefits. The authors said, "These studies show that enduring change to an individual's sexual orientation is uncommon. The participants in this body of research continued to experience same-sex attractions following SOCE [sexual orientation change efforts] and did not report significant change to other sex attractions that could be empirically validated, though some showed lessened physiological arousal to all sexual stimuli. Compelling evidence of decreased same-sex sexual behavior and of engagement in sexual behavior with the other sex was rare." They also found some evidence that attempts to change a person's sexual orientation cause harm (i.e. iatrogenic effects) such as loss of sexual feeling, depression, suicidality, and anxiety. However, research in this area was limited; as the authors said, "There are no methodologically sound studies of recent SOCE that would enable the task force to make a definitive statement about whether or not recent SOCE is safe or harmful and for whom." The press release announcing the resolution included an interview with Dr. Judith Glassgold, chair of the task force, who said, "Without such information, psychologists cannot predict the impact of these treatments and need to be very cautious, given that some qualitative research suggests the potential for harm. Practitioners can assist clients through therapies that do not attempt to change sexual orientation, but rather involve acceptance, support and identity exploration and development without imposing a specific identity outcome."

What should we take away from this resolution? The resolution states that efforts to change a person's sexual orientation are unlikely to be successful and involve some risk of harm. If a licensed mental health profession ignores this resolution and tells a client or family that they can use therapy to change someone's sexual orientation they risk a malpractice lawsuit. While the standards for malpractice vary by jurisdiction, it is generally defined as deviation from the accepted standards of practice and causing injury to the patient. Gay youth who are in good mental health and may be in some way forced by family to undergo a "treatment" to change their sexual orientation may have particularly strong grounds for a malpractice lawsuit if the "treatment" leads to psychological distress or injury.

I hope that this resolution, and the threat of future malpractice, leads clinicians to abandon claims that they can alter a person's sexual orientation through therapy. I also hope it leads families and individuals to realize such practices are not in the best interest of the LGBT individual. It will be interesting to follow any resulting malpractice cases over the next few years.

Here are links to the press release and full resolution.
http://www.apa.org/releases/therapeutic.html
http://www.apa.org/pi/lgbc/publications/therapeutic-response.pdf

Image from Truth Wins Out.

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What to do when someone calls you a “fag.” How to cope with microassaults.

Brian Mustanski, Ph.D. — Fri, 10 Jul 2009 19:24:12 +0000

Two very close friends of mine had people yell "fag" at them this last week. The first was when one was crossing the street in a gay-identified neighborhood in Chicago. Apparently the woman thought the cross-walk belonged to her and wanted to make it clear she didn't like stopping for him to cross. The second was when another friend pulled into a parking space that the other driver thought she deserved. Both friends of mine are gay. Both have been out for a while, have strong and positive connections to the gay community, and have pride in their sexual orientation. Both are successful, generally happy, and have strong self-esteem. Both were upset by what happened. Not crying upset. Not on-the-verge-of-lapsing-into-depression upset. But upset when it happened and still bothered a few days later. They both said almost the exact same thing, "I really don't care what she thinks, but is still bothered me. I should have confronted her more. "

Recently I wrote a blog about microaggressions, which are aggressions against minority people that are more subtle than what we think of traditionally as overt racism or sexism. These microaggressions can range from more overt behaviors like name calling, to insensitivity to a person's racial heritage, to comments that negate the feelings of minority people. What is particularly insidious about these experiences is that not only are they an assault against the minority person, but they often lead the victims to question themselves. Why was I so upset by that? Am I making too big of a deal of this? Did I handle the situation right?

One of the amazing things about people is that they can cope and thrive in the face of adversity. Stress and coping research has repeatedly shown that coping behaviors are protective against stressors...but some coping strategies work better than others.

Researchers generally divide coping into two kinds. Active coping strategies are designed to change the nature of the stressor itself or how one thinks about it. Avoidant coping strategies are activities (such as alcohol or drug use) or mental states (such as denial) that keep people from directly addressing stressful events.

So what is the best way to cope with a microassault? The answer may depend on the individual, but in general passive forms of coping are the least effective. Active, problem-focused coping have been shown to be the most effective. The positive effects of active coping with discrimination have been found on outcomes ranging from mental health to blood pressure across a range of minority groups.

Based on this research, what advice do I have for my friends who were called "fag?" How do you actively cope when something like this happens? Here are a couple of suggestions from the coping literature: 1) When it is safe, confront the person who victimized you. 2) Take action to deal with the specific situation or the general problem. If it occurred in a business setting, report the perpetrator to their supervisor. Consider joining or supporting a gay rights group. 3) Plan a way to deal with this problem in the future. 4) Seek support from your friends that focuses on getting assistance, information, or advice on what to do. 5) Get emotional support from your friends. 6) Think about ways that you can learn and grow from the experience. These are just a few active coping strategies. If you have other ideas, post them below.

Little research has been done on discrimination, coping, and health in LGBT populations. My research team has a study underway now looking at these relationships and I look forward to writing about our findings when the study is completed.

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F- You (Very Much): Pop star Lily Allen sums up the youth perspective on homophobia

Brian Mustanski, Ph.D. — Tue, 19 May 2009 18:02:13 +0000

Let me start by saying this post and the embedded video are not for people who are offended by "the F word." It is for people who are offended by homophobia.

The 23 year old pop star, Lily Allen, has a song on her new CD titled "Fuck You (Very Much)" which is a serenade to homophobic people. The song opens with the Allen singing in a sweet and cheery voice, "Look inside, look inside your tiny mind. Then look a bit harder. ‘Cause we're so uninspired, so sick and tired. Of all the hatred you harbor."

There was a time when efforts to subvert homophobia and anti-gay policies were more aggressive and hard line. Marches and protests were the primary form of action. In recent years the gay rights movement has taken a more amiable approach to advocacy by focusing on working with politicians and trying to sway public opinion by creating opportunities to empathize and identify with LGBT people. The social and political change that has come in the last decade is undeniable. Consider the legal recognition of same-sex relationships or the polls indicating acceptance of gay couples, families, and communities.

At the same time, my interactions with LGBT young people indicate a frustration with the pace of progress and a disconnect between their daily experiences, friendships, public policy, and the hate crimes against LGBT people reported in the media. How does a young person whose friends are widely accepting of them being gay reconcile this with stories of young people committing suicide because of bullying or protests and opposition to same-sex marriage? How do young people with a gay friend feel when they hear about another young person being murdered because of their sexual orientation?

The chorus of Allen's song is "Fuck you. Fuck you very, very much. ‘Cause your words don't translate and its getting quite late. So Please don't stay in touch." That sentiment I think reflects the growing perspective of youth who are tired of the intolerance of older generations and a minority of their peers.

Songs like this, I suspect, will become more common. I think they reflect the frustration youth are experiencing with this time of disconnect between growing acceptance of LGBT people and horrible cases of victimization and oppression. Youth led movements take advantage of new media, like the Internet and social networking sites. Below I posted a video created by a group of youth to the music of Lily Allen's song. A "collab" is a group of people, often times who don't even know each other, who work together to create a YouTube video by each creating pieces of the larger video. This video clearly illustrates the creativity, sense of humor, and great frustration of these young people.

Do you have other examples of how youth are using new media and creative expression to demonstrate their frustrations with homophobia and intolerance? Share them below.

Speaking of new media, the Sexual Continuum Blog now has a facebook page. To become a fan of the blog, click here and then choose to "become a fan." By joining you will get updates as new blog posting come out.

Today is National Day of Silence: Remembering Joseph Walker-Hoover

Brian Mustanski, Ph.D. — Fri, 17 Apr 2009 16:07:04 +0000

Today is the 13th annual Day of Silence, which is the largest single student-led action towards creating safer schools for all, regardless of sexual orientation, gender identity or gender expression. Students across the country will bring attention to the issues of harassment and name calling of Lesbian, Gay, Bisexual, and Transgender (LGBT) youth by staying silent.

Unfortunately, nearly 9 out of 10 LGBT youth (86.2%) reported being verbally harassed at school in the past year because of their sexual orientation, nearly half (44.1%) reported being physically harassed and about a quarter (22.1%) reported being physically assaulted, according to the Gay, Lesbian, and Straight Education Network's (GLSEN) 2007 National School Climate Survey of more than 6,000 LGBT students.

In our own studies of LGBT young people living in Chicago we found that 94% of them had experienced some kind of victimization because of their sexual orientation or gender expression, including things like being threatened with physical violence, having things thrown at them, being chased, or spat upon. We also found that these kinds of experiences were strongly related to depression and suicidal feelings. While the only way to stop these toxic effects is by preventing the bullying and violence, we also found that peer and family support promote mental health. This means we need to stop the violence AND support LGBT young people.

This year I will be commemorating the day of silence by mourning the loss of 11 year old Carl Joseph Walker-Hoover, who hung himself last week after enduring bullying at school, including daily taunts of being gay, despite his mother's weekly pleas to the school to address the problem. Carl, a middle-school student in Massachusetts who did not identify as gay, would have turned 12 today. His death reminds us that you don't have to identify as gay to suffer the negative effects of stigma experienced by LGBT people in our society. While our research shows that the vast majority of LGBT youth grow up to be happy and healthy adults, we also need to remember those who are suffering from this kind of bias and discrimination and do what we can to help. Below are a few links with more information and organizations that you may want to consider supporting.

http://www.glsen.org
http://www.dayofsilence.org
http://www.PFLAG.org

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Triumph of scientific reason: Iowa becomes third state to legalize same-sex marriage

Brian Mustanski, Ph.D. — Sun, 05 Apr 2009 18:42:42 +0000

This last week Iowa became the third state to legally recognize marriage between same-sex couples. This recognition resulted from a unanimous ruling of the Iowa Supreme Court. I have followed a number of court decisions on this topic and one thing particularly impressed me about this one-- the court carefully weighed and correctly reviewed social science research on the impact of recognizing same-sex relationships. As I have written about in previous postings (Why not allow gay marriage?), the research evidence is pretty clear that recognizing same-sex marriages helps gay and lesbian couples and their children and there is no evidence that it harms anyone. But several previous courts have either accidentally or purposely misunderstood this research to be much more mixed or even just ignored the research entirely.

Let's hope the approach taken by the Iowa Supreme Court catches on. Based on an Amicus curiae brief filed by the American Psychological Association, expert testimony by Psychologists Gregory Herek, and their own review of the research, the court said, "The plaintiffs produced evidence to demonstrate sexual orientation and gender have no effect on children raised by same-sex couples, and same-sex couples can raise children as well as opposite-sex couples. They also submitted evidence to show that most scientific research has repudiated the commonly assumed notion that children need opposite-sex parents or biological parents to grow into well-adjusted adults. Many leading organizations, including the American Academy of Pediatrics, the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, and the Child Welfare League of America, weighed the available research and supported the conclusion that gay and lesbian parents are as effective as heterosexual parents in raising children. For example, the official policy of the American Psychological Association declares, There is no scientific evidence that parenting effectiveness is related to parental sexual orientation: Lesbian and gay parents are as likely as heterosexual parents to provide supportive and healthy environments for children. [FN3] Almost every professional group that has studied the issue indicates children are not harmed when raised by same-sex couples, but to the contrary, benefit from them."

I particularly liked their discussion of opinions by people who want to prevent same-sex couples from achieving marriage equality. They court said, ""Plaintiffs presented an abundance of evidence and research, confirmed by our independent research, supporting the proposition that the interests of children are served equally by same-sex parents and opposite-sex parents. On the other hand, we acknowledge the existence of reasoned opinions that dual-gender parenting is the optimal environment for children. These opinions, while thoughtful and sincere, were largely unsupported by reliable scientific studies." This is a very respectful way for the court to disagree with what was surely a very vocal group opposed to same-sex marriage that likely implied that same-sex couples are not fit parents.

Finally, the court had a particularly nice way of summing up the fact that there are no benefits in denying same-sex couples the right to marry. "Thus, the sole conceivable avenue by which exclusion of gay and lesbian people from civil marriage could promote more procreation is if the unavailability of civil marriage for same-sex partners caused homosexual individuals to 'become' heterosexual in order to procreate within the present traditional institution of civil marriage. The briefs, the record, our research, and common sense do not suggest such an outcome."

As a behavioral scientist, I am heartened by the use of research by the court to inform sound public policy. Over the last eight years it has sometimes felt like research was having very little impact on the government's policies, which can be very demoralizing for those of us who do research in order to improve people's health and wellbeing. This triumph is cause for celebration because it can help to improve the lives of same-sex couples and their families living in Iowa, but also because it is a resounding example of how decision makers should use science.

Acknowledgment: The sections from the Iowa Supreme Court decision highlighted in this posting were brought to my attention in an email by Dr. Gregory Herek on the APA division 44 listserv. To learn more about Dr. Herek's important research and advocacy on behalf of LGBT people visit his website at http://psychology.ucdavis.edu/rainbow/.

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Unmasking subtle heterosexism: Microaggressions and microvalidations in everyday life

Brian Mustanski, Ph.D. — Mon, 16 Mar 2009 04:34:24 +0000

Columbia University Psychologist Dr. Derald Wing Sue has pioneered research on what are called "racial microaggressions" or experiences of racism that are so subtle that neither victim nor perpetrator may entirely understand what is going on. These microaggressions can range from more overt behaviors like name calling, to insensitivity to a person's racial heritage, to comments that negate the feelings of minority people. Think about things like an Asian American person repeatedly being asked "where are you from?" which can send the message that they are not American. Or an African American person being followed around a store. In both of these cases it isn't entirely clear that a racist even occurred, but if you are a minority and these things happen all the time you start to really notice them.  While a single negative comment isn't likely to send someone spiraling to full blown depression or substance abuse, emerging research suggests that the accumulation of these subtle negative experiences can build up and may prove to be especially toxic for minority people.

Dr. Sue has grouped various kinds of microaggressions into three areas:

A microassault is an explicit verbal or nonverbal attack meant to hurt the intended victim through name-calling, avoidant behavior, or purposeful discriminatory actions.

A microinsult is characterized by communications that convey rudeness and insensitivity and demean a person's racial heritage or identity. Microinsults represent subtle snubs, frequently unknown to the perpetrator, but clearly convey a hidden insulting message to the recipient of color.

Microinvalidations are characterized by communications that exclude, negate, or nullify the psychological thoughts, feelings, or experiential reality of a minority person.

After reading this article on microaggressions in the APA Monitor I have been spending a lot of time thinking about this topic. I have been particularly curious about how gay and lesbian people may experience these kinds of microaggressions and how we might go about studying their occurrence and effects. I turns out almost no research has been done on LGBT people and microaggressions. So I started paying attention and making a note of various kinds of experiences I have in my daily life and recent travels. Here are a few examples of things I have recently experienced:

1) A customs agent pointedly agent asking my partner and I if we are "friends." While I thought about correcting him and saying in fact we are partners, I eventually decided it wasn't worth it. I wasn't entirely sure why he said it the way he did and didn't want to raise an issue that may not have existed, but it did feel like it invalidated my relationship and made me frustrated that I wasn't sure how to respond.

2) A colleague told me that she knew what is was like to be gay because she was a religious minority. While I certainly agree that there are certain aspects of minority status that may illuminate the experience of other minority groups, it seemed to deny the unique aspects of LGBT people to assume total understanding of my experience.

3) I read an article in a magazine that talked about how fantastic gay men were at fashion and art. This made me feel like a stereotype (whether it fits me or not is another question).

4) Proposition 8 passed in California and invalidated the legal recognition of same-sex relationships.

While these kinds of experiences can make a LGBT person feel invalidated or stigmatized, I also have been thinking the kinds of events that can instill feelings of validation. For example, on a recent flight a couple sitting next to me were gushing to me about their gay son and his male partner. The casual way that they talked about their son and his partner on the crowded plane made me feel at ease telling them about my partner and our recent travels.

My research team and I are in the process of creating a measure of microaggression and microvalidation experiences unique to LGBT people that we can administer in an upcoming study. Help us create this measure by leaving a comment below about experience that made you feel assaulted, insulted, invalidated. Or just as important, leave a comment about a positive experience you had that made you feel validated as an LGBT person.

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A cartoon guide to sexual orientation

Brian Mustanski, Ph.D. — Tue, 27 Jan 2009 00:07:15 +0000

Ever since we published the first genetic scan for male sexual orientation, one of the most frequent questions I get asked is "why are people gay." While I have done my best to share information about the science of sexual orientation (this blog being one example), I am not an animator so I haven't explored cartoons as an option. Fortunately, I don't have to now because a cartoon recently posted on YouTube does a fairly good job. The video tries to take on two of what I like to call "the big three arguments against gay people." If you listen to enough anti-gay rhetoric you will find it usually comes down to at least one of the following statements, "I don't believe in it, its unnatural, it's a choice." Watch the video and then let me fill in some of the details from research on sexual orientation.

Parents.

The video starts out with theories about parental influences on sexual orientation, like having a distant father or overbearing mother making a man gay. In fact, this was a theory put forward by some Psychologists and Psychiatrists. It was also used to explain why some people were schizophrenic. Eventually it was disproved in both cases. For example, in the 1970 researchers at the Kinsey Institute conducted a large survey and found no support for the idea that these kinds of parental influences made children gay (Bell, Weinberg, & Hammersmith, 1981). In the 28 years since that book was published there hasn't been any credible evidence showing that any kind of parental behavior changes the sexual orientation of their children.

Being gay is natural.

Next the video tackles the question of if homosexuality is "natural." This is one of the big three. I don't believe something being "natural" is a good argument for or against it. After all, lead is natural, but that doesn't mean I want it in my drinking water. Nevertheless, the point made in the cartoon about animals is true. Many species of animals engage in same-sex behavior and some have members that exhibit primary sexual attractions to their own sex. A few very good books have addressed this topic (Bagemihl, 1999; Sommer & Vasey, 2006).

You don't decide who to love.

When Martha says "You don't just decide who to love," I think she is right. Research shows that sexual attractions emerge around the time of puberty. If you think back to puberty, do you remember making a choice of who you would be attracted to? In fact, research shows that it doesn't matter what your sexual orientation is, it tends to emerge around the time of puberty. All indications are that people don't choose their sexual orientation.

It's in our genes.

Twin research has indeed found that if one identical twin is gay the other twin is also more likely to be gay. More importantly from a scientific perspective, is the fact that identical twins are significantly more likely to have the same sexual orientation than fraternal twins (Mustanski, Chivers, & Bailey, 2002). One of the best of these studies found the heritability of sexual orientation to be 62% (Kendler, Thornton, Gilman, & Kessler, 2000). This means that 62% of why some people are gay and others are straight is due to genetic effects. The cartoon is right in saying this is higher than handedness, which has a heritability of around 25% (Medland, Duffy, Wright, Geffen, & Martin, 2006).

Older brothers.

One of the most established findings in all of developmental psychology is that each older brother increases the chance that a man will be gay. Younger brothers don't seem to have an effect and neither do sisters. In fact, siblings don't seem to be related to a women's sexual orientation at all. But among men, each older brother increases the chance of homosexuality by about 33% (Blanchard & Bogaert, 1996). It has been hypothesized that this effect is due to mothers producing antigens to male fetuses and that these antigens have effects on the developing brain (Blanchard, 2008). However, the cartoon seems to make it seem like this is a fact, when at this stage it is only a theory.

My therapist made me straight.

The video ends with a discussion of whether it is possible to change a person's sexual orientation through therapy or prayer. Conclusive research has yet to show this is possible and some very well respected doctors have said it is not possible (for a good summary of research in this area see Professor Gregory Herek's website). The video is correct in saying that all major mental health organizations have some out with statements saying that homosexuality is not a mental illness and attempts to change it are not advisable (for example, see the statement by the American Psychological Association).

I hope you enjoyed the cartoon. Share it by clicking the "Share/Email" button below and maybe if enough people watch it the statement "I don't believe in it, its unnatural, it's a choice," will become a think of the past.

The Sexual Continuum Blog now has a facebook page. To become a fan of the blog, click here and then choose to "become a fan." By joining you will get updates as new blog posting come out.

References

Bagemihl, B. (1999). Biological exuberance : animal homosexuality and natural diversity (1st ed.). New York: St. Martin's Press.

Bell, A. P., Weinberg, M. S., & Hammersmith, S. K. (1981). Sexual Preference: Its development in men and women. Bloomington: Indiana University Press.

Blanchard, R. (2008). Review and theory of handedness, birth order, and homosexuality in men. Laterality, 13(1), 51-70.

Blanchard, R., & Bogaert, A. F. (1996). Homosexuality in men and number of older brothers. American Journal of Psychiatry, 153, 27-31.

Kendler, K. S., Thornton, L. M., Gilman, S. E., & Kessler, R. C. (2000). Sexual Orientation in a U.S. National Sample of Twin and Nontwin Sibling Pairs. The American Journal of Psychiatry, 157, 1843-1846.

Medland, S. E., Duffy, D. L., Wright, M. J., Geffen, G. M., & Martin, N. G. (2006). Handedness in twins: joint analysis of data from 35 samples. Twin Res Hum Genet, 9(1), 46-53.

Mustanski, B. S., Chivers, M. L., & Bailey, J. M. (2002). A critical review of recent biological research on human sexual orientation. Annual Review of Sex Research, 12, 89-140.

Sommer, V., & Vasey, P. L. (2006). Homosexual behaviour in animals : an evolutionary perspective. Cambridge ; New York: Cambridge University Press.

Surprise—Families Matter

Brian Mustanski, Ph.D. — Tue, 06 Jan 2009 14:56:53 +0000

A new study reports that young gay people whose parents or guardians responded negatively when they revealed their sexual orientation were more likely to attempt suicide, experience severe depression and use drugs than those whose families accepted the news. The results were published in the current issue of the journal Pediatrics by Caitlin Ryan and her team at the SFSU's Family Acceptance Project. Specifically, the study showed that teens that experienced negative feedback had more than eight times the odds of attempting suicide, nearly six times the odds of severe depression and more than three times the odds of drug use. My research team recently published converging findings that family support and acceptance significantly reduced the chance that a young gay or bisexual man would have HIV. Our study, published in the Journal of Adolescent Health, found that higher family support resulted in a 30% reduction in the odds that a gay or bisexual teen would be HIV positive.

What's surprising about these findings is that they are surprising to people. We have known for decades that positive family relationships have profoundly positive impacts on the health and development of youth. Strong family ties have been shown to reduce drug and alcohol use, risky sexual behavior, improve mental health, self-esteem, school achievement, and the list of positive effects goes on. Why would we expect that it would be any different for gay youth? Unfortunately, not much research on family relationships among gay youth has been conducted because of the misperception that parents are not involved in the lives of their gay youth, unaware of their child's sexual orientation, or universally rejecting. It's time to update our thinking.

As Ritch Savin-William documents in his book, The New Gay Teenager, the lives of gay youth have changed dramatically in recent years. In our article in the Journal of Adolescent Health, we found that among 16-24 year old gay and bisexual men, 83% reported their mother knew they were gay or bi and 70% reported their father knew. 83% of these mothers were accepting or tolerant, as were 74% of the fathers. While these statistics are promising, unfortunately not 100% of parents are accepting of their gay youth.

Our research, and the research of Ryan, suggests it is time to take seriously the role of parents in the lives of gay youth. Import efforts to support families have been going on for years by organizations such as Parents, Families, and Friends of Lesbians and Gays (PFLAG), but no systematic research has been conducted to develop proven ways to improve acceptance. The payoff will be big for a program that can successfully documents greater parental acceptance in terms of less suicide attempts and HIV risk in their kids. In their hearts, parents want the best for their children, and research is now catching up and showing that accepting gay kids is the best thing for them.

The Sexual Continuum Blog now has a facebook page. To become a fan of the blog, click here and then choose to "become a fan." By joining you will get updates as new blog postings come out.

References:

Garofalo, R., Mustanski, B., & Donenberg, G. (2008). Parents know and parents matter; is it time to develop family-based HIV prevention programs for young men who have sex with men? Journal of Adolescent Health, 43, 201-204.

Ryan C, Huebner D, Diaz RM, Sanchez J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346-352.

Photo credit: W. Rumfelt

The compatibility of same-sex relationships

Brian Mustanski, Ph.D. — Wed, 17 Dec 2008 04:22:17 +0000

As the debate about marriage equality for same-sex couples rages on, legally recognized same-sex partnerships have been recognized in several states for long enough to begin to study them over time. Studying couples right after they marry doesn't provide a great window into relationships because most couples go through a honeymoon period that doesn't last. Studies on the development of marriages have actually found relationship satisfaction to follow a U-shaped curve like the one shown to the left (just a simulation). This is because researchers have found couples to have greater happiness at the earlier and later stages of the relationship. Because of this phenomenon it is important to try and study relationships over time.

Until very recently, studies of same-sex relationship have been limited because there haven't been legal definitions of these relationships. This has forced researchers to come up with their own criteria for defining when a relationship exists as well as when it should be considered over. This is difficult because the gold standard for measuring a relationship in our culture is marriage. Trying to define a relationship with a cutoff of a certain number of years doesn't work. It simply isn't clear how many years you have to be together to call it a "relationship." If you don't believe me, ask five of your friends this question and I bet you will get five different answers.

To soundly study the quality of same-sex relationships we need longitudinal data and some valid definition of a "relationship." Luckily, a newly published study by Kimberly Balsam and her research team reports some of the first long term follow-up data on same-sex domestic partnerships and compares their relationship quality to similar opposite-sex couples. The authors studied couples in Vermont, which legalized domestic partnerships in 2000. To create comparison groups, they asked the couples to help recruit a heterosexual married sibling and a gay or lesbian couple in their friendship circle who had not had a civil union. The researchers recruited the couples in 2002, and then followed up with them three years later. They asked the couples to complete a variety of standard measures of relationship satisfaction, conflict, quality, commitment, and intimacy.

Across the three year follow-up period, same-sex couples not in civil unions were more likely to have ended their relationship than same-sex couples in civil unions or heterosexual married couples. One interpretation of these findings is that legal recognition may help stabilize relationships. In fact, qualitative interviews with same-sex couples suggests that legal unions help create an incentive to try and work out relationship issues instead of splitting up. It also helps to instill a shared sense of commitment to the relationship. Further supporting the idea that legal unions stabilize relationship was the finding that these couples showed no statistically significant differences when they were asked these same questions at the beginning of their relationships in 2002.

One of more interesting findings of the study was that same-sex couples reported more positive relationship quality and less conflict than heterosexual married couples on nearly all of the measures included in the study. This finding is consistent with other research that has found that same sex-couples tend to fare better than heterosexual couples on most relationship variables. For example, Gottman found in 2003 that same-sex couples showed less belligerence, whining, and tension and showed more affection, humor, and joy than the comparable heterosexual married couples.

Since we don't have a lot of research to tell us why same-sex couples seem to have better relationships I will draw on a little personal experience. First, in the absence of legal marriage equality, there are fewer social forces pushing same-sex people into relationships. Because of this, people who choose to enter committed same-sex relationships are more likely to be doing it because they love and truly want to spend the rest of their life with their partner. Opposite-sex couples also get married because of love and desire for the relationship, but they also sometimes get married because of family pressure or unplanned pregnancy. Shotgun weddings are rare for same-sex couples. Second, in the absence of strong social norms for relationships, same-sex couples are forced to discuss and define their relationship for themselves-and this is healthy. We know that division of labor in relationship still tends to fall along traditional gender lines, but these lines don't exist with two people of the same sex. This forces same-sex couples to discuss how they are going to take care of the home, expenses, and family; all of which are topics that that unfortunately fail to get discussed in many relationships. Discussing these topics helps build the foundation of the relationship through shared expectations and a fair division of labor. It also helps to build skills for how to discuss other important topics. From my perspective this communication is the key to strong and positive relationships. It's probably what led my mother to recently comment that she is sometimes jealous of how well my partner and I communicate and get along. Plus, as I told her, it might just be easier to get along with someone of the same sex--after all, you inherently have more in common.

There are three important things to take away from these studies. First, same sex couples can have strong, stable, and healthy relationships. Anyone who tells you otherwise is suffering from a failure to recognize reality. Second, legally recognizing same-sex relationships could increase their stability. It certainly would bring a number of other important benefits as I have previously discussed. Third, same-sex couples have a lot to teach everyone about how to have healthy relationships. Strong communication and fair division of labor in a relationship are universal recipes for success no matter if the couple is two men, two women, or one of each.

The Sexual Continuum Blog now has a facebook page. To become a fan of the blog, click here and then choose to "become a fan." By joining you will get updates as new blog postings come out.

References

Balsam, K. F., Beauchaine, T. P., Rothblum, E. D., & Solomon, S. E. (2008). Three-year follow-up of same-sex couples who had civil unions in Vermont, same-sex couples not in civil unions, and heterosexual married couples. Developmental Psychology, 44(1), 102-116.

Gottman, J. M., Levenson, R. W., Swanson, C., Swanson, K., Tyson, R., & Yoshimoto, D. (2003). Observing gay, lesbian and heterosexual couples' relationships: mathematical modeling of conflict interaction. Journal of Homosexuality, 45(1), 65-91.

Today is World AIDS Day- what are you doing?

Brian Mustanski, Ph.D. — Mon, 01 Dec 2008 19:27:18 +0000

December 1st is World AIDS Day, the day when individuals and organizations from around the world come together to bring attention to the global AIDS epidemic. This year marks the 20th anniversary of World AIDS Day. While we have come a long ways since 1988, there is still much more to be done.

While there has been much important attention on HIV/AIDS abroad, more attention is needed domestically. This year the CDC announced that it had been underestimating the cases of HIV/AIDS diagnosed each year by about 40%. The new numbers estimate that over 56,000 people were diagnoses with HIV/AIDs in 2006 or approximately one American every 10 minutes. Additionally, we know that HIV disproportionately affects some communities. Gay, bisexual, and other men who have sex with men but don't use these labels are disproportionately infected (CDC, 2008). We know they experience disparities both in infections rates, but also the governments' inadequate response to prevention and care for this population. We know that youth are one of the only groups showing an increase in infections, but within this population young men who have sex with men, are particularly infected. One of the largest studies of its kind showed that 7.2% of young men who have sex with men were HIV positive, with the majority of these young men not aware of their status until the study (Valleroy, MacKellar, & Karon, 2000). In other words, about one out of every 14 gay and bisexual youth may be infected. We also know African Americans show a disproportionate infection rate (CDC, 2008). Something must be done about this epidemic.

Throughout the history of the HIV epidemic we have know that mental health issues have been inextricably tied with HIV. Persons with mental health diagnoses are at increased risk for HIV and personal with HIV are at increased risk for mental health problems. Persons with HIV are at increased risk for mental health problems both because of the stigma and stressors of living with HIV, but also there can be neuropsychological complications associated with having the HIV virus. Persons with mental health problems are also at risk for a number of reasons (see an article by Donenberg and Pao (2005) for more information).
Over the last two and a half decades of the epidemic we have learned a lot about HIV risk and how to prevent it. We have identified the importance of key HIV risk factors like: HIV prevention and transmission knowledge, intentions to stay safe, motivation and peer norms for safer sex, attitudes, self-efficacy, situational influences (e.g. substance use, mood), family relationships, and health related resources or barriers. Of course these are just some of the important factors in a long list that has helped researchers develop HIV prevention programs that work. Check out the CDC's website for a list of just some of these effective programs (http://www.effectiveinterventions.org/).

The problem is that interventions that work haven't received enough resources to be fully implemented and some communities that are at the highest risk (like young gay and bisexual men) have been neglected.

I am hoping that with a new administration the federal response to our domestic HIV epidemic will be given the attention that it deserves and resources will be focused on those communities at the greatest risk. There is currently no effective HIV vaccine, and while further research is desperately needed in this area, we have behavioral approaches that we know work and should be supported to help prevent further infections.

In honor of World AIDS day, here are a few suggestions about things you can do to help change the epidemic and to support those who are currently infected.

1) Get informed. Learn how to prevent HIV transmission and differentiate myths from facts. Spread good information to your friends and family members so that they can help protect themselves. Help dispel myths that lead to stigma against people living with HIV. The Body is a great website to check out for information: http://www.thebody.com/

2) Advocate for more resources for HIV at every level. You can make donations to your local AIDS care and prevention organization and lobby your elected officials. Advocate for Obama to launch a national AIDS strategy similar to the strategies we require from other nations we fund. You can sign on for the strategy here: http://www.nationalaidsstrategy.org/

3) Do something to help prevent HIV or care for someone who is living with HIV. If you work at a mental health or other health organization, consider what your organization can do to help prevent your patient population from being infected. The CDC's list of effective interventions is a good place to start as they have been designed to be readily deployed (see http://www.effectiveinterventions.org/). Think about what your organization is doing to support the mental health needs of people living with HIV. If you are a mental health professional you are in a unique place to make a difference as you have been trained on how to help people make positive and health changes.

4) Know your status. If you are sexually active or use IV drugs, get tested. Knowing your status is an important part of protecting your health and the health of your partners. Visit http://www.hivtest.org/ to find a testing location close to you.

5) The Body website has a further list of things you can do to make a difference (http://www.thebody.com/content/art49412.html) If you have other ideas please post them here as comments.

Doing something about this epidemic can change World AIDS day from a memorial of the millions of people who have lost their lives to this terrible disease into a day of hope for the future.

Reference

CDC. (2008). Subpopulation estimates from the HIV incidence surveillance system--United States, 2006. MMWR Morb Mortal Wkly Rep, 57(36), 985-989.

Donenberg, G. R., & Pao, M. (2005). Youths and HIV/AIDS: psychiatry's role in a changing epidemic. J Am Acad Child Adolesc Psychiatry, 44(8), 728-747.

Valleroy, L. A., MacKellar, D. A., & Karon, J. M. (2000). HIV prevalence and associated risks in young men who have sex with men: Young Men's Survey Study Group. Journal of the American Medical Association, 284, 198-204.