Homophobia fueling HIV

Our society is too focused on arguing whether LGBT people belongs with others, whether their behavior is legal or not or finding ways to convert them to be ‘straight’ rather than seeking a way to minimize consequent mental and physical health issues.

We make it a taboo in discussions and deprive the younger generation of education. Entangled in all these negative attitudes and phobias against a human being’s sexual orientation, it seems like we have been overlooking more important consequences of that orientation. Health care officials say that in order to combat HIV/AIDs, we have to first combat homophobia.

In one hand, the relationship between HIV and gay and bisexual men has existed since the beginning of the epidemic, which is most clearly demonstrated by HIV’s former name, Gay-Related Immune Deficiency, or GRID.  On the other hand homophobia is often noted as one of the drivers of the epidemic for gay and bisexual men. In Sri Lanka, HIV health care providers identify that one of the major barriers in preventing HIV/AIDs from spreading in the society is the homophobic attitude present among people.

The American Heritage Dictionary (1992 edition) defines homophobia as ‘aversion to gay or homosexual people or their lifestyle or culture’ and ‘behavior or an act based on this aversion.’ In simpler terms, ‘homophobia’ is the hatred or fear of homosexuals – that is, lesbians and gay men – sometimes leading to acts of violence and expressions of hostility.

Creating awareness in order to eliminate the homophobic attitude and discrimination against the LGBT community are among the main goals of the International Day against Homophobia and Transphobia. This Day was introduced in May 17, 2004 as the International Day against Homophobia. In 2009, ‘Transphobia’ was added explicitly in the title of the name, in recognition of the very different issues at stake between sexual orientation and gender expression. Since 2015, ‘Biphobia’ is added to the title, to acknowledge the specific issues faced by bisexual people.

Homophobia is not limited to any one segment of society. It can be found in people from all walks of life. One of the most common notions among people with a homophobic attitude in Sri Lanka is that homosexuality is a western import and that it goes against the culture of our country. “Penal Code 365A by virtue of the fact that it is an old colonial anti sodomy law, is still used by many, particularly in law enforcement to discriminate against and violate the rights of LGBTIQ (lesbian, gay, bisexual, transgender, intersex, and questioning) persons in Sri Lanka,” said EQUAL GROUND Executive Director,  Rosanna Flamer-Caldera. EQUAL GROUND is a nonprofit organization seeking human and political rights for LGBTIQ.

She further said that this permeates into every section of society where the threat of this law and the misinformation about it is used to discriminate and subjugate the community.  As Flamer-Caldera explained what we call Sri Lankan culture today is based on Victorian morality depriving us of an open mind. “We hear many persons saying that Homosexuality is a western import and that it goes against the culture of this country.  In fact our culture is based on Victorian morality and our laws our based on Victorian laws – brought by the British!  So these are what are imported, not homosexuality which has been around way before the Colonizers came to our fair land.”

Flamer- Caldera rebuked media organizations for quoting prominent health officials stating that the rise in HIV in Sri Lanka is due to the rise of homosexuality. “This is not only erroneous but highly misleading,” she said.  “In fact it should be stated that homophobic attitudes in the health sector and their inability to reach members of the community due to their apathy and homophobia is the reason HIV is rising within this community,” she further said.

In addition she said that while HIV is indeed prevalent in the LGBTIQ community, it makes up only up to 15 percent of the total numbers infected – the rest (85 persons) being heterosexual persons. “Misguided notions about homosexuality and gender identity coupled with rampant homophobia and transphobia is hampering interventions in this area a hundred fold.”

As she explained, the Government should first and foremost repeal the laws that criminalize homosexuality. “The state has no business in our bedrooms and consensual sex between adults is of no concern to anyone other than the two people who are engaging,” she emphasized adding that strengthening the laws to protect women and children should be foremost on the government’s agenda but at the same time they must be certain to uphold democratic values and give everyone their rights as Human Beings including the LGBTIQ community.  The health sector must be sensitized to accept and understand the LGBTIQ community and the corporate sector must also follow suit and encourage diversity in the work place.

“EQUAL GROUND is the only LGBTIQ advocacy group focusing on the rights – Human Rights – of the LGBTIQ community, seeking equality for all sexual orientations and gender identities; human rights for everyone.  EQUAL GROUND holds sensitizing workshops all over the island and is currently conducting such programs with the corporate sector, the media and the public at large,” she mentioned.

“It will be most happy to be called upon to sensitize the government sector, the health sector and others to be better able to understand and accept LGBTIQ persons as human beings and productive citizens of this country,” she added.

Dr. Dayanath Ranatunge, UNAIDs (United Nations Programme on HIV/AIDS)  Country Manager for Sri Lanka, speaking to The Nation also admitted that the support of the government and society as a whole is needed in combating HIV in Sri Lanka. He lamented that the discrimination against the LGBTIQ community is found mostly in the grassroots level while speaking in the context of health care facilities and law enforcement agencies.  “Our advocacy programs in relation to homosexuality and HIV started 10 years ago. Comparatively, the situation is much improved now,” he said. “All senior ranking officers in law enforcement and health care settings are being educated about the importance in the involvement of MSM (Men who have sex with men) HIV awareness programs. Yet, the gap of awareness between the senior officers and grass-root officers is wide,” he said.

HIV epidemic is related to human sexual behaviors where people exchange bodily fluids in a form of sexual intercourse- anal or vaginal or oral sex. Ranatunge further explained how homophobic attitudes deprive LGBTIQ community of health care facilities.

“This homophobic attitude keeps them away from HIV testing and HIV care and support and this makes MSM more vulnerable to HIV,” he argued. “If somebody wants to stop the disease spreading, HIV testing must be given priority. The more number of people take the tests, the more it can be prevented,” he added.

Speaking specifically about MSM, Ranatunge emphasized the need of education on safe sex methods. If the test results come negative they should be encouraged to practice protective sexual behavior where bodily fluids will not be exchanged. “In simpler terms they should be encouraged to use a condom and a lubricant together,” he said.  “It’s more important that they use lubricant with the condom. “Usually condoms tend to break during anal sex. There are local health care services which provide this,” he said. “Education is available in health care services and this education should be freely available for everyone without any stigma or discrimination based on their sexual orientation,” he added.

Secondly, if the test results are positive, they should be encouraged to engage with the existing health care services for a longer period. Ranatunge explained that patients with a homosexual orientation withdraw from treatments because they fear discrimination and stigma against them. “It is evident that if an HIV infected person is put in to a proper treatment schedule, the ability to infect another -‘infectivity’- becomes almost zero meaning that if a person is undergoing proper treatment he or she is no longer a threat,” he iterated. Also, he expressed grief on how a lot of people drop out in the middle of treatment unable to face the stigma.

If we are to work towards taking prevalence of HIV infection down to zero in Sri Lanka, these homophobic attitudes should somehow change. Relevant authorities and stakeholders should be educated further about the situation. “There are cases reported where homosexual men were forced to pretend as straight men and get married to women. Sometimes they might have kids too. Unfortunately, through these forceful acts, the general community also becomes vulnerable to HIV,” he reiterated.

Was Buddha the first psychologist?

Psychology is the science of the mind. The psychologists say that human mind is the source of all thought and behavior. When we think about psychology, the first person recalled is usually Sigmund Freud or some other prominent Western psychologist who explained human behavior using a theory they believed. True enough, being the father of psychoanalysis Sigmund Freud’s work, or being the father of modern psychology Wilhelm Wundt’s work were largely responsible for the development of modern day psychology.  Yet, were they really the first people to talk psychology?

In psychology, the psyche is the totality of the human mind, conscious and unconscious (Wikipedia). Freud discussed this model in the 1920 essay ‘Beyond the Pleasure Principle’ and this can be considered as the earliest examples where the concept of mind was spoken in a western context.  Although we cannot observe the mind directly, everything we do, think, feel and say is determined by the functioning of the mind. It was not the modern day psychologists who first identified ‘the mind’. Almost two millennia before Freud spoke about psyche, the Buddha spoke of the human mind, identifying that all human behavior is under the responsibility of the mind.

Manopubbangama dhamma 
manosettha manomaya
manasa ce padutthena
bhasati va karoti va
tato nam dukkhamanveti
cakkamva vahato padam.

All mental phenomena have mind as their forerunner; they have mind as their chief; they are mind-made. If one speaks or acts with an evil mind, dukkha follows him just as the wheel follows the hoof print of the ox that draws the cart (Dhammapada )
Buddha explained that the mind is the most dominant, and it is the cause of the other three mental phenomena, namely, Feeling (vedana), Perception (sanna) and Mental Formations or Mental Concomitants (sankhara).

Buddhism more closely resembles Western psychotherapy than any Western concept of religion. Jon M Cefus writing to the Joseph Campbell Foundation blog in 2009, spots how Buddhism provides tools helping to alleviate psychological suffering.  “These are called the Four Noble Truths.  The truths taught by Siddhartha Gautama offer a view of reality that is based on natural law,” he explains. 

Buddha was commonly referred to as ‘the great physician’ and like any therapist, made it his aim to identify, explain and end human suffering. All therapists do have similar aims. Four Noble Truths (Chathurarya Sathya) are the method to adopt a diagnostic format to explain suffering and its cure.  The Four Noble Truths are the truth of suffering, the truth of the cause of suffering, the truth of the end of suffering, and the truth of the path that leads to the end of suffering. In a therapeutic setting; the first Noble Truth identifies the disease, the second provides etiology, the third gives a prognosis and the forth suggests a remedy.

How Buddha helped Kisagothami is one of the many examples where Buddha can be seen as a modern day psychologist. Kisagothami was desperate after losing her children and family that she went from house to house clasping her dead child to her breast, asking for medicine to revive the dead son. Buddha welcomed her with Unconditional Positive Regard (a concept developed by the humanistic psychologist, Carl Rogers, is the basic acceptance and support of a person regardless of what the person says or does), identified her irrational beliefs and helped her dispute them on her own, asking her to bring a handful of mustard seeds from a house where no one has died.

This is just one example found in Buddhist Jataka Stories which show similarities to Albert Ellis’s ABC model in Cognitive Therapy. The ABC Model refers to three components of experience in which a person can ascertain if his or her belief system is distorted. The well-known stories of Aalawaka, Angulimala as well the episode of queen Khema who had irrational beliefs about her beauty are few other examples of how Buddha helped people to eliminate their irrational beliefs.

A main view of Behavioral psychologists is that Behaviorists view humans as being born neither good nor bad by nature, but rather as being neutral by nature. But wasn’t Buddha the first one to point this out too?

Najaja wasalo hothi
Najajja hothi Brahmano
Kamano wasalo  hothi
kammano hothi brahmano

You do not become a Brahman (Nobel) with your birth nor does birth make you a low cast. It’s your own deeds that decide which. (Dhammapada)

Existential psychology is another major branch in psychology which speaks of ontological anxiety (dread, angst). Its therapy operates on the belief that inner conflict within a person is due to that individual’s confrontation with the givens of existence.  “Buddha said that life is suffering. Buddha said that suffering is due to attachment. Existential psychology also has some similar concepts. We cling to things in the hope that they will provide us with a certain benefit. Buddha said that suffering can be extinguished. The Buddhist concept of nirvana is quite similar to the existentialists’ freedom. Freedom has, in fact, been used in Buddhism in the context of freedom from rebirth or freedom from the effects of karma. For the existentialist, freedom is a fact of our being, one which we often ignore. Finally, Buddha says that there is a way to extinguish suffering. For the existential psychologist, the therapist must take an assertive role in helping the client become aware of the reality of his or her suffering and its roots. Likewise, the client must take an assertive role in working towards improvement–even though it means facing the fears they’ve been working so hard to avoid, and especially facing the fear that they will ‘lose’ themselves in the processes. (Boeree CG. Towards a Buddhist Psychotherapy, 1997 )

Our very own psychiatrist D VJ Harishchandra in his book titled, ‘Buddhism and Psychiatry’ identified common psychological theories in Western psychology explained in Buddhism. In his book he discusses Viyo Duka (bereavement), Balaporottu Kadaweema hevath Ichchabangathwaya (Frustration), Buddunwahanse Mano Chikithsakawarayaku Lesa (Lord Buddha as a psychiatrist of eminence), Maranaya Saha Viyoduka (death and grief counselling) Bheethika (Phobias), Danathmaka Mano Vidyawa (Positive psychology), Pasuthevilla (Regret) Grantha Chikithsawa (Bibiliotheraphy), Sihina Vigrahaya (Analysis of dreams) and Mano Ranga Chikithsawa (group psychotherapy).

In psychology, American Psychologists Association’s Ethical Principles of Psychologists and Code of Conduct lay out standards for psychologists and identify behaviors that deserve punishment. Interestingly, long before ‘psychologists’ existed and psychology was named ‘psychology’, Buddha helped people who came seeking his help in an ethical manner. British Indologist CF Rhys Davids translated Abhidhamma Pitaka from Pali and Sanskrit texts in 1900. She published the book entitled, ‘Buddhist Manual of Psychological Ethics’. In 1914, she wrote another book ‘Buddhist psychology: An inquiry into the analysis and theory of mind’ (Journal article Buddha philosophy and western psychology by Tapas Kumar Aich).  Rhys Davids in her book ‘Buddhist Manual of Psychological Ethics’ wrote, “Buddhist philosophy is ethical first and last. Buddhism set itself to analyze and classify mental processes with remarkable insight and sagacity”.

What can be mentioned in this article is limited. Yet connections between modern day psychology and Buddhism are unlimited. These Buddhist traditions have been built and refined for almost 2,500 years, and are older than any of the modern day theories in psychological practice and still valid in contemporary practice.

 In summary, as any of the psychological theories, Buddha’s teachings attempt to define why we suffer and offer ways in which to ease this suffering.  Stress, depression, anxiety are few among the common psychological problems. Compared with a few decades ago, the numbers of complaints are on the rise today, even in the Buddhist society.  Are these issues on the rise because we are losing the grip on the essence of Buddhism;  because we go behind worshiping statues more, rather than trying to understand the depth of dharma? However, isn’t it heartbreaking how people suffer from psychological issues so much, when we were being told the correct path to take to ease our pain, millennia ago? 

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