1) Not born that way
2) Same sex attraction as a symptom
3) Same-sex attraction is preventable
4) At-risk, not predestined
6) Goal of therapy
1) Ministry to individuals experiencing same-sex attraction
2) The role of the priest
3) Catholic medical professionals
4) Teachers in Catholic institutions
5) Catholic families
6) The Catholic community
PART I CONSIDERATIONS
The Catholic Medical Association is dedicated to upholding the
principles of the Catholic Faith as related to the practice of medicine
and to promoting Catholic medical ethics to the medical profession,
including mental health professionals, the clergy, and the general
No issue has raised more concern in the past decade than that of
homosexuality and therefore the CMA offers the following summary and
review of the status of the question. This summary relies extensively on
the conclusions of various studies and points out the consistency of the
teachings of the Church with these studies. It is hoped that this review
will also serve as an educational and reference tool for Catholic
clergy, physicians, mental health professionals, educators, parents and
the general public.
CMA supports the teachings of the Catholic Church as laid out in the
revised version of the Catechism of the Catholic Church, in particular
the teachings on sexuality: "All the baptized are called to chastity" (CCC,
n.2348); "Married people are called to live conjugal chastity; others
practice chastity in continence" (CCC, n.2349); "... tradition has
always declared that homosexual acts are intrinsically disordered...
Under no circumstance can they be approved" (CCC, n.2333);
It is possible, with God's grace, for everyone to live a chaste life
including persons experiencing same-sex attraction, as Cardinal George,
Archbishop of Chicago, so powerfully stated in his address to the
National Association of Catholic Diocesan Lesbian & Gay Ministries: "To
deny that the power of God's grace enables those with homosexual
attractions to live chastely is to deny, effectively, that Jesus has
risen from the dead." (George 1999)
There are certainly circumstances, such as psychological disorders and
traumatic experiences, which can, at times, render this chastity more
difficult and there are conditions which can seriously diminish an
individual's responsibility for lapses in chastity. These circumstances
and conditions, however, do not negate free will or eliminate the power
of grace. While many men and women who experience same-sex attractions
say that their sexual desire for those of their own sex was experienced
as a "given" (Chapman 1987) this in no way implies a genetic
predetermination or an unchangeable condition. Some surrendered to
same-sex attractions because they were told that they were born with
this inclination and that it was impossible to change the pattern of
one's sexual attraction. Such persons may feel it is futile and hopeless
to resist same-sex desires and embrace a "gay identity". These same
persons may then feel oppressed by the fact that society and religion,
in particular the Catholic Church, do not accept the expression of these
desires in homosexual acts. (Schreier 1998)
The research referenced in this report counters the myth that same-sex
attraction is genetically predetermined and unchangeable and offers hope
for prevention and treatment.
1) NOT BORN THAT WAY
A number of researchers have sought to find a biological cause for
same-sexual attraction. The media have promoted the idea that a "gay
gene" has already been discovered (Burr 1996), but in spite of
several attempts, none of the much publicized studies (Hamer 1993;
LeVay 1991) has been scientifically replicated. (Gadd 1998) A number
of authors have carefully reviewed these studies and found that not only
do the studies not prove a genetic basis for same-sex attraction; the
reports do not even contain such claims. (Byne 1963; Crewdson
1995; Goldberg1992; Horgan 1995; McGuire 1995; Porter 1996;
If same-sex attraction were genetically determined, then one would
expect identical twins to be identical in their sexual attractions.
There are, however, numerous reports of identical twins who are not
identical in their sexual attractions. (Bailey 1991; Eckert 1986;
Friedman 1976; Green 1974; Heston 1968; McConaghy 1980; Rainer 1960;
Zuger 1976) Case histories frequently reveal environmental factors which
account for the development of different sexual attraction patterns in
genetically identical children, supporting the theory that same-sex
attraction is a product of the interplay of a variety of environmental
factors. (Parker 1964)
There are, however, ongoing attempts to convince the public that
same-sex attraction is genetically based. (Marmor 1975) Such
attempts may be politically motivated because people are more likely to
respond positively to demands for changes in laws and religious teaching
when they believe sexual attraction to be genetically determined and
unchangeable. (Ernulf 1989; Piskur 1992) Others have sought to
prove a genetic basis for same-sex attraction so that they could appeal
to the courts for rights based on the "immutability". (Green 1988)
Catholics believe that sexuality was designed by God as a sign of the
love of Christ, the bridegroom, for his Bride, the Church, and therefore
sexual activity is appropriate only in marriage. Catholic teaching holds
that: Sexuality is ordered to the conjugal love of man and woman. In
marriage the physical intimacy of the spouses becomes a sign and pledge
of spiritual communion.E(CCC, n.2360) Healthy psycho-sexual development
leads naturally to attraction in persons of each sex for the other sex.
Trauma, erroneous education, and sin can cause a deviation from this
pattern. Persons should not be identified with their emotional or
developmental conflicts as though this were the essence of their
identity. In the debate between essentialism and social constructionism,
the believer in natural law would hold that human beings have an
either male or female
and that sinful inclinations (such as the desire to engage in homosexual
acts) are constructed and can, therefore, be deconstructed.
It is, therefore, probably wise to avoid wherever possible using the
words "homosexual" and "heterosexual" as nouns since such usage implies
a fixed state and an equivalence between the natural state of man and
woman as created by God and persons experiencing same sex attractions or
2) SAME-SEX ATTRACTION AS A SYMPTOM
Individuals experience same-sex attractions for different reasons. While
there are similarities in the patterns of development, each individual
has a unique, personal history. In the histories of persons who
experience same-sex attraction, one frequently finds one or more of the
· Alienation from the father in early childhood because the father was
perceived as hostile or distant, violent or alcoholic (Apperson
1968; Bene 1965; Bieber 1962; Fisher 1996; Pillard
1988; Sipova 1983)
· Mother was overprotective (boys) (Bieber, T. 1971; Bieber
1962; Snortum 1969)
· Mother was needy and demanding (boys) (Fitzgibbons 1999)
· Mother emotionally unavailable (girls) (Bradley 1997; Eisenbud
· Parents failed to encourage same-sex identification (Zucker 1995)
· Lack of rough and tumble play (boys) (Friedman 1980; Hadden 1967a
· Failure to identify with same/sex peers (Hockenberry 1987; Whitman
· Dislike of team sports (boys) (Thompson 1973)
· Lack of hand/eye coordination and resultant teasing by peers (boys)
(Bailey 1993; Fitzgibbons 1999; Newman 1976)
· Sexual abuse or rape (Beitchman 1991; Bradley 1997; Engel
1981; Finkelhor 1984; Gundlach 1967)
· Social phobia or extreme shyness (Golwyn 1993)
· Parental loss through death or divorce (Zucker 1995)
· Separation from parent during critical developmental stages (Zucker
In some cases, same-sex attraction or activity occurs in a patient with
other psychological diagnosis, such as:
· major depression (Fergusson 1999)
· suicidal ideation (Herrell 1999)
· generalized anxiety disorder
· substance abuse
· conduct disorder in adolescents
· borderline personality disorder (Parris 1993; Zubenko 1987)
· schizophrenia (Gonsiorek 1982) 
· pathological narcissism (Bychowski 1954; Kaplan 1967)
In a few cases, homosexual behavior appears later in life as a response
to a trauma such as abortion, (Berger 1994; de Beauvoir 1953) or
profound loneliness (Fitzgibbons 1999).
3) SAME-SEX ATTRACTION IS PREVENTABLE
If the emotional and developmental needs of each child are properly met
by both family and peers, the development of same-sex attraction is very
unlikely. Children need affection, praise and acceptance by each parent,
by siblings and by peers. Such social and family situations, however,
are not always easily established and the needs of children are not
always readily identifiable. Some parents may be struggling with their
own trials and be unable to provide the attention and support their
children require. Sometimes parents work very hard but the particular
personality of the child makes support and nurture more difficult. Some
parents see incipient signs, seek professional assistance and advice,
and are given inadequate, and in some cases, erroneous advice.
The Diagnostic and Statistical Manual IV (APA 1994) of the American
Psychiatric Association has defined Gender Identity Disorder (GID) in
children as a strong, persistent cross gender identification, a
discomfort with one's own sex, and a preference for cross sex roles in
play or in fantasies. Some researchers (Friedman 1988, Phillips,
1992) have identified another less pronounced syndrome in boys
chronic feelings of unmasculinity. These boys, while not engaging in any
cross sex play or fantasies, feel profoundly inadequate in their
masculinity and have an almost phobic reaction to rough and tumble play
in early childhood often accompanied by a strong dislike of team sports.
Several studies have shown that children with Gender Identity Disorder
and boys with chronic juvenile unmasculinity are at-risk for same-sex
attraction in adolescence. (Newman 1976; Zucker 1995; Harry 1989)
Early identification (Hadden 1967) and proper professional
intervention, if supported by parents, can often overcome the gender
identity disorder. (Rekers 1974; Newman 1976) Unfortunately, many
parents who report these concerns to their pediatricians are told not to
worry about them. In some cases the symptoms and parental concerns may
appear to lessen when the child enters the second or third grade, but
unless adequately dealt with, the symptoms may reappear at puberty as
intense, same-sex attraction. This attraction appears to be the result
of a failure to identify positively with one's own sex.
It is important that those involved in child care and education become
aware of the signs of gender identity disorder and chronic juvenile
unmasculinity and have access the resources available to find
appropriate help for these children. (Bradley 1998; Brown 1963;
Acosta 1975) Once convinced that same-sex attraction is not a
genetically determined disorder, one is able to hope for prevention and
a therapeutic model to greatly mitigate, if not eliminate, same-sex
4) AT-RISK, NOT PREDESTINED
While a number of studies have shown that children who have been
sexually abused, children exhibiting the symptoms of GID, and boys with
chronic juvenile unmasculinity are at risk for same-sex attractions in
adolescence and adulthood, it is important to note that a significant
percentage of these children do not become homosexually active as
adults. (Green 1985; Bradley 1998)
For some, negative childhood experiences are overcome by later positive
interactions. Some make a conscious decision to turn away from
temptation. The presence and the power of God's grace, while not always
measurable, cannot be discounted as a factor in helping an at-risk
individual turn away from same-sex attraction. The labeling of an
adolescent, or worse a child, as unchangeably "homosexual" does the
individual a grave disservice. Such adolescents or children can, with
appropriate, positive intervention, be given proper guidance to deal
with early emotional traumas.
Those promoting the idea that sexual orientation is immutable frequently
quote from a published discussion between Dr. C.C. Tripp and Dr.
Lawrence Hatterer in which Dr. Tripp stated: "... there is not a single
recorded instance of a change in homosexual orientation which has been
validated by outside judges or testing. Kinsey wasn't able to find one.
And neither Dr. Pomeroy nor I have been able to find such a patient. We
would be happy to have one from Dr. Hatterer." (Tripp & Hatterer 1971)
They fail to reference Dr. Hatterer response:
"I have 'cured' many homosexuals, Dr. Tripp. Dr. Pomeroy or any other
researcher may examine my work because it is all documented on 10 years
of tape recordings. Many of these 'cured' (I prefer to use the word
'changed') patients have married, had families and live happy lives. It
is a destructive myth that 'once a homosexual, always a homosexual." It
has made and will make millions more committed homosexuals. What is
more, not only have I but many other reputable psychiatrists (Dr. Samuel
B. Hadden, Dr. Lionel Ovesey, Dr. Charles Socarides, Dr. Harold Lief,
Dr. Irving Bieber, and others) have reported their successful treatments
of the treatable homosexual." (Tripp & Hatterer 1971)
A number of therapists have written extensively on the positive results
of therapy for same-sex attraction. Tripp chose to ignore the large body
of literature on treatment and surveys of therapists. Reviews of
treatment for unwanted same-sex attractions show that it is as
successful as treatment for similar psychological problems: about 30%
experience a freedom from symptoms and another 30% experience
improvement. (Bieber 1962; Clippinger 1974; Fine 1987; Kaye
1967; MacIntosh 1994; Marmor 1965; Nicolosi 1998; Rogers
1976; Satinover 1996; Throckmorton; West )
Reports from individual therapists have been equally positive. (Barnhouse
1977; Bergler 1962; Bieber 1979; Cappon 1960; Caprio
1954; Ellis 1956; Hadden 1958; Hadden 1967b; Hadfield
1958; Hatterer 1970; Kronemeyer 1989) This is only a
representative sampling of the therapists who report successful results
in the treatment of persons experiencing same-sex attraction.
There are also numerous autobiographical reports from men and women who
once believed themselves to be unchangeably bound by same-sex
attractions and behaviors. Many of these men and women (Exodus
1990-2000) now describe themselves as free of same-sex attraction,
fantasy, and behavior. Most of these individuals found freedom through
participation in religion based support groups, although some also had
recourse to therapists. Unfortunately, a number of influential persons
and professional groups ignore this evidence (APA 1997; Herek
1991) and there seems to be a concerted effort on the part of
"homosexual apologists" to deny the effectiveness of treatment of
same-sex attraction or claim that such treatment is harmful. Barnhouse
expressed wonderment at these efforts: "The distortion of reality
inherent in the denials by homosexual apologists that the condition is
curable is so immense that one wonders what motivates it." (Barnhouse
Robert Spitzer, M.D., the renowned Columbia University psychiatric
researcher, who was directly involved in the 1973 decision to remove
homosexuality from the American Psychiatric Association's list of mental
disorders, has recently become involved with research the possibility of
change. Dr. Spitzer stated in an interview: "I am convinced that many
people have made substantial changes toward becoming heterosexual...I
think that's news... I came to this study skeptical. I now claim that
these changes can be sustained." (NARTH 2000).
6) THE GOALS OF THERAPY
Those who claim that change of sexual orientation is impossible usually
define change as total and permanent freedom from all homosexual
behavior, fantasy, or attraction in a person who had previously been
homosexual in behavior and attraction. (Tripp 1971) Even when change
is defined in this extreme manner the claim is untrue. Numerous studies
report cases of total change. (Goetze 1997)
Those who deny the possibility of total change admit that change of
behavior is possible (Coleman 1978; Herron 1982) and that
persons who have been sexually involved with both sexes appear more able
to change. (Acosta 1975) A careful reading of the articles opposing
therapy for change reveals that the authors who see therapy for change
as unethical (Davison 1982; Gittings 1973) do so because they
view such therapy as oppressive to those who do not want to change (Begelman
1975; 1977; Murphy 1992; Sleek 1997; Smith 1988) and
view those persons with same-sex attraction who express a desire to
change as victims of societal or religious oppression. (Begelman
1977; Silverstein 1972)
It should be noted that almost without exception, those who regard
therapy as unethical also reject abstinence from non-marital sexual
activity as a minimal goal (Barrett 1996), and among the therapists
who accept homosexual acts as normal many find nothing wrong with
infidelity in committed relationships (Nelson 1982), anonymous
sexual encounters, general promiscuity, auto-eroticism (Saghir 1973),
sado-masochism, and various paraphilias. Some even support a lessening
of restrictions on sex between adults and minors (Mirkin 1999) or
deny the negative psychological impact of sexual child abuse. (Rind
1998; Smith 1988)
Some of those who consider therapy unethical also challenge established
theories of child development. (Davison 1982; Menvielle 1998)
These tend to place blame for the undeniable problems suffered by
homosexually active adolescents and adults on societal oppression. All
research conclusions must be evaluated in light of the biases which the
researchers bring to the project. When research is infused with an
acknowledged political agenda, its value is seriously diminished.
It should be pointed out that Catholics cannot support forms of therapy
which encourage the patients to replace one form of sexual sin with
another. (Schwartz 1984) Some therapists, for example, do not consider a
patient "cured" until he can comfortably engage in sexual activity with
the other sex, even if the patient is not married. (Masters 1979) Others
encouraged patients to masturbate using other-sex imagery. (Blitch 1972;
For a Catholic with same sex attraction, the goal of therapy should be
freedom to live chastely according to one's state in life. Some of those
who have struggled with same-sex attractions believe that they are
called to a celibate life. They should not be made to feel that they
have failed to achieve freedom because they do not experience desires
for the other sex. Others wish to marry and have children. There is
every reason to hope that many will be able, in time, to achieve this
goal. They should not, however, be encouraged to rush into marriage
since there is ample evidence that marriage is not a cure for same-sex
attractions. With the power of grace, the sacraments, support from the
community, and an experienced therapist, a determined individual should
be able to achieve the inner freedom promised by Christ.
Experienced therapists can help individuals uncover and understand the
root causes of the emotional trauma which gave rise to their same sex
attractions and then work in therapy to resolve this pain. Men
experiencing same-sex attractions often discover how their masculine
identify was negatively effected by feelings of rejection from father or
peers or from a poor body image which result in sadness, anger and
insecurity. As this emotional pain is healed in therapy, the masculine
identity is strengthened and same sex attractions diminish.
Women with same sex attractions can come to see how conflicts with
fathers and/or other significant males led them to mistrust male love,
or how lack of maternal affection led to a deep longing for female love.
Insight into causes of anger and sadness will hopefully lead to
forgiveness and freedom. All this takes time. In this respect
individuals suffering from same-sex attraction are no different than the
many other men and women who have emotional pain and need to learn how
Catholic therapists working with Catholic individuals should feel free
to use the wealth of Catholic spirituality in this healing process.
Those with father wounds can be encouraged to develop their relationship
with God as a loving father. Those who were rejected or ridiculed by
peers as youngsters can meditate upon the Jesus as brother, friend, and
protector. Those who feel unmothered can turn to Mary for comfort.
There is every reason for hope that with time those who seek freedom
will find it. However, while we can encourage hope, we must recognize
that, there are some who will not achieve their goals. We may find
ourselves in the same position as a pediatric oncologist who spoke of
how when he first began his practice there was almost no hope for
children stricken with cancer and the physician's duty was to help the
parents accept the inevitable and not waste their resources chasing a
"cure." Today almost 70% of the children recover, but each death leaves
the medical team with a terrible feeling of failure. As the prevention
and treatment of same-sex attraction improves, the individuals who still
struggle will, more than ever, need compassionate and sensitive support.
PART II RECOMMENDATIONS
1) MINISTRY TO INDIVIDUALS EXPERIENCING SAME-SEX ATTRACTIONS
It is very important for every Catholic experiencing same sex
attractions to know that there is hope, and that there is help.
Unfortunately, this help is not always readily available in all areas.
Support groups, therapists, and spiritual counselors who unequivocally
support the Church's teaching are essential components of the help that
is needed. Since the notions of sexuality in our country are so varied,
patients seeking help must be cautious that the group or counselor
supports Catholic moral imperatives. One of the better known Catholic
support agencies is an organization known as Courage (see Appendix) and
its affiliated organization Encourage. While any attempt to teach the
sinfulness of illicit homosexual behavior may be greeted with
accusations of 'homophobia', the reality is that Christ calls all to
chastity in keeping with their particular state of life. The desire of
the Church to help all live chastely is not a blanket condemnation of
any who find chastity difficult, but rather the compassionate response
of a Church seeking to imitate Christ, the Good Shepherd.
It is essential that every Catholic experiencing same-sex attractions
have easy access to support groups, therapists, and spiritual counselors
who unequivocally support the Church's teaching and are prepared to
offer the highest quality help. In many areas the only support groups
available are run by Evangelical Christians or by people who reject the
Church's teaching. The failure of the Catholic community to provide for
the needs of this population is a serious omission which must not be
allowed to continue. It is particularly tragic that Courage, which under
the leadership of Fr. John Harvey has developed an excellent and
authentically Catholic network of support groups, is not yet available
in every diocese and major city.
Anecdotal reports of individuals or organizations under Catholic
auspices or directly associated with the Catholic Church, counseling
persons with same-sex attractions to practice fidelity in same-sex
relationships rather than chastity according to their state in life are
quite distressing. It is most important that Church-related counselors
or support groups be very clear about the nature and genesis of same-sex
attraction. This condition is not genetically or biologically
determined. This condition is not unchangeable. It is deceitful to
counsel individuals experiencing same-sex attractions that it is
acceptable to engage in sexual acts provided these occur within the
context of a faithful relationship. The teachings of the Catholic Church
on sexual morality are explicitly clear and do not allow exceptions.
Catholics have a right to know the truth and those working with or for
Catholic institutions have an obligation to clearly enunciate that
Some clerics, perhaps because they erroneously believe that same-sex
attraction is genetically determined and unchangeable, have encouraged
individuals experiencing same-sex attractions to identify with the gay
community, by publicly proclaiming themselves gay or lesbian, but live
chastity in their personal lives. There are several reasons why this is
a misguided course of action: 1) It is based on the mistaken idea that
same-sex attraction is an unchangeable aspect of the individual and
discourages persons from seeking help; 2) The "gay" community promotes
an ethic of sexual behavior which is totally antithetical to the
Catholic teaching on sexuality and has made no secret of its desire to
eliminate "erotophobia" and "heterosexism." (There is simply no way the
position articulated by spokespersons for the "gay" movement and the
teachings of the Catholic church can be reconciled); 3) It puts easily
tempted persons into places which must be considered the near occasion
of sin.; 4) It creates a false hope that the Church will eventually
change its teaching on sexual morality. Catholics must, of course, reach
out to individuals experiencing same-sex attraction, to those actively
involved in homosexual acts, and particularly to those suffering from
sexually transmitted diseases, with love, hope, and the authentic,
uncompromised message of freedom from sin through Jesus Christ.
2) THE ROLE OF THE PRIEST
It is of paramount importance that priests, when faced with parishioners
troubled by same-sex attraction, have access to solid information and
genuinely beneficial resources. The priest, however, must do more than
simply refer to other agencies (see Courage and Encourage in the
Appendix). He is in a unique position to provide specific spiritual
assistance to those experiencing same-sex attraction. He must, of
course, be very sensitive to the intense feelings of insecurity, guilt,
shame, anger, frustration, sadness, and even fear in these individuals.
This does not preclude him from speaking very clearly about the
teachings of the Church (see CCC, n.2357 - 2359), the need for
forgiveness and healing in Confession, the need to avoid occasions of
sin, and the need for a strong prayer life. A number of therapists
believe that religious faith plays a crucial part in the recovery from
same-sex attraction and sexual addictions.
When an individual confesses same-sex attractions, fantasies, or
homosexual acts, the priest should be aware that these are often
manifestations of childhood and adolescent traumas, sexual child abuse,
or unmet childhood needs for the love and affirmation from the same-sex
parent. Unless these underlying problems are addressed, the individual
may find the temptations returning and fall into despair. Those who
reject the Church's teachings and encourage persons with same-sex
attractions to enter into so called "stable, loving homosexual unions"
fail to understand that such arrangements will not resolve these
underlying problems. While encouraging therapy and support group
membership, the priest should remember that through the sacrament, he
can help individual penitents deal not only with the sin, but also with
causes of same-sex attraction. The following list, while not exhaustive,
illustrates some of the ways in which a priest may help the individuals
with these problems who come to the Sacrament of Reconciliation:
a) Persons, experiencing same-sex attraction or confessing sins in this
area, almost always carry a burden of deep emotional pain, sadness, and
resentment toward those who have rejected, neglected or hurt them,
including their parents, peers, and sexual molesters. Helping them to
forgive can be the first step in healing.(Fitzgibbons 1999)
b) Individuals experiencing same-sex attractions often report a long
history of early sexual experiences and sexual trauma. (Doll 1992)
Homosexually active persons are more likely to have engaged in sexual
activity with another person at a young age. (Stephan 1973; Bell
1981) Many have never told any one about these experiences (Johnson
1985) and carry tremendous guilt and shame. In some cases, those
who were sexually abused feel guilty because they reacted to their
trauma by acting out sexually. The priest can delicately inquire about
early experiences, assuring these persons that their sins are forgiven,
and helping them to find freedom through forgiving others.
c) Individuals involved in homosexual activity may also suffer from
sexual addiction. (Saghir 1973; Beitchman 1991; Goode
1977) Those who engage in homosexual activity are also more likely
to have engaged in extreme forms of sexual behavior or to have exchanged
sex for money. (Saghir 1973) Addictions are not easy to overcome.
Frequent recourse to confession can be a first step to freedom. The
priest should remind the penitents that even the most extreme sins in
these areas can be forgiven, encouraging them to resist despair and to
persevere, while at the same time suggesting a support group designed to
deal with addiction.
d) Persons with same-sex attractions are often abuse alcohol,
prescription drugs and illegal drugs. (Fifield 1977; Saghir
1973) Such abuse may weaken resistance to sexual temptation. The
priest may recommend membership in a support group which addresses these
e) Despair and suicidal thoughts are also frequently a part of the life
of an individual troubled by same-sex attraction. (Beitchman 1991;
Herrell 1999; Fergusson 1999) The priest can assure the penitent that
there is every reason to hope that the situation will change and that
God loves them and wants them to live a full and happy life. Again,
forgiving others can be extremely helpful.
f) Persons experiencing same-sex attraction may suffer from spiritual
problems such as envy (Hurst 1980) or self pity. (Van den Aardweg 1969)
It is important that the individual experiencing same-sex attractions
not be treated as though sexual temptations were their only problem.
g) The overwhelming majority of men and women experiencing same-sex
attraction and women report a poor relationship with their fathers (see
footnotes 17 to 23). The priest, as a loving and accepting father
figure, can through the sacrament begin the work of repairing that
damage and facilitating a healing relationship with God the Father. The
priest can also encourage devotion to St. Joseph.
The priest needs to be aware of the depth of healing needed by these
seriously conflicted persons. He needs to be a source of hope for the
despairing, forgiveness for the erring, strength for the weak,
encouragement for the faint of heart, sometimes a loving father figure
for the wounded. In brief, he must be Jesus for these beloved children
of God who find themselves in most difficult situations. He must be
pastorally sensitive but he must also be pastorally firm, imitating, as
always, the compassionate Jesus who healed and forgave seventy times
seven times, but always reminded, "Go and do not commit this sin again".
3) CATHOLIC MEDICAL PROFESSIONALS
Pediatricians need to know the symptoms of Gender Identity Disorder (GID)
and chronic juvenile unmasculinity. With early identification and
intervention, there is every reason to hope that the problem can be
successfully resolved. (Zucker 1995; Newman 1976) While the
primary reason for treating children is to alleviate their present
unhappiness (Newman 1976;
Bradley 1998; Bates 1974), treatment of GID and chronic
juvenile unmasculinity can prevent the development of same-sex
attraction and the problems associated with homosexual activity in
adolescence and adult life.
Most parents do not want their child to become involved in homosexual
behavior, but parents of children at-risk are often resistant to
treatment. (Zucker 1995; Newman 1976) Informing them of estimates
that 75% of children exhibiting the symptoms of GID and chronic juvenile
unmasculinity will without intervention experience same-sex attraction
(Bradley 1998) and letting them know the risks associated with
homosexual activity (Garofalo 1998; Osmond1994; Stall
1988b; Rotello 1997; Signorile 1997) may help to overcome
their opposition to therapy. Parental cooperation is extremely important
if early intervention is to succeed.
Pediatricians should familiarize themselves with the literature on
treatment. George Rekers has written a number of books on the subject. (Rekers
1988) Zucker and Bradley provide a comprehensive review of the
literature in their book Gender Identity Disorder and Psychosexual
Problems in Children and Adolescents (1995), as well as numerous cases
histories and treatment recommendations.
Physicians encountering patients with sexually transmitted diseases
acquired through homosexual activity can inform the patients that
psychological therapy and support groups are available, and that
approximately 30% of motivated patients can achieve a change in
orientation. In terms of disease prevention, an additional 30% are able
to remain celibate or eliminate high risk behavior. They should also
question these patients about drug and alcohol abuse, and recommend
treatment when appropriate, since a number of studies have linked
infection with STDs to substance abuse. (Mulry 1994)
Even before the AIDS epidemic a study of men who have sex with men found
that 63% had contracted a sexually transmitted disease through
homosexual activity. (Bell 1978) In spite of all the AIDS
education, epidemiologists predict that for the foreseeable future 50%
of men who have sex with men will become HIV positive. (Hoover 1991;
Morris 1994; Rotello 1997)
They are also at risk for syphilis, gonorrhea, hepatitis A, B, C, HPV,
and a number of other illnesses.
Mental health professionals should familiarize themselves with the works
of therapists who have successfully treated persons experiencing
same-sex attraction. Because same-sex attraction does not arise from a
single cause, different individuals may require different types of
treatment. Combining therapy with support group membership and spiritual
healing is also an option that should be considered.
4) TEACHERS IN CATHOLIC INSTITUTIONS
Teachers in Catholic institutions have a duty to defend the teachings of
the Church on sexual morality, to counter false information on same-sex
attraction, and to inform at-risk or homosexually involved adolescents
that help is available. They should continue to resist pressure to
include condom education in the curriculum to accommodate homosexually
active adolescents. Numerous studies have found that such education is
ineffective at preventing disease transmission in the at-risk
population. (Stall 1988a; Calabrese 1987; Hoover 1991)
"Gay" rights activists have insisted that at-risk adolescents be turned
over to support groups which will help them "come out." There is no
evidence that participation in such groups prevents the long-term
negative consequences associated with homosexual activity. Such groups
will definitely not encourage the adolescent to refrain from sin and
live chastely according to his state in life. Symptoms of GID and
chronic juvenile unmasculinity in boys should be taken seriously.
At-risk children do, however, need special help, particularly those who
have been victims of sexual child abuse.
Educators also have a duty to prevent teasing and ridicule of children
who do not conform to gender norms. Resources to educate teachers,
lesson plans, and strategies for dealing with teasing need to be created
and provided to teachers in Catholic schools, CCD programs, and other
5) CATHOLIC FAMILIES
When Catholic parents discover that their son or daughter is
experiencing same-sex attractions or engaging in homosexual activity,
they are often devastated. Afraid for the child's health, happiness, and
salvation, parents are usually relieved when informed that same-sex
attraction is treatable and preventable. They can find support from
other parents in Encourage. They also need to be able to share their
burden with loving friends and families.
Parents should be informed about the symptoms of Gender Identity
Disorder and the prevention of gender identity problems, encouraged to
take such symptoms seriously and to refer children with gender identity
problems to qualified and morally appropriate mental health
6) THE CATHOLIC COMMUNITY
There was a time in the not too distant past when pregnancy outside of
marriage and abortion were taboo topics and attitudes toward the women
involved were judgmental and harsh. The legalization of abortion forced
the Church to confront this issue and provide an active ministry to
women facing an "unwanted" pregnancy and to women experiencing
post-abortion trauma. In a few short years the approach of dioceses,
individual parishes, and the Catholic faithful has been transformed and
today true Christian charity is the norm rather than the exception. In
the same way the attitudes toward same-sex attraction can be
transformed, provided each Catholic institution does its part.
Those experiencing same-sex attractions, those who are engaging in
homosexual behavior, and their families often feel that they are
excluded from the loving concern of the Catholic community. Prayer for
persons experiencing same-sex attractions and their families offered as
part of the intentions during mass is one way to let them know that the
community cares for them.
The members of Catholic media need to be informed about same-sex
attraction, the teachings of the Church, and resources for prevention
and treatment. Pamphlets and other materials, which clearly articulate
the Church's teaching and provide information on resources for those
with immediate needs in this area, should be developed and distributed
from racks already present in many churches.
When a member of the Catholic media, a teacher in a Catholic
institution, or a pastor, misstates the Church's teaching or gives the
impression that same-sex attraction is genetically determined and
unchangeable, the laity can offer information designed to correct these
The Catholic Medical Association recognizes the responsibility that a
Diocesan Bishop has to oversee the orthodoxy of teaching within his
Diocese. This certainly includes clear instruction in the nature and
purpose of intimate sexual relations between persons and the sinfulness
of inappropriate relations. The CMA looks forward to working with
Bishops and priests in assisting in the establishment of appropriate
support groups and therapeutic models for those struggling with same-sex
attractions. While we see the Courage and Encourage programs as very
useful and valuable and actively promote them, we are certain that there
are other modes of support and are willing to work with any
psychologically, spiritually and morally appropriate program.
Jeffrey Satinover, MD and Ph.D., has written of his extensive experience
with patients experiencing same-sex attraction:
"I have been extraordinarily fortunate to have met many people who have
emerged from the gay life. When I see the personal difficulties they
have squarely faced, the sheer courage they have displayed not only in
facing these difficulties but also in confronting a culture that uses
every possible means to deny the validity of their values, goals, and
experiences, I truly stand back in wonder... It is these people
former homosexuals and those who are still struggling, all across
America and abroad
who stand for me as a model of everything good and possible in a world
that takes the human heart, and the God of that heart, seriously. In my
various explorations within the worlds of psychoanalysis, psychotherapy,
and psychiatry, I have simply never before seen such profound healing."
Those who wish to be free from same-sex attractions frequently turn
first to the Church. CMA wants to be sure that they find the help and
hope they are seeking. There is every reason to hope that every person
experiencing same-sex attraction who seeks help from the Church can find
freedom from homosexual behavior and many will find much more, but they
will come only if they see love in our words and deeds.
If Catholic medical professionals have in the past failed to meet the
needs of this patient population, failed to work diligently to develop
effective prevention and treatment therapies, or failed to treat
patients experiencing these problems with the respect due every person,
we ask forgiveness.
The Catholic Medical Association recognizes that healthcare
professionals have a special duty in this area and hopes that this
statement will help them to carry out that duty according to the
principles of the Catholic Faith.
The research referenced in this report is drawn from a wide variety of
sources. In most cases, numerous other sources could have been cited.
For those desiring to make an in- depth study of the issues raised, a
comprehensive bibliography can be obtained (firstname.lastname@example.org)
along with reviews of the relevant literature.
It should also be pointed out that many of the authors cited do not
accept the Church's teaching on the intrinsically disordered nature of
homosexual acts. No effort has been made to distinguish between those
who do and those who don't, since those who favor prevention and
treatment and those who support gay-affirming therapy present
essentially consistent statistical evidence and case material, differing
on the interpretation and relevance of the evidence. The endnotes
contain numerous direct quotations from the material cited.
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Courage and Encourage
St. John the Baptist Church and Friary
210 West 31st Street
New York, NY 10001
AUTHORS, CONTIBUTORS & EDITORS
Eugene Diamond, M.D.
Professor of Pediatrics
Loyola Stritch School of Medicine
Richard Delaney, M.D.
Sheila Diamond, RN, MSN
John Paul II Institute
Richard Fitzgibbons, M.D.
Comprehensive Counseling Service
W. Conshohocken, PA
Rev. James Gould
St. Raymond Parish
Rev. John Harvey
Director, Courage Ministry
New York, NY
Ned Masbaum, M.D.
Kevin Murrell, M.D.
Dept. of Psychiatry
Univ. of Georgia Medical School
Peter Rudegeair, Ph.D.
W. Conshohocken, PA
Edward Sheridan, M.D.
Dept. of Psychiatry
Georgetown Univ. School of Medicine
 Chapman and Brannock (1987) found than 63% of the lesbians in their
survey stated that they had chosen to be lesbians, 28% felt they had no
choice, and 11% did not know why they were lesbians.
 Schreier writes in support of a therapist (Wolpe 1969) who refused
to patient's request for therapy directed toward change of sexual
orientation from homosexuality to heterosexual: "Perhaps instead of
sexual reorientation, individuals could seek religious reorientation to
any number of major U.S. religions that are affirming of people with
same-sex orientations.... Not all religions are judgmental and
condemning. Advocating for sexual reorientation while being critical of
religious reorientation again demonstrates nothing more than bias."
 Burr: Cover story of The Weekly Standard, "Suppose there is a Gay
 Hamer claimed to have found a marker for homosexuality on the x
 LeVay claimed to have found that a certain part of the brains of
homosexual men who died of AIDS differed from that of heterosexual men
 Byne: "Critical review shows the evidence favoring a biologic theory
to be lacking. In an alternative model, temperamental and personality
traits interact with familial and social milieu as the individual's
sexuality emerges." (p.228) "Research into the inheritability of
personality variants suggests that some personality dimensions my be
heritable, including novelty seeking, harm avoidance, and reward
dependence. Applying these dimensions to the above scenario, one might
predict that a boy who was high in novelty seeking, but low in harm
avoidance and reward dependence, would be likely to disregard his
mother's discouragement of baseball. On the other hand, a boy who was
low in novelty seeking, but high in harm avoidance and reward
dependence, would be more likely to need the rewards of maternal
approval, would be less likely to seek and encounter male role models
outside the family, and would be more likely to avoid baseball for fear
of being hurt. In the absence of encouragement from an accepting father
or alternative male role model, such a boy would be likely to feel
different from his male peers and as a consequence be subject to
non-erotic experiences in childhood that may contribute to the
subsequent emergence of homoerotic preferences. Such experiences could
include those described by Friedman as being common in pre-homosexual
boys, including low masculine self-regard, isolation, scapegoating, and
rejection by male peers and older males, including the father. " (p.237)
 Crewdson: ".... no other laboratory has confirmed Hamer's findings."
 Horgan: "LeVay's finding has yet to be fully replicated by another
researcher. As for Hamer, one study has contradicted his results."
 McGuire: "... some people want homosexuality to be biological or
genetic because they then believe that because homosexuals are 'born
that way' they will somehow be tolerated. Others advocate environmental
causes since this justifies their belief that individuals 'chose a gay
lifestyle'." (p.141) "Even if we knew absolutely everything about genes
and absolutely everything about environment, we still could not predict
the final phenotype of any individual." (p.142)
 Rice et al. attempted unsuccessfully to replicate the Hamer study.
 Bailey: A study of the male siblings of homosexually active males
found that "52% (29/56) of monozygotic co-twins, 22% (12/54) of
dizogotic co-twins, and 11% (6/57) of adoptive brothers were
homosexual... rate of homosexuality among non-twin biological siblings,
as reported by probands, 9.2% (13/142). (p.1089)
Parker: Case A: "Their mother, then 39 years old, learnt only a few
days before the confinement that she was having twins, as she already
had a 7-year-old son was anxious that one of them should be a girl.
Sensing her obvious disappointment following the normal delivery of two
6 1/2 pound sons, the labour ward Sister consoled her with the
suggestion that the first-born, and one subsequently to become a
homosexual, was pretty enough to be a girl. Although they were so alike
that they could not be distinguished, the mother seized on this idea and
put a bracelet around the first twin to ensure there would be no
confusion of identity, and from then on he was treated as if he were a
 Marmor: "The myth that homosexuality is untreatable still has wide
currency among the public at large and among homosexuals themselves.
This view is often linked to the assumption that homosexuality is
constitutionally or genetically determined. This conviction of
untreatibility also serves an ego-defensive purpose for many
homosexuals. As the understanding of the adaptive nature of most
homosexual behavior has become more widespread, however, there has
evolved a greater therapeutic optimism about the possibilities for
change, and progressively more hopeful results are being reported...
There is little doubt that a genuine shift in preferential sex object
choice can and does take place in somewhere between 20 and 50 per cent
of patients with homosexual behavior who seek psychotherapy with this
end in mind." (p.1519)
 Ernulf found that those who believed that homosexuals are "born
that way" held significantly more positive attitudes toward homosexuals
than subjects who believed that homosexuals "choose to be that way"
and/or "learn to be that way."
 Piskur: "The major finding of this study was that exposure to a
written summary of research supporting biological determinants of
homosexual orientation can affect scores assessing attitudes toward
homosexuals when measured immediately after the reading." (p.1223)
 Green: "The Supreme Court ruled in Bowers v Hardwick that there is
no fundamental right under a substantive due process analysis to engage
in homosexual behavior. Therefore, the remaining constitutional route to
protecting homosexuals against discrimination is the equal protection
clause of the fourteenth amendment. For the highest level of protection
there, a class of persons must be declared 'suspect.' To so qualify, the
class should demonstrate, inter alia, that the trait for which it is
stigmatized is immutable." (p.537)
 Apperson: "The importance of the relationship
or lack of it
with the father is again emphasized, with the homosexual S[ubject]s
showing marked difference from the controls in perceiving the father
more as critical, impatient, and rejecting, and less as the socializing
 Bene: "Far fewer homosexual than married men thought that their
fathers had been cheerful, helpful, reliable, kind or understanding,
while far more felt that their fathers had no time for them, had not
loved them, and had made them feel unhappy." (p.805)
 Bieber : "Profound interpersonal disturbance is unremitting in the
homosexual father-son relationship. Not one of the fathers (of
homosexual sons)... could be regarded as reasonably 'normal' parents."
(p.114) "We have come to the conclusion that a constructive, supportive,
warmly related father precludes the possibility of a homosexual son; he
acts as a neutralizing protective agent should the mother make
seductive or close-binding attempts." (p.311)
 Fisher: "Fisher analyzed the 58 studies and reported that a large
majority supported the notion that homosexual sons perceive their
fathers as negative, distant, unfriendly figures." A review of
literature on childhood experiences of male homosexuals found "With only
a few exceptions, the male homosexual declares that father has been a
negative influence in his life. He refers to him with such adjectives as
cold, unfriendly punishing, brutal, distant, detached. There is not a
single even moderately well controlled study that we have been able to
locate in which male homosexuals refer to father positively or
 Pillard: "Alcoholism occurs more frequently in fathers of
HS[homosexual] men (14 fathers of HS men versus five fathers of
HT[Heterosexual] men.)" (p.54)
 Sipova: "It was found that the fathers of homosexuals and
transsexuals were more hostile and less dominant than the fathers of the
control group and hence less desirable identification models." (p.75)
 Bieber: "In about 75 per cent of the cases, the mothers had had an
inappropriately close, binding, and intimate bond with their sons. More
than half of these mothers were described as seductive. They were
possessive, dominating, overprotective, and demasculinizing." (p.524)
 Bieber: "By the time the H[homosexual]-son has reached the
preadolescent period, he has suffered a diffuse personality disorder.
Maternal over-anxiety about health and injury, restriction of activities
normative for the son's age and potential, interference with assertive
behavior, demasculinizing attitudes, and interference with sexuality
interpenetrating with paternal rejection, hostility, and lack of support
produce an excessively fearful child, pathologically dependent upon his
mother and beset by feelings of inadequacy, impotence, and
self-contempt. He is reluctant to participate in boyhood activities
thought to be physically injurious
usually grossly overestimated. His peer group responds with humiliating
name-calling and often with physical attack which timidity tends to
invite among children... Thus he is deprived of important empathic
interaction which peer groups provide." (p.316)
 Snortum studied 46 males separated from military service because of
homosexual behavior and concluded: "It appears that the pathological
interplay between a close-binding, controlling mothers and a rejecting
and detached father is not unique to the subculture of sophisticated,
upper-middle-class families who engage psychoanalysts." (p.769)
 Fitzgibbons: "The second most common cause of SSAD [same sex
attraction disorder] among males is mistrust of women's love... Male
children in fatherless homes often feel overly responsible for their
mothers. As they enter their adolescence, they may come to view female
love as draining and exhausting." (p.89)
 Bradley: "Girls with GID ...have difficulty connecting with their
mothers, who are perceived as weak and ineffective. We see this
perception as arising from the high levels of psychopathology observed
in these mothers, especially severe depression and borderline
personality disorder." (p.877)
 Eisenbud "Broken homes and alcoholic conditions in Lesbian women's
early backgrounds as well as inadequate mothering, afford no further
chance of warm inclusion. The death of a beloved mother leaves cold
isolation. Even when mother is present, the Lesbian girl frequently
experiences her withdrawal from her after 18 months." (p.98-99)
 Zucker: "...we feel that parental tolerance of cross-gender
behavior at the time of its emergence is instrumental in allowing the
behavior to develop...What is unique in the situation with children who
develop a gender identity disorder is the co-occurrence of a multitude
of factors at a sensitive period in the child's development
that is, most typically in the first few years of life, the period of
gender identity formation and consolation. There must be a sufficient
numbers of factors to induce a state of inner insecurity in the child,
such that he or she requires a defensive solution to deal with anxiety.
This must occur in a context in which the child perceives that the
opposite-sex role provides a sense of safety or security."(p.259) "...
we were unable to identify in any case reports a clinician who felt that
the parents unequivocally encouraged a masculine identity in their
 Friedman: "Thirteen of the 17 homosexual subjects (76%) reported
chronic, persistent terror of fighting with other boys during the
juvenile and early adolescent period. The intensity of this fear
approximated a panic reaction. To the best of their recall, these boys
never responded to challenge from a male peer with counter-challenge,
threat, or attack. the pervasive dread of male-male peer aggression was
a powerful organizing force in their minds. Anticipatory anxiety
resulted in phobic responses to social activities; the fantasy that
fighting might occur led to avoidance of wide variety of social
interactions, especially rough-and-tumble activities (defined in our
investigation as body-contact sports such as football and soccer).
"These subjects reported that painful loss of self-esteem and loneliness
resulted from their extreme aversion to juvenile peer aggressive
interactions. All but one (12 of 13) were chronically hungry for
closeness with other boys. Unable to overcome their dread of potential
aggression in order to win respect and acceptance, these boys were
labeled "sissies" by peers. These 12 subjects related that they had the
lowest possible peer status during juvenile and early adolescent years.
Alternately ostracized and scapegoated, they were the targets of
continual humiliation. All of these boys denied effeminacy..."
(p.432-433) "No pre-homosexual youngster had any degree of experience
with fighting or rough-and-tumble during the juvenile years. None
engaged in even the modest juvenile sex-typed interactions described by
the least aggressive heterosexual youngster." (p.434)
 Hadden: "In analytical examination of the pre-school period of life
it is usually revealed that the boy who became homosexual never felt
accepted by and never felt comfortable in relationships with his age
peers. Quite often because of parental interference he was prevented
from participation in the play activities with other children and had
little opportunity of running, romping, rolling around, tugging,
wrestling, and scrambling with his peers from the toddling stage to the
kindergarten or school age." (p.78)
 Hockenberry: "The conclusion was made that the five item function
(playing with boys, preferring boys' games, imagining self as a sport
figure, reading adventure and sports stories, considered a "sissy") was
the most potent and parsimonious discriminator among adult males for
sexual orientation. It was similarly noted that the absence of masculine
behaviors and traits appeared to be a more powerful predictor of later
homosexual orientation than the traditionally feminine or cross-sexed
traits and behaviors." (p.475)
 Whitam developed and administered a six item inventory to 206
homosexual and 78 heterosexual male respondents regarding their
childhood interests in cross-dressing, playing with dolls preferences
for affiliating with girls and older women, being regarded as a "sissy"
by peers, and the nature of one's childhood sex play. Virtually all of
the homosexuals (97%) reported possessing one or more of these
"childhood indicators," whereas 74% of the heterosexual subjects
reported a complete absence of any of the indicators in their childhood.
(In Hockenberry, p.476)
 Thompson compared 127 male homosexuals with 123 controls: "The
seven most discriminating items in order from the highest were: (a)
played baseball... with homosexuals concentrating on never or
sometimes...;(b) played competitive group games (homosexuals never or
sometimes...); (c) child spent time with father (homosexuals, very
little...); (d) physical makeup as a child (homosexuals, frail, clumsy,
or coordinated, heterosexuals, athletic); (e) felt accepted by father
(homosexuals, mildly or no...); (f) played with boys before adolescence
(homosexuals, sometimes...); and (g) mother insisted on being center of
child's attention (homosexuals, often or always...)"(p.123)
 Bailey: "Male homosexuals were remembered by their mothers as less
masculine and more non-athletic." (p.44)
 Fitzgibbons: "Weak masculine identity is easily identified and, in
my clinical experience, is a major cause of SSAD in men. Surprisingly,
it can be an outgrowth of weak eye-hand coordination which results in an
inability to play sports well. This condition is usually accompanied by
severe peer rejection. .The 'sports wound' will negatively affect the
boy's image of himself, his relationship with peers, his gender
identity, and his body image." (p.88)
 Newman: "Experiences of being ostracized and ridiculed may play a
more important role than has been recognized in the total abandonment of
the male role at a later time." (p.687)
 Beitchman: "Among adolescents, commonly reported sequalae (of child
sexual abuse) include sexual dissatisfaction, promiscuity,
homosexuality, and an increased risk for re-victimization. (p.537)
 Bradley: "In our female adolescents with GID, a history of sexual
abuse or fears of sexual aggression has appeared commonly." (p.878)
 Engel: "Some lesbian patients [victims of sexual abuse] go through
a time of confusion, not being sure whether they are with women out of
choice or whether it is just because they are afraid, angry, and
repulsed by men due to the sexual abuse." (p.193)
 Gundlach reported that 39 of 217 lesbians versus 15 of 231
non-lesbians reported they were objects of rape or attempted rape at age
15 or under. (p.62)
 Golwyn: "We conclude that social phobia may be a hidden
contributing factor in some instances of homosexual behavior." (p.40)
 Fergusson et al found that in a birth cohort sample the gay,
lesbian, bisexual subjects has significantly higher rates of: Suicidal
Ideation (67.9%/29.0%), Suicide Attempt (32.1%/7.1%), and psychiatric
disorders age 14 -21
Major depression (71.4%/38.2%), Generalized anxiety disorder
(28.5%/12.5%), conduct disorder (32.1%/11.0%), Nicotine dependence
(64.3%/26.7%), Other substance abuse/dependence (60.7%/44.3%), Multiple
disorders (78.6%/38.2%) than the heterosexual sample. (p.879)
 Parris in a study of consecutive admissions found that the rate of
homosexuality in the BPD [Borderline Personality Disorder] sample was
16.7%, as compared with 1.7% in the non-BPD comparison group. The
homosexual BPD group had a rate of overall Childhood Sexual Abuse rate
of 100% as compared to 37.3% for the heterosexual BPD group. "It is
interesting that 3 out of 10 homosexual borderline patients also
reported father-son incest." (p.59)
 Zubenko: "Homosexuality was 10 times more common among the men and
six times more common among the women with borderline personality
disorder than in the general population or in a depressed control
 Gonsiorek discusses the treatment of homosexuals who are also
 Bychowski: "... homosexuals, in whom the ego has remained fixated
in the stage of early narcissism, find it impossible to substitute
consistent and successful dealings with reality for homosexual acts
which they invest heavily with magic. The structure of these individuals
is in many respects close to schizophrenia." (p.55)
 Kaplan: "In a sense, the homosexual has much in common with the
narcissist, who has a love affair with himself. The homosexual, however,
is unable to love himself as he is, since he is too dissatisfied with
himself; instead he loves his ego-ideal, as represented by the
homosexual partner whom he chooses. Thus for this particular type of
individual, homosexuality becomes an extension of narcissism." (p.358)
 Berger: "A possible aetiological factor that has not been mentioned
before in the literature, the abortion of a pregnancy conceived by the
male patient that may have led to the patient 'coming out' or declaring
homosexuality, is discussed." (p.251)
 APA: "Gender Identity Disorder can be distinguished from simple
nonconformity to stereotypical sex role behavior by the extent and
persuasiveness of cross-gender wishes, interests, and activities." (p.
 Phillips: "The 16-item discriminate-function ... yielded correct
classification of 94.4% of heterosexual men and 91.8% of the homosexual
men. These results indicate that heterosexual and homosexual men are
classified with equivalent accuracy on the basis of recalling having had
or not having had gender conforming (masculine) experiences in
 Harry: "These data suggest that some history of childhood
femininity is almost always a precursor of adolescent homosexual
 Hadden: "In my experience with male homosexuals, they almost
universally recognize that they were maladjusted at the time they
started school. Many were recognized by their parents as needing
psychiatric assistance much earlier." (p.78)
 Rekers: "When we first saw him, the extent of his feminine
identification was so profound ... that it suggested irreversible
neurological and biochemical determinants. After 26 months follow-up, he
looked and acted like any other boy. People who viewed the video taped
recordings of him before and after treatment talk of him as 'two
 Brown: "In summary, then it would seem that the family pattern
involving a combination of a dominating, overly intimate mother plus a
detached, hostile or weak father is beyond doubt related to the
development of male homosexuality...It is surprising there has not been
greater recognition of this relationship among the various disciplines
that are concerned with children. A problem that arises in this
connection is how to inform and educate teachers and parents relative to
the decisive influence of the family in determining the course and
outcome of the child's psychosexual development. There would seem no
justification for waiting another 25 or 50 years to bring this
information to the attention of those who deal with children. And there
is no excuse for professional workers in the behavioral sciences to
continue avoiding their responsibility to disseminate this knowledge and
understanding as widely as possible." (p.232)
 Acosta: "...better prospects for intervention in homosexuality lie
in its prevention through the early identification and treatment of the
potential homosexual child." (p.9)
 Green: "This longitudinal study of two groups of boys demonstrates
that the association between extensive cross-gender behavior in boyhood
and homosexual behavior in adulthood, suggested by previous
retrospective reports, can be validated by a prospective study of
clinically or family-referred boys with behaviors consistent with the
gender identity disorder of childhood. However, not all boys with
extensive cross-gender behavior evolved as bisexual or homosexual men.
No boys in the comparison group evolved as bisexual or homosexual."
 Bieber: "The therapeutic results of our study provide reason for an
optimistic outlook. Many homosexuals became exclusively heterosexual in
psychoanalytic treatment. Although this change may be more easily
accomplished by some than by others, in our judgment a heterosexual
shift is a possibility for all homosexuals who are strongly motivated to
 Clippinger: "Of 785 patients treated, 307 - or approximately 38%
were cured. Adding the percentage figures of the two other studies, we
can say that at least 40% of the homosexuals were cured, and an
additional 10 to 30% of the homosexuals were improved, depending on the
particular study for which statistics were available." (p.22)
 Fine: "Whether with hypnosis..., psychoanalysis of any variety,
educative psychotherapy, behavior therapy, and/or simple educational
procedures, a considerable percentage of overt homosexuals became
heterosexual... If patients were motivated, whatever procedure is
adopted a large percentage will give up their homosexuality... The
misinformation that homosexuality is untreatable by psychotherapy does
incalculable harm to thousands of men and women... All studies from
Schrenk-Notzing on have found positive effects virtually regardless of
the kind of treatment used." (p.85-86)
 Kaye: "Finally, we have indications for therapeutic optimism in the
psychoanalytic treatment of homosexual women. We find, roughly, at least
a 50% probability of significant improvement in women with this syndrome
who present themselves for treatment and remain in it." (p.634)
 MacIntosh queried psychoanalysts who reported that of 824 male
patients of 213 analysts - 197 (23.9%) changed to heterosexuality, 703
received significant therapeutic benefit; and of the 391 female patients
of 153 analysts
79 (20.2%) changed to heterosexuality, 318 received significant
therapeutic benefit. (p.1183)
 Marmor: "The clinicians represented in this volume present
convincing evidence that homosexuality is a potentially reversible
condition. There is little doubt that much of the recent success in the
treatment of homosexuals stems from the growing recognition among
psychoanalysts that homosexuality is a disorder of adaptation." (p. 21)
 Nicolosi surveyed 850 individuals and 200 therapists and counselors
specifically seeking out individuals who claim to have made a degree of
change in sexual orientation. Before counseling or therapy, 68% of
respondents perceived themselves as exclusively or almost entirely
homosexual, with another 22% stating they were more homosexual than
heterosexual. After treatment only 13% perceived themselves as
exclusively or almost entire homosexuality, while 33% described
themselves as either exclusively or almost entirely heterosexual. 99% of
respondents said they now believe treatment to change homosexuality can
be effective and valuable.
 Rogers: "In general, reports on the group treatment of homosexuals
are optimistic; in almost all cases the therapists report a favorable
outcome of therapy whether the therapeutic goal was one of achieving a
change in sexual orientation or whether it was a reduction in
concomitant problems." (p.22)
 Satinover reviewed literature in treatment and found that in the
eight years between 1966 and 1974 alone, the Medline database
which excludes many psychotherapy journals
listed over a thousand articles on the treatment of homosexuality.
According to Satinover, these reports contradict claims that change is
impossible. Indeed, it would be more accurate to say that all the
existing evidence suggests strongly that homosexuality is quite
changeable. Most psychotherapists will allow that in the treatment of
any condition, a 30% rate may be anticipated. (p.169)
 Throckmorton: "Narrowly, the question to be addressed is: Do
conversion therapy techniques work to change unwanted sexual arousal? I
submit that the case against conversion therapy requires opponents to
demonstrate that no patients have benefited from such procedures or that
any benefits are too costly in some objective way to be pursued even if
they work. The available evidence supports the observation of many
that many individuals with same-gender sexual orientation have been able
to change through a variety of counseling approaches." (p.287)
 West summarizes the results of studies: behavioral techniques have
the best documented success (never less than 30%); psychoanalysis claims
a great deal of success (the average rate seemed to be about 25%, but
50% of the bisexuals achieved exclusive heterosexuality.)"Every study
ever performed on conversion from homosexual to heterosexual orientation
has produced some successes."
 Barnhouse. "These facts and statistics about cure are well known
and not difficult to verify. In addition, there are many people to have
experienced their homosexuality as a burden either for moral or social
reasons who have, without the aid of psychotherapy, managed to give up
this symptom; of these, a significant number have been able to make the
transition to satisfying heterosexuality. Quite apart from published
studies by those who have specialized in the treatment of sexual
disorders, many psychiatrists and psychologists with a more general type
of practice (and I include myself in this group) have been successful in
helping homosexual patients to make a complete and permanent transition
to heterosexual." (p.109)
 Bergler: "In nearly thirty years, I have successfully concluded
analyses of one hundred homosexuals... and have seen nearly five hundred
cases in consultation. On the basis of the experience thus gathered, I
make the positive statement that homosexuality has an excellent
prognosis in psychiatric-psychoanalytic treatment of one to two years'
duration, with a minimum of three appointments each week
provided the patient really wishes to change. A considerable number of
colleagues have achieved similar success." (p.176)
 Bieber: "We have followed some patients for as long as 20 years who
have remained exclusively heterosexual. Reversal estimates now range
from 30% to an optimistic 50%" (p.416).
 Cappon reported that of patients with bisexual problems 90% were
cured (i.e., no reversions to homosexual behavior, no consciousness of
homosexual desire and fantasy) in males who terminated treatment by
common consent. Male homosexual patients: 80% showed marked improvement
(i.e., occasional relapses, release of aggression, increasingly dominant
heterosexuality)... 50% changed." (p.265-268) Of female patients 30%
 Caprio: "Many patients of mine, who were formerly lesbians, have
communicated long after treatment was terminated, informing me that they
are happily married and are convinced that they will never return to a
homosexual way of life." (p.299)
 Ellis: "... it is felt that there are some grounds for believing
that the majority of homosexuals who are seriously concerned about their
condition and willing to work to improve it may, in the course of active
psychoanalytically-oriented psychotherapy, be distinctly helped to
achieve a more satisfactory heterosexual orientation." (p.194)
 Hadden: "From my experience I have concluded that homosexuals can
be treated more effectively by group psychotherapy when they are started
in groups made up exclusively of homosexuals. In such groups the
rationalization that homosexuality is a pattern of life they wish to
follow is destroyed by their fellow homosexuals." (p. 814)
 Hadden: "As each patient is brought into the group, we make it
clear to him that we do not regard homosexuality as a particular
disease, but as a symptom of an overall pattern of maladjustment.... I
anticipate that better than one-third of the patients who persist in
treatment will experience a reversal of their sexual pattern, but it may
be necessary to continue in treatment for two or more years." (p.114)
 Hadfield reported curing 8 homosexuals: "By cure I do not mean...
that the homosexual is merely able to control his propensity ... Nor ..
do I mean that the patient is rendered capable of having sexual
relations and bearing children; for ... he might do this by the help of
homosexual fantasies. By 'cure' I mean that he loses his propensity to
his own sex has his sexual interests directed towards those of the
opposite sex, so that he becomes in all respects a sexually normal
 Hatterer reported: 49 patients changed (20 married, of these 10
remained married, 2 divorced, 18 achieved heterosexual adjustments); 18
partially recovered, remained single; 76 remained homosexual (28
palliated - 58 unchanged) "A large undisclosed population has melted
into heterosexual society, persons who behaved homosexually in late
adolescence and early adulthood, and who, on their own, resolved their
conflicts and abandoned such behavior to go on to successful marriages
or to bisexual patterns of adaptation." (p.14)
 Kroneymeyer: "From my 25 years' experience as a clinical
psychologist, I firmly believe that homosexuality is a learned response
to early painful experiences and that it can be unlearned, For those
homosexuals who are unhappy with their life and find effective therapy
it is 'curable'" (p.7)
 Exodus North America Update publishes a monthly newsletter
containing testimonies of men and women who have left homosexuality. PO
Box 77652, Seattle WA 98177, see issues from 1990 - 2000
 "APA "Fact sheet: Homosexuality and Bisexuality: ... There is no
published scientific evidence supporting the efficacy of 'reparative
therapy' as a treatment to change one's sexual orientation."
 Herek: "As recently as January of 1990, Dr. Bryant Welch, Executive
Director for Professional Practice of the American Psychological
Association, stated that 'no scientific evidence exists to support the
effectiveness of any of the conversion therapies that try to change
one's sexual orientation' and that 'research findings suggest that
efforts to 'repair' homosexuals are nothing more than social prejudice
garbed in psychological accouterments.E(p.152)
 Tripp: "From my point of view, there is no indication that
fundamental changes in anybody's sex life are ever wrought by therapy,
nor would they be particularly desirable anyway. A person's best sexual
orientation is the one that helps him get the most out of himself,
spontaneously. Killing off his guilt and his childish expectation that
conformity is the road to heaven both tend to give him confidence and
the energy to make a much smoother social integration... Since
homosexuality is an alternate orientation and not a disease, 'cure' is
patently impossible. What passes for 'cure' is surface symptom
suppression or outright avoidance." (p.48)
 Goetze reviewed 17 studies a found a total of 44 persons who were
exclusively or predominantly homosexual experienced a full shift of
 Coleman: "... to offer a cure to homosexuals who request a change
in their sexual orientation is, in my opinion unethical. There is
evidence, as reviewed in this paper, that therapists can help
individuals change their behavior for a period of time. The question
remains whether it is beneficial for patients to change their behavior
to something that is inconsistent or incongruent with their sexual
 Herron: ""Changing a person's sexual behavior from homosexual to
heterosexual might be accomplished by working with a potential already
present, but this would not really change the person's preference. While
it may appear that psychoanalysis can change a person's sexual
orientation, in truth this is a limited accomplishment that happens only
occasionally and even then is of questionable duration." (p.179)
 Acosta: "Most therapeutic success seems to be with bisexuals rather
than exclusive homosexuals. The combined use of psychotherapy and
specific behavioral techniques is seen to offer some promise for
heterosexual adaptation with certain kinds of patients." (p.9)
 Davison: "... even if one were to demonstrate that a particular
sexual preference could be modified by a negative learning experience,
there remains the question of how relevant these data are to the ethical
question of whether one should engage in such behavior changes regimens.
The simple truth is that data on efficacy are quite irrelevant. Even if
we could effect certain changes, there is still the more important
question of whether we should. I believe we should not." (p.96) "Change
of orientation therapy programs should be eliminated. Their availability
only confirms professional and societal biases against homosexuality,
despite seemingly progressive rhetoric about its normality... " (p.97)
 Gittings: "The homosexual community looks upon efforts to change
homosexuals to heterosexuality, or to mold younger, supposedly malleable
homosexuals into heterosexuality... as an assault upon our people
comparable in its way to genocide."
 Begelman: "The efforts of behavior therapists to reorient
homosexuals to heterosexuals by their very existence constitute a
significant causal element in reinforcing the social doctrine that
homosexuality is bad." (p.180)
 Begelman: "My recommendation that behavior therapists consider
abandoning the administration of sexual reorientation techniques is
based on the following considerations. Administering these programs
means reinforcing the social belief system about homosexuality. The
meaning of the act of providing reorientation services is yet another
element in a causal nexus of oppression." (p.217)
 Murphy: "There would be no reorientation techniques where there no
interpretation that homoeroticism is an inferior state, an
interpretation that in many ways continues to be medically defined,
criminally enforced, socially sanctioned, and religiously justified. And
it is in this moral interpretation, more than in the reigning medical
theory of the day, that all programs of sexual reorientation have their
common origins and justifications." (p.520)
 Sleek quotes Linda Garnet, Chair of APA's Board for Advancement of
Psychology in the Public Interest who stated that reorientation
therapies "feed upon society's prejudice towards gays and may exacerbate
a patient's problems with poor self-esteem, shame, and guilt."
 Smith: ""Naturally, all parents wish their children to be happy and
to resemble themselves, and if it were possible to prevent homosexual
adjustment (not to mention transsexualism) most parents would welcome
the intervention. On the other hand, this raises ethical issues along
the lines of other 'Final Solutions' to minority problems." (p.67)
 Begelman: "The recommendation is not based on any abstract
disagreement with the principle that patients have a right to seek aid
in reducing their anxiety or upset. But it does take cognizance of the
fact that the homosexual person who seeks treatment does so most of the
time because he has been forced into adopting a conventional and
prejudicial view of his behavior. On what ethical basis, it may be
asked, are we obliged to desert the patient in favor of allegiance to an
abstract set of considerations." (p.217)
 Silverstein: "To suggest that a person comes voluntarily to change
his sexual orientation is to ignore the powerful environmental stress,
oppression if you will, that has been telling him for years that he
should change... What brings them into counseling is guilt, shame, and
the loneliness that comes from their secret. If you really wish to help
them freely choose, I suggest you first desensitize them to their guilt.
Allow them to dissolve the shame about their desires and actions and to
feel comfortable with their sexuality. After that, let them choose, but
not before." (p.4)
 Barrett: "Assisting gays and lesbians to step away from external
religious authority may challenge the counselor's own acceptance of
religious teachings." (p.8)
 Nelson, a professor of Christian ethics defends homosexual
infidelity: "... it is insensitive an unfair to judge gay men and
lesbians by a heterosexual ideal of the monogamous relationship... Some
such couples (as is true of some heterosexual couples) have explored
relationships that admit the possibility of sexual intimacy with
secondary partners." (p.173)
 Mirkin: "This article will argue that, like homosexuality, the
concept of child molestation is a culture and class specific modern
creation. Though Americans consider intergenerational sex to be evil, it
has been permissible or obligatory in may cultures and periods of
history. Sex with male youths is especially widespread." (p.4)
 Smith: "Pedophilia may be a cultural label rather than anything
inherently medical or psychiatric; anthropological findings support this
 Davison: "Bieber et al. found that what they called a
'close-binding intimate mother' was present much more often in the life
history of the analytic homosexual patients than among the heterosexual
controls. But what is wrong with such a mother unless you happen to find
her in the background of people whose current behavior you judge
beforehand to be pathological? Moreover, even when an emotional disorder
is identified in a homosexual, it could be argued that the problem is
due to the extreme duress under which the person has to live in a
society that asserts that homosexuals are 'queer' and that actively
oppresses them." (p.92)
 Menvielle in letter criticizing an article on GID by Bradley and
Zucker (1997): "The ethical implications of whether childhood GID is a
psychiatric disorder versus a manifestation of normal homosexual
orientation are vital because labeling pre-homosexual children as
disordered would be incorrect." (p.243) Bradley and Zucker responded:
"Dr. Menvielle is naive in his assumption that these children would be
happy if they were simply allowed to 'grow up' pursing their
cross-gender behavior and interests, including the desire to change sex.
They are unhappy children who are using these behaviors defensively to
deal with their distress." (p.244)
 Fitzgibbons: "Experience has taught me that healing is a difficult
process, but through the mutual efforts of the therapist and the
patient, serious emotional wounds can be healed over a period of time."
 Doll: 42% of a sample of 1,001 homosexual men reported childhood
experiences that meet the criteria for sexual abuse.
 Stephan: "... homosexuals reported experiencing their first orgasm
at a younger age than the heterosexuals" 24% of homosexuals first
orgasms occurred during homosexual contacts versus 2% of
 Bell: Homosexuals average age of first homosexual encounter 9.7
years. Heterosexuals' first sexual encounter 11.6 years.
 Johnson: "The 40 adolescent males reporting sexual victimization
ranged in age from 15 to 21 years at the time of their initial clinic
visit... No adolescent under 15 years of age reported having been
sexually assaulted, and only six of the 40 were under age 17...Only six
of the 40 patients reported having revealed the assault to anyone prior
to the interview... All six patients identified themselves as currently
homosexual." (p.374) "Even though nearly half of our adolescent male
clinic population is under 15 years of age, all the adolescents who
admitted sexual molestation were over 15 years of age. Since all the
reported molestations occurred during the preadolescent years, we can
only speculate that our young adolescent males did not report earlier
sexual abuse. " Of the 40 reporting sexual abuse 47.5% self-identified
as homosexual. (p.375)
 Saghir and Robins found that while less than 6% of heterosexual
men under 19 and 0% of those over 19 masturbated 4 or more times per
week, 46% of homosexual men under 19, 31% of those 20 to 29, and 26% of
those over 30 did so. (p.49 - 50)
 Beitchman:"...sexually abused school-age children of both sexes,
like their sexually abused pre-school counterparts, appeared more likely
to manifest inappropriate sexual behaviors (e.g., excessive
masturbation, sexual preoccupation, and sexual aggression) than did both
normal and clinical controls." (p.544)
 Goode: Never masturbated - 28% Homosexually inexperienced women
versus 0% homosexually experienced. Masturbated 6 or more times in past
month - 13% of HIW v. 50% of HEW.
 Saghir and Robins' study found 40% of homosexual men paid or
received money for sex, verses 17% of controls (not homosexual) who paid
for sex, none received. (p.81)
 Fifield:"... an alarming number of gay men and women (31.96%) are
trapped in an alcohol-centered lifestyle."
 Saghir and Robins found that 30% of the homosexuals in their
sample reported excessive drinking or alcohol dependence verses 20% of
the heterosexuals. (p.119)
 Beitchman: "A review of studies reporting symptomology among
sexually abused adolescents revealed evidence for the presence of
depression, low self-esteem, and suicidal ideation."(p.544)
 Zucker: "...In general we concur with those (e.g. Green 1972;
Newman 1976; Stoller, 1978) who believe that the earlier treatment
begins, the better."(p.281) "It has been our experience that a sizable
number of children and their families can achieve a great deal of
change. In these cases, the gender identity disorder resolves fully,
and nothing in the children's behavior or fantasy suggest that gender
identity issues remain problematic.... All things considered, however,
we take the position that in such cases a clinicians should be
optimistic, not nihilistic, about the possibility of helping the
children to become more secure in their gender identity."(p.282)
 Newman: "Feminine boys, unlike men with postpubertal gender
identity disorders seem remarkably responsive to treatment." (p.684)
 Newman: "Teasing and social rejection by male peers decreases and
is replaced by acceptance. During the initial 12 - 24 months of
treatment, these patients begin to enjoy being accepted as boys, and
their acceptance is a strong, continuing reinforcer." (p.684)
 Bradley: "Our experience is that such suffering diminishes
radically, and self esteem improves when the parent are able to value
the child and to support and to encourage same-sex behavior." (p.245)
 Bates: "It seems likely that it is the combination of effeminacy,
fearfulness, social aversiveness; and immaturity that together
constitute sufficient conditions for parents, schools, and others to
seek clinical intervention for effeminacy." (p.14)
 Newman: "Mothers generally fear losing the son's companionship as
he becomes more masculine and therefore reluctant to begin a treatment
 Garofalo: "Gay and bisexual teenagers may take more risks, and
engage in risky behavior earlier in life, than teenagers who describe
themselves as heterosexual. GLB [gay, lesbian, bisexual] teenagers were
more likely to consider or attempt suicide, abuse alcohol or drugs,
participate in risky sexual activity, or be victimized, and to initiate
these behaviors earlier."
 Osmond et al. conducted a household survey of unmarried men 18
through 29 years of age found that of 328 homosexual men 20.1% tested
positive tested for HIV.
 Stall: "... the prevalence of use of particular drugs within this
sample of an urban gay community is quite high and significant
differences exist between the number of drugs used by the homosexual and
heterosexual respondents. The finding that a sizable proportion of gay
men use many different types of drugs raises the possibility that
concurrent drug use is relatively common among gay men." (p.71)
 Signorile, quoting Steve Troy: "It's the age of AIDS and I think
people's attitude is, 'I don't know how long I'm going to live... The
majority of people who go to the circuit parties are HIV-positive, I
really think so. Their attitude is, 'I'm going to live for the moment.'
The circuit parties are the one outlet we have for total escapism. The
unfortunate part of it is that when we do the drugs, we become much less
inhibited. Things that we might normally not do when we have our wits
about us, we actually do... And, to be honest, I can't say I'm... I
can't say that I haven't done that myself. When people are on drugs, the
chances of unsafe sex are greater
like ten times higher." (p. 116)
 Rekers: "With major research grants from the National Institute of
Mental Health, I have experimentally demonstrated an affective treatment
for "gender identity disorder of childhood" which appears to hold
potential for preventing homosexual orientation in males, if applied
extensively in the population."
 Mulry: "..men who never drank prior to sex were very unlikely to
have engaged in unprotected anal intercourse, whereas 90% of men who had
at least one occasion of unprotected anal intercourse also drank at
least some of the time prior to sexual intercourse." The report found:
"a virtual absence of individuals who did not drink but did engage
unprotected anal intercourse." (p.181)
 Bell: 62% of 575 homosexual men in a study published in 1978 had
contracted a sexually transmitted disease from homosexual contacts.
Rotello: "Who wants to encourage their kids to engage in a life that
exposes them to a 50 percent chance of HIV infection? Who even wants to
be neutral about such a possibility? If the rationale behind social
tolerance of homosexuality is that it allows gay kids an equal shot at
the pursuit of happiness, that rationale is hopelessly undermined by an
endless epidemic that negates happiness." (p.286)
 Stall: "Even using cross-sectional designs, the efficacy of health
education interventions in reducing sexual risk for HIV infection has
not been consistently demonstrated... More education, over long period
time, cannot be assumed to be effective in inducing behavior changes
among chronically high-risk men." (p.883)
 Calabrese, Harris, and Easley studying a sample of gay men living
outside of the large coastal gay communities, found that neither
attendance at a safe sex lecture, reading a safe sex brochure, receiving
advice from a physician about AIDS, testing for HIV antibodies, nor
counseling at an alternative test site was associated with participation
in safe sex.
 Hoover: "The overall probability of seroconversion [from HIV - to
HIV+ ] prior to age 55 years is about 50%, with seroconversion still
continuing at and after age 55. Given that this cohort consists of
volunteers receiving extensive anti-HIV-1 transmission education, the
future seroconversion rates of the general homosexual population may be
even higher than those observed here." (p.1190)
Catholic Medical Association
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