Saturday, October 23, 2010


Give Life. Give Blood.
Blood brothers.
"One drop" rule.
Blood on your hands.
What does blood mean to you?

Blood fascinates me. It tastes great, it feels great. It is vibrant and alive like nothing else.

The sweet gush of warm, salty liquer that erupted in my nose after a punk on Thayer Street clocked me 'cuz I said he'd look good in a dress, too. The blood is what made it come alive. I was afraid for my life, and not without reason. The blood, though, that's what told me "this is real". The pain told me too. But the blood, the blood made all of my senses jump into hyperdrive. At the same time, the blood was a secret joy in the midst of the pain.

I don't have a fetish around blood (though hats off if you do). I don't seek it out. But blood is a lovely thing.

And yet.
When I bleed, I'm very conscious to make sure that my blood doesn't come into anyone else's life. I hide the fact that I'm bleeding, and I clean up more carefully than I would, say, sweat or tears. Or for that matter, snot. Or cum.

And blood makes me queasy, too.
I don't think I could watch surgery on TV. Getting blood drawn makes me wince.

Blood has so many fascinating associations. It means so many different things. Often contradictory.

I wish I could talk about giving blood and what it means. But I can't. Not yet.

What does blood mean to you?

Wednesday, October 6, 2010

Make it Better!

Here's the perfect antidote to the "There's nothing you can do now, so just wait until It Gets Better" campaign.
There's real hope in these messages.

What are some specific things you can suggest for queer and pre-queer youth to make it better? Right now?

Sunday, September 26, 2010

It Gets Better

Today I took a stand against gay youth suicide.
Sort of.
Don't get me wrong, I'm not in any way in favor of youth suicide, gay or otherwise.

I was inspired by the "It Gets Better" campaign, and when I heard that they were doing some shooting today within a few blocks of where I live, I decided to go over and lend a hand.
The most popular of the videos in this series presents Dan Savage and his partner Terry, with the aim of telling queer (or pre-queer) kids in high school that it may be rough now, but it gets better.

But I was also concerned about a couple of themes in this video that didn't sit well with me.

For one, I remember when people told me "don't worry, just wait. It gets better."
There is nothing more frustrating to a t(w)eenager than telling them to wait and sit on their hands. It makes it sound like everything it out of their control. All you have to do it wait - but waiting may be the one thing a young person cannot do well.
When people told me to wait and that "it gets better", I wrote them off as out of touch and out of options.

For another, I think it is potentially quite damaging to suggest that the best thing a queer (or pre-queer) kid can do is nothing, to sit back and wait for things to get better. What about coming out? What about taking a little bit of control over their lives? What about living authentically? I don't think that Savage and crew are suggesting that the best thing to do is nothing, but it's easy to read that message out of what they are saying.

Another thing that bugged me was the suggestion that the best thing you can do is tough it out, then leave everything behind and move to the big city. Well, the truth is, the big city sucks for a lot of people. I can't tell you how many people I've talked to living in San Francisco who moved here thinking that they would fall into the lap of a sweet landlady bearing magic brownies and get swept up into a fabulous and unstoppable social life, only to find that, just like everywhere else, you've got to build your social network from the ground up.
And when you don't have a solid grounding of who you are, the big city can chew you up and spit you out faster than you can say "doublemint".

OK, enough with the negativity!

So, I decided to go on over to the taping, and do my best to shift the message, a little bit. I wrote out a couple pages about what I wanted to say on my phone while walking over there, read & re-read it, and then shoved the phone in my pocket & spoke into the camera. I don't remember exactly what I said, but it was something like this:

Hi, I'm Bill. And you are awesome.

It will get better. It will. But that's not much help to you now.

There's a couple things you can do to make it better now.

One is that you can write, and read, about everything. Reading about history, how people have overcome amazing obstacles in the past.

And you can make things better now. For yourself and others.

To make things better, be yourself. When you are you, authentically you, then it doesn't matter what other people think or say.

And one more thing. 'It gets better' doesn't mean you have to leave everything you know and love behind and go to the big city. To be honest, the big city can be a pretty lousy place for young people.

But all across this country, from Portland Oregon to Portland Maine, from Austin Texas to Helena Montana, there are great queer communities. And when you do something to make things better, you make your home town better, too.

Things have been changing so fast in this country, all over the country.

So, it will get better. You can make it better.

I don't know if they will use it, or how they will edit it, but if it makes the cut, I'll post the video here.

More theory...
My thesis was about gay youth suicide. Well, actually, it was and it wasn't.
I was frustrated by seeing people amplify the statistics about gay youth suicide up into the scariest monster possible. Their intent was good - they wanted to draw attention to the plight of queer youth in order to do something to prevent suicide.
But, then the question is what do you do? Most of the boys who are struggling the hardest are not open about their sexuality, many may be completely unaware that they have a sexual orientation at all. Some of them don't want to be gay and are trying to find another way to be in the world.
So reaching out to queer youth is good for all kinds of reasons - but preventing suicide may be the least of them.
What is likely to be a lot more effective is changing the culture we live in so that it produces less stress in the first place.
So that's why I did my thesis about measuring heteronormativity in the social environment, and specific ways to improve the social environment (like passing gay rights laws), rather than trying to identify the individual-level risk factors that affect queer and pre-queer youth.

Sunday, August 22, 2010

Legal Pot. Public Health. Queers.

Pot is going to be legalized in California. No matter what your stance on the voter proposition, legal marijuana is coming, and Public Health will probably be in the mix in ways it has not been until now. I myself haven't decided how I will vote, but that's not the point. My point is that as marijuana slowly moves from the eagle eyes of law enforcement, public health is the natural next step for surveillance, monitoring, and control.

A couple weeks ago, I had a great conversation with a former (and future?) student about, among other things, what will happen once pot is legalized in California. He's been involved in the efforts to identify tobacco use as a health concern for gay men, lesbians, bisexuals and trans folks for many years, and we were wondering about how the activists who have built such a strong network around tobacco and smoking will react to legal joints in California.
Will the queer tobacco activists see themselves as primarily focused on tobacco (including smokeless tobacco like snuff & snus), or on smoking, which could potentially include pot, or both (which could possibly include vaporizers, brownies, etc.). Or will the idea of sounding like a negative Nancy on pot mean that we will just ignore the health consequences of smoking marijuana on queer folks?

Then, the other thing that got me thinking was looking into the environmental impacts of growing pot, because I'm looking for good material for my upcoming class on environmental health, and I figured that topic might engage some of the students.

At any rate, there are a lot of issues to think about there...
One can hope that the legalization of marijuana in California will lead to more environmental growing conditions - fewer diesel-powered generators, fewer diesel spills, less pesticides and more sustainable farming practices all around. But if there is an increased demand with no change in Federal enforcement efforts, there will still be a lot of pressure to grow pot in ways that are extremely damaging to the environment. What will the role of public health and environmental health be in developing policy and regulations? Will "organic" pot be certified by the same rules as USDA has developed for food?

For many years now, marijuana has been promoted as "medicinal". I'm sure it is for many people. But there are unintended consequences of promoting marijuana as medicine.
For one thing, a lot of people seem to be convinced that smoking marijuana is healthy, is good for you, even if you're not treating any health condition with it.
For another, a lot of people seem to think that smoking marijuana is just not dangerous compared to smoking tobacco.

If marijuana has been promoted as good for you, and now it becomes legal, it is complicated to modulate that message to be honest about ways in which it is not good for you, too.

So, where does public health come in on legal marijuana? We've gotten a pass because regulating marijuana has been the province of law enforcement. The "soft power" of Public Health has not been called on, and the research, as stunted at the field has been, is very polarized, with some researchers claiming that marijuana has virtually no down side, and others saying that marijuana smoke is more hazardous than tobacco smoke, and most researchers just not making much of it one way or another, because being illegal, it is assumed to be a bad thing anyway.

But that brings up another point - it is really hard to get any decent epidemiologic data on the health effects of smoking marijuana. On the one hand, the illegality of pot has led to the polarization above: the researchers are often so devoted to one side of the debate or the other that it is hard to trust their work. On the other, the illegality of pot makes asking questions about people's use a bit more ethically complicated, and also hard to trust people's self-reports of engaging in an illegal activity. And then on the third hand, there's the simple fact that most (but certainly not all) people who smoke marijuana also smoke tobacco, which makes teasing apart the effects of marijuana on health very tricky.

So where am I after thinking about all this?
Not much farther from where I began. I don't see myself likely to get very engaged in this debate. But, I will be interested to see what happens as the desire for society to somehow curb and contain the use of this substance moves from law enforcement to public health. And I will be curious to see how the message that "marijuana is medicine" gets tagged with the small print we're now familiar with from ads for pharmaceutical drugs, and tobacco products, for that matter. What will the Surgeon General's warning be? What will the breathless, low volume pitch-man sound like when rattling off the unpleasant side effects? And when will the large cohort studies needed to answer the fundamental health questions get funded?

Saturday, August 7, 2010

invalid votes

I've been thinking a lot about similar gender marriage lately. And its proponents.
I followed the prop8 trial very closely, even going to observe it two days. I watched every second of the proposition 8 trial re-enactment on YouTube. I've even listened to Family News in Focus to try to understand where the other side is coming from, and how they've interpreted the trial.

I've been absolutely mystified by the approach that the prop8 defendants ( took during the trial. It seemed like they opened up a shotgun on one foot, then the other, then still not satisfied, started gnawing off their hands. Their defense was really that incompetent. It can't be unintentional. They must have wanted to lose the case. But why?

I still don't have a good theory on that.

Were they just so cocky that they are going to win in the Supreme Court that they decided not to invest any resources in the trial? That doesn't make sense to me. Why sabotage their own trial if they thought they might have to defend it in the Supreme Court?

Were they hoping to portray the trial as a miscarriage of justice - in essence setting up Judge Walker to take on the unwitting role of an "activist judge"? That makes some sense to me, because they certainly have been making hay in their news broadcasts about how San Francisco justice is about to be foisted on the whole country. But how often (if ever) would they get the opportunity to get a new trial rather than have it appealed up to the 9th district? And is it worth losing the war in order to get a few bucks out of scaring people with the threat of having an activist judge force everyone in the country into a similar gender marriage?

In a related vein, maybe they really need a new front in this battle in order to keep donations up. Now that every state with a voter initiative process has had a marriage restriction amendment of some sort on the ballot, they need a new bogey man, and have found it in this trial. But that is just too conspiratorial for my taste. I believe that these people are earnest in their beliefs. I think that there are some people like Karl Rove who have done some truly cynical manipulation of them, but I think that the vast majority of them, the people giving money, even those running television ministries and organizations to "protect" marriage, are honest and heartfelt, if (from my perspective at any rate) misguided.

And that brings me around to the thought that I started out with when sitting down to write tonight. In the circles I travel, it is easy to be flip and dismissive about the millions of people who voted for proposition 8. I mean, what were they thinking, right?
In response to claims that one wacko judge in California had just over-ruled the entire voting public, I recently posted on FaceBook:

"Correction: one judge AND THE CONSTITUTION invalidated the votes of millions of Californians".

Hey, it's good for a laugh, but after posting that, I've been thinking, you know, invalidating the votes of millions of Californians is really no laughing matter. It's pretty serious business.
It was the right thing to do, but it's also unreasonable for our side to just think, OK, no biggie, now that's over and we're on the right path again. A lot of people did vote, and a lot did vote against us. And now they've just been told that their votes were wrong, unconstitutional, un-American.
It shouldn't be surprising if a lot of them resent having their votes invalidated, and there will probably be some who might be swayed to the right side of the issue, but will resist it just because they feel like their vote was stolen from them.

And that got me thinking about how should we go about acknowledging the hurt of having their votes taken away from them, and still trying to convince them that their position was wrong in the first place? Its thoughts like that that make me glad I'm not a political consultant. I mean, how can you square that circle?

day of decision

This is moments after Judge Walker's decision was announced, before the "whoop" that you've probably heard on TV.

And this is after the "whoop", as the cameras were swinging around trying to find some "human interest".

Then, of course, there's the inhuman interest...

A procession towards City Hall to try to get a couple married. The judge's stay was ordered while these folks were en route.

I had a chat with this lovely couple, who were thrilled to share their special day.

Seth is beaming.

Sunday, June 20, 2010

Internalized Homophobia - Why Measure it?

Recently I saw an article that suggested that measuring internalized homophobia might be a waste of time.

I was intrigued. I have to admit, I've never been a big fan of internalized homophobia. Measuring it, I mean. But I never stopped to think out why the idea made me a bit queasy.

Maybe I should back up a bit. One of the leading theories about how homophobia affects people is that homophobia operates simultaneously at multiple levels: societally, institutionally, interpersonally, and internally.

Multiple levels of homophobia
At the societal level, homophobia (often called heteronormativity in this context), is the shared set of beliefs and assumptions about who ought to be porking whom. But more than that, it is a nexus of assumptions about what family structure and kinship should look like, about what gendered identities are possible and how they should be expressed. That's one reason why the debate over same sex marriage has been so contentious within the gay community - one the one hand it is about equality of opportunity, on the other, marriage is practically the very definition of heteronormative values.

Institutionally, homophobia can be expressed in official policy, or less official actions that intentionally treat sexual minorities differently than heterosexuals, or that result indirectly in the same effect.

Interpersonal homophobia is probably what most people think of when they hear "homophobia" - it's the disparaging words, the punch in the nose (then the gut, the groin, the kick when you're already on the ground, need I go on?). Interpersonal homophobia is the expression of prejudice from one person directed at another.

Internalized homophobia can mean a couple different things depending on who you're asking. Usually it refers to a form of self-loathing among gay men, lesbians, and bisexuals, the internal application of societal views on homosexuality on oneself. Sometimes people talk about internalized homophobia in anyone, including heterosexuals, as the result of internalizing the societal homophobia as being what one believes about homosexual and bisexual people.

So all these levels are in constant interaction with each other as well. A person is unlikely to let off a string of interpersonally homophobic slurs unless they have internalized societal views about homosexuality. They are unlikely to internalize these assumptions unless there is a shared ethos of homophobia in which that person lives, or grew up, and so on.

And all these can be in conflict with one another. For instance, one may live in a relatively non-homophobic society (like Rhode Island) with relatively few institutional policies that hinder people with same sex desire, but be in a more homophobic institution within this (such as a Catholic school), which nonetheless has a strong tradition of supporting individuals within the institution, and exposing them to very little interpersonal homophobia, so long as they maintain an internalized sense that their homosexuality is wrong.

So what's wrong with measuring internalized homophobia?
Based on the above, I obviously think that internalized homophobia is an important part of how homophobia/heteronormativity affect people. If nobody internalized homophobic assumptions, then it could not survive at a societal level either.
So why not measure it?

The article I read said that measures of internalized homophobia had very little predictive value for why some gay men get HIV and others don't. Not only that, but what predictive capacity it once had is rapidly diminishing. So, their argument was that it doesn't predict much, so measuring internalized homophobia may be a bit of a futile exercise.

But that wasn't entirely satisfying to me as a reason to avoid measuring it. So what if internalized homophobia has relatively little impact on HIV transmission - maybe it still plays a big role in some other health issue, like depression.

No, what I've decided bugs me about measuring internalized homophobia is the "internalized" part. I mean, describing "internalized homophobia" as a major health risk may in some sense be an important mechanism, but what sort of intervention does it lead to? How does one use that information to try to prevent disease, or better yet, promote health?

By describing "internalized homophobia" as a major health threat to sexual minority populations, the implication is that there are some of us who are in trouble (those of us who have internalized societal degradation as just), and others of us who are fine (we've coughed up the furball of societal hatred). Then what? Either the people who have internalized societal homophobia need some sort of intervention (which is paternalizing if that person is not actively seeking help), or they have some how brought these problems on themselves, failed to do what they need to do to take care of themselves.

The problem, as I see it, is that a focus on "internalized homophobia" focuses the potential for interventions internally, and doesn't take into account the full spectrum of the levels at which homophobia operates. Focusing on identifying and intervening with individuals who have internalized homophobia in no way explicitly challenges the broader social context within which these internalization processes occur.


Michael E. Newcomb, Brian Mustanski. (2009). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Archives of Sexual Behavior Epub aread of print 04 Nov 2009.

Michael W. Ross, B. R. Simon Rosser, Derek Smolenski. (2010). The importance of measuring internalized homophobia/homonegativity. Archives of Sexual Behavior Epub ahead of print 12 May 2010.

Wednesday, June 9, 2010

Transit ads to make your eyes sing.

Like it or not, advertising is a big part of our visual environment.

San Francisco is a city that advertisers love to target. We are trendsetters, I suppose, so the ads often get quite aggressive in order to capture our jaded attentions.
I've seen pillars mounted with palm fronds (selling what, I can't remember), lavish inside views of the first class cabins of some upstart airline, all kinds of eye-catching stuff. And I have to admit, as much as I resent having my attention grabbed for profit, a lot of it is fun and playful.

But that's downtown. Up at Castro, your eyes are much more likely to be met by the sad empty face of a meth addict warning you not to follow in his footsteps.

The Castro is an international destination for gay men, and yet our visual environment is a long series of sad, unhappy, preachy, demeaning advertisements designed to remind us of how precarious our lives are, how we are one short step from misery and pain.
Well, at least until you emerge onto the street level, and your eyes are met with a series of bulges and slick colors designed to turn your money into alcohol.

So, when I came across these ads this morning on my way to work, I was happily surprised. I've seen these same ads on the BART, but in this context, they are obviously designed to appeal to a gay (male) audience, first by their location, and particularly because of the color scheme, the lollipop bright red-orange-yellow-green-blue-violet rainbow flag of smiling children, with a heavy dose of bubblegum pink tying it all together. These ads aren't cheap, the production values are high, and they spent a good bit of effort custom sizing everything for this particular space.

So I find myself wondering two really different things:
First, with the evangelical Right itching for a fight over adoption, why did decide to take the risk of catering to gay potential adoptive parents in such a blatant manner?

But the thing that's really got my head spinning is this. These ads are so different from any health-oriented ads I've seen in San Francisco. The first obvious difference is that they are up-beat. The second thing is that they are asserting quite forcefully that we have talents and capacities that are desperately needed.

Now, I don't know exactly what an ad campaign about gay men's health that was up-beat and urged us to exercise our talents and capacities would look like. But I'm hungry to see it.

Friday, April 2, 2010

The Census, Partiotism & Selfishness

I remember filling out the 1980 Census.
I begged my dad to fill it out. I was excited to participate in this civic duty.
I guess I was a data nerd all the way back in Junior High.

As a nine year old on Independence Day in 1976, I was bursting with pride to the point of tears while riding my bike tricked out with blue and red streamers in our (no longer) small New Hampshire town.
The President made a compelling case for conserving energy, and I was eager to do my part for the country, shutting off un-needed lights, helping dad weatherize the house.

In short, I was fervently proud to be an American, and when the country asked for my help, I was only too eager to give to the common good.

Then the 1980's heralded in an age of selfish, individualist, suspicious governance that no longer asked for my help. Patriotism was recast as being against communists rather than for each other in this great nation.

I didn't get to fill out the 1990 Census, because I was off at college.

But when the 2000 Census came across my threshold in March, I was again eager to fill it out as a head of household for the first time. It was just the right thing to do.

The 2010 Census finds me under someone else's roof again, but we worked to together to make sure everyone was fairly represented.

Census and Distrust

It seems like this year, the Census has been politicized to a much greater degree than in the past. Rather than a simple civic duty, not filling out the Census has become a way to express distrust of government.
Certainly there are valid reasons to be distrustful of government, such as failing to protect the civil rights of minority populations, failing to ensure the provision of a basic level of social services to all our citizens, failing to protect us from pollution in our air, water, soil, and food, or failing to explore all reasonable options before engaging military solutions to political problems.

But the selfish rejection of government because you don't feel like paying taxes or whatever baffles me. It's so toxic to true Patriotism, which to me is all about pulling together in times of hardship, and helping each other out in times of plenty.

The Bus Ad
There's a bus ad circling the streets of San Francisco (and other metro areas as well) that says: "If we don't know how many PEOPLE we have, how do we know how many BUSES we need?"
This struck me as odd the first time I saw it. Anyone in San Francisco knows that the right answer to "How many buses do we need?" is "More". But bus lines are getting cut back instead while fares are jumping through the roof. There's no connection.

My gripe about the bus ad is not just that it offers a false promise (that buses will be provided in direct proportion to need), but more importantly, that it suggests that the best reason to fill out the Census is for selfish reasons - to make sure that you and your community get their share of buses, schools, hospitals, etc.

But isn't the best reason to fill out the census form that it's our civic duty? It's one of the most direct connections we as citizens have to our venerable Constitution. And the framers thought it so important that it's in the second section.
Article 1, Section 2:
The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct.

What's wrong with appealing to our sense of civic pride, of patriotism, of doing our part?

Sunday, February 28, 2010

New Word Game

Rule #1. Put all 21 letters into a crossword-type format.
Rule #2. Take a snapshot of your result and send it to me, or type your result into the comment section, using underscores "_" to space the letters out.

Winning categories:
#1. Smallest perimeter (the shortest length of string that could be used to encircle the resulting crossword)
#2. Longest word
#3. Longest shortest word (i.e. if you use any 2 letter word, you lose, on the other hand, if all your words are at least 5 letters long, you're doing well).
#4. Shortest longest word (i.e. if your longest word is seven letters, eh, not so great. If your resulting puzzle shape is a diagonal series of two letter words, you're amazing. And you have too much time on your hands.)
#5. Least safe for work
#6. A five year old could read it (Simplest words possible)
#7. Most thematically related (all the words are fruits, colors, 'things you'd find in a wallet', verbs connoting motion, etc.)
#8. Make up your own category!

Use real English words. I will use Merriam-Webster's Original Scrabble Players Dictionary, 4th edition to verify. Honestly, it is a pretty far stretch on "real" English. I mean 'PTUI'? Really? That's a word? On the plus side, it has both British & American spellings.
Exception: this dictionary does not contain a lot of the juicy words for the LSFW winner (#5). I'm assuming it will be fairly easy to identify those unambiguously.

Here they are again, all upright and in alphabetical order.

Any suggestions for a better format for the digital/analog give and take for this game would be greatly appreciated. I'm hoping to turn this into a series.

And a big shout out to Aunt Sue for suggesting it!

Saturday, February 13, 2010

HeLa reparations

Henrietta Lacks made an incredible contribution to biomedical science, HeLa cells.
Her cervical cancer cells have a very unusual property: they can grow in the lab indefinitely. Because of this property, they have been produced by the ton for various lab experiments.

The ethically squeamish issue comes in that Henrietta was not asked for her contribution when she was treated for cervical cancer in 1951, and neither she nor her family was told about it until much later.

I used to work in a lab doing basic immunology. I never touched the "wet" stuff, so I don't really know, but as far as I can remember, our lab didn't use HeLa cells, at least while I was there. But, the knowledge base that we worked off of was certainly informed by work done on Henrietta Lacks's cells.

I owe some of my livelihood to Henrietta and the Lacks family. So I made a modest donation to the Henrietta Lacks Foundation. I made it on the basis of an appeal by the author of a book about Henrietta Lacks, her cells, her family, and the Johns Hopkins physicians who interacted with her and her family over the years. The author claimed that the donations would go towards providing educational opportunities and medical care for Henrietta Lacks descendents. But the incorporation papers suggest a much broader reach.

Sunday, February 7, 2010

Seeing Healthy Gay Men

I've been invited to take part in a panel discussion on Wednesday. Here's a preview of my talk. I'd love feedback on the flow, grammar, anything to make it roll off the tongue easier. I don't have a lot of time to deliver the talk, and I want to get some key ideas out there clearly.

Introduce yourself to the person next to you, just your name. Hold their hand, and look right into their eyes, take a good deep look. Think about how healthy this person is. Through all of life's adversities, here is this healthy person in front of you.

What I've just asked you to do is very different from how I, as a public health researcher, look at gay men. To put it bluntly, in public health, we don't see healthy gay men.

First of all, we are not accustomed to look at health in anyone, queer or bland. We almost always look at sickness and death, and very rarely at health. Sickness is easier to measure than health. Sickness is seen as objective, while 'health' and 'well-being' are subjective states. Death is the most objective health outcome, and thus the most trustworthy object of study. So it's nothing special about gay men. We're not used to seeing anyone as healthy.

But there other reasons that public health, broadly written, is not used to seeing healthy gay men.

One of these is that a little over a hundred years ago, the fields of medicine (and later psychology) tried to exercise authority over homosexuality, to claim it as their turf, a claim widely supported by homosexuals at the time. It was a humane alternative to being regarded as the embodiment of sin, or being treated like a criminal.
Old habits die hard, and it has been hard to let go of these 'humane' impulses, despite the official depathologization of homosexuality in 1975.

Another reason that public health has a hard time seeing healthy gay men is that we actually have a lot invested in gay men being ill. That may sound strange at first, but think about it - citing health disparities is how we raise awareness about the health challenges facing us. Playing up health disparities is how we get money for programs. It's often how we make claims that legal protections are needed, how we describe ourselves in media stories to gather support.
So seeing healthy gay men risks upsetting the apple cart, derailing the gravy train, if you will.
And then there's the right wing. Not only are we a threat when we're sick, but if we're not sick, then we don't need "special" protections. We just can't win with those guys.

The last reason that public health has a hard time seeing healthy gay men that I want to raise is the perceived 'failure' of HIV prevention. While it would make sense to look at the relatively small number of new infections these days compared to the early 1980's and claim a great deal of success in HIV prevention, there is a tendency in public health circles to treat each and every new infection as a failure.
After all, we know a lot more about the biology and psychology of how HIV is transmitted. Hundreds of millions, probably billions of dollars have been spent on research and prevention efforts in the US, so even a single new infection represents some sort of failure in our prevention efforts.
Often implicit in our conversations about the 'failure' that each new infection implies is some blame directed at the man who got infected, and perhaps towards the man who infected him. Were these guys high? Careless? Selfish? Immature? Maybe they were just looking for love in a harsh world. Maybe they were possessed by the worst affliction a gay man can have in the eyes of public health: being a bug-chaser. All of these explanations imply that the infection was enabled by an individual weakness. So we are used to seeing gay men as sick, or at least as perpetually 'at risk'. And any attempt to break free from a life constantly 'at risk' must be a little crazy.

There may be other reasons that we public health types have trouble seeing gay men, but these are some of the big ones: 1) public health has a hard time seeing anyone as healthy, 2) the historical disciplinary claim of medicine and psychology implies that there is something inherently pathological about homosexuality, even though an explicit claim of pathology would be rejected in most circles. 3) seeing healthy gay men undercuts our ability to raise awareness within the community, and funds for services from public and private granting agencies, and 4) how else does one explain 'failures' in HIV prevention?

And so, a little over a year ago, when I came across evidence that gay men might well be healthier that straight men, I was dubious.
I was looking at data from the 2003/2005 California Health Interview Survey, the idea I had was to systematically go through the CHIS, documenting the disparity of each health outcome for gay and bisexual men relative to straight men, and for lesbians and bisexual women relative to straight women.
The first one on the list was pretty boring, at least from an epidemiologic standpoint: "in general, would you say your health is excellent, very good, good, fair, or poor?" Although this is by far the most common question on health surveys, analytically, we usually treat it like a throw-away question, basically a way to build rapport with the person on the other end of the phone before getting in to the more personal and revealing questions.
I expected to see what others before me had seen, that gay and bisexual men were more likely to report "poor" overall health. And they were in this dataset, too. But more striking was that gay men were also more likely to report being in excellent health. And that difference was larger.

But like I said, I was skeptical. Maybe it was a statistical fluke. I did what any sensible epidemiologist would do. I ignored it and moved on.

But, it stuck in the back of my mind.
When the 2007 data came on-line a short while later, I took another look, and the same pattern held. So now, I began to wonder if there might be something to it, these healthy gay men, not less healthy than straight men as everything had led me to expect, not equally healthy as straight men, but actually more likely to be healthy.
So then I began to look at other datasets. In most datasets, but not all, gay men were more likely to report excellent health.
I was still dubious.
Perhaps gay men were more likely to be in excellent health because they were younger, more educated, affluent. In most studies, men who say they are gay tend to be younger, more educated, affluent, and these things also tend to produce better health. So now I needed to find a dataset that was large enough to break people down by age and socioeconomic position.
I found two very large datasets, the Current Population Survey, and the Behavioral Risk Factor Surveillance System.
In both of these datasets, gay men were more likely to be in excellent health than straight men in all age groups, and within all levels of educational attainment. The BRFSS dataset was so large that I could stratify by both age and educational attainment simultaneously. Same result.
So now I knew it wasn't a fluke, it wasn't just because men who say they are gay to a stranger on the phone are just demographically healthier. Gay men were actually more likely to report being in excellent health.

Once I'd convinced myself that gay men are more likely to be in excellent health, that it was a 'real' finding, the next question is "Why?".
With all the HIV, STD's, alcohol abuse, drugs, depression and anxiety, even suicide documented in the literature, it still baffles the public health mind.
I'm going to leave the question "Why?" open, and move on instead to a related question: "So What?".
If gay men are more likely to be in excellent health, what are the implications of that?
One implication is that in the face of the long, oft-repeated litany of health-related faults, some gay men have found a way to thrive, arguably with no assistance from us in public health.
Perhaps we can learn from these healthy gay men. But that requires being able to see healthy gay men, and then to talk with them, and ask the right questions.

The salutogenic (health-creating) processes that these men have undertaken could be a blueprint for the rest of us, a novel approach to addressing the troublesome health disparities that gay men face.

Another implication is that gay men may well be doing some things 'right' that heterosexuals could do well to emulate. Perhaps the ways that we gay men have learned to structure our lives, with strong friendship networks, provides space for us to excel. Perhaps our more nuanced approach to monogamy and relationship structures gives us permission to be truer to ourselves and the ones we love. Pure speculation on my part, but if more of us are in excellent health despite all the social forces arrayed against us, we've got to be doing something right, and maybe if we knew what that something was, it would help society at large.

{I haven't quite figured out how to wrap it up yet}

Friday, January 22, 2010

Reflections on Proposition 8 Trial

I've had the privilege of sitting in for part of the proposition 8 trial (Perry v. Schwarzenegger), yesterday and this morning.
The trial has been incredibly interesting, although I have to say, the parts I sat in on were kind of slow.

I'm not a big fan of similar-gender marriage as a goal. And I'm dubious about the chances that this trial will succeed. But I have to say, it is doing an amazing job of revealing what the debate over similar-gender marriage is really all about: the prejudice that Evangelicals (and various allies) have against queers.

I'm convinced that this wouldn't be a big issue item on "the gay agenda" if the Evangelicals hadn't shoved it on us. An excellent book Courting Justice describes how individual queers have for decades (at least back to 1963, if not before) have tried to get some sort of official recognition of similar-gender marriage rights in the courts. But the issue didn't take off for the wider queer population.

Even after the Hawai'i decision in 1993, it still didn't take off. Even in 1998, when Alaska and Hawai'i were the first states to vote to restrict marriage, the wider gay community wouldn't touch marriage. A few people wanted it, but many of us thought of it as a badge of heterosexuality, a cowardly dodge from realizing one's full queer potential. A very bizarre "right" to demand.

But by 2000 there were the beginnings of a shift, and by 2004, it was absolutely clear we were being attacked with this thing, and we'd better start defending ourselves. Tell someone loud enough that they can't do something, and you know what they'll want to do next.

immutability, identity/behavior/desire
At any rate, here we are, many not excited about similar-gender marriage, but pissed off by being attacked as pedophiles, unfit parents, mentally deranged, sinful, and the certain cause for the ruin of Western Civilization.
In today's grueling 5+ hour cross-examination, Prop 8 lawyer Nielson badgered anti-prop 8 witness Gregory Herek with hundreds of variations on the same theme, trying to get him to say that homosexuality is neither definable nor immutable.
It is fairly clear that what the pro-prop 8 side was trying to do today is to make two claims. First, that homosexuality can't be clearly and unambiguously defined in the same way for all contexts, so homosexuals shouldn't be considered for equal protection under the U.S. constitution.
Second, that people's sexual orientation can change over time, and if so, which "class" a person fits in is ambiguous, making it impossible to consider equal protection under the U.S. constitution.

This seems like a pretty risky strategy on their part, since the exact same logic would lead one to conclude that religious affiliation should not be a basis for seeking equal protection. After all, one of the central tenets of Evangelical Christianity is that one's religious affiliation can change, and even ought to change in order to become 'saved'. Furthermore, it is not possible to define religious affiliation in clear and un-ambiguous terms.
Nielson hammered away at the themes of "identity, behavior, and desire" or words to that effect, as being multiple dimensions along which one could define sexual orientation, for research purposes.
Identity: "What do you call yourself?"
Behavior: "What have you done?"
Desire: "What do you want?"
A nearly-perfect analogy could be applied to religious affiliation, and the first two dimensions are routinely differentiated by sociologists studying religious affiliation. So should religious affiliation not be considered for equal protection because some people might define themselves as "Catholic", but not attend services, while others would decline to identify any particular denomination while attending services regularly?

Also, another category traditionally considered for equal protection would also fall apart under this logic, namely marital status. One's marital status can change over time (by becoming married, or becoming widowed, separated or divorced). Should it not be protected as a result? In this case, it is a change that is clearly under conscious choice (one certainly hopes that marriage doesn't happen by accident, or for unknown reasons).

The plaintiffs lawyers, for reasons I don't understand, haven't yet gone for the jugular on these points. Why not freely admit that sexual orientation changes over time, and is devilishly difficult to define in unambiguos terms? That doesn't seem to have much to do with whether a "class" of people should be protected from discrimination. Then come right back at 'em. Instead, the plantiff's witnesses have mentioned, from time to time, that ethnicity and race aren't easy to define either, and what "class" one "belongs" in can change over time. True, but the analogies between religious affiliation and sexual orientation seem more apt to me, and have the added advantage of putting it right back on their plate.

why get hung up on choice?
Another issue that Nielson fought over with Dr. Herek was the degree to which people's changing sexual orientation is under conscious control. Knowing what I know now, I would choose to be gay. But back in high school, when I was struggling to figure it out, I would have done anything to "choose" heterosexuality. It would have been easy. It would have made my parents happy. Heck, I even tried to be heterosexual - on my second "date" the girl laughed out loud when I said I thought it was a date, saying "But Bill, you're gay!" Sigh, I miss Rachelanna.

But back to the issue at hand, I think it's perhaps too easy to say that Evangelicals often believe homosexuality is a choice (conscious or otherwise) because their understanding of the Bible is that it is a sin, and that much like stealing, one may choose to "do" or not "do" no matter how strong the urge.

But I wonder if there isn't another reason that's just as strong. By enacting and re-enacting, and re-enacting, and
re-enacting stories about "coming to the Lord", Evangelicals narrate to themselves and each other a story of conscious choice about a fundamental aspect of their being. I've listened to enough religious right radio to know that spontaneous conversion isn't nearly as common as stories of spontaneous conversion, which are ubiquitous.
Perhaps the belief that homosexuality is chosen reflects these continuously repeated narratives about choosing to be saved. Perhaps insisting that homosexuality is chosen despite all available evidence is really another means to re-inforce their own narrative of choice in matters religious.

In the past, I've pondered the fact that gay men tend to reinforce innate-ness and lack of choice in their coming-out stories. Mirroring the process above, when we tell and re-tell our stories to one another, these characteristics of innate, unchosen immutability become more and more central to our sense of self and identity. I think that's a lot of how I became gay, anyway.
I was Bill, then I became gay Bill. I didn't become gay out of being straight, I became gay out of unformed nothing-ness because it was the social construct available to me that best fit who I was, innately. In another setting, I might well have become celibate, or str8, or something like it, depending on what was available to me in the way of social role narratives.
Now that my gay identity is fully formed, I no longer need to tell coming-out stories to reinforce my sense of who I am, and rarely do. Part of that is that everyone who
needs to know already knows, but mostly it's because I don't need to tell that story any more to know who I am.

Hate crime statistics
Yesterday, one of the prop 8 lawyers tried to run an event in the Oppression Olympics by comparing the number of crimes reported as being bias-motivated around sexual orientation to the number reported as being bias-motivated against Judaism.
I was shocked when the witness seemed to fall for it. He ended up giving a fairly reasonable response, but the premise that these numbers would be in any way comparable I find ludicrous.
As I covered at length in a previous post, the numbers of
reported bias-motivated crimes appear to indicate, if anything, an environment that is relatively less hostile to queers.
Perhaps a minor point, but I was surprised that the plantiffs' lawyers didn't seem to latch on to it.

History in the making
The most exciting thing about it, for me, was the feeling of being at the moment of "history in the making". This trial is big. In the league of the Scopes monkey trial, Bowers v. Hardwick, Lawrence v. Texas. It may not be Roe v. Wade or Brown v. Board of Education, but it's up there, a massive culmination of social forces distilled into one bundle (that
this Supreme Court will likely fumble). It will be a major reference in the evolution of queer history, no matter the result.
When similar-gender marriages were first issued in Massachusetts, I went up to Boston and sat on the steps of City Hall, chatting with a handsome stranger. I was moved far more than I thought I would be.
When similar-gender marriages were re-legalized in California, I went to City Hall, and snapped hundreds of photos, mostly of a pair of handsome strangers getting hitched. I was moved to tears repeatedly that day.
I feel fortunate, to have been in the right place at the right time, to bear witness these momentous events.

Sunday, January 17, 2010

Cool Word Trick

Don't ask me how I know, because I don't know how, but copied work in a student's paper just jumps off the page. I usually detect it in under two seconds, and not because I'm looking for it, it just looks wrong immediately.

At first, when I was looking for the original source that a student copied from, I would guess what the most unique combination of words was, picking two or three multi-syllabic scientific-sounding words, and then do an internet search for them.
But I noticed a curious thing. In most cases, those unique words I was looking for often weren't particularly unique. But what did tend to be very unique was the "packaging" of banal words around them.

I've been shocked to find that, given about 5-6 words in sequence, it is almost always possible to find the one unique occurrence in the history of the English language that those particular words occurred in that particular order.

So now, I just type in the first 5-6 words of a sentence, no matter how banal and mundane the sentence structure sounds, and it almost always uniquely identifies the source. Neat trick, eh?
Try it at home. Grab a few words from anywhere nearby. Type them into your favorite web search. Watch the magic unfold.
See how many words you can get rid of, especially the words that sound most unique, and still have that one source pop up to the top of your list. (Hint: using quotes around the words to hold them in their original order makes it a lot easier.)

Somebody needs to write a paper about this phenomenon.

Thursday, January 14, 2010

Obesity is NOT levelling off in the US

If anything, we're getting fatter faster.

Over the past few days, I've been seeing and listening to reports in credible news sources, the New York Times and National Public Radio, repeating a claim by CDC researchers that the obesity epidemic in the U.S. is leveling off.

I was suspicious. I had heard essentially the same story two years ago and found that claim to be less than credible, so I decided to investigate more closely.

So here's the data as they present it - the red line that they want you to focus on represents the proportion of the adult population who are overweight, but not obese - you can see that in recent years it has turned down a bit. But the blue and green lines, which represent obese (but not extremely obese), and extremely obese have been increasing, with no sign of slowing down whatsoever.

I used exactly the same data, from the same table in their report to generate this graph.
You can see a little more clearly here (at least I think), that the proportion of people who are overweight, obese, or extremely obese has been increasing, not leveling off.

Taking a closer look at the last few years, the proportion of the population that was some degree of overweight in 1999-2000 was 69.5%. It increased 1.6% to 71.1% in 2001-2002, 0.3% to 71.4% in 2003-2004, and 2.1% to 73.5% in 2005-2006. So the latest two years of data show the largest increase in overweight in the U.S. population so far documented. (the steepness of the little lines between the bars on the graph tell the same story)

So how could the esteemed news agencies I mentioned at the top of the blog gotten the story completely wrong? Not only that, but they were able to find a plethora of obesity experts to proffer explanations and predictions based on the erroneous conclusion that the obesity epidemic in the U.S. is leveling off.

There were two fundamental misunderstandings, as far as I can excavate: first, almost everyone involved seems to have mis-understood the term "statistical significance", and second, there seems to have been a widespread (excuse the pun) misunderstanding of looking at changes in the middle of the weight distribution.

As to mis-understanding the term "statistical significance", here is the sentence from the original CDC report:
The NHANES 2005-2006 data for persons age 20 years and over suggest an increase, between the late 1980s and today, in obesity in the United States, with the estimated age-adjusted prevalence moving upward from a previous level of 23 percent in NHANES III (1988-94) to approximately 34 percent. The change between 2003-2004 and 2005-2006, however, was not statistically significant. {emphasis added}

This little phrase "not statistically significant" was mis-interpreted to mean "no change", that is, a leveling off, between the data collected in 2003/2004 and that collected in 2005/2006.
Interestingly enough, that exact same mis-interpretation was made when comparing the 2001/2002 data to the 2003/2004 data in this CDC report. Apparently, the last time they got it right was in comparing the 1988-1994 data to the 1999-2002 data, when they didn't invoke the problematic concept of statistical significance at all, in this CDC report.

But obesity rates didn't level off in their data - as I showed above - in fact it was the largest increase seen yet in this data set.

The other mis-interpretation seems to have arisen from how this report discussed being overweight as something distinct from being obese, and being obese as something distinct from being "extremely" obese. That is, when the broke up the overweight population into three sub-groups, the proportion of people who are "just" overweight has decreased in the last few years (the red line in the top graph)
Here's the offending sentence from the original report cited above:
Although the prevalence of obesity has more than doubled since 1980, the prevalence of overweight has remained stable over the same time period.

Which only makes sense if you completely ignore the fact that lots more people are becoming more than "just" overweight (i.e. obese), and many fewer people have been at a "normal" weight (the tan bars in my re-graphing). That is, they have pulled the middle of a rapidly shifting distribution out and claimed that it isn't changing, but that is misleading because the size of the weight distribution on either side of it is changing

I'm afraid I may sound like some punctuation-correcting nag, nipping at the heels of our most esteemed news outlets for some petty transgression all the while making it sound like the English language is on the verge of collapse into a ruin of uninterpretable gibberish.

But this isn't a punctuation or spelling error. It's getting the story completely backwards.
And I don't really blame the NYT or NPR for screwing it up. They were, after all, following the lead of our most esteemed public health agency. They were able to find plenty of esteemed experts willing to line up and go on at length about the implications of this erroneous interpretation of the findings.

I trace it back to the deeply ingrained mis-training that scientists get about what the phrase "statistical significance" means. When the British eugenicists who were followers of Darwin coined the phrase "statistical significance" in the late 1800's, they intended it to mean (at least as far as I can interpret their meaning over 100 years later) something like "significant in a statistical sense only, and quite possibly not in any other sense". So to them the phrase "not statistically significant" wouldn't have had any particular meaning at all, perhaps a study that was "not statistically significant" wasn't looking at a big difference. Perhaps there was some sort of bias hiding a real difference. Perhaps there just wasn't enough of a sample size to reveal the real difference in a statistically striking manner.
At any rate, over the years and in order to simplify the concept of "statistical significance", it has been taught as "an unlikely probability of a finding arising from chance alone", and the phrase "not statistically significance" has increasing become mis-interpreted as meaning "no difference".

And that, my friends, is why you'll find that I seldom, if ever, use the phrase "statistical significance" - because in the end it doesn't really mean anything - it's only about the statistical interpretation of a dataset, which is only one small window for understanding and interpreting numbers.