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Brian C. Kelly, MA

Brian C. Kelly is with the Department of Sociomedical Sciences, Columbia University, New York, NY.

Correspondence: Requests for reprints should be sent to Brian C. Kelly, MA, Columbia University, 722 W. 168th Street, 9th Floor, New York, NY 10032 (e-mail: bck{at}columbia.edu).

Dr Meyer should be commended on his organization of the special issue of the Journal (June 2001), focused on lesbian, gay, bisexual, and transgender (LGBT) health, which should raise awareness and bring new interest to LGBT concerns. My hope is that this issue enables the call for proposals and programs of which Meyer wrote¹ and the examination, free of stigma and discrimination, of LGBT health concerns. In "Why Lesbian, Gay, Bisexual, and Transgender Public Health?" Meyer addresses the intersection of sexual identity and gender identity with public health concerns.¹ With this letter I hope to address one issue in Meyer's editorial.

Meyer discusses 3 categories for LGBT health issues—unique exposures, high prevalence not associated with unique exposures, and the need for culturally competent approaches. As an example, he notes that "the area most often addressed under this category [unique exposures] is risk related to sexual behavior (e.g., anal intercourse, which places men who have sex with men [MSM] at risk for HIV and other sexually transmitted diseases)."^1(p857) However, anal intercourse is not unique to MSM. Prevalence estimates in the United States show that over one fourth of heterosexual men, as well as over one fifth of heterosexual women, have ever engaged in anal intercourse.² Furthermore, almost 10% of heterosexual men and 9% of heterosexual women have engaged in anal intercourse over the previous year,² and 6.7% of heterosexuals engage in anal intercourse at least once per month.¹ The frequency of anal intercourse among heterosexuals has been shown in other countries as well, particularly in Latin America, where the female anus is eroticized more than elsewhere.^4–7 Women who engage in anal intercourse are at increased risk for HIV and STD transmission.⁸ Thus, anal sex is prevalent among and poses risk for HIV infection to heterosexuals, particularly women.

The labeling of anal intercourse as a homosexual act occurs regularly. Yet, sexual acts do not define a person's sexuality. Men and women, gay and straight, largely partake in the same sexual acts, albeit to varying degrees dependent on the manner in which such acts are socially constructed in a given cultural milieu and the physiologic equipment that a person has to work with. Classifying sexual practices creates further divisions between the LGBT community and heterosexuals. When we are able to view sexuality and sexual practices in a more fluid manner, rather than in a gay–straight dichotomy, we will be able to further reduce stigma and discrimination.

References

1. Meyer IH. Why lesbian, gay, bisexual, and transgender health? Am J Public Health.2001;91:856–859.[Medline]

2. Laumann EO, Gagnon JH, Michael RT, Michaels S. The Social Organization of Sexuality: Sexual Practices in the United States Chicago, IL: University of Chicago Press; 1994.

3. Erickson PI, Bastani R, Maxwell AE, Marcus AC, Capell FJ, Yan KX. Prevalence of anal sex among heterosexuals in California and its realtionship to other AIDS risk behaviors. AIDS Educ Prev.1995;7:477–493.[Medline]

4. Parker RG. Bodies, Pleasures, and Passions: Sexual Culture in Contemporary Brazil. Boston, Mass: Beacon Press; 1991.

5. Halperin D. HIV, STDs, anal sex and AIDS prevention policy in a northeastern Brazilian city. Int J STD AIDS.1998;9:294–298.[Abstract/Free Full Text]

6. Goldstein DM. AIDS and women in Brazil: the emerging problem. Soc Sci Med.1994;39:919–929.

7. Miguez-Burbano MJ, Angarita I, Shultz JM, et al. HIV-related high risk sexual behaviors among women in Bogota, Colombia. Women Health.2000;30:109–119.[Medline]

8. Abdool Karim SS, Ramjee G. Anal sex and HIV transmission in women. Am J Public Health.1998;88:1265–1266.

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