THE REPUBLIC OF UGANDA
Ministry of Health

10th February 2014

I. INTRODUCTION

The Minister of Health requested the Director General Health Services to constitute a team of expert scientists to review research data, deliberate and advise him on key questions about homosexuality.

A team of scientists was appointed to respond to two questions:
1) Is there a scientific /genetic basis for homosexuality?
2) Can homosexuality be learned and unlearned?

A series of meetings were held after the experts reviewed existing literature and presented their views, which were discussed to reach a consensus. Answering the above questions requires a background discussion and understanding of sex and homosexuality.

II. BACKGROUND

Sex is a natural phenomenon in all life forms and is the basis for the reproduction and continuum of life, though some lower forms of life may have asexual reproduction. Sexuality is determined by biology (anatomy, physiology, biochemistry) and how one relates to others which is a function of psychology, sociology, and the culture in which one lives, the latter includes anthropology, religion and other environmental factors. Ultimately, these functions are determined by genes and their interactions with the environment. What, therefore, constitutes normal sexual behavior in any given society (learned sexual practices) is a function of one's biology, psychology, sociology and culture, the last three being dynamic and often changing. Sexuality, on the other hand, depends on four interrelated factors:
i) sexual identity (XX or XV karyotype that will determine the sex phenotype),
ii) gender identity (the psychological feeling of being male or female and the accompanying gender roles),
iii) sexual orientation (one’s inner sexual attraction impulses: heterosexual - to opposite sex, or homosexual - to same sex),
iv) sexual response (desire, excitement, orgasm, resolution).

Homosexual behavior has existed throughout human history including in Africa. Judeo-Christian religions (Judaism, Christianity and Islam) condemn it but not all religions of the world condemn it. Many Western-based evangelistic missionaries and Arabs penetrated Africa and influenced her people with their views on homosexuality. This continues today. However, different cultures practice their sexualities di1ferently and these practices have often changed with times.

Homosexuality existed in Africa way before the coming of the white man. However, most African cultures controlled sexual practices, be they heterosexual or homosexual, and never allowed exhibitionistic sexual behavior. Almost universally, they contained homosexual practices to such a point that overt homosexuality was almost unheard of. Indeed there are undeclared homosexuals in Africa who may not even know it because their cultures never give room for the expression of such behavior. Many non-sex practicing individuals exist throughout African societies. No one has done any study to unpack their sexual orientations. The present fad of sexual exhibitionism, both heterosexual and homosexual, is alien and repugnant to most African cultures.

III. THE SCIENTIFIC BASIS OF HOMOSEXUALITY

All studies of human sexuality in all races throughout the world and throughout human history have documented the presence of homosexuality. Studies in the animal world have also shown homosexual practices to exist in animal and insect species. Genetic studies have attempted, though unsuccessfully, to pinpoint to one specific homosexual gene. A singular determinant for sexual orientation has not been demonstrated. As a result, many scientists hypothesize that a combination of genetic, hormonal, psychological, environmental and social factors determines sexual orientation.

Studies in sexology have shown that sexual phenomena exist on a normal distribution continuum like most human attributes e.g height - most people are in the middle but others may be taller or shorter. Thus also in sexuality, there are spectrum of sexual behaviors. Some people are less fixed in one form of sexuality than others. Thus sexuality is a far more flexible human quality than used to be assumed in the past, demonstrating the biological variability within the human race .

Sexual expression is the function of biology, psychology, sociology and anthropology, the latter including cultural and religious influences. Ultimately, all sexual functions are determined by genes and their interactions with the environment. Thus the causes of homosexuality can be traced to biological, social, environmental, psychological or a combination of them. These influence each other. Reparative therapies to change people's sexual practices have not proven successful and their scientific validity has remained questionable.

IV. CAN HOMOSEXUALITY BE LEARNED OR UNLEARNED?

Homosexuality is sexual behaviour (not a disorder) involving sexual attraction to people of the same sex. It is not clear whether this differing physiological response exists at birth or develops after homosexual experience later in life. The conclusion from the current body of scientific evidence is that there is no single gene responsible for homosexuality and there is no anatomical or physiological data that can fully explain its occurrence.

Psychosocial causes of homosexuality imply that it may be learned through experiences in life. Previous disastrous heterosexual encounters (e.g. erectile dysfunction, premature ejaculation) may lead to aversion towards homosexual intercourse. A chance homosexual encounter in early life may be associated with sexual pleasure leading to homosexual relationships being associated with pleasure. The increasing influence of Western culture provides homosexuality as a choice one can make, it's therefore seen as a socially acceptable option for a few. In conclusion, homosexual tendencies can be taken up based on the person's judgement on what is pleasurable for them . Why this happens to some people is not clear. Whereas some homosexuals may take up the behaviour as an open choice, for others it may be due to indoctrination. In summary, homosexuality has no clear-cut cause, several factors are involved which differ from individual to individual. It's not a disease that has a treatment.

Genetically, homosexuality represents one of the ‘sexual orientation’ variants possible in the same species. As is the case for many human behavioral variants, the evolution and emergence of one's self identity as a 'homosexual- be it gay or lesbian’ must be governed by nature and nurture. Ironically, an argument for a purely structural-genetic basis of the origins of homosexuality contravenes the essence of sex, which is that of procreation.

Specifically, the essence of homosexuality would be an antithesis for the Darwinian evolution of sex in species largely because homosexuality does not offer an opportunity for the self-propagation of the species. This has been a critical and fundamental argument by some scholars against the non-genetic basis of homosexuality. However, the counterargument has been for group survival, that some individuals in a group not overburdened by reproduction responsibilities would be available to give a hand to weak members of the group (e.g, the elderly and children) as happens in social animals. In our view, at least from existing knowledge and literature, there is no basis for a single, definitive structural genetic basis of homosexuality.

That said, the influence of the largely unstudied processes of epigenetics-which involves non-structural modifications of the genetic code, and represent one of the ways by which we learn many of our acquired traits that we can even pass on to our off-springs, cannot be ruled out.

Chromosome linkage studies, based on linking a single gene loci to a physical trait, previously identified a position on the female chromose X (denoted Xq28) as a possible influence (Hamer, 1993). A preponderance of gay relatives on the maternal side, was also stated. Subsequent studies, however, failed to replicate these findings. More recently, a group from the American Societies of Human Genetics have used a genome-wide study to replicate Hamer's Xq28 in animal model studies, in Drosophila. In Korea a scientific team induced attraction to urine of the same sex mice by deleting a single gene. These studies were not conclusive .

The practice of homosexuality in animals is, however, uncommon as are many physical deviants. Brain structure, again provides another area of controversy, with reports of homosexual versus heterosexual variations at the suprachiasmatic area and more recently the hypothalamus. Again this study did not provide any conclusive evidence.

V. THE NEED TO REGULATE SEXUALITIES

Throughout the world, human activity IS regulated to 'safeguard citizens, especially the weak and vulnerable, against the dangers inherent in human activities. Thus human sexuality also needs to be regulated especially as it is the core of the family and hence the nation. At anyone time rules and regulations are based on the current prevailing knowledge and understanding of what is to be regulated. This knowledge and understanding may change depending on the times and circumstances. Today the world has come to the realization that indeed homosexuality is a minority sexual expression practiced by some few members of the community. But, like heterosexuality, it needs to be regulated. No country, in the world today, has come up with a successful way to regulate human sexuality, hence the daily scandals and rapes of this world including sexual and gender based violence or human trafficking for sex. That vulnerable populations (including children, minorities, refugees, the poor, the elderly, mentally ill etc) need to be protected against sexual (and other) exploitations is not in question. African cultures had contained sexual vices. Maybe we need to revisit them to contain the present explosion of overt and coercive homosexual activity with the exploitation of our young children.

VI. CONCLUSION
a) There is no definitive gene responsible for homosexuality
b) Homosexuality is not a disease
c) Homosexuality is not an abnormality
d) In every society, there is a small number of people with homosexual tendencies
e) Homosexuality can be influenced by environmental factors (e.g. culture, religion, information, peer pressure)
f) The practise needs regulation like any other human behaviour, especially to protect the vulnerable.
g) There is need for studies to address sexualities in the African context.

VII. REFERENCES

1. American Psychiatric Association, (1974). Position statement on homosexuality and civil rights. American Journal of Psychiatry, 131(4):497. American Psychological Association, Task Force on the Appropriate Therapeutic Response to Sexual Orientation. (2009). Report of the Task Force on the Appropriate Therapeutic Response to Sexual Orientation. Washington, DC.

2. Bagemihl, B. (1999). Biological Exuberance: Animal Homosexuality and Natural Variation. New York: St. Martin's Press.

3. Bailey, J. & Pillard, R. (1991). A genetic study of male sexual orientation. Archives General Psychiatry, 48:1089-1096.

4. Bell, A.P., Weinberg, M.S. & Hammersmith S.K. (1981). Sexual Preference: Its Development in Men and Women. Bloomington, IN: Indiana University Press.

5. Drescher, J. ,~ Byne, W. (2009). Homosexuality, gay and lesbian identities, and homosexual behavior. In: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th Edition, eds. B.J. Sadock, V.A. Sadock & P. Ruiz. Baltimore, MD: Williams and Wilkins, pp. 2060-2090.

6. Drescher, J. & Zucker, K.J., eds. (2006). Ex-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture. New York: Harrington Park Press.

7. Hooker, E.A. (1957). The adjustment of the male overt homosexual. J. Projective Techniques, 21:18-31.

8. Mustanski B.S., Chivers M.L. & Bailey J.M. (2002). A critical review of recent biological research on human sexual orientation. Annual Review of Sex Research, 13:89-140.

9. Spitzer, R.L. (2012). Spitzer reassesses his 2003 study of reparative therapy of homosexuality. Archives Sexual Behavior, 41(4):757.

10. World Health Organization (1990). International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva, World Health Organization.

11. Colonizing African Values: How Christian groups influenced politicians. www.politicalresearch.org

12. Gregory M. Herek and Linda D. Garnets(2007) : Sexual Orientation and Mental Health. Annual Review of Clinical Psychology. 3:353-375. www.annualreviews.org

13. Rubio-Aurioles E & Wylie K. (2008): Sexual Orientation Matters In Sexual Medicine. JSex Med 5:1521- 1533.

14. Savic I, Berglund H, Lindstrom P. Brain response to putative pheromones in homosexual men. Proc. Natl. Acad. Sci. U. S. A. 2005;102(20):7356-7361.
Purves D, Augustine GJ, Fitzpatrick D, et aI., eds. Neuroscience. 4th ed. Sunderland, MA: Sinauer Associates; 2008.

SIGNED
DR. Ruth Jane Aceng, Director General Health Services Ministry of health

Members of the Ministerial Scientific Committee on Homosexuality

l. Dr. Jane Ruth Aceng, Director General Health Services
2. Dr. Isaac Ezati, Director Planning and Development
3. Dr Jacinto Amandua, Commissioner Clinical Services
4. Dr. Sheila Ndyanabangi s., Head Mental Health Desk
5. Prof. Seggane Musisi, Professor of Psychiatry, Makerere University
6. Assoc. Prof. Eugene Kinyanda, Senior Research Scientist, Medical Research Council
7. Dr David Basangwa, Director, Butabika Hospital
8. Dr. Sylvester Onzivua, Senior Pathologist, Mulago Hospital
9. Dr. Misaki Wayengera, Geneticist, Makerere University
10.Dr. Paul Bangirana, Clinical Psychologist, Makerere University
11.Prof. Wilson Byarugaba, Retired Professor and former Head of Human and Molecular Genetics, Dept of Pathology, Makerere University