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Historical Perspective

Photo: Oscar Wilde
Public Domain Image taken by Napoleon Sarony 1882.

"Historically, laws that partitioned the sexes and punished individuals who bridged or blurred the divide arose with the creation of patriarchal class divisions. The paradigm of two genders based on two biological sexes began to prevail in Western dominant culture only in the early 18th century."[1]

In the Hippocratic Oath having sex with one’s patients is mentioned and is prohibited. The interesting fact is that both heterosexual and homosexual relationships are mentioned, making it seem as though both were acceptable as long as the relationship was not between a doctor and his patient[2].

Since at least the 19th century, and the application of the biomedical model to sexuality and normalcy, same-sex attraction and behaviour were defined as a disease. Many gay men and lesbians were confined to psychiatric or criminal asylums due to the pervasive belief that homosexuality was dangerous and contagious. Later, lesbians and gay men were studied by the medical community and treated in an attempt to cure them of their homosexuality[3].

Until 1973, the American Psychiatric Association listed Homosexuality in the DSM as an illness or pathological condition[4]. This had implications for non-heterosexual physicians at that time as well as the general population, since coming out would have meant a diagnosis of a psychiatric illness and might have had serious professional ramifications.

Historically, in many Aboriginal communities, two-spirit people were considered valuable members of the society and the term was used with respect, dignity and acceptance. It was not until the Europeans came to North America, colonized the new world and brought a Western ideology to Aboriginal communities, that the role of two-spirited people became stigmatized. It is only recently that some communities are beginning to welcome two-spirited people back into their societies[6].

Linking Gay and HIV

Gay Bowel Syndrome (GBS) was the first "medical condition" used as a tool for the surveillance, regulation, definition, medicalization, identification and fragmentation of gay men’s bodies. GBS began to appear in the medical literature and mainstream media prior to, and early in, the recognition of HIV/AIDS. Attaching the term "gay" to a group of symptoms caused by receptive anal intercourse and analingus medicalized and pathologized the gay male body, assumed all gay men engage in receptive anal intercourse, and separated gay male anal intercourse from heterosexual anal intercourse. The definition of GBS was also problematic in that it included over 50 conditions from viruses, parasites, and bacteria, to foreign bodies and anal incontinence and also included conditions that are perianal such as warts. The diagnosis of GBS also required a determination of the patient’s sexual orientation. GBS contributed to the construction of HIV/AIDS as a gay man’s disease[5].

Prior to using the terminology HIV/AIDS, the severe immune deficiency syndrome seen in AIDS was referred to as GRID (Gay-Related Immune Deficiency) again pathologizing gay men[5].

In the 1980’s HIV/AIDS was first seen in gay men and was thought of as a gay disease[5], as late as 1993, AIDS was seen by some as being caused by a "gay lifestyle" rather than by HIV[5]. This thinking persists despite the fact that globally, the vast majority of those with HIV/AIDS were infected through heterosexual sex and the group at greatest risk is women[4].


1. Feinberg L. Trans health crisis: for us it's life or death. American Journal of Public Health. 2001;91(6):897-900.

2. Hippocrates. Oath of Hippocrates. From HIPPOCRATIC WRITINGS, translated by Chadwick J and Mann WN, 1950. Penguin Books. Accessed January 18, 2004.

3. Hudspith M. Caring for Lesbian Health: A Resource for Canadian Health Care Providers, Policy Makers and Planners, Revised Edition. 2001. Health Canada. Accessed October 24, 2003.

4. Solarz, AL Ed. Lesbian Health: Current Assessment and Directions for the Future. Washington DC. National Academy Press; 1999.

5. Scarce M. Smearing the Queer: Medical Bias in the Health Care of Gay Men. Binghampton NY. The Haworth Press, Inc.; 1999.

6. Brotman S, Ryan B, Jalbert Y, Rowe B. Reclaiming space-regaining health: the health care experiences of Two-Spirit people in Canada. Journal of Gay & Lesbian Social Services. 2002;14(1):67-87.

All references for this section