Diecinueve años de experiencia hacen de la atención PROFIN VIH un concepto único en México.
RISK OF CONTRACTING HIV IN ADULTHOOD: ACCIDENT OR A PREVENTABLE CONSEQUENCE?
Dra Ma de la Paz Mireles Vieyra
Psicot. Araceli García Salazar.
IBB Raúl Martín Cruz M.
Translate: Paul Kersey
Generally speaking in medical practice when health professionals are with patients they inquire into their personal and family background as they seek an explanation of the illness. This is because the
vast majority of diseases, whether infectious or degenerative, have background data that make it possible to explain why certain types of people are affected and not others. Among the potential predisposing elements we can mention those related to genetics, the environment, social class, religion, and culture, among others.
The search for the elements that best explain the ultimate causes of a specific health problem depends on physicians and the focus or approach they have acquired during their professional and everyday lives. Some will take into account
primarily biological antecedents, such as heredity and microbes, etc.; while others will pay more atten- tion to economic, cultural and social factors.
Because of its specific focus and theoretical orientation, epidemiological research tends to visualize a broad range of variables as causes of harm, not only at the individual level, but also with respect to col- lectivities or populations. While an initial approach may show that a certain medical condition is not as- sociated with all members of a community, additional probing may reveal a link to the groups in which the harm or effect under study has manifested itself.
When treating patients with HIV infection, physicians may think that a certain kind of exposure led to its development, while the patients might relate the cause of their condition to a particular situation; both perhaps believing that the risk of contracting HIV occurred at a specific moment. However, upon examining clues from many patients, analyzing their exposure to HIV, and considering their family background, growth and life histories, it appears that in the vast majority of cases exposure to HIV through sexual contact was not an isolated event, much less an accidental occurrence.
Our studies, in contrast, lead us towards a different type of explanation; one related to early infant development in a social family milieu with specific characteristics. As a result of this, and because sexual preference can be an acquired behavior, we argue that generally speaking humans are not born homo- sexual or bisexual, but neither are they born with some innate form of heterosexual "behavior". Simply put, people are born male (boys) or female (girls), but this only implies that each individual has a genetic constitution with either an XX or XY chromosomal pair (females, males).
In the face of this incontrovertible and conclusively-demonstrated truth, it follows that when we see a newborn all we can affirm is that it is male or female; that is, no boy or girl is born heterosexual, homo- sexual, or bisexual. All that birth entails is an anatomical-genetic con- formation to which, from the very first day of life, experiences and so- cial and cultural events will be added to mold her or his behavior.
It is according to their natural biological growth, together with everything they see, hear, experience and perceive, that individuals' gradu- ally develop behavior related to sex -sexual preference- which may turn out to be heterosexual, homosexual or bisexual in nature.
This leads us to adduce that because sexual preference is a behavior that entails certain kinds of conduct, it is not inherited but, rather, ac- quired.
Also, since little boys and girls are necessarily the product at least up to now of the union of a man with a woman or, to be more precise, an ovule with a spermatozoid, each of which contributes 50% of the genetic load, generally speaking the predominant experiences of a newborn will involve these two figures (man - woman) in a world where heterosexuality (not only as sexual activity but also as the contrast between the sexes) constitutes -again, at least up to today- the habitual environment portrayed in all forms of mass media -i.e., books, schools, television, the Internet, etc.- that dominate our social and cultural life. Hence, this referent will, in all probability, be virtually the only one seen habitually, or that the child is obliged to see, hear and perceive from earliest infancy. Therefore, this behavior will not only be the one that the child learns almost "naturally", but also the conduct that the collectivity around her/ him expects and even imposes.
Moreover, it seems that nature itself entails this same behavioral expression for it has endowed men and women, respectively, with the precise anatomical and endocrinological resources required to
achieve the fundamental objective of heterosexuality: natural procreation.
THE EARLY YEARS
According to reports by psychologists from diverse schools of thought around the world, the experiences we live during the first 6-to-7 years of life lead us to acquire patterns that become basic to our development, and will permanently nourish our minds and behavior (6,7,8,9,10). One of these patterns is called IDENTIFICATION.
According to the theoretical developments of classical psychoanalysis, identification is the process through which a boy (we will refer to girls later) comes to find in the home a male model to follow. This figure allows the child to identify himself as a member of the group "MEN" and, hence, of the masculine sex, and this identification leads to the acquisition of self-worth and security.
Normally, the best masculine mold that a boy can identify with is that provided by his biological father, with whom he shares a series of biogenetic characteristics that make the progenitor and his son unrepeatable and unique in the male universe. But it is important to stress that the presence of the father in the household (or of the mother for girls) has cultural, religious, moral, spiritual and emotional components that, regardless of who he may be, endow him with certain qualities or strengths that his family expects and that, moreover, society as a whole deems desirable. And these qualities are the ones that a small boy gradually assumes -one way or another- and that he can legitimately expect from that "special" male figure.
When a boy's father provides protection and love -two basic elements of infant development- the minor can more easily grow in a secure, appropriate manner; but when one of these elements is missing, or is offered too generously or too scantily, there will be repercussions for the child.
Because it is an abstract variable, it is very difficult to measure love in terms of expression or repercus- sions, but the protection offered to a child can be more effectively quantified and, in some sense, also reflects love; albeit indirectly, since a person generally protects another only to the extent to which she/he is interested in her/him or has importance (note: this may not hold true in all cases, as we well know that protection can be offered without expressions of love). Finally, love seems to be one of the infant's essential perceptions, so it is difficult to believe that it could exist without generating protection, though it is quite possible for protection to exist without expressions of love. Also, an individual may wish to offer something that allows another to avoid harm or injury, such as protection from the environment, aggression, or any- thing that could cause discomfort or annoyance.
Our research did not deal with newborns or interview minors. Rather, it focused on adults who were asked to recall life experiences from their early years. In almost every case, the memories that went back to the age of 4-6 years were relatively clear, while for ages below 4 they were blurred or non-existent.
Once we were able to operationalize the variable "protection" it became possible to quantify for each case the degree of protection that the adults in our studies considered that their father and mother - separately- had offered them during infancy. What drew our attention was that in over 90% of cases in the groups of HIV patients studied (from urban and rural backgrounds, and high, middle, low and mar- ginal social classes) the paternal male figure was portrayed negatively with respect to two fundamental elements of the life of small children: namely, protection and expressions of love. Though the study identified variants in its results (from 0 to 100%), some constants were identified in these diverse groups of patients that related preponderantly to the paternal figure and his role in the father-son relationship.
Our research grouped subjects by age, categorized the paternal figures in relation to their presence or absence from birth onwards, and tabulated their characteristics. It also analyzed the presence of supple- mentary masculine figures to the biological father, such as stepfathers, grandfathers, uncles, godfathers, elder brothers, family friends, and others. In the cases in which supplementary figures were present, we examined what they offered the child in terms of protection, and then used this measure to derive the love that the infant required.
HIV-INFECTED PATIENTS AND HOMOSEXUAL PREFERENCE
What we found is that the HIV patients in the exclusively homosexual group revealed a predominant pattern marked by the absence of a father figure or the presence of unsuitable paternal surrogates, most of whom were characterized by behaviors towards the child in early infancy that offered little, or no, pro- tection. Indeed, their conduct was most often anti-protective or even abusive, as it involved mistreatment and verbal, physical and/or emotional aggression. Thus, in most cases, the male protection that the men interviewed received as small boys was classified as minimal or non-existent.
What this meant for those young boys were persistent, intensified feelings of helplessness, loneliness, abandonment and even rejection in relation to the male figure, circumstances that negatively influenced their self-identification and yearning for acceptance from a protective, paternal father figure.
One important aspect of the lack of protection during the first 10 years of life in this group (adults with HIV who reported experiences from their infancy and lacked a permanent, protective paternal figure) was that the number of instances of sexual abuse was significantly higher than in the other study groups. We found that of every 10 minors who lacked male protection in early infancy no fewer than 7 were subjected to sexual abuse -with or without penetration- from a very young age. The most frequent and marked kind of sexual abuse consisted in forcing the minor to perform oral sex on his abuser; fol- lowed in order of frequency by caresses over the entire body, kissing, and anal penetration. In a high percentage of these young boys the sexual abuse continued for as many as 8 years. The minimum number of episodes was just one.
The most severely compromised figures in this sense were precisely those men that should have provided the boys with the highest level of male protection: namely, uncles. Maternal uncles were implicated more often -which is understandable because when mothers are abandoned by their partners they generally seek refuge with the nuclear family where, in most cases, their brothers would be the men closest to their sons- but cousins, brothers and even non-relatives who were close to the family were also mentioned. Those men were pre- dominantly adults over 18 years of age (72%), but 20% were adolescents or pre-pubertal boys, and 9% were men over 50.
In 8 out of 10 cases, those boys -who are now adults- did not blame or accuse their violator for what happened to them, for in over 50% of cases social interaction with them took place on a daily or occa- sional basis after the violation or abuse because the violator was usually a member of the household. Due precisely to this circumstance, veiled threats were often issued to dissuade the boys from ever mentioning the acts performed. In other cases, boys were manipulated by their abusers into feeling guilty and ashamed because they were made to think that they were the ones who had sought contact or provoked the sexual abuse, even though in all cases they were younger (almost always much young- er) than their abusers.
Another significant finding is that 2 of every 5 adults who suffered aggression during infancy showed
affection or sympathy towards their aggressor. In their own words they explained that, despite the abuse, their aggressors had at least paid them some attention and showed affection. Also, the intimate acts performed were often 'staged' as play or were rewarded with candy or some other item that the boys wanted, including stories or 'plots' that they confused with games.
In almost all cases, the (now) adult men that fit this profile acquired HIV after relations with various sexu- al partners over the course of a year. The vast majority still lived with their families and looked after their mothers. Also, the percentage of cases in which a sister cared for the man and provided emotional support was high (52% of these men were only children or had just one sister, sometimes from a different father). A low percentage suffered from moderate-to-severe alcoholism, but most were social drinkers with only occasional bouts of drunkenness.
Upon discovering that they were infected with HIV, many accepted the diagnosis calmly because they were aware of the risk, recognized that they had been exposed to it, and were willing to modify their be- havior in an effort to get better.
As mentioned above, most of these men lived with their families, and over 70% informed them of their diagnosis, usually confiding in a sibling, though a lower percentage had told their mothers. Generally speaking, their families were supportive. Most of these men were employed and their rate of compliance with antiretroviral treatment has usually been good-to-high.
Our assumption -as yet unproven- is that families, especially mothers, were aware of the absence of the male figure during their sons' infancy, and sought to remedy it by being overprotective of their sons when they faced hardships during childhood. Many mothers admitted that their sons may have exhibited diverse sexual behaviors as a means of avoiding severe reprimands. On this topic, mothers often spoke of the overprotection their sons had received as infants, but rarely mentioned the father's desertion and its repercussions. In fact, they tended to blame themselves for their sons' behavior while striving to erase all traces of the absent father. This finding emerged in virtually all cases, so patients' effeminate behavior was overwhelmingly attributed to maternal overprotection and only rarely to the absence of the father or the abuses he inflicted (during short return periods).
There was, however, a sub-group within the larger group that did not experience this evolution or these parameters. In those cases, violations in early infancy were multiple or committed by several family members, almost always repetitively. Those children tended to receive even less protection and more pronounced dis- affection, in circumstances in which both the female and male parental figures were strongly implicated.
The study included numerous minors who during their infancy had lived with multiple siblings, two or more of whom had violated or abused them sexually, rarely together, but almost always in isolation and during activities typified as 'play'. Most incidents of abuse took place at night among siblings who shared beds because they lived with adults in overcrowded conditions.
Thus, the predominant pattern consisted in an abusive mother and a severely alcoholic surrogate male figure who was often physically violent with the mother. A second common pattern involved the pres- ence of an indolent or inattentive mother who may or may not have consumed alcohol occasionally, but was often verbally aggressive. No reports of drug consumption by mothers were received, at least not for the period of study (1998-2008).
The children's sufferings in terms of housing, alimentation and conditions of comfort were intense, and when those needs were satisfied it was often thanks to the acts not of the maternal or paternal figure but of surrogate figures such as grandparents or aunts and uncles.
In general, when these minors became adults they were prone to a highly promiscuous sex life in which alcoholism and drug addiction were common (mostly oral or nasal consumption). Several subjects practiced prostitution and showed a tendency towards extreme behaviors. Adopting physical roles of a female type was also common in this group, and the vast majority presented some physical element that reflected their homosexual behavior; perhaps the use of women's clothes, or implants or oil injections to give the appearance of feminine attributes.
Among these individuals, taking the feminine role during sexual activity was common, though this often resulted in mistreatment and/or economic exploitation at the hands of their partners. Several had been beaten, while others ended up establishing relationships with violent partners.
The families of these men usually accepted this kind of feminoid role, manifesting scant opposition. In- deed, several of these men actually provide for their families, almost always including the mother. In some cases, they accomplished this by practicing prostitution, openly or covertly, and the mother and other family members benefitted economically from this activity.
It is important to note that very frequently the men in this group with homosexual preference, most of whom lacked a paternal figure, perhaps even from birth, were the breadwinners or providers for their families and fulfilled paternal roles with respect to their nephews. In not a few cases, they actually became substitute fathers for a younger brother or nephew born to a sister who had been abandoned byher partner. They also tended to show deep attachment to their mothers and offered them protection.
When we asked several of these men about their paternal grandfa- ther and the role he had played as the father to his young son, we found that the behavioral characteristics were repetitive and similar, though in some cases the father considered that his father's behavior had been even more cruel and strict than his own; often characteriz- ing it as cruel, rough, rigid and violent, with frequent beatings and/or bouts of drunkenness. It is important to note that reports were similar regardless of the social class of the family involved.
In six cases, the father of the affected boy showed clearly homosexual behavior; in four others, it was suspected; and in two cases the father's homosexuality was well known to, and accepted by, the family, including the son who today is an adult with HIV infection.
What the men in the bisexual group said that they missed the most was emotional closeness with the father, a feeling that still causes many of them intense pain and anguish, largely because they feel that they failed their fathers by not fulfilling their expectations. Also, they experience bouts of depression for they think that their father suspected their homosexuality even before they realized it, and this led them to accept, or resign themselves to, paternal rejection. They felt guilty and disdained in their fathers' eyes.
In several cases, the mother let the man know that if he became homosexual he would be rejected and repudiated, and in nine cases this was the result when the family confirmed his homosexuality. In other households, pressure on the men to have children was intense and when he abandoned them, things were no longer the same in terms of sustenance and protection. With respect to violence against their wives, the men's families rarely repudiated it, simply stating, "That's their problem".
Another important contrast between the homosexual and bisexual groups was the information that the adult gave his family as to his sexual preference. In the former group, 32% had informed some member of the family directly about their preference, while the rest simply assumed that their families knew of their inclination, not only because of how they behaved towards him but also by acts that demonstrated it (eg. close male friends). However, neither the men nor their families faced these situations head-on.
Finally, it seems that everyone was aware of the situation to some extent, except the father or stepfather who, according to the testimonies collected, usually "ignored everything".
In the bisexual group, in contrast, none of the men said that they had informed their families of their pref- erence for men. In some cases, families clearly suspected it, but the topic was never discussed, or the mother had broached the issue only to have her son negate it. Thus, almost all these men concealed their preference, though several had sexual relations with men close to their families, including direct relatives or relatives of their wives. Despite this, their proclivity was kept secret.
The sub-group of bisexual men whose father figure was present but provided inadequate protection dur- ing early infancy generally had feelings of guilt for something they had not done or because they sensed that they had failed to satisfy certain family expectations. The perception that they had "sinned" haunted many, and the guilty feelings were often so overwhelming that they led to binge drinking. Severe alco- holism was a predominant pattern in this group, as episodes of drunkenness were habitual and almost always led to sexual relations with other men, often anonymously, thus greatly increasing the risk, for they rarely used condoms despite the fact that those partners were also high-risk; i.e., male prostitutes working in areas like the Zona Rosa or contacted over the Internet, or simply random men picked up on the street or in bars.
Another important contrast is that the first sexual experience among the men in the bisexual group was usually a consensual act with a friend. They spoke of initiating sexual activity in encounters at school; sometimes Primary school, but more commonly in Junior High or High School, when friendship led to sexual acts. The prelude to such episodes almost always involved drinking. Our data show that sexual abuse occurred in 22% of these cases, but normally began when the child was older than those in the homosexual group, perhaps 9 to 12 years of age. We cannot discard the possibility that in several cases consent was given before initiating the sexual relationship.
Parallel to this, and in relation to efforts to satisfy family expectations -especially those of mothers- the- se men often established a relationship with a woman who was actually just a friend. Those arrangements were not based on 'true love' and could hardly be described as 'passionate'. Indeed, the men of- ten found that having sexual relations with their partners was unpleasant, or even tortuous because satisfying the women's demands brought them no satisfaction. In many cases, of course, the men were simply unable to express love or pas- sion to the women because of their amorous preference for male- male relations.
Many of these men, however, were able to reduce family tensions by having children, whose arrival was joyously accepted and highly valued, though in many cases they paid little attention to their children, and offered much less protection than the young ones desired due to prolonged absences or indifference when they were at home.
In many cases, these conditions worsened due to alcoholism. Many of the men in this group drank heavily for two reasons: first, to relax the strictures that prevented them from satisfying their true amorous desires; and, second, to avoid facing the unpleasant reality of tensions in the home that often led to episodes of domestic violence and the reproduction of patterns they had experienced in infancy.
With time, concealing their true sexual preference became habitual, and as the need to hide it grew so did their feelings of tension and depression. Due to this concealment, when the men in this group received their HIV+ diagnoses they generally became even more depressed. Almost none informed their families, choosing instead to suffer in silence. But this circumstance extended the period without treat- ment and allowed the infection to evolve into more severe stages, accentuated by depression and other complications -gonorrhea, cytomegalovirus, hepatitis, etc.- born of their obsession to conceal their sexual activity.
It seems that in this group of patients the most worrisome aspect of their HIV+ diagnoses was not the organic damage it would cause, but the fact that it would expose what they had struggled so long to conceal. Facing the possibility that everything would come out into the open, their anxiety grew, fostering even greater harm than the infection itself would cause.
-The father clearly preferred another child, or for reasons that the boy could not compre- hend blamed him for things that were not his responsibility, or that he could not understand. This caused estrangement between father and son and produced feelings of anger and rejection in the latter.
-Episodes of aggression and/or unpleasantness that were etched into the memory of the minor because his father had beaten him, ridiculed him in front of others, or insulted him publicly, almost always because of some minor incident or situation that made the boy feel
that he had been treated unjustly and generated intense suffering and sadness.
-The father had made it clear that if the boy began showing feminine or suggestive behavior, he would be rejected, exposed and repudiated. Also, the father occasionally made fun of the way the minor talked or his gestures, especially if he were timid or fearful. Fathers always blamed the mother for the son's feminine traits.
-The fathers' alcoholism and violent character were other constants in this group, where the paternal figure failed to perform the role of protector, constantly beat the mother and was verbally or physically aggressive towards his children. In virtually all these boys this generated growing tension and considerable fear -even terror- on a daily basis when the male figure was about to arrive home, often accompanied by the absence of economic and/or emotional support in practically all critical situations.
ORIGIN OF THE PROBLEM
When we began attending HIV/AIDS patients in the 1990s, like many other health professionals we fo- cused primarily on the medical problem and its repercussions. However, gradually, and as the epidemi- ological focus associated with this field of medical specialization developed, we began to turn our atten-
tion to data sets that coincided among several patients independently of their birthplace or social class.
Over time, this led us to conduct a broad research project that involved 2,500 adult patients with HIV infection and generated a large corpus of significant data. The analysis presented in this article is based on those data, as are other reports that our working group has published previously in medical journals (1,2,3,4,5).
In our view, the origins of the problem can be traced to the patients' infancy, so research must go back in time to identify a certain series of variables in people infected with HIV. In order to achieve credibility
as evidence, those findings must be contrasted to data from individuals without HIV infection. Then a
detailed analysis of the differences between these two groups will show whether those elements reach the level of statistical significance, and allow us to ascertain whether a specific association can, or can- not, be considered causal.
In our experience, the variables of homosexuality and bisexuality are the constants most consistently identified in people affected by HIV. Like many reports worldwide, this revealed that male-to-male (M - M) sexual exposure represents the riskiest type of sexual contact for acquiring HIV. Obviously, the vast majority of reports concur with this affirmation; however, differences appear when they identify the mo- tives that lead a man to choose homosexual or bisexual behavior (Note: we deal with women in a sepa- rate article).
Currents of thought on this perspective run the gamut from those that argue for a genetic origin to those that reject this position outright, almost always from a vision colored by religion, and pass through argu- ments based on volition that conceive homosexual activity to be a consequence of an individual's free choice and sexual non-determination.
Our studies, in contrast, lead us towards a different type of explanation; one related to early infant devel- opment in a social-family milieu with specific characteristics. As a result of this, and because sexual preference can be an acquired behavior, we argue that generally speaking humans are not born homo- sexual or bisexual, but neither are they born with some innate form of heterosexual "behavior". Simply put, people are born male (boys) or female (girls), but this only implies that each individual has a genetic constitution with either an XX or XY chromosomal pair (females, males).
The men in this group more often abandoned treatment or showed much less rigorous compliance with the regimen prescribed. This was due to both their abuse of alcohol and certain ruses and chicanery that they concocted, consciously or not, that made compliance and control more difficult and worsened their prognoses. This leads us to suspect that THESE PATIENTS FELT THAT THEY DESERVED TO BE PUNISHED AND BY SUSPENDING TREATMENT AND ALLOWING AIDS TO DEVELOP THEY WOULD RECEIVE THEIR JUST REWARD FOR ALL THEIR DECEPTIVE OR DEPLORABLE BEHAVIOR TOWARDS THEIR FAMILIES AND SOCIETY.
Boys do not grow up to be homosexuals because they lacked a paternal figure, nor bisexual be- cause their fathers mistreated them. The essential point here is that young people of both sexes need to feel protected and receive concrete protection in early infancy when they are most vulnerable to all forms of aggression¼ physical, emotional, psychological or moral, This is because at that age they are incapable of generating forms of self-defense. And this is true of all minors, regardless of ethnicity, place of residence, or social class, in the present, the past and the future.
The lack of protection, and all it entails in terms of the expres- sions of love that the child may receive, is intimately linked to the same-sex parental figure. Of course, both parents are essen- tial in the lives of their children, but the parent of the same sex represents the model of masculinity or femininity that the boy or girl will identify in his/her environment and that they require to establish self-esteem and feel secure.
This lack of identification in early childhood may produce around the girl or boy a milieu marked by physical, emotional and affective dis-protection that seems to constitute a neces- sary but not always sufficient cause for the minor, as an adult man or woman, to generate behaviors distinct from those that are expected of them in their sexual/emotional environment. The broad variability of situations related to this may generate a pos- sibility of just 1 in 100, but it is clear that this causal base can be exacerbated by elements that prove "sufficient" to generate homosexual or bisexual expressions. Moreover, according to our experience, sexual abuse during childhood constitutes a particularly strong element that may add to, or reinforce, the behavioral expressions that arise from this conflict. It is more common to find this in men with homosexual preference because our research has found that men with this tendency received much less protection as minors, almost always from a very young age. These two elements leave the young child defenseless when they later come to face high-risk situations. Of course, not all boys who experience such conditions suffer abuse, but if due to an absent or deficient paternal figure the child is left largely unprotected in the human circle around him, the most probable outcome is that abuse will occur.
In these circumstances, abuse appears not to be a fortuitous act but, rather, one propitiated precisely by the lack of parental protection. This seems to be especially true for boys who lack a father figure and thus feel the need to fill that void with affection and attention. Unfortunately, their search often leads to encounters that contain a sexual element and a series of circumstanc- es that alter the sexual behavior of the victims of such aggression.
In contrast, in a high number of cases in the male population that may not be fully identified in quantitative terms due to the clandestine nature of their behavior, the necessary cause related to mistreatment, paternal rejection, or lack of protection, seems to entail essential factors that lead the child-adult -perhaps in ways that are barely perceptible- to feel an inclination towards emo- tional and, secondarily, sexual behaviors that with the onset of adolescence may begin to emerge almost uncontrollably. In these circumstances, alcoholism could play an important role as a complementary sufficient cause.
In the bisexual condition, meanwhile, what seems to predominate is the necessary cause; that is, the lack of parental protection and emotional closeness with the father figure over long periods of time. In these cases, the father or surrogate is present, but aloof and inaccessible to the boy
throughout infancy, during puberty, and perhaps even into adolescence. And this form of pater-
nal conduct includes constant emotional aggression against the child-man that seems to be sufficient "in itself" to propitiate clandestine behaviors in the minor during adolescence and young adulthood in relation to other men. However, precisely because of their clandestine nature it is difficult to quantify and measure such acts. But we do know that they can attack the individual intensely, causing deep feelings of personal devaluation, guilt, rejection, violence and depression that may on occasion lead to extreme behaviors -such as suicide- because the man is unable to find answers to his questions and doubts as to what lies behind his behavior or his internal sentiments. These men may come to consider that "they were born with defects or problems" and that something of which they are utterly unaware does not allow them to share or experience the things that others seem to enjoy in relation to sex and love. These elements can destroy their self-esteem and self-identification; although in truth his degree of responsibility is minimal -even non-existent in early infancy- and emanates from family patterns that are almost always generational and negative in nature but also hidden away. Unfortunately, the child-man himself helps replicate them and continue them because of the ignorance that usually envelops
As a result, in male bisexuality, the lack of parental protection particularly in relation to the father figure, and the child's need to overcome the emotional inaccessibility he suffered for years, may lead him at school-age and/or in adolescence to seek emotional bonds with other males that can generate, through diverse circumstances, sexual needs which when joined to his affective needs could modify his sexual behavior and create contradictory internal emotions that generate deep, intense conflicts due to biological-behavioral incongruence.
Conception through the union of an ovule and a spermatozoid cannot be reduced to a simple act of fertilization, for it entails and demands emotional, affective and loving contact with those ori- gins that allow us to identify ourselves through the opposite-sexed parent and establish the type of emotional and empathetic relationship that one seeks to develop with that other "half of the world". It does not suffice to receive protection from only one of the two parents that life gives us. We require both in the same measure and proportion, though for distinct existential and ex- periential purposes. For this reason, when our societies are governed primarily by interests more commercial than humanistic in nature, it becomes difficult to imagine what the reaction of minors might be when at the root of their lives, instead of a mother, they can only identify a uter- us, or only a sperm as their vital explanation.
Up to now, diverse postures have sought to identify an exclusively individual responsibility in relation to homosexual and bisexual behavior. They argue, on the one hand, that people who practice such behaviors must be protected and, on the other, that abusers or violators once identified must be sanctioned. However, it is surprising to find that in almost all societies there is a series of situations that instead of stopping or impeding the factors involved, actually repro- duces everything that favors or buttresses them, intensely and persistently. Examples of this include: rampant alcoholism among adolescent men and women, the sex trade involving minors, human-trafficking, endless talks on infant and sexual pornography and other types, increasingly intense sexual violence that goes unpunished, etc., etc. Unfortunately, these issues have not spurred interest in collective research designed to clearly identify the magnitude of the problems and determine the extent to which such behaviors are a consequence of something more tran- scendental. Rather, diverse groups and currents of thought have striven to reduce these phe- nomena to what is perhaps the path of least resistance -but by no means necessarily the most appropriate one- that consists in attributing responsibility to the individual, with little or no effort to probe how societies the world over have failed to procure the level of protection and care re- quired by children of all social classes who are exposed to intra- and extra-domestic domination and violence on a daily basis; this world in which individual rights seem to hold for only the few, especially adults, and where laws are applied, but not for the many and, most certainly, never in the home. There, it is the law of the strongest -almost always the most unjust and abusive- that holds sway, allowing them to enjoy almost complete impunity and, all too often, maximum approval.