In perhaps the most moving scene in the film Philadelphia, Tom Hanks as Andrew Becket, a lawyer wrongfully dismissed from his job because he has AIDS, is in his flat discussing his case with his defence counsel, Joe. An opera is quietly playing in the background. Becket, suddenly caught up by the music, starts talking about it to Joe.

It's Maria Callas singing Maddalena's aria from Giordano's Andrea Chenier in which she describes how, during the French Revolution, her mother set fire to their home in order to prevent it falling into the hands of the revolutionaries. Becket, fighting the terminal stage of Kaposi's sarcoma and in obvious pain, translates Callas' words as he circles the room, clutching his drip stand: 'The place that cradled me is burning. Do you hear the heartache in her voice? Do you feel it, Joe? I bring sorrow to those who love me.' Who could not but feel compassion for him and be moved by the bitter irony in the words he quotes?

The entire film evokes our sympathy and paints a very positive picture of homosexual life. Becket is portrayed as a kind, sensitive and highly successful man in a loving supportive relationship with his partner. His family adores him and unconditionally affirms his lifestyle. His gay friends clearly enjoy life to the full and certainly know how to throw a great party.

In contrast to this idyllic tolerance, anyone who attempts to raise awareness of the medical dangers of gay sex is by definition in today's society, a homophobic bigot. Doctors are not immune to the stigma associated with such stereotyping and additional tensions may result from their drawing attention to the dangers of gay life. Homosexuals do often face both prejudice and hatred in our culture and articles like this are sometimes misused to fuel such intolerance. That is not its intent however. Health care workers also face misunderstanding by the gay and lesbian patients for whom they care. Yet highlighting the risks of gay sex does not mean doctors do not feel compassion for their gay patients, whom they should serve to the highest professional standards. The Christian doctor should always remember that Christ died for gay and straight alike and both depend absolutely on his mercy and forgiveness.

This said however, as teenagers and even younger children are no longer to be protected under the law from material promoting homosexuality, there is a greater need than ever to heighten awareness of its risks. Around a quarter of all 14-year-old boys are ambivalent about their sexual orientation. Most of them will not be homosexual as adults and they need to know about the dangers of engaging in anal sexual activity.[1]

Gay advocates often object that it is promiscuity and specific sexual behaviours, whether homosexual or heterosexual, that present the risks. Some would even take the view that homosexual sex is actually safer since there is no chance of an unplanned pregnancy, but one cannot be complacent even here. One review cautions, 'Because lesbians often engage in sex with men, pregnancy prevention and diagnosis should not be overlooked'.[2]

However, though the adverse consequences of heterosexual sex do of course lead to an immense medical and social burden, sex between men involves particularly high specific risks. Furthermore, sexual orientation and sexual behaviours are intimately related. It is not likely that men engaging in straight sex or lesbians in gay sex will have ano-receptive intercourse for example. Finally, though promiscuity is all too prevalent in heterosexual relationships, the British survey on sexual attitudes and lifestyles (The Wellings Survey) nevertheless indicates that promiscuity is higher in gay relationships. In an interview with The Independent, the researchers comment: 'The proportion of homosexual men reporting ten or more partners within the past five years was 9.1% against 5.2% of heterosexual men. If we eliminate those who have not had partners for the past five years, the contrast is even more marked: 23.8% of homosexual men against 5.3% of heterosexuals. This calculation, it must be emphasised, is based on small numbers.'[3]

The most unequivocal indicator of the higher risk posed by sex between men is the fact that those who have engaged in it, even only once, are not ever allowed to donate blood in the UK. The National Blood Service advice states, 'You must not give blood if you are a man...who has ever had sex with another man'.[4] The main reason for this prohibition is, of course, the high risk of transmission of AIDS. Sex between men was and is the major route of HIV infection in Britain.[5] A recent review on HIV prevention estimates that 'the risk of contracting HIV from one sexual act may be around 1 in 1000 from penile - vaginal sex, and as much as 30 times higher for receptive penile-anal intercourse'.[6]

Gay advocates often point out that anal intercourse is not universally practised by gay men and is used by many heterosexuals. However a recent view concludes that among heterosexuals '10% seems a conservative estimate of the proportion of sexually active Americans who engage in this behaviour with some regularity'.[7] The Wellings survey similarly found that only 13.9% of men had ever had anal sex with a woman.[8] By contrast 89.5% of men who had had genital contact with another man had had anal intercourse.[9]

The incidence of anal cancer has increased in recent decades, particularly among women in whom receptive anal intercourse particularly before the age of 30 has been shown to be a risk factor. [10] In gay and bisexual men, however, the incidence of anal cancer now exceeds the incidence of even cervical cancer in women. [11] Anal squamous epithelial lesions were diagnosed in 36% of HIV positive and 7% of HIV negative gay and bisexual men in one study. [12] Another study concludes 'a history of receptive anal intercourse was strongly associated with the occurrence of anal cancer (relative risk 33:1).' [13] In addition to the risks of HIV and anal cancer, anal intercourse is also associated with the spread of a wide variety of other sexually transmitted infections, [14] the 'gay-bowel syndrome' [15] and rectal incontinence. [16]

A further important issue is the high rate of use of drugs and alcohol in the gay community both to facilitate intercourse and generally to enhance sexual pleasure. Most comprehensive reviews comment on this and Chris Woods, a leading gay journalist, has commented that 'the fleeting nature and instability of many gay and lesbian relationships... mean that drug consumption, namely the lowering of barriers plays an important role in our social habits'. Studies have reported that gay men and lesbians are often unable to have sex unless using drugs of some nature - usually alcohol. [17] The use of poppers (amyl nitrate) to relax the anal sphincter is 58 times greater by homosexuals than by men in general. [18] The condom is still widely perceived by many people as being synonymous with safe sex. However anal intercourse with or without a condom is dangerous. A review article cites one study which found a condom breakage rate of 32% and slippage of 21%. This is significantly higher than the corresponding rates of 5.3% and 6.3% respectively cited for vaginal intercourse. [19]

Some who consider the above to be an unrepresentative view of homosexual life argue that most studies recruit from genito-urinary medicine clinics and hence are notrepresentative of the gay community as whole. However the Wellings data showed that of those who had any sexual partners in the previous five years, 25% of gay men had attended a GU clinic during that time compared with only 3% of straight men. [20] Whilst it is quite possible that the other 75% of gay men who may not appear in most studies celebrate their sexual lives in exclusively monogamous, long term relationships in which they never take drugs or have anal sex and always wear a condom, the evidence of morbidity amongst the remaining quarter of gay men is disturbing enough. [21]

Receptive anal intercourse, whether hetero or homosexual, is surely not to be commended by those who understand that their bodies are 'a temple of the Holy Spirit'? [22] True 'brotherly love' [23] (philadelphia) is as much needed today as in the early church. The New Testament plainly teaches that such love is intimately connected with purifying ourselves 'by obeying the truth' [24] and living 'a holy life'. Such concepts seem far removed from the homosexual lifestyles of Philadelphia.