Psych Unit 18 and 19

Question 1

STIs/STDs

Answer 1

refers to infections transmitted thru sexual contact with an infected individual
- STI term is preferred

• STI refers to an infection (vs. disease which makes it sound scarier)
• disease usually refers to when the infection causes symptoms, damages body parts, or leads to long-term illness (most STIs don’t do this)

Question 2

Why STIs are Public Health Problem

Answer 2

STIs are a very big public health problem
- a lot of STIs don’t show symptoms
- people don’t get treated for them if they’re unaware they have an STI
- can lead to long-term health problems

Question 3

CDC Data on STIs - General

Answer 3

data from 2018
- 1 in 5 people in the US have an STI
- 26 million new cases of STIs in 2018
- STIs are a problem among young people (15-24)

• HPV is more prevelant than HSV-2
• Chlymadia and ghonorrea have high incident rates but low overall prevalence

Question 4

Bacterial STIs

Answer 4

caused by the entry of some bacteria into the body
- can be cured by antibiotics
- if the bacteria continues living in body for a long time, it can cause long-term health problems

ex: chlymadia, gonorrhea, syphilis, trichomonoiasis (it’s a protozoa, not bacterial but can be treated)

Question 5

Virals STIs

Answer 5

caused by the entry of some virus into the body
- can enter host cells and stay in your body for the rest of your life
- can’t be cured (but we do have ways to help symptoms, prevent spread, and prevent further damage)

Ex: HPV, hepres, HIV, hepatitis B

Question 6

Chlamydia

Answer 6

more common STI
- spread thru vaginal, oral, anal sex with someone who has it
- can get it from someone’s pre-cum
- infected pregnant people can infect their baby during childbirth (the baby can get eye infection or pnemonia)
- usually transmitted thru bodily fluids

Even though we have effective treatments, the rates have increased in most years except for 2020

Question 7

Chlamydia Symptoms

Answer 7

Men:
- 50% of males are asymptomatic
- clear discharge from penis
- discomfort while peeing

women:
- a lot of women are asymptomatic
- unusual vaginal discharge
- burning sensation while urinating

Question 8

Chlamydia Treatment

Answer 8

treatment:
- antibiotics
- penicilin (a lot of people are resistaant to penicilin)

if you don’t get treated:
- can cause urethral damage
- infections in epididymis
- Reiter’s Syndrome (retroactive arthritis)
- for women: pelvic inflammatory disease (can impact future fertility)

Question 9

Chlamydia Prevention

Answer 9

• condoms, regular testing (many ppl are asymptomatic)
• doctors usually test for this bc it’s so common
• one idea is to screen kids from 13 and older (North Carolina did this and found many asymptomatic cases)
• free home test kits
• communication with partners

Question 10

Gonorrhea

Answer 10

high incidence rate but low prevelance
- really common but less common than chlamydia
- bacterial infection (gonococus)
- spreads thru vaginal, anal, or oral sex with infected person

• one of the oldest infections (talked abt in the Bible)
• greek doctor thought it developed from a too much pleasure of Venus (goddess of love)
• always been a problem especially during wartime (epidemic during WWI and WWII)
• more cases because many people are on The Pill and don’t use condoms :)

Question 11

Gonorrhea Symptoms

Answer 11

women:
- cervical infection - pus
- most women don’t have symptoms
- can spread to urethra

• if infection isn’t treated, it can move into uterus and and infect fallopian tubes (tissue becomes enflamed and turns into pelvic inflammatory disease)
• if PID isn’t treated it can scar fallopian tubes, making the women infertile

men:
- thin, clear discharge
- symptoms show up around 2-3 days being infected
- burning sensation during urination

Question 12

Gonorrhea Diagnosis

Answer 12

bc chlamydia and gonorrhea symptoms are so similar, they get misdiagnosed – now few misdiagnosis

diagnosis:
- urine test for men
- if you think the gonorrhea is in throat, you can swab there
- swab for the rectum
- women need urine test and pelvic exam

Question 13

Gonorrhea Treatment and Prevention

Answer 13

treatment:
- antibiotics
- it’s resistant to penicilin

without treatment:
- sterility and infertility
- infection (rash, fever)
- painful infection in tubes attached to testicles
- pelvic inflammatory disease
- stomach pain
- scar tissue in fallopian tubes
- ectopic pregnancy

Prevention: condoms, regular testing, communication with partners

Question 14

HPV (Human Papillomarvirus)

Answer 14

increases the risk of cervical cancer and other cancer
- HPV isn’t cancer, but it increases the risk for certain cancers
- causes genital warts but many cases don’t have warts (no cure for the warts)
- there’s an HPV vaccine!!!

• the majority of people with HPV are asymptomatic

in the US:
- HPV is the most common STI
- but the rate has dropped
- before the vaccine, 12% of women were infected

genital warts: warts on genitals
- males: around the urethral opening, shaft of penis and scrotum
- females: vuvla, vaginal walls, and cervix

HPV can also cause oral cancer (cancer of the mouth or throat)

Question 15

HPV Vaccine

Answer 15

given to ideally aged 11-12, but can give up to 26 yrs old
- get 3 shots over a 6-month period (given to all genders, not just girls)

Gardasil 4 vaccine:
- protects against types 16 and 18 (cancer types ) and type 2 (wart type)
- 95% effective

Gardasil 9:
- protects against 9 types
- the additional 5 types are more common in African Americans
- Gardasil 4 was developed to protect white people not black people

Question 16

Genital Herpes: Herpes Simplex Virus, Type 2 (HSV-2)

Answer 16

different types of herpes (also HSV-1 the cold sores on mouth)
HSV-2 – genital herpes

• no cure bc it’s a virus
• rates of HSV-2 are much higher for women (infections are easier to transmit between men and women than women to men during intercourse)

spread thru:
- vaginal, oral and skin-to-skin contact with someone who has genital herpes (includes kissing)

Question 17

Genital Herpes Symptoms

Answer 17

“outbreaks”
- many infected ppl have no symptoms
- one or more blisters around the genitals, rectum, or mouth
- blisters break and can leave painful sores

• outbreaks last 7-10 days (shorter with anti-viral drug)
• some people get an outbreak and never get another one

when no outbreak: they still have the virus but no shedding
- low level of the virus

Question 18

Genital Herpes Treatment

Answer 18

anti-viral meds: shorten outbreaks
- no cure (no drug that kills the virus)

long-term issues:
- increases risk of HIV infection
- can be tranferred from mom to baby during birth (can cause the bay to die)
- risk in infection in baby is highest for pregnant women who experience their first outbreak
- C-sections usually done to prevent transmission from mom to baby

• narrow urethra that leads to scarring (problems with urination)
• condoms can help prevent the spread

Question 19

HIV & AIDS

Answer 19

a doctor in LA first discovered AIDS and it plagued the gay community

AIDS = Acquired Immune Deficiency Syndrome
HIV = Human Immune Deficiency Virus
- 2 types: HIV-1 and HIV-2

• many people have died from AIDS
• under control in the US now (but it can be an epidemic or pandemic)
• Black men are more affected by HIV than any other racial or ethnic group
• more trans women have HIV

Question 20

HIV/AIDS Infected

Answer 20

HIV is common in men
- 66% of men who have sex with men have this
- 7% from heterosexual contact
- 4% from injecting drugs
- 1% from hemophiliacs (get blood transfusions)

women:
- from heterosexual sex
- from injecting drugs

Question 21

HIV/AIDS Transmission

Answer 21

bodily fluids:
- semen, blood, less likely thru vaginal or cervical secretions
- unlikely from saliva

sex:
- penis-in-vagina sex
- anal (person recieving is at higher risk bc the rectum lining can be torn which makes it easier for HIV to get in)

• less likely from oral-genital sex
• female-female transmission is rare

contaminated blood:
- blood transfusions (in the US, blood is screened)
- there’s still a stigma that gay men shouldn’t donate blood)

• needles
• childbirth

Question 22

How HIV Turns Into AIDS

Answer 22

• untreated HIV can get to a point where you can’t fight off any infection
• can be controlled if dealt with properly
• HIV weakens immune system
• invades Helper T cells to copy itself and then destroys the Helper T cells

Helper T cells: tell immune cells to do their jobs
- in HIV, Helper T cells are destroyed, so the body isn’t alerted to defend itself against other infections

***when the body can’t fight off infection on its own, HIV turns into AIDS

Question 23

Stages of HIV to AIDS

Answer 23

stage 0: initial infection, body develops antibodies (2-8 weeks)
- asymptomatic
- t cell count 1,000 (normal count)
- ppl can stay in stage 0 for years

stage 1: t cell count greater than 500
- no symptoms
- if symptoms, swollen lymph nodes, night sweats

stage 2: t cell count between 499 and 200

stage 3: HIV is now turned into AIDS
- t cell count is less than 200
- opportunistic infections (infections that happen only in people with really compromised immune systems - invasive cervical cancer)

Question 24

Forgotten History of AIDS - Video

Answer 24

1980s – public reacted with prejudice to people with AIDS (bc in gay community)
- people thought there should be a quarentine for gay people, drug users, and prostitutes

• they thought ordinary ppl couldn’t get AIDS
• a little boy (Ryan) got AIDS from a blood transfusion
• people don’t have the same access to treatment for AIDS

Question 25

HIV Prevention and Treatment

Answer 25

no current cure for AIDS - condoms are really effective to prevent HIV transmission - get tested (1 in 5 ppl don't know they're infected) PrEP: preventitive drug - Uninfected people can take anti-retroviral drugs to prevent becoming infected (ex: if your partner is HIV-Positive, you will want to take this drug) - Person has to take the pill every day or at least 4 times a week Azit (drug) - can stop the virus from multiplying but can't repair person's damaged immune system Protease Inhibitors: they attack the viral enzyme protease which is needed for HIV to make copies of itself and multiply ART: Antiretroviral Treatments - “Cocktail” combination (combo of lots of different kinds of drugs) - Can supress the virus so that the viral load is really low that it can’t be detected (the person can’t transmit this disease once the viral load is so low) - Viral suppression can be reached within 6 months of using ART Can suppress the amount of the virus in the system to a point where HIV in transmissible

Question 26

HIV and AIDS Stigma

Answer 26

people can live with it - ex: Magic Johnson is living with HIV - HIV/AIDS is the 5th leading cause of death for women in the US - trans people are at high risk for HIV pediatric AIDS: kids with AIDS - can get it from being birthed by mom who has HIV people of color: - racial health disparity - not common in asian populations

Question 27

HPV Diagnosis

Answer 27

- DNA test on cells from cervix can detect HPV types related to cervical cancer - no test for high risk types of HPV on penis or anus - if there are warts, diagnosis can be made just from looking at the warts

Question 28

HPV Treatment

Answer 28

- Chemicals can be applied to the warts directly - Cryotherapy (warts are frozen off) - Creams with drugs in them can be applied **if you have a low strain of it, HPV can go away

Question 29

Most Likely to get HIV

Answer 29

- reciever of anal intercourse - people with many sexual partners - sex is riskier if it's with an infected person with HIV heterosexual couple in Uganda Study: - one partner had HIV and the other didn't - the higher the viral count of the infected person, the greater rate of transmission - none of the circumsiced men got infected

Question 30

HIV: Retrovirus

Answer 30

retrovirus = reproduce only in living cells of the host species, in the case of humans - they invade a host cell, and everytime the host cell divides, the virus makes copies of itself - researchers are trying to make drugs that prevent the virus from infecting host cells - HIV invades a specific group of white blood cells (T cells) - when HIV reproduces, it destorys the T cells

Question 31

HIV Diagnosis

Answer 31

- blood tests detect the prescence of antibodies to HIV - the tests are cheap and easy the tests used: - screen donated blood - to help ppl see if they're infected (HIV-Positive) - the problem is that it takes awhile after being infected for the antibodies to form (tests are inaccurate until enough antibodies are formed) - lab tests are more accurate than home tests

Question 32

Psych Issues in HIV/AIDS

Answer 32

- most people experience denial, anger and depression - need to be sensitive to people with AIDS and their families - people can experience posttraumatic growth (those ppl tend to have higher T cell counts)

Question 33

Progress in AIDS Research

Answer 33

- need a cure need an HIV vaccine: - hard to do this bc HIV has so many forms and mutates quickly - the strains are diff. from country to country - need a mosiac vaccine (vaccine that works against multiple strains)

Question 34

Genetic Resistance: HIV

Answer 34

- scientists have found a mutation in a gene that is resistant to HIV infection - the mutation happened when humans spread out of Africa - mutation selected for during bubonic plague - people who are homozygotes are resistant

Question 35

Microbicides: HIV

Answer 35

usually an ointment form that kills microbes like HIV - need new ones bc the old ones are making ppl more susceptible to infection - a gel has reduced infection rates

Question 36

Syphilis

Answer 36

- early disease - bacterial disease - less common than gonorrhea or chlamydia - very serious if not treated (can damage nervous system and cause death) - having syphilis can make you more susceptible to HIV

Question 37

Syphilis Symptoms

Answer 37

chancre (main symptom) -- round, raised edge (looks like a crater) but painless - in women: chancre in cervix - in men: chancre in penis or scrotum tranmission: - bacteria can enter thru mouth, rectum or cut in skin - most cases can be treated with penicilin

Question 38

4 Stages of Syphilis

Answer 38

Primary Stage: chancre forms - end of primary stage is when chancre goes away - usually chancre goes away on its own Secondary Stage: body rash develops - rash usually on palms and feet - hair loss - even if symptoms go away, still infected with disease Latent: symptoms from secondary stage have diseappeared - can last for years - no symptoms - bacteria in body tissues, blood vessels, CNS, and bones - not infectious but pregnant person can pass it on to child - half of ppl in latent stage stay in it forever Late: - cardiovascular syphilis (the bacteria attacks heart and major blood vessels) - can cause death - neursyphilis (bacteria attacks brain and spinal cord) - congenital syphilis (baby gets syphilis from pregnant mom) - can kill fetus

Question 39

Syphilis Transmission and Diagnosis

Answer 39

transmitted thru mucos membranes of the genitals thru intercourse diagnosis: hard to diagnose bc symptoms are similar to other diseases - physical exam - women need pelvic exam - if person had anal sex, they need rectal exam - inspect chancre - blood test

Question 40

Syphilis Treatment

Answer 40

penicilin - latent, late and congenital syphilis need higher dose of penicillin

Question 41

Tuskegee Experiment

Answer 41

many poor black men were entered into a study without knowing - researchers wanted to know the effects of untreated syphilis - the researchers told them they were being treated for "bad blood" - instead of treating them, they watched the effects of untreated syphilis (didn't give them penicillin which would've cured them) -

Question 42

Hepatitis B

Answer 42

viral hepatitis B = disease of the liver hepatitis b = kind that is sexually transmitted - not as common bc we treat this well - many types of hepititis (A, B, C, D, E) - hep b. most common in STIs - more contagious than AIDS - people who have it always have a positive blood test for it - many adults with it are asymptomatic - both short-term and long-term types of it

Question 43

Hepatitis B Symptoms and Transmission

Answer 43

Symptoms: - enlarged liver that is a little tender - some people are asymptomatic - others have fever, fatigue, jaundice, vomitting, and flu-like symptoms Transmission: - blood, saliva, semen, vaginal secretions, other bodily fluids - needle sharing, vaginal and anal intercourse, and oral-anal sex

Question 44

Hepatitis B Treatment

Answer 44

- vaccine for hep. B (teens and infants get vaccinated for it) - antiviral treatments for people with chronic hep. b

Question 45

Trichomoniasis (Trich)

Answer 45

caused by the protozoan Trichomonas vaginalis (it’s a type of germ that can make people sick) - organism can survive for awhile on toilet seats (sometimes transmitted non-sexually) - usually transmitted thru sex women: - vaginal discharge that irritates vulva and smells men: - discharge from penis and irritation in urethra - some men are asymptomatic

Question 46

Trich Diagnosis

Answer 46

- need an accurate diagnosis bc the drugs that treat it are used to treat other STIs - untreated trich can cause long-term effects (infertility, pelvic inflammatory disease, increased susceptibility to HIV) - medicine taken orally

Question 47

Pubic Lice

Answer 47

tiny lice that attach themselves to the base of pubic hairs and feed on blood of humans - resemble a crab (sometimes called "crabs") - they lay eggs that live for 30 days but die within 24 hrs once taken off human host - transmitted thru sexual contact (can also get from dirty sheets, toilet seats)

Question 48

Pubic Lice: Treatment and Symptoms

Answer 48

Symptoms: - Itching in the region of pubic hair - Diagnosis is made by finding the lice or the eggs attached to the hairs Treatment: - Drugs (kill the lice) - The person needs to wear clean clothes - Eggs can live up to 6 days and may need to boil clothes to get rid of them

Question 49

How to Protect Yourself from STIs

Answer 49

- monogamy!!! - latex condoms :) - wash genitals before sex - inspect partner's genitals - don't assume someone doesn't have an STI even if you can't see anything (some ppl are asymptomatic) - urinate after sex (helps keep bacteria out of urethra) - get treatment if you have an STI

Question 50

Vaginitis

Answer 50

vaginal inflammation or irritation - very common in women - not STI (they're not transmitted thru sexual contact) prevention: - wash and dry vulva - don't use deoderant sprays in vulva - wear cotton underwear - wipe butt from front to back - don't go from anal to vaginal sex

Question 51

Candida

Answer 51

yeast infection - usually just in women - form of vaginitis caused by yeast fungus - yeast in vagina but if growth is crazy, it can move to other places Long-term use of birth control pills, periods, diabetes, prediabetic conditions, pregnancy and long-term use of antibiotics can cause yeast infections - not an STI but sex can aggravate it

Question 52

Candida: Symptoms and Treatment

Answer 52

symptoms: - thick vaginal discharge - causes extreme itching treatment: drugs pregnant mom can give baby yeast infection - if baby gets it in their digestive system, they get Thrush - thrush can be caused from oral genital sex

Question 53

Prostatitis

Answer 53

inflammation of the prostate gland - only happens in males - caused by bacteria E. Coli - can be caused by gonorrhea or chlamydia symptoms: - fever, chills, pain, need to pee a lot - painful ejaculation - lower back pain - some ppl are asymptomatic treatment: antibiotics

Question 54

Why Study Ethics, Religion, and Sexuality

Answer 54

- everyone is influenced by religion - in the US, Christianity and Judaism have shaped the culture and continue to (ex: sexual scripts are from religion) - it can help u understand your own values and where your sexual behavior comes from *religion is an institution that influences our sexuality

Question 55

Ethics

Answer 55

- a system of moral principles (help us determine what is right and wrong) - principles established by some group (ex: Roman Catholic Church) - people are motivated to follow rules if there are punishments (ex: committing a sin makes you unable to go to heaven)

Question 56

Religion

Answer 56

- religion gives us an ethics code to follow - gives us rewards and punishments for certain behaviors - shapes our views on human sexuality

Question 57

Hedonism -- Ascenticism

Answer 57

hedonism: maximizes pleasure and avoids pain - they would say our ultimate goal is to chase pleasure and avoid pain asceticism: self-denial, impulse control - they think that pleasure isn't important and that other things are more important ex: celibacy, virginity, poverty, orders of munks and nuns

Question 58

Legalism ---- Situationalism

Answer 58

legalism: morality consists of obeying laws/rules - an outside source is creating laws, and people follow them situationalism: few absolute, universal rules, what is ethical depends on the situation

Question 59

Possible to Combine both Dimensions

Answer 59

you can see where people fall on hedonsim, ascetisism, legalism, and situationalism ex: people would characterize the Catholic Church as being close to legalism and asceticism ex: people would characterize unitarians are more situationism and hedonism

Question 60

Historical-Critical Method

Answer 60

- when people take a literal reading of the Bible - biblical passages mean what their authors intended at the time - not what a 21st century reader thinks of it, as translated into English and taken out of context

Question 61

Judaism

Answer 61

- traditional Judaism (based on Hebrew Scripture and Old Testament) - see sexuality as a gift (they command you to marry and procreate) - sex-positive (within marriage - want people to procreate) - they think sex is an important part of maintaining a relationship and building intimacy *leans towards legalism but not very ascetic

Question 62

Why the Jewish Laws

Answer 62

- sex has social consequences - sex is linked to the discovery of STIs (they think monogamy prevents STIs) national and religious loyalty: - they think ppl having sex with other people or outside of marriage could threaten the Jewish population - didn't want to do anything the Caananites did bc it would threaten loyalty to Judaism - didn't want ppl committing adultery bc it would cause jealousy - said no nudity, cultic prostitution or other Caananite practices *laws were humane for their time - ancient law recognizes 6 genders

Question 63

Christianity

Answer 63

- Christianity developed from cults that were characterized as dualism (idea that body and spirit were opposed and the goal of life was to be purely spiritual) - stereotyped as sex-negative, but it's more complex - based on Old Testament, New Testament, and teachings of Jesus

Question 64

Teachings of Jesus

Answer 64

- said almost nothing about sex - more concerned with other sins like greed, lack of caring for others - compassionate toward sexual sinners

Question 65

Christian Rule of Monogamy

Answer 65

other major religions allowed polygamy - some ppl think it's restrictive, but it actually moves us toward gender equality before monogamy, there was patriarchal view that women were objects - men had wives and "collected" them like objects - more laws now that prevented men from divorcing women and leaving them with nothing

Question 66

Current Trends on Sex: Christianity

Answer 66

- sex is a temptation that we need to control - sex outside of marriage is bad - marriage and family is good - procreation for sex is okay

Question 67

Premarital Sex (Fornification)

Answer 67

- differences in Christian and Jewish beliefs on premarital sex - roman Catholic, orthodox jews, and conservative protestants think pre-marital sex is bad liberal protestants and reform jews think about premarital sex in situationalism context (in some situations, they're okay with premarital sex) - if someone is widowed, sex outside of marriage is okay - if sex improves their relationship, it's okay - think explotiation is the problem (if sex is being used to coerce someone, that's a problem) ***none of these religious or religious sub-groups favor casual sex

Question 68

Therapeutic Abortion vs. Elective Abortion

Answer 68

- some ppl think abortion is okay under certain circumstances ex: if the fetus isn't viable, if person is pregnant bc of rape or incest (therapeutic abortions) - many don't approve of elective abortions (ex: teen pregnancy from premarital sex)

Question 69

Moralism vs. Pluralism

Answer 69

Moralism = everyone should follow strict moral rules (similar to legalism) pluralism = recognizing and valuing diverse ethical perspectives in a culture, emphasizes freedom to decide ex: Roman Catholic Church is against all abortions and aligns with moralism - but not majority - people's views can change over time or become more complex

Question 70

Abortion Attitudes

Answer 70

Gallup Poll: - 1975 - 21% thought abortion should be legal under any circumstances - 2022 - 35% thought abortion should be legal under any circumstance *table shows that there is a strong belief that abortion should be legal

Question 71

Same-Gender Sexuality

Answer 71

- bible condems homosexuality depending on how you interpret it - usually, ppl reference the Sodom story to say that homosexuality is a sin (story is taught that God destroys the angels to prove that homosexuality is a sin) - but, others think God does this to condem rape, lack of hospitality instead of homosexuality *today, major religious institutions are re-evaluating belief of homosexuality - a lot of queer ppl say they don't want to be involved in religion bc a lot of ppl use religious texts to justify their homophobia

Question 72

Assisted Reproductive Technology (ART)

Answer 72

ex: artificial insemenation, IVF, embryo transplant, surrogacy - people are fighting over whether this is okay to do, if people have a right to procreate unnaturally, if you can pay someone to carry your baby - Roman Catholic Church doesn't allow ART

Question 73

Classical Greek Philosophy

Answer 73

socrates, plato, and aristotle thought abt ethics - nothing in greek culture says sex is evil or bad - the goddesses enjoyed having sex philosophers developed ascetic view (impulse control) and said people should seek wisdom - they said to be wise, you have to avoid sex (bc it's a pleasure)

Question 74

Humanism

Answer 74

many philosophers have tried to find a moral framework that isn't based in religion - humanistic ethics says that values can only be found in human experience - they think the goals are: avoid human pain, be self-aware, fulfill human needs - people have to make their own decisions and accept the responsibility of the consequences *they don't like the legalistic approach

Question 75

Islam

Answer 75

founded by Prophet Muhammed - the Kuran is their religious text - classical view of sexuality is positive - thought sex in marriage is very good for healthy relationship - disliked polygamy sex outside of marriage was a sin: - but men could have extramarital affairs - a woman should cheat on her husband is allowed to be killed - little ascetic tradition - male-dominated faith (women have few rights) - strong double standard - contraception is allowed - recognizies 4 genders

Question 76

Adultery and Contraception

Answer 76

adultery: in the Hebrew Bible, the penalty for adultery is to be stoned to death contraception: Jews and many Protestants approve of contraception - Roman Catholic Church only approves of the Rhythm Method

Question 77

Rejectionism

Answer 77

Assumed that Judeo-Christian tradition opposed sexual acts between people in the same gender - They interpret the Bible literally