Category Archives: MSM

Gay Men “Serosort” to Prevent Contracting HIV

One study in Seattle showed that approximately 40 % of men who are HIV negative make sure to only have sex with others who share their serostatus in order to attempt to prevent contracting the virus. A similar German study found that 10 percent of HIV positive gay men believe they are noninfectious if they have a viral load that is undetectable. Both studies’s results were presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

In Seattle, two different questionnaires that included 1902 gay men accessing an HIV/ STI clinic between February and August of 2013,  were conducted by researchers.  The first one asked questions about their recent sexual behavior.  For example, the HIV status of their partners, what role they played during sex, whether they use condoms, and other topics were brought up. The second questionnaire asked about what they did to reduce their risk of HIV.

Both questionnaires were completed by a total of 964 people, including 835 (87%) who were HIV negative and 129 (13%) who were HIV positive. Forty-two percent of HIV negative men were strict serosorters; they reported to only have sex with other HIV negative men (with or without a condom). Thirty-nine percent of these men said this was a deliberate strategy. A total of 6.5% practiced condom serosorting, which means they only  reported  having sex without a condom with other HIV negative men. 5.2% said this was deliberate. Lastly, 7.1 % were seropositioning, which means they only had condomless sex if they were the top, no matter their partner’s HIV status; 6.5% said this was a strategy.

Gay Men "Serosort" to Prevent Contracting HIV

Thirty-two percent of HIV positive men were strict serosorters, 25% of them doing this deliberately. Eleven percent engaged in condom serosorting and 10% in seropositioning.

In the German study presented at CROI, researchers asked 269 gay men who were HIV positive about whether they thought they could infect somebody if they had a viral load that was undetectable.  Ten percent of this group thought they were noninfectious, with a fully suppressed virus and they held this belief when making choices about sex.  Of these viral sorters, 57.5 %  reported condomless sex,  compared with 36% of men who were not viral sorters. Nineteen percent of the viral sorters said that recently they told someone about their status, while 22 % had not discussed HIV recently at all.  On these two counts, the respective figures for the rest of the men were 42% and 44%.

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MSM Remain Most Affected by HIV

The Center for Disease Control and Prevention (CDC) has confirmed through new research that gay and bisexual men are still the most affected by HIV, as the rate of infection has gone up in the past few years.

Two studies were presented by the CDC at the annual Conference on Retroviruses and Opportunistic Infections (CROI). The studies dealt with HIV and its impact on men who have sex with men (MSM) and the impact on groups within the MSM community.

According to the CDC, each year MSM account for two thirds of newly diagnosed cases of HIV. Despite the fact that overall, the number of HIV diagnoses went down between 2003 and 2012, certain areas of the US saw an increase in numbers, particularly in the MSM population, between 2008 and 2012. Data analyzed by the CDC from the National HIV Surveillance System (NHSS) shows that these Metropolitan Statistical Areas (MSA) are usually cities with populations over 500,000, such as New York, Washington D.C., Miami and Dallas.

The overall rate of HIV diagnoses decreased on an average of 3.7 percent, out of the 105 MSAs that were analyzed. There was a notable decrease in nearly two-thirds of MSAs. But, the HIV rate among MSM in these MSAs increased by over 10 percent, between 2003 and 2007. The rate evened out and decreased between 2008 and 2012, yet the rate was less than that of the national average. Between 2008 and 2012, HIV rates for MSM only declined 2.2 percent.

MSM Remain Most Affected by HIV

During that last four year period, MSM between 13-24 had an HIV diagnosis rate increase by 15 percent, while older generations saw unchanged rates.

A separate study looked at more than just age as a separate factor–it included an examination of the correlation between MSM, their ethnicity, and diagnosis rate. Results showed that African American men were diagnosed at a higher rate than others. There is an overwhelming disparity between both HIV infection rate and awareness between white and African American MSM.

Despite the fact that African American MSM did not report a higher rate of sex without a condom, it was shown that they were less aware of their infections and those under 40 were “significantly more likely to be HIV-positive compared to all other racial/ethnic groups”.

It’s obvious that this data from the CDC shows where HIV prevention needs to focus: younger MSM, particularly African American MSM. This is a day and age where sexual health information is incredibly accessible, especially with Internet resources available.

Condoms are the number one way to prevent HIV transmission during sex. Plus, now that Pre-exposure prophylaxis (PrEP)/Truvada is available from many health plans, it’s important to speak with a doctor about your possibilities. It’s also vital to be tested for your status regularly. If you do test positive, you’ll want to take medication as soon as possible to make the best quality of life with HIV that is possible.

 

Common Anxieties New Intergenerational Gay Couples Experience

Intergenerational couples face anxieties related to their age differences and prejudices from the outside that can make it exceptionally difficult for their relationships to grow. By taking the obvious anxieties (sometimes they’re not apparent to either partner) and tackling them head on, differences can be deemed worthy of addressing or irreconcilable. Read on to learn of some of the top anxieties some gay intergenerational couples face.

Perception
When intergenerational couples are first beginning their relationship, they’re often concerned about the perception of others. A lot of anxieties for the couple dictate their approach to the relationship. Significant negative impacts may result from outside societal pressure.

Opportunism
Both partners in a relationship may suspect that they’re being taken advantage of in some way. For example, does the younger one in the relationship just use the older partner for their money? Or, is the older partner using the younger partner for sex, or as “arm candy”? It’s important to have this discussion with your partner before assuming opportunism is the case because it can be very hurtful if that assumption is incorrect. Of course, if it’s true, it’s a legitimate reason to call it quits.

Common Anxieties New Intergenerational Gay Couples Experience

Sexual performance
This is more often an anxiety experienced by the older partner.  As men age, their sexual function often decreases and they focus on those problems. They might have concerns with performance and how their younger partner will judge them. It’s also the case that the younger man might fear they’re not experienced enough for their older partner.

Autonomy
This is more of a problem for the younger partner in a relationship. The older partner is quite often more established financially and professionally. And, they have usually been out of the closet for a longer period of time; more secure with their sexuality. At the same time, the older partner may fear that they’re holding back their younger partner when it comes to to their development and sexual experiences.

Rejection
This happens in many relationships that are new– the fear of rejection. All of the anxieties we have feed into this fear. Is the younger man experienced or educated as much as the older man? On the other hand,  is the older man fit enough, with sufficient energy to keep up with his younger partner?  If there’s any concern, these are important questions to explore with your partner; they can be confronted and dealt with…and the relationship can flourish.

LGBT Youth Experience More Cyber Bullying

LGBT youth face significant difficulties with discrimination, harassment and lack of family support.

It also happens that they face more harassment online–a place where many youth go to feel as if they’re more part of a community, receive support, medical information, and other opportunities . One study by the Gay, Lesbian and Straight Education Network (GLSEN) found that LGBT youth faced cyber bullying three times more than non-LGBT youth. The study points out that those living in more rural areas experience even higher levels of harassment online and shows that 42 percent of LGBT youth face a higher level of online bullying, compared to 15 percent of those who are straight/cisgender. Part of the study resulted in findings that show LGBT youth were twice as likely to report bullying through text messages.

This study, called “Out Online: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth on the Internet”, included results from a national survey which included 5,680 middle and high school students, grades 6-12. It was found that lower grade point average and self-esteem, and a higher chance of depression were linked to youth affected by bullying.

LGBT Youth Experience More Cyber Bullying

Dr. Eliza Byard, GLSEN’s Executive Director said, “LGBT youth continue to face extraordinary obstacles in their day-to-day lives whether at school or online, but the Internet can be a valuable source of information and support when they have no one or nowhere else left to turn to. As social media evolve, so must our efforts to serve LGBT youth to ensure their safety, health and well-being.”

It is important for LGBT youth to have access to resources available on the Internet that they either would not be able to find elsewhere, or that they don’t feel comfortable seeking offline.  For example, this study shows that LGBT youth (particularly those who are transgender) are twice as likely to look up medical information online than their straight/cisgender peers. It is vital that LGBT youth know they have a safe place to be themselves online, especially if they don’t feel that support elsewhere.

LGBT Health Disparities and Cancer

We don’t know a sufficient amount about cancer in the LGBT population.

There are specific prevention and treatment programs that have been designed for groups based on statistics. Such data comes from certain geographic, racial and ethnic groups. Lesbian, gay, bisexual and transgender people need to know exactly how prevalent cancer is among their groups because they currently don’t.

Even without official data, it’s pretty safe to say that LGBT people are disproportionately affected by cancer. There is plenty of research to confirm LGBT people have a specific “cluster of risk factors” that would give them greater incidence of cancer and diagnosis in a later stage. It is estimated that there are currently over 1 million LGBT cancer survivors in the US. This disproportionate amount of risk factors and burden of disease is referred to as “health disparities”.

Although there aren’t any biological or physiological differences between heterosexual and LGBT people, disparities exist due to a combination of economic and social factors and behaviors. These can frequently be linked to the stresses that come with living as a gender and/or sexual minority in the US.

LGBT Health Disparities and Cancer

One study of health disparities of lesbian, gay, and bisexual women found that bisexual women and lesbians were more likely than heterosexual women to:

  • Generally be in worse physical and mental health
  • Have asthma
  • Have diabetes
  • Be overweight
  • Smoke
  • Consume too much alcohol

This study showed that these women were at a higher risk for breast cancer and other cancers associated with alcohol abuse, obesity and smoking.

Health disparities in the LGBT community are not limited to cancer incidences. The quality of life for cancer survivors in the LGBT population is profoundly different from heterosexuals with regard to sexuality, relationships in general, and interactions with medical professionals. For example, gay and heterosexual men are affected much differently when it comes to changes in sexual function due to prostate cancer treatment. Unfortunately, few health care professionals will bother asking gay men about their sex lives or even know how to respond if the patient inquires about the issue. It is important that those in the LGBT community receive competent, compassionate medical treatment, with unique problems considered and addressed.

Study Shows Truvada Cuts HIV Spread 86%

A recent UK trial shows that a pill taken by men who have sex with men (MSM) on a daily basis, can protect them from HIV infection. Experts are saying that the drug called “Truvada” offers hope that the spread of HIV will be reversed. Truvada can be taken daily, as a regular part of the routine for MSM. The National Health Service (NHS) will be looking at the results to consider whether it is cost effective for men who risk infection.

Truvada was approved in the FDA in the US in 2012 and is available through Medicaid and many private health insurance plans. It was the first pill approved by the FDA to be taken daily to help prevent HIV and is already used extensively here in the US.

Proud (Pre-exposure Option for reducing HIV in the UK: immediate or Deferred (the  name of the study) shows that Truvada decreased infections in MSM by 86 percent. Experts in the study were thrilled, particularly because the study was conducted in “real world” circumstances. The participants were allowed to take (or not take) the pills as they wished. Proud has entered the scene following a line of other trials, with a greater rate of success than all of them.

Study Shows Truvada Cuts HIV Spread 86%

The 545 men involved in the trial were deemed to be at a high risk for HIV through sexual health clinics; the median of partners the men had was 10 within the past 90 days. Fifty percent of the men were given Truvada immediately, while the other half received the drug after one year. Three HIV infections occurred among the men who were given the drug immediately and 19 among the men who didn’t receive the drug.

These results are very encouraging. Richard Gilson, principal investigator for the Proud study thinks the drug “appeared to be an important and practical solution” for high risk men who were willing to take it on a regular basis. He believes the next step should be cost-benefit analysis from the trial. Gilson said, “I shall be surprised if it is not cost-effective at the usual threshold they apply, at least for individuals with this high-risk profile.”

This important study proves that pre-exposure prophylaxis (PrEP) can prevent HIV infection and has been tested in real life circumstances. It is a significant form of defense against HIV.

 

 

http://www.theguardian.com/society/2015/feb/24/daily-pill-truvada-cuts-spread-of-hiv-by-86-study-shows

Understanding Anal Cancer Screenings

It is a rare disease, but anal cancer does exist and deserves our attention.

The cases of anal cancer are a lot more prevalent in gay and bisexual men or, “men who have sex with men” (MSM).  Unfortunately, most MSM’s have not been tested or know that any screenings are out there, and do not know much, if anything about anal cancer. Medical professionals are actually divided on whether they should even screen for it and how they would do so. Currently, there isn’t any standardized protocol for anal cancer screening.

Facts about anal cancer:

  • Anal cancer is diagnosed in approximately two out of every 100,000 people in the general population every year.
  • MSMs who are HIV negative are 20 times more likely to receive an anal cancer diagnosis (about 40 per 100,000 people)
  • MSMs who are HIV positive are up to 40 times more likely to receive this diagnosis (about 80 per 100,000 people)
  • The same strains of Human Papillomavirus (HPV) that cause cervical cancer in women also cause anal cancer
  • In MSMs, HPV is transmitted through both protected and unprotected anal intercourse and skin-to-skin contact. HPV is very common– approximately 75 percent of all sexually active adults acquire HPV; not all HPV infections lead to cancer.

Understanding Anal Cancer Screenings

A number of men don’t have any apparent symptoms of HPV, but possible symptoms include:

  • Genital warts affecting the anus, penis and/or peritoneum
  • Abnormal discharge from the anus
  • Bleeding from the anus and rectum
  • Itching of the anus; pain or pressure around the anus
  • A sore or sores that do not heal, around the anus

Since the cervix and anus are similar, biologically, and both are target areas for HPV infection, a pap smear can be used test the anus for pre-cancerous cell changes and cancer.  More and more health activists and gay physicians believe this procedure could reduce the incidence of anal cancer as significantly as it has with cervical cancer in women.

It is recommended by them that all MSMs, especially those who are HIV positive, receive testing every 1 to 3 years, depending on their CD4 count and immunology wellbeing.  Their recommendation for HIV negative MSMs is for testing every 3 years.  Other physicians don’t believe all MSMs need to be tested due to the small number of cases, facility shortages for follow-up procedures, and the cost, pain and fear of looking at small changes in cells (dysplasia). In addition, the number of insurance policies that would cover pap smears for the anus is low.

Even though the AIDS Institute of New York recommends that HIV positive gay men “and others with history of HPV disease” be tested annually, there appears to be little agreement about the importance and practicality of offering all MSM clients this testing.

 

Ethical Implementation of PrEP for MSM is Vital

The World Health Organization (WHO) recently recommended pre-exposure prophylaxis for men who have sex with men (MSM).  This is a monumental step towards eliminating the HIV epidemic.  Certain ethical matters must be addressed to ensure the best execution of this recommendation, such as confidentiality, privacy and stigma.  Of course, anything that would aid in eradicating HIV is extremely important, but so far discussions regarding the possible barriers, ethically and where implementation is concerned, have not been properly addressed.

The resolute recommendation: “among men who have sex with men, pre-exposure prophylaxis (PrEP) is recommended as an additional HIV prevention choice.”, goes further than a conditional recommendation in 2012 which looked at  serodiscordant relations.  The new recommendation acknowledges potential obstacles to implementation and tries to take the proven benefits of PrEP into consideration for balance.  This is of vital importance for a population that is at high risk for HIV infection.

Ethical Implementation of PrEP for MSM is Vital

Stigma towards the MSM population and those with HIV is not new.  But, the PrEP debate has served to intensify the discussion as emtricitabine/tenofovir disoproxil fumarate (Truvada) serves as a catalyst for the talk surrounding stigma within the community affected by the recommendation,  as well as the public health and medical communities.  For example, the term “Truvada whore” has been coined by some individuals in the MSM community, which assumes that those using PrEP want to do so in order to participate in risky sex.  This is unfortunate and misinformed stigma.  Those who choose to use PrEP are making a responsible and personal decision about their health.  Following a similar line of illogic, it would be just as rational to assume that someone using a birth control pill was doing so in order to engage in high-risk sex.

It is crucial for health care providers to make a commitment to put a stop to stigma surrounding HIV care and put an end to HIV exceptionalism.  It is also of critical importance that we refrain from generalizing the MSM population as being a high-risk community, instead focusing on the individual.  There are many limitations to implementing the WHO recommendation  to consider and steps to be taken which include:

  • The development (or continuation) of tools to prevent HIV in MSM who are unaware of exposure risks (and who haven’t disclosed their sexual practices to their doctor)
  • Significant concerns related to confidentiality in the MSM and/or HIV positive populations.
  • Medical professionals providing PrEP need to be mindful of the surroundings in the exam rooms to ensure the strictest confidentiality.
  • Office staff should be keenly knowledgeable of Health Insurance Portability and Accountability Act (HIPAA) considerations when discussing information on the phone and otherwise.
  • Doctors need to obtain permission to discuss health matters in front of family and/or partners.

PrEP, as a concept, has been around for decades, but it has taken over a decade to generate clinical evidence to support the use of a particular regimen for an at risk population, and years to disseminate when determined.

HPV Vaccine and Benefits for the LGBT Community

While recent advertising campaigns have educated women all over the world of the risks of the the Human Papillomavirus virus (HPV) and the benefits of the now available vaccines, recent studies have found a distinct lack of awareness among the LGBT community, and of the risks that HPV presents to those with in the LGBT community.

What is commonly known is that HPV is the leading cause of cervical cancer in women. However HPV can also cause an genital (anal) cancer, for which LGBT men are at the greatest risk. Genital HPV is transmitted through skin to skin contact, the likelihood of transition is greater in the presence of irritated skin often present as a result of penetrative sex. Studies have consistently found that only 25% of men who have sex with men are familiar with HPV or the benefits of the HPV vaccination.

HPV Vaccine and Benefits for the LGBT Community

There are more than 60 forms of HPV, many of which are transferred by sex, and primarily infect the genitals frequently causing genital warts, and less frequently causing cervical, or anal cancers.

HPV is viewed as the most common sexually transmitted disease, at any time between 20 to 40 million persons are infected with the virus, and infections have been on a rise over the past decade. In adition, those infected with HIV are at a greater chance of complications from forms of HPV.

There exist two forms of vaccination against the forms of HPV which can lead to cancer—Cervarix and Gardasil. The United States approved Gardasil for use in men in 2010, and is particularly advised for LGBT men.

Gay Men’s Health & Healthcare Providers

Have you ever had a healthcare provider who didn’t understand you?

Maybe you just didn’t feel comfortable with him, or maybe she was outright rude. Either way, having an open relationship with your physician is extremely important. Aside from the fact that you don’t want to work with someone looking down their nose at you, being able to raise concerns and discuss health issues openly and honestly is a major contributor to your long-term health.

As a gay man, there are a couple of issues that are particularly important to discuss with your healthcare provider.

Gay Men's Health & Healthcare Providers

#1 HIV/AIDS

Men who have sex with men are at disproportionately high risk for contracting HIV, in addition to other sexually transmitted infections. Many infections may not initially show symptoms so following up regularly for check-ups and discussing your sexual practices with your physician may end up making all the difference in the long run. Many healthcare providers are also able to provide you with other resources and referrals – when it comes to your doctor, it’s always good to talk!

#2 HPV

The serious effects of HPV have only recently hit the forefront of health news. HPV has many strains, but it is mostly known for being the virus that causes genital warts. Genital warts are generally easy to treat, your healthcare provider can prescribe a removal cream, or, if needed, laser treatment. The concern with HPV isn’t the genital warts as much as it is cancer. Unfortunately, there aren’t many other symptoms of HPV to warn you, but the virus is now being linked to increased levels of anal and oral cancer. Oral sex can transmit HPV to the mouth and throat, causing problems in the long run. The virus is also transmitted through anal sex, possibly causing anal cancer. While this is difficult to test in men, keep up to date with your check ups.

If you are a sexually active man, find a healthcare provider that you are comfortable with and check in regularly. Reach out to a professional today!