Tag Archives: MSM

Mental Health’s Influence on HIV Prevention

The HIV epidemic has changed a lot within the past 20 years, and still yet, continued high risk behaviors have remained the same.  Contributing factors to these behaviors include a lack of power or oppression, marginalization, sexual abuse, sexual compulsivity, low self esteem, depression, and loneliness.  These are not issues that can be fixed quickly.  Addressing these issues requires effort and time and may extend beyond the capabilities of many HIV programs for prevention.

An important thing learned from HIV prevention research is one size doesn’t fit all. Programs require different components that address the various different needs of clients.  Increased access to syringes for people who inject drugs, and condoms to those who have sex are necessary to win the battle against HIV.  Skill building and increasing knowledge about HIV are good methods for prevention, but they don’t work for everyone.  For most, the obstacles related to behavior changes involves dealing with mental health problems.

What people experience and what they do have effects on their mental health. Substance abuse and use (even when the drugs are not abused), marginalization, poverty, and discrimination are all serious factors that can have a big impact on one’s mental health and can place some people at a higher risk for contracting an HIV infection.

Mental Health's Influence on HIV Prevention

Do Issues with Mental Health Affect HIV Risk?

Yes. When someone decides to engage in a risky drug or sexual act, it doesn’t always occur due a consciously made decision.  Instead, these decisions are sometimes based on an attempt to get satisfaction for another need related to a mental health condition. For example:

  • Low self-esteem: For many men who have sex with other men (MSM), internalized homophobia and low self-esteem can impact their risk of of contracting HIV.  Internalized homophobia is a feeling which results in a person having a lack of self-acceptance, feeling unhappy, or self-condemnation for being gay.  In one study, it showed that men who did test positive for HIV were the ones that were in fact the ones that experienced internalized homophobia.  These men seemed to spend less time with others who lived the same lifestyle, and they also showed less satisfaction in their relationships.
  • Male to female transgender persons, also known as MTFs, identify depression, rejection, feelings of isolation, and low self esteem as barriers to risk of HIV reduction.  Many MTFs state that they take part in unprotected sex because it verifies their identity and helps boost their self esteem.
  • Post traumatic stress disorder:  People who are diagnosed with PTSD seem to partake in high-risk sexual behaviors.  One study showed that 59% of the women who were HIV positive had full PTSD due to traumas, such as rape, assault, or witnessing a murder. Non-violent traumas including serious accidents, loss or children, or homelessness.  Still yet, these women were not being treated for PTSD.  A national study performed on veterans found that substance abusers who had PTSD were more than 12 times as likely to be HIV infected than those veterans who were not suffering from PTSD or substance abuse.
  • Depression and anxiety: Those suffering from depression and anxiety are more likely to take part in high- risk sexual activities, such as substance abuse, including injection drug use, prostitution and choosing a high-risk partner.  A study following city youths for over a several year time period found that the change in risk behaviors wasn’t associated with access to information, counseling or knowing someone had AIDS.

What can be done?

As you can clearly see, mental health conditions by far increase risky sexual behaviors.  In order to address mental health issues, it is important that a person visit an individual therapist or counselor, as well as a physician to be put on appropriate medication(s). It’s also important for such people to have access to structural and community level programs that address mental health needs and HIV.

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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%.

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.

 

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.

 

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.

2013 Report Finds Highest Recorded STI Rates

In the United States, STIs are at their highest level in almost two decades.

This is according to a newly released STI surveillance report conducted by the Centers for Disease Control and Prevention. But the rise did not affect all demographics equally. The population that saw the greatest rise is men who have sex with men. In fact, the CDC found higher rates of men who had syphilis, and those who had both syphilis and HIV.

The rates are from 2013, the latest year on record — but that year saw the highest recorded rate of infection since 1996. 2013 saw a 10% jump in syphilis rates mostly among the MSM community. No increase in infection rates were seen among women. The number of those suffering both syphilis and HIV infections combined grew an astounding 52%, mostly among MSM.

2013 Report Finds Highest Recorded STI Rates

Some lamented that the new report failed to include statistics among the transgendered community. Previous reports suggest HIV and STI infection rates are high among trans women.

Another concern the study raised was the increasing threat of antibiotic resistant gonorrhea, and complications driven by genital herpes and the human papilloma virus (HPV). Due to the dramatic increase in infections among the gay and bisexual male population, the CDC launched a new campaign called Start Talking. Stop HIV. It includes advice on how to address the issue of HIV and ways to start the conversation with one’s partner, no matter what kind of relationship they have.

All sexually active adults should be tested for STIs routinely, according to the CDC. That means annually for most. Those who are at higher risk should be tested every three to six months. This includes MSM, sex workers and intravenous drug users.

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!

FDA Considering Revision of Ban on Gay Blood Donations

Following the outbreak of the HIV/Aids epidemic the Food and Drug Administration, the Federal Agency who oversees the nation’s blood banks instituted a ban on blood donations from “Men who have sex with men,” or (MSM). For the first time since the ban’s institution, the FDA are set upon recommendation from the federal department of Health and Human Services to consider a revision to the ban.

As presently constituted, the ban places a “lifelong deferral,” on donations of blood from any men who have taken part in sexual activity with other men, as well as a one year deferral on women who have had relations with MSM. In explanation of the ban, as the FDA explains, “MSM are, as a group, at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion.”

FDA Considering Revision of Ban on Gay Blood Donations

The revised plan would call for a one year deferral in which the man wishing to donate must remain abstinent prior to donating.
The plan has drawn fire from LGBT health groups, pointing out that no such ban exists for any other group, including women who have sex with other women.

“While the proposed change from a lifetime ban to a 12-month deferral is a step forward, it does not go far enough,” explains Gay Men’s Health Crisis, a nonprofit organization scheduled to send a representative to speak in front of the FDA’s Blood-Products Advisory Committee, who will be taking up the possible revision.

“Do you require heterosexuals to be abstinent for one year, regardless of assessing their risk for HIV? This step forward still bans gay and bisexual men who routinely engage in low-risk behavior — men who would otherwise be eligible to donate if they happened to be heterosexual,” explained the group in an official statement, “For example, two legally married, HIV-negative, gay men who participate in low-risk behavior are still banned for life under this proposed policy, while a similar straight couple could still be eligible to donate.”

The FDA is expected to issue a statement on the matter before the end of 2014.

LA Urges CDC to Investigate: MSM at Higher Risk for Meningitis

Also known as Invasive Meningicoccal Disease (IMD), meningitis cases in the U.S. have been very low during the past decade. In those ten years, there have been two outbreaks among gay men; one in Chicago and the other in New York City. Between December 2013 and May of this year, 33 cases of IMD broke out in Los Angeles, 12 of which were reported to be gay men. In the majority of these cases, the men reported were HIV/AIDS positive.

Thankfully the issue isn’t going unnoticed! NYC’s Health Department began looking into three cases of meningitis that had developed in HIV-positive gay men over the last two weeks. Dr. Robert Bolan, the medical director of Los Angeles LGBT centers has written a letter, co-signed by officials with more than a dozen other leading HIV/AIDS organizations, asking the U.S. Centers for Disease Control and Prevention to investigate why the gay/bisexual male population is at a greater risk for IMD.  “We’ve got to learn why gay and bisexual men seem to be at greater risk of IMD, what correlation there may be to someone’s HIV status and what should be done about it, including potential updates to the CDC’s vaccine recommendations,” said Dr. Bolan.

LA Urges CDC to Investigate: MSM at Higher Risk for MeningitisEven though we are not sure why men who have sex with men are more likely to get IMD, we do have quite a bit of information on who is at greater risk. The bacteria typically associated with it (IMD) are spread through bodily fluids. That means sharing drinks, cigarettes, or joints with anyone infected are all potential ways to spread the disease. Kissing and most other sexual activities are also risky behaviors. Having HIV increases the possibility of contracting IMD on top of many other health issues.

Meningitis is a potentially life-threatening disease that modern medical science considers an immediate emergency. It affects the body by inflaming the protective membranes surrounding the spinal cord and brain known as meninges.

There are not currently enough cases to declare an outbreak, but as previously mentioned IMD can be fatal. This is reason enough for the patterned infection to be a major health concern. Symptoms of meningitis include fever, stiff neck, headaches, nausea, vomiting, and an outbreak of blotchy rashes. Dr. Bolan encourages all men who have sex with men from L.A. to get vaccinated, especially if they HIV. If you believe you have been exposed to IMD, seek immediate treatment and go to an emergency room. It can be treated, but the best treatment is prevention.

Ending the Silence and Beating HIV

Ending the Silence and Beating HIVSince 2002, the Journal of the American Medical Association reports the rate of HIV infection in men who have sex with men ages 24 and younger has increased 132. While there are more treatment options available than ever before, there still is no cure and prevention should take top priority. Many older gay men credit this rise of contraction to a lack of fear, something they faced head on during the height of the initial outbreak in the 80’s. Experts seem to argue otherwise, saying social consciousness and stigma are the root of the modern HIV epidemic.

AIDS activist and blogger Peter Staley points fingers at the social issues with infection. He has observed that many people are so afraid of testing positive, that they do not want to get tested. This not only increases the possibility of an undetected spread, but also adds weight to the shame contraction carries. Nobody wants to be the catalyst. “All of the negative guys are walking around thinking they don’t know any positive guys. The silence feeds the stigma which feeds more silence,” Staley said.

Other issues concern the technological advances society has made towards dating. With all of the websites available to meet people, it is very easy to meet new people and be sexually active. This extends far beyond the gay community, although they are at a hire risk of infection. While many of these sites ask users to display their STI status, there is nothing to guarantee they will truthfully display such information. Furthermore, many express on their profiles refusal to date anyone with HIV, giving those who have it less reason to speak up. Dr. Christian Ramers, assistant director for research and special populations at Family Health Centers of San Diego, notes “It’s kind of like an ignorance is bliss; they don’t really want to know. More than half of new infections are caused by people who are unaware of their status.”

The answers everyone seem to be discussing are to raise awareness, reform the cultural practices that spread HIV and lift the societal negativity from getting tested. Ramers feels MSM communities need to practice condom use more aggressively. The CDC revealed that those who used condoms 100% of the time were 70% less likely to catch HIV in 2013. Sadly, only 1 in every 16 men report using them with every sexual encounter. It is difficult to encourage them because most associate condoms with preventing pregnancy, not just STDs.

We live in a different time medically when compared to the first outbreak. Keep in mind, it is very possible to survive and lead a normal life for people who have HIV. With innovations like PrEP, which not only suppresses the disease but staves off infections, there are many way to ensure it is not an issue. The real reforms need to be made within gay culture. This gay-on-gay shaming that scares people away from  testing is the killer that needs to be stopped.