Tag Archives: sexual health

Doctors Need to Initiate Communication with LGBTQ Patients

LGBTQ patients are faced with a variety of health obstacles.

Within the community are high rates of substance abuse and suicide. Men who have sex with men (MSM) make up the majority of new cases of HIV. In order to narrow and eventually close the health gaps between LGBTQ patients and those who are straight, doctors need to talk about sexual orientation and gender identity with their patients.

Dr. Harvey Makadon, director of the National LGBT Health Education Center at the Fenway Institute in Boston said that few physicians talk to patients about sexual behavior, desires and issues of identity.

It’s important for doctors to speak up about sexual orientation and gender identity with patients. It’s a huge part of one’s life and certain issues need to be addressed that affect both mental and physical health. Doctors are potentially missing some of the big issues. Those in the transgender community are of particular concern. Statistics in the community are unsettling. Transgender individuals suffer high rates of poverty, crime and STDs. Almost one-third of transgender women have HIV. According to Makadon, that’s a rate 49 percent higher than other adults of reproductive age.

Doctors Need to Initiate Communication with LGBTQ Patients

Physicians who are not afraid to treat transgender patients hold the key to preventing significant medical issues. It’s tricky because not all MSM identify as gay and some transgender people may have trouble defining gender clearly, particularly those who are younger and. It’s important for people to become comfortable and get to know LGBTQ people. It will allow individuals to feel at ease in seeking care.

Health issues may start early; children and teens struggle with sexuality. LGBTQ teens have a higher suicide rate than straight teens—two to three times higher, in fact. There are also issues with regard to lack of support systems, as many of them have faced parental rejection. This often leads to homelessness, which leads to risky behaviors that include drug and alcohol abuse and sex work. Transgender and gay minorities face rates of HIV infection that are even higher.

Makadon says, “Most people who I’ve had this discussion with say that the duty to care for everybody has to outweigh personal values. For people who continue to feel too conflicted, they probably shouldn’t continue to be in a caring profession. That may sound harsh, but I do think it’s a reality that if we do provide healthcare that we have to provide healthcare for everybody.

HIV Used to Fight Cancer

HIV and cancer are the most feared diseases on the planet.

But now researchers at the University of Pennsylvania are using one to fight the other. 125 patients with either non-Hodgkin’s lymphoma or chronic leukemia took part in this study, 36 of which were children. Two-thirds of participants had either gone through partial or full remission due to the experimental procedure.

Researchers at the university’s School of Medicine are reprogramming billions of cells in the body’s own immune cells to attack the cancer, a tactic which originated from studying HIV. The portion of the virus that allows it to pass into white blood cells is being used to fight cancer. What they are using isn’t HIV per se, but the genetic portion that gives the virus this ability. This method could replace bone marrow transplantation in some instances. This is the current treatment which is complex and can be dangerous.

HIV Used to Fight Cancer

The genetic material fashioned from the type HIV uses is inserted into the patient’s T-cell, an immune system cell known to fight pathogens. Certainly it isn’t the virus itself nor can patients develop HIV from the procedure. When the new cells are refurbished as cancer fighters, they are once again reintroduced into the body, where they can do mighty battle and crush cancer. These cells also reproduce spreading throughout the body and taking the fight right to cancer.

Dr. Doug Olson was diagnosed with Leukemia in 1996. He has undergone four treatments since. The cancer keeps resurfacing. By 2010, around half of all the bone marrow cancer in his body was infected with cancer. With few options left, he underwent this new treatment. Four weeks later, he was cancer free. Oncologists and others wonder if this sort of therapy can be adapted to fight other forms of cancer.

An HIV Cure is Still a Long Way Away

Though HIV treatment today is better than at any time in the past, challenges remain.

We have antiretroviral therapy (ART) today which can help HIV patients lead a normal life. But this requires lifelong care. What’s more ARTs are expensive and compliance with the drug remains an issue for many patients. Besides medications that can control the virus, the case of the “Berlin Man” or Timothy Brown encourages researchers. In 2007 Brown went for leukemia treatment. He received a transplant of hematopoietic stem cells. These are all the cells associated with blood. But the donor these cells came from had a rare genetic disorder, which proved to make Mr. Brown HIV resistant. To date there is no sign of HIV in Brown’s body. He no longer has to take antiretroviral drugs. Despite this, there are still many challenges in curing HIV.  In fact, the task is more complex than researchers first imagined.

An HIV Cure is Still a Long Way Away

Though scientists are able to halt the virus’s replication, it continues to be able to hide out in the body, in what are known as HIV reservoirs. It can attach its DNA to a cell’s genome, and continue on in long living cells, such as CD4+T cells found within the immune system. One recent study suggests that the HIV virus can be kicked out of their hiding places and neutralized. Another study found a way to snip HIV’s DNA out of a cell’s genome.

A recent John Hopkins University study found that these latent reservoirs are 60 times more prevalent than previously thought.  ARTs are not only a method of controlling the virus but also preventing it. Many health experts say ARTs should be more widespread to prevent the virus, particularly amongst at-risk populations. Now that researchers understand the challenges they face more clearing in locating HIV reservoirs, extracting the virus and it’s DNA, they can now develop better methods and someday a cure.

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.

“Biphobia” Is a Common Problem

Most people are familiar with the word “homophobia”.  There are many terrible, damaging myths and stereotypes out there that remind us far too much about how common it is to hate and be ignorant. There is another form of phobia that is less spoken about and it’s fairly safe to say that many have never heard of it: It’s called “biphobia” and it comes from all parts of the human sexuality spectrum.

Not everyone who is biphobic is homophobic.  There are those who believe bisexuals must be either straight or gay.  It’s an unfair judgment that’s not only invalidating, but is effectively saying that those identifying as bisexual are dishonest people.  It causes them to be unjustly assessed–as if their supposed ‘lies’ stretch to other areas of their lives.  Examples of biphobic statements are:

  • Bisexuals are confused.
  • Bisexuals just want to have threesomes/kinky sex.
  • Bisexuality is a phase.
  • Bisexual women just want to get men “hot and bothered’.

Many bisexuals stay ‘in the closet’ due to attitudes from the LGBT community and heterosexuals.  They might try to pass as either gay or straight.  Sadly, bisexuals are viewed as gay or lesbian when they’re with a same-sex partner and heterosexual when they have an opposite-sex partner.  The attitude that bisexuality doesn’t exist is a dangerous one to hold.

Bisexuality is not an undecided sexuality or a phase.  It’s not about being confused.  If anything, it’s biphobia that’s making things complicated.  Even if you’re not bisexual, take it upon yourself to help stop these myths. When you hear someone engaging in biphobic behavior, stop them and let them know the truth.  It’s best to be calm while doing this, of course…the message will be received more openly and taken more seriously that way.

If a loved one comes out to you, treat it seriously and with compassion.  Don’t treat them as if they’re suddenly all about sex or they’re just experimenting. It took a lot of courage for them to come out.  A little education and compassion goes a long way!

LGBT Youth and Sexual Health

The CDC defines sexual health as “…a state of physical, emotional, mental and social well-being in relation to sexuality.”

Research shows that people who identify as LGBT tend to report lower satisfaction rates in regards to sexual health. In large part this is due to a lack of discussion about LGBT relationships and sexuality. While many people get such information on dating, relationships, and sexuality during their developmental years from parents, teachers, and other community establishments, LGBT youth generally get their information online. This can be a great resource, but it can also be full of misleading or inaccurate information.

It is important for LGBT youth to have access to sexual health resources. A significant factor in establishing sexual health is for both partners to feel safe and satisfied in their relations. Exploring questions pertaining to sexuality and safe practices with adults will help develop self-confidence and eliminate some fears.

LGBT Youth and Sexual Health

Unfortunately, research continues to show that Lesbian, Gay, and Bisexual youth are at an increased risk for being victims of violence, bullying, and suicidal thoughts. It is understandable then that youth who live under constant fear and harassment also encounter greater difficulty in maintaining sexual health within their personal relationships.

In addition to discussing such issues individually, communities can support youth by facilitating open discussions and youth organizations. Creating a safe place for youth to explore questions, raise concerns, and meet with people who share similar thoughts and feelings can go a long way in supporting LGBT sexual health well into adulthood.

Needless to say, having open and honest conversations about sexuality within the LGBT community is instrumental to achieving sexual health. The first step in achieving sexual health is to discuss concerns with a healthcare practitioner. Research also shows that people LGBT youth and adults visit healthcare practitioners less frequently – reach out to a professional today and make an appointment.

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!

Drug Therapy Soon After Contracting HIV Improves Outcomes

 

A new study shows that U.S. service members and beneficiaries who acquired HIV and were treated with antiretroviral therapy (ART) soon after contraction were 50% less likely to develop AIDS. They also had a better chance at a resurgence of CD4+T-cells, the immune system’s defense against pathogens. The results of this study were published in JAMA Internal Medicine.

Researchers also found an increased ability for the immune system to respond to pathogens, and reduced T-cell activation in those who quickly received ART. These factors can significantly influence the course of HIV.

800 CD4+T-cells per cubic millimeter was defined as a normal count in a 2013 New England Journal of Medicine report. Healthcare providers often wait until an infected person possesses a T-cell count of 500 cells per cubic millimeter before beginning therapy. But this research suggests beginning ART immediately gives the best outcomes. Health data regarding the treatment and outcomes for 1,100 service members and beneficiaries from all branches of the armed forces were utilized for this study.

Drug Therapy Soon After Contracting HIV Improves Outcomes

This was a collaborative study which included researchers at the Veterans Affairs Research Center for AIDS and HIV-1 Infection, the VA Center for Personalized Medicine at the South Texas Veterans Health Care System, and The University of Texas Health Science Center at San Antonio. Professor of medicine, microbiology/immunology, and biochemistry at the UT Health Science Center, Sunil K. Ahuja, M.D., was the lead author in this study. He said:

“The immune system can be reconstituted most effectively and durably if ART is initiated quickly after infection…While the practice has been to generally defer ART till CD4+ counts decline to less than 500 cells per cubic millimeter, our results suggest that any delay in ART even in people maintaining higher levels of CD4+ counts impairs their ability to subsequently normalize CD4+ T-cell counts.”

Those who began ART within 12 months of infection had the best outcomes. Testing for sexually active adults should occur at least once per lifetime. Those who are single should be tested once per year. Anyone in a high risk group should get tested once every three months. These are men who have sex with men, intravenous drug users, transsexuals, and sex workers. The faster treatment is administered, the better the chance of living a normal life.

HIV and AIDS among Youth and Young Adults

Youth and young adults between the ages of 13 and 24 in the United States are among the highest risk groups of being infected with HIV. The CDC reports that the greatest number of new HIV infections within this age group are among gay and bisexual males, with African-American and Latino males who have sex with other men being at even greater risk.

Why is this population increasingly at risk? There are a myriad of reasons, including a lack of sexual education and information promoting abstinence and delaying initial sexual encounters. These groups are also among the highest populations suffering from substance abuse, homelessness, and sexually transmitted infections.

HIV and AIDS among Youth and Young AdultsLooking at global numbers, a young person becomes HIV-positive every 30 seconds. Studies have shown that the majority of youth and young adults in the U.S. are not afraid of contracting HIV, which equates to low testing rates and low rates of condom use. While there are an increasing number of HIV and AIDS awareness promotion programs, youth advocacy, and health counseling, the data translates to a dire need for greater outreach efforts.

The best way to prevent infection with HIV is abstinence. Secondly, reducing the number of sexual partners, avoiding unprotected sexual encounters, and being tested regularly are the most important steps you can take to prevent infection or spreading the virus. More than half of the percentage of youth infected with HIV/AIDS were not aware that they had the virus.

While many young adults are not concerned with contracting HIV, a large number are still in denial of the increasing risk of contracting and spreading the virus. Even if you think you are not at risk, it is recommended that you get tested regularly. Speak to a professional today, there are a number free test sites available as well as youth programs and counseling services .

Is “Undetectable” Becoming a Thing?

The results of the partner study known as HTPN 052 really have people talking. Although further research must be conducted, the study shows the use of Antiviral Treatments/Therapy (like PrEP) can successfully reduce the spread of the HIV by at least 96%. Not one case of the virus has been reportedly transmitted by people receiving treatment with an undetectable viral load.

This brings an interesting questions regarding sexuality: is an undetectable status as safe as uninfected, or will this study bring false hope that essentially causes an outbreak of the virus?

The answer to both of these questions is complicated. Again, not one case where a partner had an undetectable viral load has shown to spread HIV, but the research is still young. The Partner study comes with a number of warnings, emphasizing what it has really found about undetectable viral loads. Regardless of infection status, researchers still recommend using protection.

Is "Undetectable" Becoming a Thing?The bottom line is the safest way to have sex is to take as many precautions as possible. “The most common response I get from disbelievers is that positive men use ‘undetectable’ as a way of getting people to sleep with them without a condom. Positive men don’t want to transmit the virus to someone who is negative just as much as a negative person doesn’t want to become positive,” says Tyler Curry, editor for the new group HIV Equal.

What we need to remember is that condom-less sex occurs regularly with men who have sex with men outside of marriage. This proves what many experts have been saying for some time: new infections usually spread from people that are unaware, undiagnosed and are not receiving treatment. This goes beyond sexual preference, being true for both hetero and homosexual individuals.

The more time spent on this study, the more conclusive the results will be. Scientists claim that with current research, they won’t be able to finalize until roughly 2017. Still, the facts the study presents are still facts; the maximum possible risk of transmission thus far for same-sex couples is 4%, with the risk being greater for the receptive partner and when ejaculation occurs. These numbers may not make a difference to skeptics, but the hope it breeds for people who have put themselves in risky situations is remarkable.

Curry notes that it all boils down to trust, awareness and communication between partners. Couples that discuss their status are more likely to take preventative measures and stop the spread. The same can also be said of those who get tested; they know their status, so it is easier for them to take action. PrEP is improving the quality of life for those infected, allowing them normal sex lives and relieving many of the stresses associated with HIV.

Undetectable or not the world is becoming a better place, we just need to do our part to get it there. “As far as dating goes, I don’t need to convince someone else that they are safe to date me because I am undetectable,” says Curry. “I give them the facts and they either accept them or they do not. Either way, I know what it means to be undetectable and I know that I am safe from ever transmitting the virus so long as I stay compliant.”