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Ten Things Gay Men Should
Discuss With Their Health Care Provider
Following are the health issues that the Gay
and Lesbian Medical Association (GLMA) healthcare providers have
identified as most commonly of concern for gay men. While not all of
these items apply to everyone, it's wise to be aware of these issues.
- HIV/AIDS
- Substance Use
- Depression/Anxiety
- Hepatitis
- STDs
- Cancers
- Alcohol
- Tobacco
- Fitness
- Anal Papilloma
1.
HIV/AIDS,
Safe Sex
It is well known that men who have sex with men are at an increased
risk of HIV infection, but the effectiveness of safe
sex in reducing the rate of HIV infection is one of the gay community's
greatest success stories. However, the last few years have seen the
return of many unsafe sex practices. While effective HIV
treatments may be on the horizon, there is no substitute for preventing
infection. Safe sex is proven to reduce the risk of receiving or transmitting
HIV. All health care professionals should be aware of how to counsel
and support maintenance of sexual practices.
2.
Substance Use
Gay men use substances at a higher rate than the general population,
and not just in larger communities such as New York, San Francisco,
and Los Angeles. These include a number of substances ranging from amyl
nitrate ("poppers"), to marijuana,
Ecstasy,
and amphetamines.
The long-term effects of many of these substances are unknown; however
current wisdom suggests potentially serious consequences as we age.
3.
Depression/Anxiety
Depression and anxiety appear to affect gay men at a higher rate than
in the general population. The likelihood of depression or anxiety may
be greater, and the problem may be more sever for those men who remain
in the closet or who do not have adequate social supports. Adolescents
and young adults may be at particularly high risk of suicide because
of these concerns. Culturally sensitive mental
health services targeted specifically at gay men may be more effective
in the prevention, early detection, and treatment of these conditions.
4.
Hepatitis Immunization
Men who have sex with men are at an increased risk of sexually transmitted
infection with the viruses that case the serious condition of the liver
known as hepatitis.
These infections can be potentially fatal, and can lead to very serious
long-term issues such as cirrhosis and liver cancer. Fortunately, immunizations
are available to prevent two of the three most serious viruses. Universal
immunization for Hepatitis A Virus and Hepatitis B Virus is recommended
for all men who have sex with men. Safe sex is effective at reducing
the risk of viral hepatitis, and is currently the only means of prevention
for the very serious Hepatitis C Virus.
5.
STDs
Sexually transmitted diseases (STDs) occur in sexually active gay men
at a high rate. This includes STD infections for which effective treatment
is available (syphilis,
gonorrhea,
chlamydia,
pubic
lice, and others),
and for which no cure is available (HIV,
Hepatitis
A, B, or C virus, Human
Papilloma Virus, etc.). There is absolutely no doubt that safe sex
reduces the risk of sexually transmitted diseases, and prevention
of these infections through safe sex is key.
6.
Prostate, Testicular, and Colon Cancer
Gay men may be at risk for death by prostate, testicular, or colon cancer.
Screening for these cancers occurs at different times across the life
cycle, and access to screening services may be negatively impacted because
of issues and challenges in receiving culturally sensitive care for
gay men. All gay men should undergo these screenings routinely as recommended
for the general population.
7.
Alcohol
Although more recent studies have improved our understanding of alcohol
use in the gay community, it is still thought that gay men have
higher rates of alcohol dependence and abuse than straight men. One
drink daily may not aversely affect health, however alcohol-related
illnesses can occur with low levels of consumption. Culturally sensitive
services targeted to gay men are important in successful prevention
and treatment programs.
8.
Tobacco
Recent studies seem to support the notion that gay men use
tobacco at much higher rates than straight men, reaching nearly
50 percent in several studies. Tobacco-related health problems include
lung disease and lung cancer, heart disease, high blood pressure, and
a whole host of other serious problems. All gay men should be screened
for and offered culturally sensitive prevention and cessation programs
for tobacco use.
9.
Fitness (Diet and Exercise)
Problems with body image are more common among gay men than their straight
counterparts, and gay men are much more likely to experience an eating
disorder such as bulimia or anorexia nervosa. While regular exercise
is very good for cardiovascular health an din other areas, too much
of a good thing can be harmful. The use of substances such as anabolic
steroids and certain supplements can adversely affect health. At the
opposite end of the spectrum, overweight and obesity are problems that
also affect a large subset of the gay community. This can cause a number
of health problems, including diabetes, high blood pressure, and hear
disease.
10.
Anal Papilloma
Of all the sexually transmitted infections gay men are at risk for,
human papilloma
virus - which cause anal and genital warts - is often thought to
be little more than an unsightly inconvenience. However, these infections
may play a role in the increased rates of anal cancers in gay men. Some
health professionals now recommend routine screening with anal Pap Smears,
similar to the test done for women to detect early cancers. Safe sex
should be emphasized. Treatments for HPV do exist, but recurrences of
the warts are very common, and the rate at which the infection can spread
between partners is very high.
Author: Vincent M. B. Silenzio, MD, MPH, former Member Board of Directors, GLMA and Former Co-Editor, Journal of the Gay and Lesbian Medical Association