Health Concerns for Gay Men
Let me first review various health concerns commonly found among gay men:
Although the overall rate of infection with gonorrhea is going down in many countries like the United States, the rate of gonorrhea has recently begun to rise specifically among American gay men. Between men, gonorrhea is transmitted primarily through unprotected anal intercourse and giving oral sex. Gonorrhea can be found in the penis, the rectum and the throat. The Rise in gonorrhea rates among gay men indicates an increase in high-risk sexual behavior. Because of the close link between infection with gonorrhea and HIV, the increase in gonorrhea rates may lead to a subsequent increase in HIV rates and other STDs as well, unless immediate public-health intervention takes place.
Genital and anal warts are caused by infection with the human papilloma virus (HPV). Genital warts on the penis are common in both heterosexual and gay men. However, anal warts in males tend to occur more frequently in gay men. Anal warts are primarily a result of unprotected anal intercourse and direct penis-to-rectum contact during sex.
Hepatitis A is transmitted through the oral-fecal route. Sexually, this infection is transmitted by oral-anal sex (rimming). Sexually transmitted hepatitis A tends to occur more commonly among gay men. Outbreaks of hepatitis A among gay men are a recurring problem in many large cities in Western nations. There is now a very effective vaccine to prevent infection with hepatitis A. Unfortunately, despite the higher rates of hepatitis A infection among gay men, most members of the gay community are unaware of this vaccine. Most gay men who are at risk for this infection have never been vaccinated, despite the availability of the vaccine. A strong effort needs to be made to increase hepatitis A vaccination rates among gay men.
In addition to the risks of hepatitis A, rimming may also pose a risk for certain bacterial and parasitic infections, due to potential exposure to feces while rimming is taking place.
Hepatitis B is transmitted the same way as HIV, but is much more infectious than HIV. Between men, the infection is most commonly transmitted through unprotected anal intercourse and giving oral sex. Some gay men have been infected through sharing drug needles as well. In Western nations, sexually transmitted hepatitis B tends to occur more commonly among gay men. There is now a very effective vaccine to prevent infection with hepatitis B. Unfortunately, despite the higher rates of hepatitis B infection among gay men, most members of the gay community are unaware of this vaccine. Most gay men who are at risk of this infection have never been vaccinated, despite the availability of the vaccine. A strong effort needs to be made to increase hepatitis B vaccination rates among gay men.
Worldwide, most of the people with HIV and AIDS are heterosexuals. But in North America, Western Europe and other developed nations, most cases continue to be transmitted sexually between men. In the United States, according to a recent report, most cases of recent HIV infection continue to be among gay men. This information also indicates that the rate of new HIV infections is relatively stable (it is not going down). We can therefore assume that the rate of infection among gay men is remaining relatively stable as well. Most cases of HIV transmission among gay men continue to occur through unprotected anal intercourse and, to a lesser extent, through giving oral sex (especially with ejaculation). Some gay men are also becoming infected through sharing drug needles. Based on all available data, the rate of HIV infection among gay men is not going down.
Gay men may be at increased risk for certain forms of cancer, and illnesses linked to cigarette smoking.
Some cancers are more commonly seen in persons with HIV infection. For example, Kaposi's sarcoma and certain types of lymphomas are more common in people with HIV. Since HIV is found in higher rates among gay men in Western nations, cancers associated with HIV infection are more common among gay men in these parts of the world.
Some strains of HPV -- the virus that causes genital and anal warts (see above) -- are linked to certain forms of cancer. When this virus causes cancer in men, it most often causes anal cancer. Anal HPV infection primarily occurs through unprotected anal intercourse, and direct penis-to-rectum contact during sex. Anal cancer occurs more frequently in men with damaged immune systems (including those with HIV). Smoking may increase the risk of cancer as well. HPV on the penis can also cause penile cancers, but this quite rare.
Gay men may also be at increased risk for liver cancer. As stated above, gay men are considered at increased risk for hepatitis B infection, which has been linked to liver cancer and other forms of liver disease (including cirrhosis of the liver).
In addition to anal and liver cancers, gay men may also be at increased risk for lung cancer and other cancers linked to cigarette smoking. It has been suggested that smoking rates among gay men may be higher than the general population. Of course, smoking also has many other health risks, including an increased risk for emphysema and heart disease.
Alcoholism and drug abuse
It has been suggested that alcohol use (and abuse) may be higher among gay men. This may, in part, be related to many gay men meeting in gay bars, where alcohol use is common. Alcoholism is itself a health-care problem since alcohol abuse can also lead to liver disease. In addition, alcohol use (and abuse) can also increase the risk for HIV and other STDs. While under the influence of alcohol, people tend to have sex more often, are less likely to use condoms or are less likely to use condoms correctly.
It has also been suggested that drug abuse may be a significant problem among gay men. Recreational drug use (and abuse) includes the use of poppers, cocaine, speed, crank, marijuana and other drugs. Like alcohol abuse, drug abuse leads to various health problems, including an increased risk for HIV and STDs, due to changes in judgment, while a person is under the influence of these drugs.
Gay bashing and gay domestic violence
These are often not viewed as health concerns, but they should be. Physical violence can lead to bodily harm, trauma, hospitalization, etc. Many gay "hate crimes" never get reported, due to the victims' fear of further discrimination, shame, intimidation by police and similar concerns. On a related matter, gay domestic violence can also lead to significant bodily harm, and is also very rarely reported, due to victims' fears of discrimination, intimidation by police, lack of services for male victims of domestic violence, etc. Due to the lack of reporting of these crimes, the rates of gay bashing and gay domestic violence are most likely much higher than statistics indicate.
Mental-health issues cannot be ignored. Many gay men suffer from depression and low self-esteem. Gay men live in a world where they are often told they are "bad." Some gay men are abandoned by their families. Discrimination against gays is all too common. The way that society often treats gay men can lower their self-esteem and lead to depression. For example, suicide rates among gay youth are higher than heterosexual youth. When a person has low self-esteem, they tend to value their life (and their health) less seriously. They are therefore less likely to protect themselves against HIV and other STDs, and other health problems.
I would now like to review some solutions to the health concerns discussed above.
Reducing the rate of STDs among gay men
A concerted effort needs to be made to reduce the rate of STDs among gay men. This can be accomplished in several ways:
- More effort needs to be made to increase condom use among gay men. Educational efforts need to be increased to teach men ways of having safer sex to reduce the risk of infection with STDs.
- Classes teaching about STDs, as well classes in HIV and STD prevention need to be developed specifically for the gay community. Many classes in HIV and other STDs are taught from a "straight" (heterosexual) perspective. Many gay man (and especially gay youth) cannot relate to a heterosexually oriented class. These classes are often taught in a way that gay men cannot understand. In addition, although there is a huge amount of information about HIV specifically for gay men, there is almost no information about other STDs geared specifically to gay men. A strong effort needs to be made to teach the gay community about HIV and other STDs in a way that gay men can related to. The levels of knowledge of HIV and other STDs is lower in the gay community than many people realize.
- A strong effort needs to be made to increase vaccination rates for hepatitis A and hepatitis B among gay men.
- Because sexual activity commonly occurs while under the influence of alcohol and other recreational drugs, a strong effort needs to be made to reduce the use (and abuse) of alcohol and other recreational drugs among gay men.
Reducing the rates of cancer in the gay community
This can be accomplished in a number of different ways:
- Since some cancers are associated with STDs (see above), the reduction of STD incidence rates can lead to a reduction in certain forms of cancer.
- A strong effort needs to be made to reduce the incidence of smoking in the gay community. A reduction in smoking rates can lead to a reduction in lung cancer, heart disease, emphysema and other smoking-related illnesses.
- Getting men immunized against hepatitis B can reduce the rate of liver cancer and other liver diseases (including cirrhosis of the liver) which are associated with hepatitis B infection.
Reducing the rate of alcoholism and drug abuse among gay men
This can be best accomplished by teaching gay men how to control their drinking habits before they become alcoholics. This means teaching gay men to stop drinking before they become drunk. In addition, local gay communities may want to establish programs for gay men to meet one another outside of a bar setting. Another solution is to get men with drinking problems into alcohol-treatment programs. Doing this will not only solve their drinking problems, but it will also reduce the risks of problems commonly associated with alcoholism (liver disease, increased STD risk, relationship problems, etc.).
On a related note, we need to take strong prevention efforts to prevent drug abuse with recreational drugs. One part of this solution is to get men who have drug problems into drug-treatment programs. Like treatment programs for alcoholism, drug treatment programs also reduce the risks of problems commonly associated with drug abuse (drug dependence, increased STD risk, relationship problems, etc.).
Reducing the rate of violence against gay men
This is a very difficult problem to solve, since this would involve changes in how our societies views gay men. Reduction of gay domestic violence is another issue that is very difficult to solve. However, we can teach gay men how to avoid getting into situations where violence against them is more likely to occur. And when a situation does occur (for example, having a lover who beats his boyfriend up), we need to teach gay men how to get out of that situation. This would also involve teaching local domestic-violence hotlines and law enforcement agencies about gay domestic violence and gay hate crimes, and how to handle those types of situations.
Reducing the rate of mental-health problems among gay men
This is another difficult problem to solve. A strong effort needs to be made to increase self-esteem in the gay community, especially in young gay men. Perhaps programs using gay role models can be developed to teach young gay men that their futures can be successful. In men who are suffering from depression, low self-esteem and similar issues, an effort must be made to get them into mental-health counseling, with counselors who are comfortable in dealing with gay issues.
The gay community cannot depend on the straight community to solve its problems. The gay community must depend on itself to solve these health issues. Gay problems are best solved by gay solutions. If the incidence of various health problems are to be reduced in the gay community, then it is up to the gay community itself to take action.
If you are a gay man, think about what you personally can do to make your community healthier. Work to keep yourself healthy. Get yourself vaccinated against hepatitis A and hepatitis B. Buy condoms, and learn to use them correctly. Reduce your use of alcohol and other drugs.
If you are a gay man, work to keep your community healthy as well. Teach gay youth the value of their health. Encourage them to be vaccinated against hepatitis A and hepatitis B. Encourage them to use condoms. Teach them to drink responsibly. Be a gay role model. Take pride in your community. The health of the gay community depends on you.
Finally, a good review of health concerns in the gay and lesbian community can be found in the following report which can be ordered from the online PubMed/Medline database: "Primary Care of Lesbian and gay Patients: Educating Ourselves and Our Students," by A. Harrison, from Family Medicine, Vol. 28, pages 10-23 (January 1996).
Do you want more information on AIDS, STDs or safer sex? Contact the U.S. Centers for Disease Control AIDS hotline, open 24 hours a day, seven days a week, at 1-800-CDC-INFO. Or visit The Body's Safe Sex and Prevention Forum.
Until next time . . . Work hard, play hard, play safe, stay sober!