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Health Concerns
for Gay Men and MSM
1.
HIV/AIDS
and Safer
Sex
That men who have sex with men are at an increased risk of HIV infection
is well known, but the effectiveness of safer sex in reducing the
rate of HIV infection is one of the gay community's great success
stories. However, the last few years have seen the return of many
unsafe sex practices. While HIV treatments have dramatically increased
life expectancies, there is no substitute for preventing infection.
Safer 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 safer sex 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 severe 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. At Brown, Psychological
Services can help with these problems.
4.
Hepatitis Immunization
Men who have sex with men are at an increased risk of sexually transmitted
infection with the viruses that cause 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. Safer 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.
STIs
Sexually transmitted infections (STIs) occur in sexually active
gay men at a high rate. This includes STIs 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 and others). There is absolutely no doubt
that safer sex reduces the risk of sexually transmitted diseases,
and prevention of these infections through safer 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. All college-age
men should conduct regular testicular
self-exams and be screened by a medical provider for
testicular cancer.
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 adversely affect health; however, alcohol-related
problems 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% 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 and in 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 heart disease. Our Nutrition
section includes information on healthy eating, sports nutrition,
eating concerns and campus resources.
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. Safer 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 be spread between
partners is very high.
Adapted from Vincent M. B. Silenzio, MD, MPH, Board of Directors,
GLMA
Co-Editor, Journal of the Gay and Lesbian Medical Association
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