Peter, what's the scoop on anal cancer?

[Peter Pointers is here 4 YOU, as a service to LifeLube readers - whatever question you may have regarding sexual health, physical health, mental/emotional and spiritual health - ask him. He will find the answers you are looking 4. Below is a recent Q&A you may be interested to read.]

Question: I was concerned, after seeing and hearing about Farrah Fawcett , and reading about the christian right against gay marriage due in part that gay men average life span is shorter than a hetero one, and seeing that anal cancer is 17 times higher in gay men than straight, whats the scoop. Been in monogamous relationship most of my life and been a bottom. just really scared about these facts.

Answer: Thank you for your question. I am always pleased to hear from people who are actively involved in educating themselves about their health. Being health-minded and proactive about maintaining our well-being is something the gay and bisexual community actually does very well.

Definitely, some of the information we come across in mainstream media can be a little scary; especially when the focus is on how sick one population is compared to another. You may be surprised to hear that this type of reporting gives a misperception as to the truth of the matter. Often times in reporting on health issues, there is a focus on negatives or “health disparities.” Read more about why that isn’t always the best viewpoint (especially when discussing gay health) here.

In regards to the “christian right” evidence for shorter gay men’s lifespans, you can read more about that research from a different perspective here.

Now, to the meat of your question: anal cancer and gay men. In gathering information about this topic, I spoke with Dr. Ross Cranston, from the University of Pittsburgh Medical Center, who has worked in the field of anal dysplasia (pre-cancer) for a number of years, and Matt Sharp, the Director of Treatment and Prevention Advocacy for Project Inform out of San Francisco, CA, and a long-time health educator for men who have sex with men (MSM). Both men have presented on or worked in the fields of gay men and anal health.

Human Papillomavirus (HPV) is a virus that infects the skin and can lead to genital warts, anal warts, and some types of cancers (including penile and anal cancers). Dr. Cranston informed me, “As a gay man, you are rightly concerned about developing anal cancer. Receptive anal intercourse is a major risk factor for infection with HPV that can lead to the development of pre-cancerous cells and ultimately anal cancer.” According to Cranston, HIV-positive gay men are at highest risk, with HIV-negative gay men at approximately half this (which is still much higher than the general population). Sharp adds, “But infection with HPV does not mean you will get anal cancer.” According to Sharp, “about the same proportion of men with HPV disease develop anal cancer as women with cervical cancer.” Only certain types or “strains” of HPV are linked to cancers, and often times strains that cause warts are not the same strains associated with cancers.

Being in a monogamous relationship does not rule out risk. “However, knowing this information is good for us to be able to maintain our health” Sharp assured me. Cranston continued, “There is no HPV test approved for men, so the only test that may be available is an anal Pap test that will show the effects of having HPV infection - abnormal anal cells.” While anal Pap testing remains controversial as a national screening tool - having one will allow your healthcare provider both to detect any abnormal anal cells that are present and to discuss symptoms, signs, and risk of anal cancer with you. In the absence of a Pap test or referral structure, continue to be aware of any new anal symptom such as new pain, bleeding or a 'lump', and have a clinician examine you if it does not resolve in 1-2 weeks. (Many anal conditions have these symptoms, are not serious, and will get better during this time frame - early anal cancer will not.)


As with other cancers, early detection is crucial and anal cancer is no different. Anal cancer is a slow progressing disease and can be treated effectively if detected early - giving patients and doctors time to take care of it - if an anal pap smear is performed.

There are unfortunately relatively few clinics available that can diagnose and effectively treat pre-cancerous areas, such as the one run by Dr. Ross Cranston at the University of Pittsburgh (tel. 877 788 7228). There is a great clinic right here in Chicago called Dyer GI Clinics of Illinois – Dr. Julia Dyer comes highly recommended. Their website is www.dyerclinics.com. They have more information that specifically speaks about the anal pap procedure. Doing a little research into available resources could help you in preventing anal cancer as someone who has anal sex with other men. Your pal, Peter Pointers, would be happy to assist you in that search, as well.

More information about anal pap smears. Here also. (This article mentions the Gardasil vaccine for HPV. Currently it’s only approved for use in girls and young women, but you could speak with your doctor to see if they thought it would be an option for you.)



Be Well,
Peter Pointers
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Martin Delaney - The accomplishments of people living with HIV/AIDS

by Mark Hubbard

Last Monday, the National Institute of Allergies and Infectious Diseases awarded a Director’s Special Recognition Award to Martin for his many contributions to the fight against HIV/AIDS

By now, many of you know that Martin Delaney (of Project Inform) died peacefully Friday morning surrounded by friends and family in San Francisco.

At last year’s Positive Living conference in Fort Walton Beach, Florida, Martin provided the annual treatment update. Martin only missed one meeting in the conference’s eleven-year history, having had a heart attack a week before the event. Positively Living is one of very few U.S. conferences remaining that are targeted specifically (and almost exclusively) to PLWHAs. A member of the audience was so inspired by Martin’s remarks concerning the role of activism in the history of HIV/AIDS that he approached Martin and conference organizer Butch McKay about creating a session on the subject for this year’s event.

As the gentleman and Martin began emailing back and forth, they copied Butch with the product of their efforts. For some reason the correspondence petered out in March of this year. Earlier this week, as a member of the conference planning committee, I volunteered to help format the rough document. This year’s Positive Living will feature a special tribute to Martin. I can’t think of a better way to honor his memory than to pass on this version of what Butch has deemed the “Delaney Declaration.”

The Delaney Declaration
(March 2008)

By Martin Delaney

The entire human population benefited from the way AIDS first struck the gay community. Many people wanted to blame the spread of AIDS on gay people, but the facts are exactly the opposite. The epidemic would have been dramatically worse if it had struck any other group than gay people.

Most diseases uniformly strike an entire population, spreading lightly across all economic, geographic, racial, and gender groups. As a result, nothing really unifies the patient population other than the disease itself. As a consequence, people do not bond together or organize to fight the disease because they have nothing in common that connects them.

You can see this in virtually all other major diseases. There may be millions of people who have a disease but they fail to organize to fight it. They don’t demonstrate, they don’t group together to influence the Congress, they don’t develop media strategies. They just go on with their various local groups and families and fight the disease simply as individuals.

In great contrast, when AIDS hit the gay community with unparalleled specificity, it struck a group that already identified itself as a community across the entire nation. It struck a group of people who were already organized politically with skills to influence both local and national government; it struck a population that that already knew it had to fight for its rights, even fight to survive. It knew how to use the media. It knew it had to take care of its own because no one else would. It knew it had to fight back or die.

We [the gay community] were in San Francisco, Los Angeles, New York and every other major country, yet linked together. Wherever, we were a part of a whole. We were in the scientific community; we were in the NIH (the United States’ medical research agency, the National Institutes of Health). We were in the drug companies and in Congress. Because of this unique situation, AIDS faced a far more formidable and organized enemy than had ever before been the case. Had AIDS simply hit across all the general segments of society, like other diseases, it would have encountered far less resistance. People getting the disease would have had nothing in common with each other, no underlying links or abilities, or any need to see itself as a fighting force. It would have been just another disease and it would have been treated like just another disease.

But we know it was not just another disease. It was far cleverer, more dangerous, and spread quietly because it acted slowly. It continued to spread for decades before society would even know it was there. In contrast when it struck the gay community, our underlying culture made it visible much more quickly. Within a few short years, we were able to see that it was sexually transmitted.

The normal rules for people with life threatening illnesses didn’t work very well. Usually such people are too sick to do anything about it. We saw our entire community under siege; we knew we had to change the rules or we would all be dead.

We hollered about it in the media, we went to the FDA (the United States’ Food and Drug Administration) and the NIH, we marched in Washington, got people on committees and proposed new ideas and new ways of thinking about science and the treatment of people with terrible diseases. WE changed the rules, first for ourselves but ultimately for everyone facing a life threatening disease. WE wouldn’t just listen to our doctor either. We recognized that they worked for us, that we were in charge of our lives and our bodies. We taught each other to demand that our doctors act as partners, not as dictators. We changed the doctor patient relationship. We realized that patient education was ultimately going to be done either by drug companies or by the patient community itself; we organized ourselves to teach ourselves.

We became a voice that could counter, when necessary, the messages of the drug companies, drug company advertising, and everything the companies did that affected us. As activists, we formed teams to speak up for our community regarding clinical trials.

The accomplishments of people living with AIDS:

1.Having an instrumental role in changing the rules for drug discovery, development and approval for life threatening illnesses

2.Greatly speeding up access to new drugs, both in and outside of clinical trials.

3.Changing the mindset of researchers about the wisdom of providing early access to experimental drugs.

4.Patient empowerment - helping people understand that they don’t have to be victims of a disease, but can instead be leaders in the fight against it.

5.Changing the patient mindset from hopelessness to hope; helping people see that there is always something you can do.

6.Demonstrating that you don’t have to be a scientist to influence science and have it serve people.

7.Discovering how to be taken seriously by scientists, academics and government bureaucrats, and how to influence them with without making them the enemy.

8.Learning how to organize to influence government policy.