Health Screening for Gay Men

via thehealthybear, by George Forgan-Smith

Hey there Guys,

I was recently sent an interesting question from a reader about gay men’s health checks…

As an older (well, not that old) gay man who has had a fairly long and complicated journey towards self-acceptance and becoming sexually active, beyond the basic considerations around safe sex (i.e. condoms), what should I be considering (like immunisation, screening, etc.) around managing my sexual health, and managing other health issues where gay men are at increased risk?

Really quite an interesting question. I sometimes think we forget that gay men can suffer with all sorts of health issues, not just those based around HIV.

Today I thought it would be good to give an overview of some of the health issues gay men may be at higher risk for as well as some ways to reduce or even avoid those risks.

By the very nature of our sexual expression, gay men are at a higher risk for exposure to diseases such as Hepatitis A and B and in some cases Hepatitis C.

Hepatitis A is spread from oral contact with faeces with practices like rimming potential ways of spread. Hepatitis B and C can be spread by sexual contact, blood contact and also sharing of toothbrushes and razors with people who are infected. 

While there is not vaccination available for Hepatitis C there are very good vaccinations for both Hepatitis A and B. I highly recommend all gay men consider these vaccinations.

Other vaccinations worth considering are the HPV vaccine to help prevent genital warts as well as oral and anal cancer.

The best time to consider this vaccine is before you have become sexually active however the there are recommendations that all gay men up to the age of 26 should consider the vaccination.

While it may be useful past this age there are concerns that it may not be as effective.

Gay or straight all men face similar medical issues as they age.

This includes heart disease, prostate problems, risk of cancers and other diseases as we get older. For this reason I recommend getting a good health check up as you enter your 40′s.

Currently the Australian government has a program for men aged between 45 and 49 to check for health risks like diabetes, cancers, obesity, depression, heart disease and other factors.

This is a fantastic initiative and I highly recommend talking to your doctor if you are between the age of 45 and 49. This is a great opportunity for a top to tail health checkup.

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HIV-Positive Men Who Bareback Should Have More Frequent Hep C Testing

via AIDSmeds

A new study has found that 75 percent of new hepatitis C virus (HCV) infections in HIV-positive men occurred in those with no history of injection drug use (IDU), mirroring other studies documenting a rise in cases of HCV infection in men who have sex with men (MSM) in Western Europe, Australia and urban cities in the United States. The study, published online January 31 in the journal Clinical Infectious Diseases, prompted the researchers to echo the conclusion of other cohort findings by recommending more frequent testing for HCV antibodies in those with high-risk practices, such as MSM who practice anal sex without condoms.

Because of shared transmission routes, up to 30 percent of people with HIV in the United States also have chronic HCV infection. Chronic liver disease is a leading cause of death in people with HIV, and people coinfected with both HIV and HCV are also at a higher risk of death from a number of non-liver-related diseases, including kidney disease.

The majority of HCV cases in the United States are attributable to injection drug use, but there have been reports of HCV transmission in MSM who have no IDU history. Studies of these cases have suggested that HCV risk in these individuals is associated with various sexual practices, including unprotected anal intercourse, the use of sex toys, multiple partners and fisting.

To further explore the occurrence of HCV infection in people already infected with HIV, Lynn Taylor, MD, of Brown University in Providence, Rhode Island, and her colleagues examined data from the 4,000-plus-person ALLRT study.


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San Francisco - Hep C task force launched

In an effort to address a growing public health concern, Mayor Gavin Newsom has established the San Francisco Mayor's Hepatitis C Task Force. 

via Bay Area Reporter, by Liz Highleyman

In recent years it has become evident that HCV sexual transmission is more common than previously believed, with several outbreaks among HIV-positive gay and bisexual men in Europe and the U.S. Reported risk factors include fisting, "rough sex," group sex, and nasal drug use. About one-third of HIV-positive people are coinfected with HCV.

"I found out I was hep C coinfected about three years ago, but I was likely infected sexually more than 20 years ago," said task force co-chair and longtime HIV/AIDS public policy advocate Randy Allgaier. "I was never considered in an 'at risk' category, so my doctor and I never talked about an HCV test. Even I thought hep C was a disease associated with injection drug use. I am very open about my AIDS, but when I was diagnosed as hep C positive I had a hard time telling people – there was a great deal of stigma that I had to deal with."

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[Hepatitis C is one type of hepatitis - a liver disease - caused by the hepatitis C virus (HCV). It usually spreads through contact with infected blood. It can also spread through sex with an infected person and from mother to baby during childbirth.]

Learn  more about Hep C.

Blood (fisting) rather than semen mode of HCV transmission in HIV+

via Aidsmap, by Michael Carter

Contact with blood rather than semen explains the sexual transmission of hepatitis C virus in HIV-positive gay men, German investigators suggested at the 12th European AIDS Conference in Cologne.

Fisting, group sex, and snorting drugs emerged as significant risk factors for sexual transmission of hepatitis C. Unprotected anal sex in the absence of these risk factors was not associated with transmission of the virus, and the investigators believe that their findings should lead to the refocusing of hepatitis C prevention campaigns for HIV-infected gay men which have largely stressed the risk factors of unprotected sex.

Since 2000 outbreaks of sexually transmitted hepatitis C have been reported amongst HIV-positive gay men in a number of large northern European cities including London, Amsterdam and Berlin. Unprotected anal sex and fisting were quickly identified as risk factors.  

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What Are Your Top Ten Issues To Watch in 2010? SHARE YOUR THOUGHTS

via NASTAD

Each year, NASTAD (the National Association of State and Territorial AIDS Directors) tries to inspire and spur action by talking about what it sees as the overarching issues likely to impact HIV, STD and viral hepatitis prevention programs in the coming year. 

Moving forward, this snapshot will be a major complement and source of comparison to what is actually taking place around the country and in Washington.  For example, there’s little doubt that health reform, should it be signed into law, will have a major impact on how all prevention and care and treatment takes place in this country in the future.  But what will impact be?  It is also likely that many readers would come up with other key trends or issues that are likely to impact the way we do business in 2010.  Before we try and guess, we’d like to hear from you!

Please leave a comment to let us know what you think are the top HIV, STD and viral hepatitis issues to watch in 2010.

New Hepatitis C Epidemic Outbreaks in HIV-Positive Gay Men

Outbreaks of sexually transmitted hepatitis C infection have been reported among HIV-positive gay men. Early diagnosis and treatment can prevent serious liver disease, but too few doctors notice the warning signs.

via Treatment Action Group, by Tracy Swan

A new epidemic of hepatitis C virus (HCV) infection is on the rise. In the last few years, outbreaks of HCV have been reported among HIV-positive gay men in the United Kingdom, France, the Netherlands, Australia, Germany, and the United States. Many of these cases involve sexual transmission and are associated with group sex and recreational use of noninjection drugs such as ecstasy and cocaine. There have been no reports of an HCV epidemic among HIV-positive women.

When HCV infection is detected and treated early, during the acute phase (within six months of infection), the likelihood of successfully curing the infection is greater than when treatment is begun later. However, acute HCV infection often goes undiagnosed because there are usually no symptoms; there is no specific test to differentiate acute from chronic HCV. The rising number of acute HCV infections in HIV-positive men calls for increased vigilance among doctors and better efforts to provide information to gay men, who are most at risk.

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Download a guide to Hep C for people living with HIV via the UK's George House Trust here.

Talk to Frank about Hep C

Hepatitis C is emerging as a sexually transmitted infection in gay men. So far this is only affecting HIV-positive guys. Sharing blood during anal sex may lead to infection; specifically when two bottoms share the same top during group sex. Also, HIV-positive individuals may be uniquely vulnerable to Hepatitis C infection during sex.

Frank Talk is an awareness campaign about sex and Hepatitis C developed by the Community Based Research Centre in Vancouver in partnership with the Health Initiative for Men (HIM). Have a look www.checkhimout.ca

Conference highlights the forces encouraging risk behaviour in gay men

via Aidsmap, by Roger Pebody and Michael Carter

The forces encouraging sexual risk behaviour are large and widespread, but the forces for precautionary behaviour are meagre and narrowly focussed, argued Ford Hickson of Sigma Research at the CHAPS conference of gay men’s health promoters in Brighton last week. Rather than describe HIV prevention in the UK as failing, he suggested it would be more accurate to say that it is inadequate.

Other sessions at the conference included one of the first qualitative studies of the experiences of gay men co-infected with hepatitis C and HIV, and an examination of how HIV-positive men have adjusted their behaviour in the light of prosecutions of HIV transmission.

In the plenary, Ford Hickson outlined the forces encouraging risk behaviour:

• The power of sexual pleasure. "If you do not understand sexual risk," he commented, "it is probably because you don’t appreciate sexual desire".

• The rapid expansion of the gay scene into "a large business sector supplying services for sexual contact and locations to have sex".

• The continued denigration of homosexuality in society, and the associated emotional isolation and low mood of many gay men.

• Men’s self-medication with alcohol and drugs, which is problematic in a culture which excuses risk-taking while under the influence.

• The widespread belief that ‘real sex’ is anal sex.

• The commodification and fetishisation of barebacking as a transgressive behaviour. "Gay sub-culture has long legitimised the eroticisation of unacceptable thoughts," Hickson suggested, and barebacking porn is one manifestation of this.

• Individualistic cultural norms that reject notions of responsibility. "The idea that you would sacrifice something yourself in order to protect or care for someone else seems, at the moment, to be deeply alien to gay culture and HIV prevention approaches," he said.

• Optimistic biases in our thinking: telling ourselves that risks are smaller than they really are.

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