Gay Men and MSM Health Concerns
The term gay and gay man herein refers to any individual who identifies within the masculine gender and / or sex spectrum and identifies as msm or men who have sex with men. The information herein attempts to be all encompassing of all gender identities.
The Gay and Lesbian Medical Association (GLMA) has listed 10 health care concerns that men who have sex with men (MSM) should include in discussions with their physicians or other health care providers.
1. HIV / AIDS, Safer Sex
Men who have sex with men are at an increased risk of HIV infection, but with the effectiveness of safer sex and PrEP 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. 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.
Another very effective option for communities at risk of HIV infection is PrEP, or pre-exposure prophylaxis, is a daily pill to help keep you HIV-negative. When taken as prescribed, PrEP is highly effective. PrEP is safe and generally well tolerated. Most insurance plans (public and private) cover PrEP.
PEP, or post-exposure prophylaxis, is a combination of medications that an HIV-negative person takes for 28-30 days AFTER a possible exposure to HIV. PEP is most effective the sooner it’s started, and must be started within 72 hours of the exposure.
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.
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 and B viruses 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
Sexually transmitted diseases (STD’s) occur at a high rate in sexually active gay men. 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 safer sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safer sex is key. Though the risk of transmission may be lower among trans* men who have sex with trans* men, it is important to know the risks and to practice safe sex regardless of who your partner is, as many of the same risks are shared across the gender and sex spectrums.
6. Prostate, Testicular, Colon Cancer & other related screenings
Gay men may be at risk for death by prostate, testicular or colon cancer if they are cisgender, furthermore, trans* men may be at risk for death by cervical cancer, ovarian cancer, breast cancer 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 the 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. Regardless of whether you're cisgender or transgender, it is important to get regularly screened and to be up front and honest about the gender and sex of yourself and the partners you engage in sexual activity with.
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 illnesses can occur with low levels of consumption. Culturally sensitive services targeted to gay men are important in successful prevention and treatment programs.
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 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, heaviness 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.
10. Anal Papilloma
Human Papilloma virus infections – which cause anal and genital warts – are 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 tests 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. HPV also affects the trans* masculine population and can cause a variety of health issues. It is important to be honest and up front with your health provider and to get screened accordingly.
Certainly, there are other health concerns that gay men and MSM face. And there are other cultural competence issues – gender identity, race, ethnicity, economic status, for example. But the “10 things” list is a way to get the discussions started. Every physician and every health care professional – gay or straight – should know these things. And they should provide an open, comfortable environment in which these issues can be discussed.
Hepatitis concerns for gay men and other msm individuals
What is Hepatitis?
Hepatitis refers to inflammation of the liver. Classic signs of hepatitis include darkening of urine, lighter colored feces, yellowing of the whites of the eyes and skin (jaundice). Many people who have hepatitis do not have these classic symptoms. Some just have vague complaints such as stomach pain, poor appetite, or nausea.
What is Hepatitis A?
Hepatitis A is caused by a specific virus. It usually causes an acute illness that goes away as a person’s immune system fights it. It can lead to “fulminant” hepatitis that is very serious. About 100 Americans die each year from hepatitis A. Hepatitis A does not cause chronic infection.
How does Hepatitis A spread?
Hep A spreads from one person to others by the “fecal-oral” route. It is very contagious: one cubic centimeter of infected persons feces has millions of infectious doses. When an infected person makes food or beverages, they may inadvertently contaminated items they prepare. Sex also spreads the virus easily. The virus is hardy and survives outside the body.
What is Hepatitis B?
In about 10% of cases, infection with hepatitis B virus leads to a chronic infection. Often this causes no symptoms, but it can lead to cirrhosis, liver failure, or liver cancer. Every year, over 250,000 people die worldwide from hepatitis B-associated diseases. In the US, over 1 million people carry hepatitis B chronically. About 5,000 Americans die each year from hepatitis B. People with chronic hepatitis B may also spread the infection to others.
How does Hepatitis B spread?
Hepatitis B in blood, sexual secretions, and saliva spread to other people via household or sexual contact. Hepatitis B virus is very resistant to air and light. It remains infectious outside the body for a long time.
Why are gay men or other MSM at higher risk for Hepatitis A and B?
As a group, men who engage in same sex contact have historically had higher rates of infection with Hepatitis A and B. At least two factors affect any individual’s risk of infection: how someone is exposed, and how often. Hep A spreads through sex as well as the fecal-oral route, so rimming-oral-anal contact-is especially risky. Montana also has higher than average hepatitis A case reports. Hep B spreads easily through sex, especially anal sex. The more of the behaviors and the more persons any individual is exposed to, the greater their individual risk.
How effective are the vaccines?
Hepatitis A vaccine produced protective antibodies in 99.9% of over 1,500 healthy volunteers. Hepatitis B vaccine produced protective antibodies in 98.5% of the same group.
How safe are the vaccines? What side effects are likely?
The vaccines are well tolerated. Serious problems occur in less than 1.0% of recipients. Persons who should not receive the vaccines are those who have a serious yeast allergy or who have had a serious reaction to earlier doses. The most common side effects are soreness at the injection site, headache and tiredness. More information about side effects and adverse reactions is available online at:us.gsk.com/products/assets/us_twinrix.pdf.
What about privacy? Do I have to tell anyone my sexual habits? What about records?
Your sex life is your business, not ours. The Missoula City-County Health Department follows regulations about privacy of medical information that are stricter than typical physician offices. Unauthorized disclosures are punishable by fines and jail time. We must keep records of vaccinations we administer. These records have the name, address and phone number of the recipient; the type of vaccine(s), date(s) given, vaccine manufacturers and lot numbers. A recipient signs the record to show their consent to get the vaccines. Records do not contain any individual risk factors. While anyone may seek hepatitis A and B vaccines at the Health Department, persons at higher risk should mention the Montana Hepatitis Prevention Program by name to receive the vaccines for free.
Where do I get the vaccines?
Men who have sex with men can get Hepatitis A and B vaccines through their local City-County Health Department or primary care provider.
Genital Warts: Everything you ever wanted to know about them.
Provided by the Department of Public Health San Francisco
Genital Warts (or condyloma) is a Sexually Transmitted Disease (STD) caused by the human papilloma virus (HPV). The virus may cause wart-like bumps to form on the penis, in and around the vagina, on the cervix (opening to the womb), around the anus (butt), and rarely on the mouth. The virus is passed between people during anal, vaginal, and sometimes oral sex. These are NOT the same warts commonly found on hands and feet.
How are genital warts spread?
- Many people carry the wart virus on their penis, in and around the vagina, or in and around the anus/rectum. Only a small number of these people develop warts that can be seen. It is passed with skin to skin contact during anal or vaginal sex. The wart virus is very common in adults who are sexually active.
How do I know if I have warts?
- Not everyone with the genital wart virus will have signs of disease. You may have painless wart-like growths on or in your sex organs or around your anus (butt). The warts may vary in size and be bumpy or flat. Sometimes special tests are needed to detect the wart virus.
Are genital warts serious?
- They can be. For most people warts are only a bother, and are treated if you wish. If a woman has warts on the cervix (opening to the womb), they can be a problem. It is rare, but sometimes having warts can cause a woman to have a pap smear that is not normal, (including changes that may lead to cancer). For this reason, women with warts on the cervix should have a pap smear test (part of a pelvic exam) every six months to one year. Men and women who have warts on or inside the anus should have an exam every year.
What can I do if I have genital warts?
- Be sure you see a clinician (licensed medical provider).
- Keep all your return treatment appointments.
- Your sex partner(s) should also be seen and treated.
- If you may be pregnant, tell your clinician.
- If you have sex, it is always a good idea to use a condom to avoid getting STDs.
- However, condom use is not a 100% protection from the wart virus.
How are genital warts treated?
- A clinician puts a cold liquid chemical on the warts to remove them.
- You may need to come back more than once to finish the wart treatment.
- You may need longer treatment if you have HIV. The warts may increase in size and number more quickly. Tell your clinician if you are HIV positive.
Will the warts come back?
- Warts may return, even after treatment, this is because the virus stays in your skin once you are infected. You can pass the virus to your sex partners during vaginal or anal sex, even when you don’t have warts you can see.
How can I avoid getting genital warts?
- Check yourself often for signs of actual warts; these can be treated. But remember: we treat the wart, not the virus, which stays in the skin.
- Use condoms (rubbers) every time you have sex. Condoms reduce your risk for getting warts, but they won’t guarantee protection. Condoms also help to prevent other STDS.
Risk Factors for Cervical Cancer
- Early onset of sexual intercourse (< 18 years of age)
- Multiple sex partners (3+ lifetime)
- Male partners with multiple partners
- Sexual partners of men whose previous sex partners developed cervical cancer
- Cigarette smoking
- History of HPV infection (subtypes 16, 18 – not external)
- Life-long mutual monogamy
- Use of condoms and spermicides
No Association with Cervical Cancer
- Herpes simplex I or II
- Uncircumsized male partner
- Jewish ethnicity
- Multiple pregnancies
- Use of oral contraceptives
WARNING: HIV is also an STD! All STDs are spread by having unsafe sex. When you get infected with an STD, you could also be getting HIV. Protect yourself. Use condoms!