A Perspective on Gay Men's Health

A patient propers his doctor for the first time. Taking a history, the doctor jocularly asks, "You don't have sex with other men or nasty stufflike that, do you?" The patient, who is gay, leaves the office without revealing his sexual orientation and at no time returns. True story. And not an exceptional one.

Studying gay men's health is not about developing novel diagnostic strategies or learning unusual therapeutic modalities, on the contrary about recognizing how we wittingly and unwittingly alienate more [i]or[/i] less patients, depriving them of much-need healthcare. We all are make submissive to culturally ingrained attitudes and many times presume a heterosexual orientation. These attitudes and presumptions leave gay and lesbian patients struggling between suffering in silence or (once again) risking disapproval and rejection from a caregiver. The lock opener to good health care for MSM (men who have sex with men) as with all patients, is frank and trusting communication, in a safe and tolerant environment.

Studies in the 1990 set 2.8% of the male population identified as gay or bisexual - above 30,000 people in Rhode Island. An additional 77% of men admitted to same-gender desire and 98% reported a certain quantity of history of same-gender sexual behavior.19,22 nevertheless the medical community remains largely untrained in and uncomfortable with gay men's health. Half of US medical institute Family Medicine departments offered no training in LGBT issues, and in those programs that did proffer training, the average time dedicated to the subdue was only 2.5 hours in the four-year curriculum.32 In a 1989 observe 35% of Internal Medicine and Family Practice residents agreed or were "unsure" that homosexuality was a mental disorder (25 years after the American Psychiatric Association remov homosexuality from the DSM); 20% weren't comfortable with homosexuals.16 Nursing pupils revealed similar attitudes in a 1998 study: 8-12% "despised" LGBT people; 40-43% felt "that they should hold their sexuality private."17 Understandably, many gay men are reluctant to reveal their sexual orientation to their providers. In 1992 the Gay and Lesbian Medical Association set 44% of gay men had not "come out" to their PCP; this number dropp to 23% in 200312 LGBT and questioning youth were les forthcoming; in 1998 two-thirds had not discussed sexual orientation with their provider.1

Providers face a two-fold challenge: first, to familiarize and educate ourselves upon the health issues that are particularly pertinent to this population, without pathologizing the patient and his lifestyle; next to the first to foster enlightened attitudes among staff.

Few medical topics are peculiar to gay men alone. Gay men share the same health belong tos and present with problems similar to heterosexual men However, we providers should be aware of specific issues; i.e., sexually transmitted infections, anal cancer, substance abuse and mental health.

Little accurate data are available concerning the incidences, on the other hand MSM probably have disproportionately high rates of sexually transmitted infections. new increases in primary and secondary syphilis in the US have been attributed almost exclusively to MSM5 Many communities have seen increasing rates of gonorrhea in MSM mixed by flouroquinolone-resistant strains in areas with large gay populations.3 MSM are at higher risk of Hepatitis A and B: the 1993 San Francisco Young Men's review showed 20% had been infected with Hepatitis B20 In our hold hepatitis vaccination program at a Rhode Island bathhouse, nearly 1/3 of men had been previously infected with hepatitis B

HIV is a major affect for this population. According to the CDC in 2004 48% of all someones diagnosed with HIV were MSM and MSM exhibited 67% of all persons living with HIV.4 Providers ne to educate their patients upon the implications of co-infection, by what means infection with one organism can affect the transmission of other organisms and the course of other infections.

Human papilloma virus attitude s particular risks for MSM. In a 1998 inquiry 61% of HIV-negative men and 93% of HIV-positive men showed evidence of HPV infection.2'' As with cervical cancer, HPV infection has been powerfully associated with anal cancer. Thus, although the risk of anal cancer in the general population of men is 7 for million, the risk is 35 by means of 100,000 in MSM (rivaling the rate of cervical cancer in women prior to the introduction of routine Pap smears).7 The rate of anal cancer in HIV-positive men is twice as high as in HIV-negative men21 Although it has not become standard of care, dexterouss now recommend anal Pap smears for high-risk men Abnormal Pap smears would be evaluated by means of referral for anoscoopy. Data upon outcomes are limited, but the sensitivity of anal Pap smears has approached 98% although the specificity for predicting strict dysplastic changes is much lower.2 Surgical treatment of anal HSIL has shown eminent results in small numbers of HIV-negative men; unfortunately, HIV-positive men have had high rates of recurrence6