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The New Gay Sexual Revolution

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PrEP, TasP, and fearless sex remind us we can’t advance social justice without including sex in the equation.

By Jacob Anderson-Minshall

The sexual revolution of the 1960s and ’70s came to an abrupt and brutal end for many gay and bi men the moment AIDS was traced to sexual contact. In the early days of the epidemic, sex between men was equated with AIDS, not just in the mainstream media, but also in prevention efforts by other gay men. Since AIDS in those days was seen as a death sentence, for men who had sex with men, every sexual interaction carried the risk of death. Indeed, tens of thousands died of AIDS-related conditions.

“I was alive when homosexuality was [still] considered to be a psychological illness,” David Russell, pop star Sia’s manager, recently told Plus magazine. “The two generations ahead of mine, and a good portion of my generation, were completely decimated by AIDS. They’re gone.”

While some men with HIV outlasted all predictions and became long-term survivors, the widespread adoption of condoms is credited with dramatically reducing HIV transmissions among gay and bi men in subsequent years. Yet reliance on nothing but that layer of silicone — a barrier some complain prevents true intimacy and pleasure — couldn’t erase the gnawing dread gay men felt that every sexual encounter could be the one where HIV caught up to them.

There have been, of course, moments when nearly every gay or bi man has allowed their passions to override their fears and enjoyed the skin-on-skin contact that opposite-sex couples often take for granted. Thinking back on those unbridled and unprotected moments of passion filled many of these men with terror, regret, and guilt.

“Shame and gay sex have a very long history,” acknowledges Alex Garner, senior health and innovation strategist with the gay dating app Hornet. “And it takes much self-reflection — and often therapy — to feel proud and unashamed of our sex when everything around us tells us that it’s dirty, immoral, or illegitimate.”

Since the late 1990s and the advent of lifesaving antiretroviral drugs, some of the angst around sex between men faded — and with that came changes in behavior. Condom use, once reliably high among gay and bisexual men, has dropped off in the past two decades. According to a recent study published in the journal AIDS, over 40 percent of HIV-negative and 45 percent of HIV-positive gay and bi men admitted to having condomless sex in 2014. Researchers found the decrease in condom use wasn’t explained by serosorting (choosing only partners believed to have the same HIV status) or antiretroviral drug use. And despite what alarmists say, condom use had been declining long before the introduction of PrEP.

Garner, who has been HIV-positive for over two decades, says he’s almost relieved he acquired the virus at 23, because “My entire adult life I have never had to worry about getting HIV.”

The Rise of PrEP

Now there’s hope the younger generation may also experience worry-free sex lives — without the side effects of living with HIV.

The use of the antiretroviral drug Truvada as pre-exposure prophylaxis, or PrEP (it’s the only medication approved for HIV prevention), has been shown to reduce the chance of HIV transmission to near zero. Since the medication was first approved as PrEP in 2012, only two verified cases of transmission have been documented among those who adhere to the daily schedule (a third, according to HIV expert Howard Grossman, could not be confirmed). New, longer-lasting PrEP injectables should reach market in the next few years. Studies suggest that on-demand PrEP (such as taking it before and after sexual activity) may also be effective.

“This is a revolution!” Gary Cohan, MD, who prescribes PrEP, told us in 2016. “This should be above the fold in The New York Times and on the cover of Time magazine. A pill to prevent HIV?”

Undetectable Equals Untransmittable

Those who are already HIV-positive also have a sure-fire option for preventing the transmission of HIV that doesn’t rely on condoms. It’s called treatment as prevention, or TasP. Those who are poz, take antiretroviral medication, and get their viral load down to an undetectable level, can’t transmit HIV to sexual partners. Last year, The New England Journal of Medicine published the final results of HPTN 052, a study that proved antiretroviral medication alone is enough to prevent HIV transmission among serodiscordant couples. In a Facebook Live interview for AIDS.gov, Dr. Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, noted, “The chance of transmitting [HIV] if you are virally durably suppressed is zero.

Since Dieffenbach’s statement, a number of HIV organizations and medical groups have joined the “Undetectable Equals Untransmittable” bandwagon, including GMHC, APLA Health, and the Latino Commission on AIDS.

The Centers for Disease Control and Prevention recommends the use of condoms in addition to PrEP or TasP, primarily because neither biomedical approach prevents other sexually transmitted infections like gonorrhea or syphilis. Still, PrEP and TasP make it safer to have condomless sex — and that could jump-start the new sexual revolution. “When the threat of HIV is removed from sex there is a profound sense of liberation,” Garner says. “Sex can just be about sex.”

One hurdle is PrEP stigma, furthered by the myth of “Truvada whores,” and AIDS Healthcare Foundation’s Michael Weinstein’s deliberate efforts to portray the HIV prevention pill as “a party drug.”

“Fear and shame have been ingrained in gay sex for decades,” Garner admits. “And it will take time and a great deal of work to extricate those elements.” But he remains optimistic that “together negative and poz men can shift the culture away from fear and toward liberation.”

He argues that what’s at stake is far more than just a better orgasm.

“Our sexuality is at the core of our humanity,” Garner says. “Our sexuality is as integral to us as our appetite. We can’t advance social justice without including sex. As queer people and as people of color, our bodies have been criminalized, our sexuality has been pathologized, and structures continue to dehumanize us. It’s a radical act of resistance when, as gay men, we choose to find pleasure and intimacy in our sex. Our sex has been, and will continue to be, intensely political. It can change our culture and our politics if we embrace it and run to it instead of away from it.”

Complete Article HERE!

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Time for a Sexual Revolution In Health Care Treatment

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Why is care for sexual health issues considered a luxury when it’s a necessary part of population health?

By Zachary Hafner

When Americans seek care for most common health conditions, there is rarely much question about coverage. Every day, consumers—including those on Medicaid and Medicare—seek care for sore joints, depression, and even acne without worrying about whether or not their insurance will cover their doctor visits and medications. For the most part, coverage for sexual health issues is less straightforward—but why? Is it because sexual health issues are not considered legitimate illnesses? Because the costs are significant? Or is it because raising the topic of sexual health can offend certain personal and organizational values? Whatever the reason, it is time for a change.

It’s hard to deny the human and economic burden of sexually transmitted infections (STIs) on this country. The CDC estimates that 110 million Americans are infected with an STI, resulting in direct medical costs of $16 billion annually. The most common and fastest growing STI in this country is human papillomavirus (HPV), and it is estimated that half of sexually active men and women will get HPV at some point in their lives. In 2006, a vaccine for HPV was introduced and now there are several. CDC guidelines recommend administering a multi-dose series, costing about $250–450, to all boys and girls at age 11 or 12. (Some states require the vaccine for school admission.) It was included in mandatory coverage under the ACA. Since the HPV vaccine was first recommended in 2006 there has been a 64% reduction in vaccine-type HPV infections among teen girls in the United States.

It seems clear that this kind of care for sexual health is necessary for public health and is also part of caring for the whole individual, a central tenet of population health. But what about sexual health care that doesn’t involve infectious disease? Is it still a population health issue if there’s no communicable disease involved?

Let’s take erectile dysfunction (ED) for example. It is nearly as common in men over 40 as HPV is in the general population—more than half of men over 40 experience some level of ED, and more than 23 million American men have been prescribed Viagra. With a significant portion of the population suffering from ED, is it important for payers and providers to consider ED treatment to be essential health care and to cover it accordingly? Medications like Viagra and Cialis are an expensive burden at upwards of $50 per pill. Medicare D does not cover any drugs for ED, but some private insurers do when the medications are deemed medically necessary by a doctor. A handful of states require them to do so, but they are typically listed as Tier 3 medications—nonessential and with the highest co-pays.

Almost 7 million American women have used infertility services. Coverage for infertility diagnosis and treatment is not mandated by the ACA, though 15 states require commercial payers to provide various levels of coverage. The cost of infertility treatments is highly variable depending on the methods used but in vitro fertilization treatments, as one measure, average upward of $12,000 per attempt.

Are treatments for ED and infertility elective or necessary? In an age of consumerism and heightened attention to the whole patient across a broader continuum of care, organizations that support the availability of a broad set of sexual health services to a diverse group of consumers will have a big competitive advantage, but they may face challenges balancing the costs. Health care has advanced in both technical and philosophical ways that allow people to manage their diseases, cure their problems, and overcome limitations. It has also shone light on the significant advantages to considering a diagnosis in the context of the whole individual—their social and emotional health as well as coexisting conditions. Studies have shown, for example, that infertility, ED, and STIs all have a significant relationship with depression and anxiety.

It’s time sexual health was folded in to the broader definition of wellness instead of marginalized as a separate issue. For too many Americans, it’s too big an issue not to address.

Complete Article HERE!

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Worried your partner might have a bisexual history? Why?

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Myths about LGBTQ sexual health need debunking – and healthcare professionals are part of the problem

‘You don’t have to openly identify as bisexual to get the bad side of bisexuality.’

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“Use a condom, the pill, or get an IUD – avoid pregnancy” was the drill from sexual health practitioners who came to speak at my comprehensive school in Kent. There wasn’t much detail or thought beyond, “Some of these boys are going to get some of these girls pregnant before they hit 16 – let’s try to get that down to a lower number than we had last year.”

Thankfully, when it comes to the subject of sexual identity, there’s now more guidance than ever trickling down into the societal subconscious in the west – hopefully in schools, but certainly during publicity rounds for films starring Kelly Rowland and Cat Deeley. While talking about Love By the 10th Date to the New York Post last week, Rowland espoused the importance of knowledge when embarking on a sexual relationship with another: “I can’t tell someone how to feel about dating someone who is bisexual or had a past gay experience, but it’s proper to ask [if they have] in today’s times.”

It is “proper” to ask? Maybe it’s unfortunate phrasing, or maybe not being able to hear the tone of voice in which the opinion was offered gives it negative impact, but the sentence rings faintly of suspicion and mild disapproval: “Please submit your history of sex with people of the same gender, and it will then be decided whether or not you are too risky to be intimate with.” That’s how it comes across to this particular someone who is “bisexual or [has] had a past gay experience”, anyway.

Bisexuality just continues to have a bad rep, even though it’s on the rise (according to CNN) … or then again, maybe it’s not on the rise (according to the Verge). Statistics on the spread of sexually transmitted diseases, and which groups of people are spreading them, are easily found (and quickly wielded by those mistrustful of anything beyond heteronormativity), but they can obscure a simple and universal truth that applies to all groups, whether those groups are on the rise or not. And that is: whatever genitalia you and your partner(s) have, you should protect yourselves (condom/dental dam/wash your hands and accoutrement between uses, thank you). Ignoring that fact in favour of “it’s the bisexuals, mostly” is the source of so much harm.

You don’t have to openly identify as bisexual to get the bad side of bisexuality, because it goes beyond the myths of promiscuity, greed and dishonesty still held by some – biphobia also has an impact on physical health. Here in the UK, if you’re a man who’s had sex with another man in the last 12 months, you can’t donate blood (though that stance is currently being reviewed). Women who have sex with women are less likely to get a smear test, because many of us don’t realise we need to – we’re forgotten by the healthcare system, or our needs are misunderstood.

“Gay and bisexual women are at lower risk for HPV,” we confidently tell each other, “we don’t need a smear test.” A lot of us have heard that from our doctors, as well. It was only after seeing a leaflet about the issue from lgbthealth.org.uk during this month’s Cervical Cancer Prevention Week that I realised this was just ignorance.

In 2008, Stonewall released findings that one in 50 lesbian and bisexual women had been refused a smear test, even when they requested one. The 2015 survey on training gaps in healthcare, Unhealthy Attitudes, found that three in four patient-facing staff had not received any training on the health needs of LGBTQ people. Many women get variations of the “use a condom, the pill, or get an IUD – avoid pregnancy” mantra from our doctors to this day, if we don’t declare our gayness or bisexuality as we walk through the surgery door. Sometimes even a declaration is ignored by an uncomfortable practitioner. Straightness is still automatically assumed, unless you’re lucky enough to have a doctor who doesn’t see heterosexuality as the default for everyone they treat.

According to that 2015 Stonewall study, a third of healthcare professionals felt that the NHS and social care services should be doing more to meet the needs of LGBTQ patients, which is encouraging. Knowledge is wanted – needed – to undo the harmful myths that block help and prevent education. And that is what is “proper” (to quote the star of Freddy vs Jason and Love By the 10th Date) – fighting ignorance and biphobia, rather than continuing to be suspicious of sexual histories that might have featured people of the same gender. Whatever and whoever is in our sexual pasts, we must protect each other, and stay informed. That’s healthy.

Complete Article HERE!

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Why Young Men Don’t Get The Information They Need About Reproductive And Sexual Health

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Some men may not know as much about their own sexual health because women’s health dominates that public conversation.

That could be important because the Centers for Disease Control and Prevention recently reported that sexually transmitted diseases like syphilis, chlamydia and gonorrhea — all of which can be cured with antibiotics — are spreading more than ever. Gay and bisexual men and young people were particularly affected by the infection increases.

Dr. Arik Marcell, a professor of pediatrics at Johns Hopkins and the paper’s first author, said in the statement that it shows “no one particular factor is responsible for young men’s lack of engagement” in getting sexual and reproductive health care. “We need to think about working at multiple levels to effect change rather than focusing solely on the individual level, which may place undue blame on the individual.”

Study results show that the young men surveyed talk to people in their lives, like their mothers and friends, about their health but didn’t always know where to go for care. Self-consciousness also played a role in their care: “Some participants also discussed needing greater self-confidence when asking and answering questions about their health in general, especially about their sexual health,” the university said.

The authors suggest that a lack of knowledge or health care could have a gender basis: According to the study, the culture around health care in the U.S. is “focused on women’s health” and males are influenced by “traditional masculinity scripts.”

“Few men also have received sexual and reproductive care because historically, few clinical guidelines have outlined care that providers should deliver to this population, and few public health efforts have focused on engaging this population,” Johns Hopkins said.

 

Care is not the only way men lag behind women when it comes to sexual and reproductive health. Another recent study showed that men don’t know a lot about their own fertility. A survey of hundreds of Canadian men found they were generally not aware of many of the factors that could reduce their sperm counts. And the authors of that study suggested one of the reasons could be that men are not are likely as women to ask questions about their own health.

Although the new study shows men have less knowledge and receive less care than women when it comes to their sexual health, some are getting a level of care. According to Johns Hopkins, about half of the men they surveyed had health insurance and a regular source of health care, and a majority had received a physical exam in the last year. Additionally, 35 of the 70 were tested for HIV.

Complete Article HERE!

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Study ties pubic hair grooming to sexually transmitted infections

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By Ronnie Cohen

Before scheduling a bikini wax, or shaving down there, consider the results of a new study.

Men and women who trimmed or removed their pubic hair were nearly twice as likely to report having had a sexually transmitted infection, or STI, compared with non-groomers, researchers found after adjusting for age and number of sexual partners.

The lesson, according to the study’s senior author, Dr. Benjamin Breyer: “I wouldn’t groom aggressively right before a sexual encounter with a partner I didn’t know well, and I would avoid having sex with an open cut or wound.”

Removing pubic hair might tear the skin, opening an entryway for bacteria or viruses, the authors write in the journal Sexually Transmitted Infections.

But in a phone interview, Breyer, a urology professor at the University of California, San Francisco, cautioned that pubic hair grooming also might mask other contributing factors to STIs. Groomers, for example, could be more likely to engage in risky sexual behaviors – behaviors not considered in the study.

It is the first large-scale investigation into the relationship between grooming practices and STIs.

Researchers surveyed 7,470 randomly sampled adults who reported at least one lifetime sexual partner. Some 84 percent of the women and 66 percent of the men groomed their pubic hair.

The 17 percent of groomers who removed all their hair were more than four times as likely to report a history of STIs compared to those who let their hair grow naturally, the study found.

The 22 percent of groomers who trimmed their pubic hair at least weekly reported more than triple the rate of STIs compared to those who left it alone.

U.S. cases of the three most common sexually transmitted infections – chlamydia, gonorrhea and syphilis – reached an all-time high last year, according to the Centers for Disease Control and Prevention.

But Debby Herbenick, a sex researcher and professor at the Indiana University School of Public Health in Bloomington, isn’t ready to advise people to discard their razors on the basis of the study.

“What was really missing from the paper was the aspect of sex,” she said in a phone interview. “That’s important because you’re not getting an STI from shaving or trimming your pubic hair.”

The only question researchers asked about sex was how many partners participants had in their lifetimes.

“For me, the study isn’t enough to urge anyone to change anything about what they’re doing about the body,” said Herbenick, who was not involved with the research.

A previous study found that women who removed all their pubic hair were more likely to engage in casual sexual hookups as opposed to long-term relationships – possible evidence that something other than grooming itself caused the STIs, she said.

Along those lines, in the romantic comedy, “How to be Single,” Rebel Wilson playing Robin laments her friend’s LTRP, or “long-term relationship pubes.”

Regardless of whether and how people groom their pubic hair, Breyer stressed the importance of practicing safe sex, especially using a condom when engaging in casual sex.

Pornography and Hollywood, particularly a painful-to-watch 2000 episode of HBO’s hit “Sex in the City,” with Sarah Jessica Parker playing Carrie Bradshaw getting a Brazilian bikini wax, popularized women stripping their genitals bald, Herbenick said.

The trend appeared to slow during the recession and may be reversing. Earlier this year, Vogue magazine ran a story headlined, “The Full Bush Is the New Brazilian.”

But men and women still remove their pubic hair. Because they frequently do so in preparation for sex, Herbenick sees groomers as unlikely to heed Breyer’s advice about waiting to heal after grooming and before having sex.

“We know people are grooming in preparation for sex,” she said. “So I don’t think waiting is the answer.”

In another recent study in JAMA Dermatology, more than 80 percent of American women said they groomed their pubic hair, and 56 percent reported doing so to get ready for sex. Women groomed regardless of how often they had sex, the gender of their sex partner and their sexual activities.

Complete Article HERE!

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