Dr Bill Coleman > Blog > 2011 > November

Monthly Archive: November 2011

PEP can stop HIV infection

Author: November 15, 2011 0 Comments

Are we being punished for irresponsible sex?

OPEN WIDE / Why we need access to PEP

Bill Coleman / Vancouver / Thursday, November 18, 2010

 

If 28 days of pills could prevent you from getting HIV after possible exposure, would you take the meds?

The meds exist. They’re called post-exposure prophylaxis (PEP) and they could significantly reduce your risk of contracting HIV. So why isn’t everyone demanding access to this treatment?

The Health Initiative for Men (HIM) has written a position paper on PEP. In it, three cases are briefly described:

Case 1
A gay guy says he went to emergency at St Paul’s Hospital and told them he had relapsed on cocaine after four years of abstinence. He had been in a monogamous relationship with an HIV-negative partner for 18 months — until he went to a bathhouse and had unprotected receptive anal sex with multiple anonymous partners.

Twenty-four hours later he went to the hospital. He was advised not to take PEP, as the risks of taking them outweighed the risk of getting HIV. He was told his chances of getting HIV were less than one in 5,000.

Two months later, he tested positive.

Case 2
A gay guy went to a clinic for HIV testing. He had tested negative six months earlier. He said he was having consensual anal sex with a partner of unknown status when that partner, despite being asked to use a condom for penetrative anal sex, removed the condom during sex and ejaculated.

The guy went to St Paul’s emergency 36 hours later. He was refused a prescription for PEP and told the risk of seroconversion was not high enough.

The guy’s HIV test came back positive three months later.

Case 3
After having unprotected receptive anal sex with a partner he had met online, a guy found HIV meds in the man’s bathroom. He went to emergency at St Paul’s 12 hours later and asked for PEP.

He was told he didn’t meet the criteria.

Like the others, he was not given the option to pay for the meds himself, even though he wanted PEP and could afford to buy it.

He later tested positive for HIV.

The paper’s conclusion: PEP should be available to gay men.

It’s great that HIM has started a push for PEP. Let’s hope they push hard enough to make BC a safer place for gay men.

So why isn’t PEP available?

Simple. I’d say the medical profession is reluctant to give people, and especially gay guys, too many opportunities to behave recklessly. And our community’s silence is letting them get away with it.

I don’t expect a change in policy until someone stands up to demand it. So far, no community group or agency has directly taken on the BC government for its shameful policy on PEP.

How PEP works

If you are exposed to HIV and are concerned about getting infected, you need to start on medication as soon as possible. The treatment has to begin within 72 hours to be effective; some local doctors suggest within 24 hours is best.

How effective is PEP? One study showed that persons who did not take PEP were seven times more likely to get HIV (Roeding et al, 2008).

But accessing PEP is not easy. You need a doctor to prescribe it, which can be tricky at the best of times, and even harder at 6am on a Saturday morning.

One more hurdle: in BC you have to cover the $1,500 price tag yourself, unlike in Quebec and  Australia where the medication is free.

If the BC government can prevent infection in even one person in 20 by providing access to effective medication, the investment is worth it. From a purely financial point of view, paying $1,500 for PEP is much cheaper than providing a lifetime of HIV treatment.

But maybe it’s not simply about saving money; maybe gay guys are not important enough for the government to prioritize. Or maybe this policy is punishment for irresponsible sexual behaviour. Or maybe it reflects an ongoing squeamishness around gay sex.

Bottom line: our government won’t care about us unless we make them care.

So talk to your community organizations and ask them to take action to make PEP available to everyone in need. Write to the health minister. And find yourself a doctor who knows about HIV and PEP, and talk to them about how you might access it quickly if you need it.

 

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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Gay guys and warts and vaccines

Author: November 15, 2011 0 Comments

Gay men and warts

OPEN WIDE / Why aren’t gay and bisexual men getting free HPV vaccines?

Bill Coleman / Vancouver / Thursday, December 16, 2010

 

Warts.  Warts.  Warts.  Almost all of us have had them (or have them now).

Warts make wonderful dinner conversation, which  can lead to all sorts of interesting discussions about homophobia, anti-gay government policy, fucking, penises, asses, hope, and even cancer and death. Who knew those little pesky spots can have so much effect on gay men?

When I was young, in the middle of the last century, my parents were not so educated and did not know anything about warts. In those days we were told to rub a penny on the wart, bury the penny for six weeks, dig it up, then rub the wart again and it would magically disappear. Now we know that a wart comes from a virus.

Yes, another virus for gay guys to worry about. But this virus has an effective vaccine.

The wart virus is called human papillomavirus, or HPV for short. Gay guys can and do get anal cancer from the HPV (wart) virus, but the BC government will not pay for gay guys to get the vaccine, even though they pay for every school-age female to get it.  (Anti-gay government policy? Homophobia?)

Warts are the most common sexually transmitted disease. So if you’ve got warts, you’ve probably been sharing them with your boyfriend. But if almost all of us gay guys have this wart virus, does it really matter?

HPV is the most common cause of cervical cancer. Granted, most gay guys do not have cervixes, but they do have asses. A penis may enter an ass and bring the HPV virus along with it. (See: now we’re on to fucking. And no, you do not have to have a wart on your dick to have the virus.)

If your dick does transmit the wart virus, in five to 10 years there can be big problems. The HPV virus can cause anal cancer.

Dr Joel Palefsky, an infectious disease expert from the University of San Francisco, says, “almost all HIV-positive gay men have HPV in their anus.”

The Vancouver sample of the ManCount survey of gay men shows 79 percent of HIV-positive guys and 62 percent of HIV-negative guys have anal wart virus.

The survey also found that 64 percent of HIV-positive guys and 34 percent of HIV-negative guys have abnormal cells in their anuses, which can lead to anal cancer.

HIV-positive gay men are 10 times more likely to get anal cancer than women are to get cervical cancer.

In a paper published in 2006 by a Vancouver group, gay men were found to be 35 to 70 times more likely to get anal cancer than the general population (Lampinen 2006).

HIV-negative gay men have a rate of anal cancer at 35 per 100,000. Women get cervical cancer from the wart virus at a rate of 8 per 100,000. Is the health of gay men not important to this government? Or are we expendable?

So here it is: there is a vaccine for warts. It is effective. Why not just take the vaccine?

Well, there are two complications. The vaccine works best if you get it before you have the virus in your ass. The BC government will pay for any female under age 26 to be vaccinated against HPV, but they will not do the same for gay guys — even though the vaccine is approved for use in males aged 9 to 26 in Canada. Gay men in the UK have been receiving the HPV vaccine for some time now.

All young gay and bisexual guys in BC should be getting this vaccine, too.  But our not-so-gay-friendly healthcare system won’t pay for it.

How many young gay and bisexual guys even think about warts, let alone have $450 lying around to pay for their own vaccines?

I wonder if our health minister thinks you deserve to get cancer and die if you let some guy put his dick in your ass.

Why is no one standing up and demanding proper healthcare for gay men?  It is time to speak out to demand proper treatment from our medical health system. We will not be heard by being quiet, by being nice. It is time to act!

Lobby the health minister, talk to your doctor, and ask your doctor if you need to be examined for HPV virus in your anus

 

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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We may get free condoms but are they the best?

Author: November 15, 2011 3 Comments

Free but are they the best condoms?
OPEN WIDE / Why isn’t the government giving us the best protection?
Bill Coleman / Vancouver / Wednesday, May 04, 2011
Studies show that some condoms break more often than others. So why isn’t the government giving gay guys the condoms that are least likely to break?

Like everyone else, gay men deserve the very best in healthcare and safer sex protection. To support our taking care of ourselves, the government generously provides free condoms to various community groups for distribution.

The condoms are appreciated and, it seems, used often. I asked a local gay shop if they sell many condoms. The answer: they sell more to straight people since gay guys use the free ones from the government.

The free ones generally come from the Ministry of Health, which supplies Durex Sheik Sensi-Creme. They come in a red package that says Durex on them.

One  local agency gives out more than 50,000 such condoms a year. Some of those 50,000 will inevitably break in use, but we want that number to be as small as possible, right?

Consumer Reports tested 22 condom brands for breakage. Unfortunately Durex Sensi-Creme was not one of them.

In February 2010 Consumer Reports found seven condoms that passed all their tests. It’s rare that anything passes all their tests. Our Ministry of Health condoms are not among of the seven top-scoring brands.

Assuming the seven that passed are the best condoms currently on the market, I have to ask: why doesn’t the ministry hand out one of those brands rather than one untested by Consumer Reports?

Maybe the Ministry of Health never bothered to research the quality of the condoms it purchases for us. Maybe it just does not care. Homophobia? More likely just uncaring.

Maybe the ministry wants to save money, especially since another department pays for treating sexually transmitted infections, including HIV.

Maybe the community never questioned the government on its choice of condoms before.

Granted, it’s not like the Durex condoms took the test and failed. They just haven’t been tested byConsumer Reports.

So, time to do some more research. I called the BC Centre for Disease Control (the arm of the Ministry of Health that gives out condoms) and asked:  “How was the brand chosen?” and “Do you have any data on breakage rate?”

The Centre for Disease Control got back to me and said they are concerned about quality but do not have ratings for the condoms they’re distributing. They said the supplier screens for quality, but no additional information is available.

So I called Durex to ask them about breakage rates for the Sensi-Creme condoms. They told me they had no data comparing different brands for breakage and that they knew of no other research regarding this brand.

I asked if they have a brand they recommend for anal sex. Durex manager Brandy Schwing did not know the answer to this question but said she would get back to me. She never did.

Some people might say, “Stop whining; the condoms are free. If you don’t like them go buy your own.” But imagine if someone told you, “Stop whining. We will give you mediocre heart surgery and if you don’t like it go find your own and pay for it yourself.

Xtra newspaper columns

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A hard man is good to find!

Author: November 15, 2011 0 Comments

A hard man is good to find

OPEN WIDE

Bill Coleman / Vancouver / Thursday, June 30, 2011

 

Hard cocks are usually fun, so it’s not surprising that many gay guys use Viagra and other erectile stimulants recreationally. They don’t necessarily need the drugs, but they can make life more interesting and fun.

What’s that saying straight females (or is it gay men?) have? Oh yeah: “A hard man is good to find.”

“It’s fun to walk around with a bulge in your pants,” many guys tell me. When you see a hot guy walk by you may start to feel those familiar stirrings in your loins, and when he stops to talk to you, your expanding bulge can quickly show him how interested you are.

There are many reports in the scientific literature about extensive use of erectile stimulants by gay guys. Several studies indicate that gay guys who use these drugs are more likely to be HIV-positive, but researchers are careful to point out that these drugs do not facilitate HIV transmission or make it easier to become infected with HIV. But, the studies suggest, with more hard cocks around there will be more sex, and if there is more sex there will be more risky sex and therefore more HIV transmission.

Well, that is the researchers’ logic, but we know that not everyone who has lots of sex gets HIV. Transmission is about risk-taking, not about the number of guys you have sex with.

Using erectile stimulants can even encourage condom use. One of the most common reasons guys give for not liking to use condoms is loss of erection, or the fear of losing an erection partway through sex. Some guys also find it difficult to come when using condoms. Erectile stimulants can help with all these problems.

If you stay hard, you can fuck freely without concerns about losing an erection, letting you relax and enjoy the moment(s). So these drugs can be very helpful for guys who tend to lose their erections.

However, there can be side effects to erectile stimulants. Common medical advice holds that you should not use poppers while under the influence of Viagra. I know this may be a hardship for some guys, but the combination can be hard on even a healthy heart. So you will have to learn to have fun with a hard cock and no poppers.

You should not use a metal cock ring when taking erectile stimulants because the ring can become difficult to remove, resulting in a painful situation with a cock that will not go down. This is called priapism. (This is not an ad for a local shop!)

Pilots are not allowed to use Viagra for a day before flying because it can affect vision. Some people have what they describe as a blue hue to their vision after taking Viagra.

Some guys have also reported problems with erectile stimulants that they buy on the street. So be careful where you get your drugs and how much you take. You may think that one pill is great, so two will be greater. Not so! Often people need only half a dose, so try that first. It is cheaper and you are less likely to have side effects.

Some of the studies suggest that taking some protease inhibitors in high doses can cause Viagra to be metabolized more slowly; the Viagra thereby stays in the body longer and has a more lasting effect. Guys taking protease inhibitors may want to try using a lower dose to lessen the side effects of Viagra, but this should be discussed with your doctor.

If you use erectile stimulants, be careful, have fun, know your limit and play within it.

 

Interesting stuff for gay guys, Xtra newspaper columns

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How often should you get tested

Author: November 15, 2011 0 Comments

How often should you get tested?
HIV / The higher the risk, the more frequent the test
Bill Coleman / Vancouver / Thursday, January 13, 2011

Most of us hate tests.Some of us thought the end of school meant the end of tests. But gay guys know better.

Gay guys face the prospect of additional tests for life — or at least until a positive one shows up. Either way, they’re not much fun.

Still, most of us should get tested regularly.

How regularly? Have a look at the matrix I created. It’s not intended to address all aspects of a gay man’s complex sexual life. It is only my suggestion for developing a testing strategy based on individual risk activities, rather than poorly defined window periods.

For more than a decade, there was some unhelpful advice that we should wait six months after a risk to get tested. The theory was it took six months for evidence of the virus to show up, and therefore six months to be sure a negative test was truly negative.

Now we know that testing three months after a risk, using the conventional antibodies test, yields a result that’s more than 99 percent accurate.

And now there’s an even quicker test available in some locations in BC.

No more waiting even three months for an accurate HIV result. The new early-detection test (called the NAAT test) can identify the presence of HIV in the body less than two weeks after possible exposure. The Health Initiative for Men is one of several clinics in Vancouver running a trial on this test.

We, as gay guys, have been the largest group of people testing positive for the last few years, so we need better information and guidelines on when to get tested. The BC Centre for Disease Control and other public health agencies should work harder to inform gay guys about testing.

In the meantime, I have made this general guide for gay guys. My theory: the greater the likelihood of testing positive, the more frequently we should get tested.

Open Wide appears in every other issue of  Xtra.

 


HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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Show us the real HIV transmission risks

Author: November 15, 2011 0 Comments

Show us the real transmission risks

OPEN WIDE / Stop dumbing down HIV for gay men

Bill Coleman / Vancouver / Thursday, February 10, 2011

 

Gay men need to know the truth about HIV transmission.

I asked staff at a local AIDS agency why they don’t tell people the whole story about the risks of HIV transmission. The reply was something like, “Well, we thought about it but decided not to.”

I tried to get another local organization to provide this information on its website, but they declined.

What is going on here? Do people think we can’t handle the truth? How can we make informed decisions when we aren’t given the information we need to calculate the level of risk we’re each comfortable taking?

Can you answer this question accurately: how likely is it that an HIV-negative guy will get HIV if he is fucked in the ass by an HIV-positive guy not wearing a condom? Most people do not know the answer and will guess wrong. The risk is not as high as you might think.

When I used to lecture groups about HIV, I would ask this question. Many people thought there was a 100 or 90 percent chance that the negative guy would get infected. Some ventured to suggest a 50-50 chance of infection.

The truth is the risk is far lower! If you’re getting fucked in the ass by a positive guy, the chance of transmission is one time in 200, according to the US Centers for Disease Control.

The only local place I know of that will tell us these facts is on the Spectrum Health website. It is not easy to find but it is there (www.spectrum-health.net/index.php?option=com&mdashcontent&view=category&layout=blog&id=83&Itemid=200).

Here is the breakdown of sexual transmission risks for gay men, according to the US Centers for Disease Control:

•    being fucked by an HIV-positive     guy who cums inside you:     1 in 200

•    fucking an HIV-positive guy:     1 in 1,500

•    sucking an HIV-positive guy:     1 in 10,000

•    getting sucked by an HIV-positive         guy: 1 in 20,000

I’m not suggesting we all go out and take risks. I’m just saying we’re all entitled to make our own decisions about how many risks, if any, we want to take.

If you like to fuck and get fucked but do not like condoms much, then you can see it is seven times more risky to get fucked than to fuck without condoms.  Make your own choice about how much risk you are comfortable taking and how important the sex is for you.

I also think there would be less stigma for poz guys if we all knew the real risks of HIV transmission. Maybe then negative guys would find poz guys less scary. Living with constant fear of getting HIV can become a huge burden. Knowing the facts can help all of us to feel more in control and can help in making informed decisions around our sexual activities.

Other factors can affect the odds of getting HIV. High viral loads and sexually transmitted infections make transmission more likely, for example. Whereas an undetectable viral load makes it less likely. (Needless to say, avoiding getting cum in your ass makes transmission even less likely.)

Newly infected guys can have a high viral load for two months or more and be up to 20 times more likely to infect someone. I have concluded that it may be safer to have sex with a poz guy with an undetectable viral load than with someone who mistakenly thinks they are negative but really has a high viral load, which is what happens three to six months after infection.

A final rule of thumb to prevent HIV transmission: don’t get cum in your eyes. Getting blood in your eyes in a hospital setting is considered high risk.

Open Wide appears in every other issue of  Xtra

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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If only there were courses on being gay

Author: November 15, 2011 0 Comments

If only there were courses on being gay

OPEN WIDE / How to make friends and connect with others

Bill Coleman / Vancouver / Thursday, July 28, 2011

 

 

If you ask me, the most common problem for gay men in Vancouveris a feeling of being lonely and disconnected.

I’m not talking about whether or not you currently have a boyfriend. I’m talking about not feeling close to anyone.

I believe that feeling of aloneness, of disconnection, alone/not connected, is the single biggest cause of guys becoming HIV-positive.

Vancouver may be full of friendly people, but there’s a common perception that it’s hard to make friends in this community. For most of us, making friends is an extremely important part of living a happy life. Feeling alone leads to social withdrawal for many guys. To build a strong community, we need to nurture confident, happy guys. We need to build a healthy community ourselves.

The beginnings of this strong community lie in supporting and respecting each other. As a therapist, I see many isolated gay guys who feel they cannot connect to anyone anywhere.

I have taken many courses in my life, most of them full of facts I did not want or need to know. But the two courses I’ve always wanted to take but could never find are Being Gay: How to Thrive in Gay Culture and Gay Sexuality: From Cruising to Kink and Everything in Between.

These are some of the most important skills for a successful, happy life, but they’re hard to learn with little or no guidance. I wonder why these courses don’t exist?

For more than 20 years, I have asked different groups in a number of cities to consider offering such courses, but no one has ever taken me up on the idea.  Maybe they’re right: maybe no one (except me) would sign up.

I’d offer the courses myself, but I wouldn’t have a clue where to start. I need them as much as — or more  than — the next guy.

I think bathhouses should offer monthly courses for new and old patrons alike. Imagine how much more enjoyable the bathhouse experience would be with a little instruction. (I’d sign up — I am a total failure in a bathhouse!)

And how about a course from online dating companies on Effective Bios and Effective Messaging: How to Find What You Want Online? They could even offer it online so people could remain anonymous.

I bet a lot of gay bar staff, who have observed years of bar behaviour, could give a course on How to Successfully Connect with a Guy in the Bar.

While we wait for gay school to start, there are some concrete things we, as individuals, can do.

We can smile more, make an effort to be more approachable and stop being so reluctant to say hi to strangers.

We can strike up a conversation first and not wait for the other person to find the courage to reach out to us.

We can stop expecting everyone to like us — and stop taking it so personally if they don’t. (Less than half the people you meet will be interested in developing a friendship with you, or with anyone else for that matter.)

We can be truly interested in the people we’re talking to, in discovering who they are and what they might share with us.

Remember: sitting at home knitting will not help you build friendships and connections.

You may wonder where I got my list of suggestions: it’s all the stuff I don’t do but think I should. I’ll try if you will. Together, maybe we can make a difference in our community and in our own lives.

 

Interesting stuff for gay guys, Xtra newspaper columns

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