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Gay Men, Sex(uality) and Crystal Meth Use

Author: May 21, 2014 0 Comments

Matters of Substance

Centre for Addictions Research of BC at the University of Victoria     http://carbc2300.wordpress.com/

 

Gay Men, Sex(uality) and Crystal Meth Use

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Drugs are people substitutes, people are drug substitutes¹

As a counsellor I prefer the term “drug use” rather than “addiction.” For many, addiction implies “bad behaviour” and can foster stigma and disempowerment for drug using individuals. One of the main characteristics of counselling is acceptance without judgment, especially when talking about sex with drugs. People use drugs for a reason, often to meet unfulfilled needs. Crystal meth was the most used illicit drug in the gay community during the 90s and early 2000s. While I am not an addictions specialist, about half of the gay men I see for therapy have current or past history of crystal meth problems. A common reason for gay men to use crystal meth relates to social and sexual inhibition and lack of connection to people.

Aspects of gay male subculture are dominated by sex. Within any medium size community, gay men can find sex within 10 minutes via phone apps. While such “hook-ups” frequently result in sexual release, they often do not meet their emotional needs. Many gay men struggle and cope with feelings of being different, or may have experienced various forms of abuse, and therefore question if they are lovable. Crystal may temporarily help users feel free of judgment, facilitate emotional connection with others and provide great pleasure with sexual partners.Crystal can also partially fulfill one’s sexual needs or fantasies, (i.e. engaging in “pig sex”), that otherwise might never be explored due to internal and/or external inhibitions. With reflection and support, these men often identify their desire for connectedness as the most important aspect of being high. Many report that without crystal, sex is boring because they are inhibited and cannot emotionally connect.

Crystal meth is not the problem but the symptom: the symptom of being unable to be free and spontaneous and therefore cannot connect with others. Thus, the primary goal of therapy is not to stop crystal use, but rather to assist the person in acquiring the skills needed to have uninhibited, drug-free and meaningful sex while feeling more connected with partners. This approach may require the therapist to be sexually open and sensitive to these topics in order to assist gay men to more intimately explore their sexual feelings and needs. As counsellors we need to lay the foundations of a nurturing therapeutic relationship that refrains from labels and judgments that disempower a person.  It seems with gay men and crystal use that, truly “drugs are people substitutes,” and with support, ideally “people can become drug substitutes.”

BillColeman

Author: Bill Coleman, counsellor

Biography: Most of Bill’s career has been working with criminals, primarily sexual criminals. He also works in the area of sexual health. Much of his work here has been with gay men at BC Centre for Disease Control, and many years in private practice.  He has also written for the LGBT newspaper, Xtra, on gay men and health. www.bcoleman.ca

¹  (Blachly, 1970) Seduction: A Conceptual Model in the Drug Dependencies and Other Contagious Ills, Paul H. Blachly, M.D., 1970, Charles C. Thomas, Springfield, Illinois

Interesting stuff for gay guys

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Achieving great gay sex with a partner

Author: February 27, 2014 0 Comments

EXPLORING GOOD SEX TOGETHER

 

This questionnaire is for couples who wish to explore improving their sex together.

Single guys can use this to better understand their sexual interests and then become more assertive in finding the sex they like.

 

It is best to fill this form out separate from your partner(s).  Try to be a through as possible in your answers.  If you need more space you can write on the margins or on other paper. Think of statements like: “I like it when you…”, or “I would like you to ….”, or “I would like to …….”.  Try to think as creatively as possible, and be as open as possible.  When you answer these questions please talk about what you would like from your partner(s) and what you want to experience/do with him/them.

Then get together with your partner(s) and discuss your answers.

These are the following categories you are asked to write your feelings about.

Kissing                                                  Hugging Holding                              Fondling/Groping

Body Touching                                  Nipple Play                                        Butt Play

Balls                                                      Cock                                                      Ass Hole

Cum                                                       Toys                                                       Fetish                                                  

SM                                                         Porn                                                      Drugs                                                   

Fisting                                                  Threesomes (+)                                                Talking during sex                          

Bath Houses/Parks, etc.               Open Relationship                          Sexual Hang-ups                             

Other

 

EXAMPLE:   KISSING

I like it when you :  stick your tongue deep in my mouth.

I would like more:  of the times you gently bite on my lower lip, it is nice.

 I kind of like/maybe like: kissing you hard and long

I don’t/not sure I like:  You spitting in my mouth, kissing in public

Other comments: I worry about me having bad breath sometimes.

 

KISSING

When we are kissing together, I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

HUGGING/HOLDING (non-sexual touching)

When we are hugging/holding each other I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

FONDLING/GROPING/CUDDLING (sexual touching, through clothes)

(for example: crotch touching, ass grabbing/patting, nipple tweaking etc.)

When we are fondling/groping each other I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

BODY TOUCHING/CUDDLING  – No clothing (sexual/sensual body touching, and/or cuddling)

(For example:  touching rubbing back/legs/face/hands etc, etc.)

When we are touching each other’s naked bodies I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

NIPPLE PLAY:

(For example: touching, licking, sucking intensity, etc.)

When we play with each other’s nipples I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

BUTT PLAY: (not ass-hole)

(For example grabbing, touching, slapping etc.)

When we touch/play with each other butts I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

BALLS:

(For example: touching, pulling, licking, slapping etc.)

When we are touching each other’s balls I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

COCK:

(For example: touching, stroking, sucking, licking, slapping etc.)

When we are playing with each other’s cock I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

ASS HOLE:

(For example: rimming, fucking, harder/longer/more often, clean, fingering, dildos, etc.)

When we are playing with each other’s ass hole I like:

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

CUM:

I have the following feelings about cum:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: _ _______________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

TOYS:

(For example:  dildos, electro, nip clamps, etc.)

I like it when you: ______________________________________________________________________

I would like more: ______________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t/not sure I like: ___________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

FETISH:

I have some interest in exploring the following fetishes:

I have the following fetishes I would like to explore/talk about: (for example:  leather, boots, jockstraps, water sports, scat, etc.)

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: ________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

SM:

I would like to maybe explore some of these things:

I would talk about/explore the follow “SM” stuff:   (For example:  being tied up, tying you up, whips, paddles, wax, slapping, edging etc.)

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: _______________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

PORN

I have the following feelings about Porn:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: ________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

 

Drugs

(For example:  Poppers, Marijuana,  E, Crystal Meth, Alcohol, etc.)

I have the follow feelings about sex and drugs together:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: _______________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

Fisting

I have the following feelings about fisting/fingering:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: ________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

Threesomes (and 4 and 5 etc.)

I have the following feelings about threesomes and 4 and 5 etc.:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like:  _______________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

 

BATH HOUSE/PARKS/PUBLIC SEX

I have the following feelings about bath houses:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: ________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

 

Talking during sex play

(for example: “that feels good”, “harder”, “I love you…” or name calling)

I would like to be able to say/express the following things when we are having sex.____________________________________________________________________________________________________________________________________________________________________________________________________

I would like you to say/express the following things when we are having sex.  _________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

SEX WITH OTHER GUYS (OPEN RELATIONSHIP)

I have the following feelings about an open relationship:

I am very interested in: __________________________________________________________________

I am curious about: _____________________________________________________________________

I kind of like/maybe like: ________________________________________________________________

I don’t think I would like: ________________________________________________________________

Other comments: ______________________________________________________________________

 

 

 

 

I HAVE THE FOLLOW SEXUAL HANG-UPS/CONCERNS/PROBLEMS

(For example: losing erection when I fuck, dirty ass hole, too shy, to horny, cum to soon, etc. etc.)

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

 

Other things not covered:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Interesting stuff for gay guys

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Gay men and Sex(uality) and Drug Use

Author: February 19, 2014 3 Comments

Gay men and Sex(uality) and drug use
Drugs are people substitutes – People are drug substitutes 1

When most people talk about drug use and sex, they think of addiction. So I should preface my comments on this subject with my take on “addiction”. First of all “addiction” is not a word I use. I believe that when people use the word addiction they are only describing what they see as “bad behaviour”. We have many repetitive behaviours that we do daily and perhaps compulsively but the word addiction would not be used to describe these behaviours. Some examples of such behaviours may be: I may wish to kiss my partner every day or a few times a day and have a negative feeling if it does not happen, I may like to cuddled daily, I may enjoy a few glasses of cold water daily etc. Often when the term “addiction” is used it seems to only provide a way of describing behaviour one is critical of, the label of addiction is not helpful and does not add to understanding.
Beginning a counselling relationship without acceptance and disempowering (http://www.pearsoned.ca/highered/showcase/shebib/pdf/samplechapter_ch07.pdf) an individual is a poor way to begin a counselling relationship. (http://www.ccpa-accp.ca/blog/?p=2996 ) One of the main characteristics of counselling is acceptance without judgment. (http://infed.org/mobi/helping-relationships-principles-theory-and-practice/) Starting counselling with a label describing the person as engaging in bad behaviour can be counterproductive. This is especially true when it is implied that “the person has no control over their behaviour.
People use drugs for a reason. There is an emotional need that is being met by the drug that is being used. Given this, the best way to begin to help an individual is to explore what they get out of using the drug. The next step is to help them to find other ways of meeting those emotional needs that more fully rewarding.
One drug that is popular with many gay men is Chrystal Meth. (http://www.wehoville.com/2013/12/02/crystal-meth-gay-men-start-load-road-addiction/ ) For some of those gay men crystal meth use can be problematic. Therefore without judgment I begin to explore with gay men what emotional needs does crystal meth allow him to satisfy. It often becomes apparent that most gay guys will use crystal meth to allow them to be the “sex pig” (http://cbrc.net/resources/2013/desire-and-defiance-pig-sex-project) that they would like to be, but do not allow themselves to explore without drugs. I was once asked to do a workshop on “Pig Sex” (http://www.realjock.com/gayforums/16537 ) . (Pig sex, is like pigging out at a Christmas dinner – that is eating too much, and a bit of everything.) The main point that came out of this workshop was: “We may not have the same kinks, but I know I will not be judged”. This lack of judgment allowed for a freedom in “pigging out”. Many gay guys have sexual needs/fantasies that they cannot fulfill without crystal meth. The use of that drug allows a person to explore many aspects of sexuality that may not be explored without some drug use, due to of internal and/or external inhibitions. It follows then that part of the motivation for crystal meth use may be because of sexual inhibition, and fear of judgment. If this true, than the goal is to help him to become less sexually inhibited, and be free to explore his sexual desires, without the problems caused by drug use. (I would suggest the therapist also must NOT be sexually inhibited.)
In addition many gay guys who use crystal meth are often looking for a feeling of being emotionally connected (at least for the moment) with the other guy(s). Many gay men grow up denying their sexual and emotional feelings. This denial of sexual and emotional feelings often happens because as the gay guy is growing up he will often have feeling of being different than other boys, of “not belonging”, and also questioning if they are lovable if parents and others knew they were gay. This sense of separation, being different, and questioning if they are lovable has a profound on most gay men.
Given that crystal meth allows a gay man to achieve feelings of connectedness, sexual openness and a feeling of freedom from judgment, it is not surprising that many gay men would be attracted to use crystal meth. Many gay men find great pleasure in what crystal meth can bring them. It is only because crystal meth is meeting these deep personal needs of a gay man that he uses this drug again and again and again. Often crystal meth users do not know of another way to feel sexually free and emotionally connected. Therefore, the goal is not, to stop crystal meth use, but to find ways to be sexually uninhibited and emotionally connected with other gay men. Stopping or reducing crystal meth use may be a byproduct of a happier more fulfilled life.
Craig Sloane reports that “By using gay affirmative treatment,” and “Promote self-acceptance, create safe and non-judgmental environments. We have to set up treatments that don’t pathologize gay sex.” (http://www.addictionpro.com/article/crystal-meth-and-its-use-among-gay-men )
Counsellors need to begin laying the foundations of a nurturing therapeutic relationship that refrains from labels and judgments that disempower a person. The therapist must recognize that drug use is meeting a person needs. Explore those needs and seek alternative ways of meeting those needs if drug use if problematic.

1. (Blachly, 1970) Seduction: A Conceptual Model in the Drug Dependencies and Other Contagious Ills, Paul H. Blachly, M.D., 1970, Charles C. Thomas, Springfield, Illinois

 

Most of my career has been working with criminals, and much of that with sexual criminals, I also work in the area of sexual health.  Much of my work has been with gay men at BC Centre for Disease Control, and in private practice.  I wrote a column in the local gay newspaper, Xtra, on gay men and health.  I tend to see the “problem behaviour that is presented” as the symptom,  (for example:  Sex, drug use, violence etc.) the goal is to discover what are the many facets that are pushing that behaviour.  Gay men have generally grown up emotionally alone, afraid of discovery, being taunted-bullied or teased with a constant fear of rejection from parents, family, friends, and classmates, this provides a unique obstacles later in life. (For more info: www.bcoleman.ca)

HIV STI info, Interesting stuff for gay guys

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How HIV agencies marginalize HIV+ guys

Author: March 7, 2012 0 Comments

 

 

Many HIV organizations will tell people to “know the HIV status of your sex partners”, I think this is bad advice.   There is now at study that shows it is bad advice.

 

It seems that anyone who tells you to know the status of your sex partner is setting you up for risk for becoming  HIV+.   The first question is why do you want to know the HIV status of your sex partner?  If you are fucking with condoms, then their HIV status does not matter.  If you are not fucking then HIV status will not matter.

 

When you compare the amount of HIV virus a person has, the guy on effective treatment likely has an undetectable load, (meaning <40), the guy who is most likely to have 200,000 time more HIV virus in them is the guy who thinks he is negative, not the poz guy.  He may have 200,000 times more virus than the poz guy on treatment for 4-26 weeks.  This makes the guy who thinks he is negative much more likely to pass on HIV.

 

Well lots of us guys fuck without condoms at times.  We know this happens, a lot.  By playing with the stats, we are trying to find ways to make fucking without condoms ok.   Well it is not easy to do.  Monogamy is one possibility, but I have talked to too many guys who say “my boyfriend thinks we are in a monogamous relationship.”  Only fucking with negative guys is another but we cannot know if they are truly negative.

 

Why would anyone tell you to know the HIV status of your partner, it seems beyond reason to me.  A person can only know their HIV status if they are HIV+, or not having anal sex and had a negative test.   Someone you meet for sex will almost for sure not be able to know they are negative.  They can say they had a negative test last month, last week or yesterday, but that does not mean they are truly HIV negative. (Positive results do not show for 10 – 90 days depending on the test.)

 

Talking about HIV status as a screening device to decide who you will have sex with goes a long way to marginalize and stigmatize HIV+ guys.   Do we really want to isolate and discriminate against 20-25% of our own population?  A study in the last year, explored anal sex contacts of 2623 gay guyswho do not always use condoms. The results showed that serosorting , that is: assuming, knowing,  or being by a sex partner that they are HIV-  -only gave a person a “small decrease in risk of getting HIV”.

 

How do we make the decision to fuck without condoms?  We know it is a risk to become HIV+.  So, some of us will drink too much to really think about it.  Some of us will do other drugs to “not care” at the time they are fucking.  Some will tell themselves he is so nice, so hot, in such good shape he cannot be HIV+.  I often think if someone wants to fuck with me without a condom, do I think I am special and the only one he does this with?  If there are other guys he fucks with then there is a bigger chance he may be positive without knowing it.  Some guys will ask if he is negative and then feel the chance is lower.

 

So we have a widely accepted practice of telling guys to “know the status of their partners, we now know this is bad advice.  This advice will further divide our community into HIV+ and HIV- guys.   We need to support each other, have sex together, and accept our differences.

Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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More on genetic immunity to HIV

Author: March 7, 2012 0 Comments

 

UPDATE!!!

http://www.delta-32.com/  This website will now give  you the test for HIV immunity.

The map below show where people are most likely to be immune to HIV.

Picture

 

Some people are immune to HIV (well, almost totally immune).  There are thousands of organizations giving public messages about HIV, but very few will talk about genetic immunity to HIV.  The general understanding of immunity to HIV is that some 1% to 3 % of the population is immune to HIV because of the genes they carry. People fromSwedenorNorthern Europeseem to be more likely to have this genetic immunity.

However, there are a few people who have become HIV+ even though they were supposed to be immune. This is an extremely small number, but the immunity is not 100%.  When I talk about immunity in this article,  I, am therefore referring to almost total immunity.

I first heard about HIV immunity back in the mid/late 90s.  At that time, a gay guy who I knew socially told me he was a researcher who was doing research into genetic immunity to HIV.  He told me that he felt that the only way someone who had the CCR5 gene (the name of the gene linked to immunity) from both parents was for them to have the virus in the anus from someone who had fairly advanced stage of HIV.  I have lost track of this guy, but the last I heard he was still working on this research in theUSon the East Coast.

To be immune to HIV both of your parents must have the CCR5 gene.  IF only one of your parents have this gene, then you will be less likely to become HIV+, and if you do become HIV+ then you are more likely to be a non-progresser, which means that HIV will not have as severe effect on your body.   About 10%-15% of the population fall in this group of being less likely to become infected.   One study from 2001 in Science Daily reported that persons with the CCR5 gene from one parent “had a 70% reduced risk of HIV infection”. I have talked to lots of guys who say: “I have had lots of unsafe sex and I am still negative so I must be immune”.  Well it may be, or it may also be that instead of 50 time of unsafe sex it may take 400 times before this person becomes infected.

I found a story by the Australian Federation of AIDS Organisations Inc. (2007) describing an Australian company, delta32.com.au, who advertised on Gaydar.com.au to offer CCR5 gene testing.  Two organizations complained that the company should not test gay guys for the CCR5 gene, and the website was soon closed.  Many other websites I found were closed down, or did not reply to my emails.  There appears to have been pressure to make sure people (gay men) are not allowed or encouraged to find out if they are immune from getting HIV.

Despite this, it is possible to get tested for the gene that causes HIV immunity (CCR5).  But before we go there, there are a few important questions to consider.  These questions are:  Would you want to know if you were immune to HIV?   What would you do with that knowledge?  Would you stop using condoms?  Would you believe someone who told you they were immune to HIV so they do not have to use a condom to fuck you? What about STIs?  How much would it be worth for you to find out if you were immune to HIV?  These are all interesting and difficult questions to sort through.  But the real question, I believe is: should you have the right to know that you might be immune to HIV?  Is it better that we do not know that HIV immunity exists?  Does this make a better and safer society?  I have no clear answers to these thought provoking questions.  But I tend to believe that honesty and transparency makes for a better society.  I do not think there are many times that hiding information from the public is a good idea.

So, I did a great deal of searching online to find someplace  you might find out if you had the CCR5 gene and if from one parent (partial immunity) or both parents (almost complete immunity).

IF you are an HIV+ guy, would you want to know if you had one of the genes meaning that you are less likely to have complications from HIV?  I am sure there are some people that think that people should not be allowed to know if they have the CCR5 gene.  But if you are not one of those and are interested, here is how you can find out if you have the CCR5 gene from one or both parents.

There is a company in the UScalled “32andme” that does a broad range of genetic tests, including testing for the CCR5 gene. To order the kit, and instructions on how to send a saliva sample to the company in the US, go to  https://www.23andme.com/store. The test costs $209 US (so that is about 50 cents Canadian LOL).  To see an example of the report you will receive, look at:  https://www.23andme.com/health/Resistance-to-HIV-AIDS/ .  I assume there are other places that test for HIV immunity, but I did not find them.  I hope that readers will post addresses of other places to get tested for CCR5 at xtra.ca as a comment to this column.

I wonder if the reason people do not hear much about HIV immunity is that some will worry that it will perhaps give people a licence to not practice safe sex.  If there is more condomless sex, then there is the chance of spread of STIs.  However, it is important to remember that we are only talking about a small number of guys who will be immune to HIV.  Although we should find in the gay community that older negative  guys who have frequent condomless sex are much more likely to have the CCR5 gene because many of those without it protection will have become positive or will have already died.

 

 

 

 

http://www.wired.com/medtech/health/news/2005/01/66198?currentPage=1

http://www.afao.org.au/library_docs/policy/Delta_32.pdf

 

 

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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More on gay guys and drug use

Author: March 7, 2012 0 Comments

 

 

There are many things that gay guys may do to excess.  The excess causing the most problems I see in our community are:  alcohol, Crystal Meth, coke, body image concerns.  The things that we do not do enough of are: self love, support for each other, self acceptance as we are, pursuing things that make us really happy.  Here I will look at the excesses.

Is there anything wrong with occasionally using drugs?  While some gay guys do not use substances there are many who do.  A few of those who use substances sometimes have trouble because of their use.

Some of the main problems around substance use are: unsafe behaviour, using drugs so much that is causes problems for the user i.e., financial concerns, and disrupting relationships, hindering personal growth.

I have tried to experience most drugs during my life, but I have not achieved that yet.

I think that the typical way of approaching problem substance use is to focus on the drug and not on the reasons for using the drug(s).  There are reasons why we may use drugs.  Drugs do something for the user.  The most common benefit we look for in substance use is to feel free/uninhibited.  Crystal Meth is a good example of this.  Crystal Meth often allows guys feel sexually free; to be free to be the sex pig they would like to be but are too inhibited to freely enjoy such sex without the assistance of drugs.  Alcohol also helps guys to feel less inhibited; coke can help guys to feel less vulnerable/more in control.  Marijuana can help us to feel more mellow/relaxed.

So the common theme behind most of this substance use is to compensate for feeling inhibited.  We do not feel free enough to be ourselves.  We learned at an early age to not be the gay kid in school, to not be who we are, to hide who we are … to inhibit our natural feelings.   It is no surprise to see our community use drugs that helps us to feel less inhibited and freer to be ourselves.

Most of us spent years trying to survive childhood and early adulthood by hiding our feelings, because we felt that was the only way to survive and thrive.  We knew that there was a risk in being free to be ourselves, these risks are real and intense, the most common fears of being ourselves centred around: safety risks (gay bashing), risk to our career advancement, risks to being teased or bullied in school, risk of losing love of our family/friends.  This early trauma of threat and survival will have an effect all our lives.  Some of us can use these experiences to make us stronger, confident that we can handle what comes our way.  For others we feel afraid, scared to be; apprehensive about the world that seems unsafe and unfair.   For most of us it is a bit of both.  (For me I think part of the reason for getting a PhD is to prove I was ok I was acceptable.)

It is not surprising that some of us use substances.  I believe that drugs are not the problem.   Drug use is the symptom. Usually the symptom is our trying to cope with fears and inhibitions in our lives.

Some guys find the traditional drug abstinence programs work for them, but many do not.

So what is another way to approach drug use in our community?  There is no one answer for everyone but I believe that for most guys it is important to explore what we get out of our drug use.  How can we get that same result without problematic substance use?  An example of this might be, how do we be free enough to be the sex pig we enjoy being without Crystal Meth?  Again in this case Crystal Meth may not be the problem but the enabler to allow us to be free.  Crystal often provides the sense of being free/spontaneous/inhibited, but most guys find the actual sexual stimulation/organism is less important than the feeling of being free to be a sex pig.

We all use substances to help us feel better it may be coffee, alcohol, chocolate, etc.  Do these substances we use bring us closer to being the person we feel good about, and do they make us a happier better person?  If these substances do not contribute to our ultimate happiness then we may want to make some changes.   We must understand our fears and inhibitions as well as work on ways to change our habits.  I think drug use is not a bad thing but if we feel it is not helping us to be the best we can be, then we may want to make some changes.  Some things that we can do is use less of the drug, try a different drug that does not cause us problems.  But addressing the underlying issues is important to grow to be who we want to be.  This may involve counselling, or self-examination, or just pushing ourselves to take some risks to be more our ultimate ourselves.

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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Help for gay guys to decide when to have bareback sex

Author: March 7, 2012 0 Comments

 

 

Sex between guys can be very complex.  Often when guys begin a sexual encounter they do not know how it will unfold, will it include: sucking, ropes, handcuffs, fucking, rimming, piss, electricity, alcohol, drugs, lots of alcohol, sounds, scat, tit play, other guys, fisting and many others.  The creative play between two guys exploring where their sex will go it part of the fun.

 

Reducing safe sex messaging to a simple prescription of “use condoms” is not very helpful, because we already know that message but who helps us to make the decisions in a complex playful experience of having sex.  The medicalization of safe sex messaging has not served us well.  Almost all new HIV infections now have emotional and psychological reasons as a main cause for lack of condom use.  The medical professional is not trained to integrate the emotional and psychological causes of problems, they are trained to look for medical causes.  Where is the messaging that helps us make the decisions we are comfortable with?

 

Let me give an example of how a psychosocial messaging may be more helpful for guys

 

A while ago a guy asked me, if he as poz bottom with long standing undetectable viral load could be fucked without condoms by his boyfriend who was negative.

 

I, as a person trained in psychology, made a few suggestions as follows:

 

1.         Consider how upset would your boyfriend be if he became poz.

 

2.         Also consider how upset you would be if your boyfriend became poz.

 

3.         Some people think that if either you or he have an STI that HIV transmission is more likely, so you could decide to not have unprotected sex outside the relationship.

 

4.         Some people think that if he cums and/or pees after fucking it will clean out the urethra and reduce the chances of getting HIV.

 

5.         If you (the poz guy) get a cold or some other infection your viral load MAY go up; you may wish to be more careful at these times.

 

6.         The spectrum Health website (the largest group of doctors treating gay men and HIV poz guys in BC, suggests that without an undetectable viral load there is 1 in 1,666 chance of getting infected as a top for each fuck.  (6.5/10,000) We can assume that with an undetectable viral load these odds are much less.  The exact chance of getting infected is not known but it may be 1 in 10,000 or maybe 1 in 100,000.  (BC is spending $50 million to reduce HIV poz guys viral load in an effort to reduce transmission; so they must believe that this will have a big effect in reducing the number of new infections.)  (The cynic in me thinks that it is not $50 million being spent because they care about the welfare of poz gay guys, or other poz persons.)

 

So by using the complex information above they can make decisions about the kind of sex they choose to have.

 

Notice that none of the above are “shoulds” but only things to consider when making decisions.  Medicine is good at “shoulds” and “musts” – at prescribing – a behaviour.  He did not want a prescription, but he really wanted to know was “what do I need to consider if we proceed with not using condoms” (if that is our choice).  He knows the normal message of use a condom, that is not what he is looking for and if no one helps him to know what to consider and give him an understanding of what are the risks and  how to reduce those risks of transmission he/they will be “fucking in the dark” – so to speak

 

What is interesting about this question is why he did not go to a medically trained person to ask this question.  I believe that he would have gotten a medical response that is prescriptive and not really useful for their decision making.  The medical profession has done wonders at supporting, treating and educating all of us on HIV.   But, the medicalization of HIV safe sex messaging has run it course.

 

It is time for medicine to step aside with the less than useful messages.  We need a psychosocial approach that will help us makes decisions that fit in our complex lived sexual experiences. What is needed is to understand that only pushing condoms is not effective.  What we need instead is messages to help guys to make informed decisions around their complex sexual decisions.

 

If there was more space I would add the following:

 

We need help to understand when and how we find ourselves vulnerable to take risks that are outside our comfort level.  For some it may be when drinking, for others it may be when depressed, for others it may be when horny, or lonely, or he is hot, or any number of things that we all need to understand more about how we put ourselves in situations where we are not comfortable afterwards.  In my experience the general pattern is when a person feels their life is falling apart, (job loss, boyfriend break up, money problems etc.) then they may do things that later they wish they had not done.

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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Risks and HIV Transmission for Gay Men

Author: March 7, 2012 0 Comments

 

 

This one tends to continuation on from my last article in Xtra on 15 Dec 2011, but from a new angle.

 

I recently talked to an MD who works for the government in the field of HIV and s/he said that we need a nuanced message to deal with the new information out there about undetectable viral load reduces the risk of transmitting HIV.  S/he feels we need new messaging because s/he see people every day coping with viral load questions.  My response was that the CDC does not know the meaning of nuance they only know short messages with an all or nothing message, Later I talked with one of those bureaucrats that is part of developing those all or nothing messages. (S/he does not see patients in real life, and I wonder if s/he only knows about sex from journals and books.)  S/he confirmed s/he likes the all or nothing short simple messages.  Short and simple seems to be more important than how accurate the message is.

 

 

 

What if you wanted to go skiing and wanted to make sure you would not get injured in an accident on the dangerous highway 99.  You could decide to drive only between 2AM and 3AM, when there are fewer cars, you can get the best snow/ice tired there are, you can get the safest car with the most air bags, you could decide to only drive on days when there is no snow or rain.  But likely this would not be practical or fun – but safer.  Likely you will just drive to the ski hill when you want to ski and tell yourself to be careful.  After all you did it for two years and had no problems so just tell yourself to be careful.  Well it is a lot like fucking.  There are things you can do to make it safer but they may not all be fun or practical.

 

The Journal Science has declared that the scientific breakthrough of 2011 was a study (HPTN 052), this study found that a person with an undetectable viral load reduces transmission of HIV by 96%.  One article said “Having an undetectable viral was as effective as condoms.

 

That is like going to buy a pair of jeans for $100.00 but finding out they are reduced by 96% so they now cost $4.00.  That is a huge difference.

 

So lets look and what this means for fucking without condoms.  If you are getting fucked raw by a HIV poz guy with and undetectable viral load the chance of getting infected goes from 1 in 200 (no HIV treatment) to 1 in 5,000.  If you are fucking a poz guy raw with undetectable viral load the chances of getting HIV goes from 1 in 1,538 (no treatment) to 1 in 38,461.

 

So if you have sex with a poz guy with an undetectable viral load and if you use a condom that reduces it a further 96%.  So it is like those $100 pair of jeans go to $4.00, and then are deduced again by 96% and now they cost 16 cents.

 

We are told that BC government is spending $50,000,000 to get as many positive persons as possible to have an undetectable viral load.  They call it “Treatment as Prevention”, but that is just the marketing to the government.  It is not preventing HIV transmission but it is reducing the risk of getting HIV by 96%.

 

The risk of fucking without condoms changes dramatically – yea it is reduced by 96%!.  What do us as gay guys do?  Do we take more risks?  Do we decide that maybe we play more in the sandbox with the poz guys with undetectable viral load because they are not so scary now?

 

Do negative guys become scarier to play with because 2.5% of them may be poz and not know it and therefore may be 20 -25 time more likely to pass on HIV. For the guys who think they are negative but are newly positive then getting fucked by them changes the risk from 1 in 200 for a (poz guy with detectable viral load) to 1 in 10 for newly poz guy.

 

You may ask a negative partner if he get tested on a regular basis.  If he does it likely is because he is concerned he is maybe positive.  So why would you think he is negative if he thinks he may be poz and gets tested regularly to find out.

 

So if you decide to have sex only with guys who believe they are negative what is the chance of getting HIV?  We know 2.5% of those guys who think they are negative are really positive.  If we assume that those 2.5% are newly infected and that is why they do not know they are poz then the chance of becoming poz is about 1 in 200 if you choose only guys who think they are negative.   An interesting number – it is the same number as getting fucked by a poz guy with detectable viral load.

 

Where do all these numbers leave us.   Well poz guys with undetectable viral load are a lot less likely to infect someone then if they did not have an undetectable viral load.   Negative guys who will take risks with you will take risks with others also, – did you think you were special – so he may be poz.

 

A number of negative guys have told me that often poz guys are just more fun to have sex with than negative guys.

 

So where does the leave us?  Are poz guys (with undetectable viral load) sought after now, and are the “negative” guys shunned as having the potential for infecting others?  The science may say there is a good case for this.  But after all it is fear and prejudges that made many negative guys shun poz guys in the first place, – it was not science!  Our prejudges against poz guys as sex partners will not change easily.

 

What we do not need is the institutional marginalization of poz guys.  Many organizations will tell us we are at higher risk if we have sex with a poz guy.  Surveys ask “do you have sex with poz guys?”, they then tell you are at more risk if you do have sex with poz guys, this is not true if the viral load is undetectable. The institutional response should be: “ know your partners viral load” not his HIV status!

 

Well this is my last regular column in Xtra,   I plan on doing a retrospective piece next month outlining what I have learned while writing these pieces and bring up a few points to consider.  I may be back with the occasional writing on gay men’s health.

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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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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