Dr Bill Coleman > Blog > Stuff that did not make it in the newspaper

Stuff that did not make it in the newspaper

Why no one speaks for Gay Men’s Health concerns

Author: March 13, 2012 0 Comments

 

 

IT may be time to explore the systematic causes for the reasons that gay men’s health is being generally ignored by governments.  Before our health needs will be addressed appropriately we need a strong lobbing or advisory group who is not government funded and it free to take a strong stand on important issues.

An example of poor government action on gay men’s health is PEP.  PEP will effectively halt HIV infection in persons who have had a risk the previous day (or two).  PEP has been made available by many governments around the world.  Even in what some may think of as a slow and backward country like South Africa has made PEP available for years.  But, not in BC.  Why are we so slow?  Why have gay men become infected by HIV for years when they did not need to be?  I believe that it is because we have not had a strong independent voice to harass the government and force change.   HIM over a year and a half ago wrote a paper on the benefits of PEP and quietly lobbied the government.  An influential gay physician wrote a strongly worded letter to the government body responsible for PEP, pushing for PEP.  Yet still we have only a local trial of the use of PEP that begins this month.  If you do not live in Vancouver you are out of luck.

A local gay agency has had some of its funding withheld because this Conservative government did not approve of their actions.  We cannot count on our non-profit agencies to take strong stands against government.  If they do embarrass governments then we risk them losing funding, and us losing these effective agencies in our community.

In the early 80s the agency which preceded Positive Living (PWA) was loud and unrelenting in forcing proper care and treatment for persons with HIV.  Guys were literally fighting for their lives, and it is because of this that they were able to force governments to address the needs of those with HIV.  We now have no group who can forcefully stand up to the government to demand proper policies and services for gay men.

When profit is part of the equation then policy advancement slows dramatically.  It took almost 20 years of research to “prove” that cigarettes cause cancer.  Everyone admitted that there was a link of cigarettes and cancer but no real proof of the cause for over 20 years.   In our case we have a study that was done that saw that people who used water based lube for anal sex were three times more likely to get HIV or STIs.  Upon exploring this relationship more it was found that likely most water based lube damages anal lining.  Now we are two years after the original research but no authority will advise you to consider not using water based lube, until it is further understood.  Though there may not be “proof” of water base lube causing HIV and STI transmission you should know there is an apparent link and you can choose lube according.  Who is advocating for us?

Another example of poor government policy came to light when I was writing about condoms provided to our community.  I was told that the Ministry of Health formulates it policy for the entire province.  They would not tell me what criteria was used to select “proper” condoms, or who was on the committee that is charged with this task.  If 10% of the population is gay, then 5% of the provincial population are gay men yet they account for over 50% of the HIV!  It seems only sensible that the most useable and effective condoms be made available to gay men.  No changes will come about until the government is forced to take action.

I am calling for the Provincial government to formulate a committee of gay men who are not part of the government or government agencies who are not afraid to ask difficult questions and push for effective public policies for our community.  Current policy that is formulated seems to come from persons who read about gay men and their sexual behaviour, but I wonder if any of them making policy affecting gay men really understands the complex dynamics that are part of our sexual community.  It seems only reasonable to ask “the experts” – in this case the experts are not those who read about gay men’s sex but those who know and understand the complexity of gay sex.

 

This is my last regular column in Xtra, but you can follow some of my thoughts on my blog – bcoleman.ca where you can find writing that did not make it into print and other random thoughts.

Stuff that did not make it in the newspaper

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Don’t stigmatize the poz guys

Author: March 13, 2012 1 Comment

 

 

 

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, Stuff that did not make it in the newspaper

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Women have to make gay helath policy – where are the gay men?

Author: March 7, 2012 0 Comments

 

 

Gay sexual health policy driven too much by women

 

For years I have been at meetings where discussion of sexual health messaging, policy and procedures is taking place.  Too often these meetings are dominated by women. Few men and often I am one of the only or few gay guys there.  Of course many meetings happen that I am not part of but it seems like most of these meetings are dominated by women.

 

I was told by a gay guy that he attended a half day meeting about spending the $50 million dollars for BC HIV “prevention” (this is another story for next time, 50 million for what?), he said the presenters never mentioned the words gay, MSM, homosexual.  But there was discussion on mother to child transmission,  which has happens much less than one time a year.  I must add that the women try hard to understand gay men’s issues.  Not long ago I was at a meeting (the only gay guy in the room), it was about gay men’s sexual health issues.  There was discussion about a new term “pig sex”, and this was being explained to all assembled.  It feels strange to be sitting with a bunch of straight females talking about gay guys having “pig sex” (as a new phenomenon). Where are the gay men in these discussions?  If gay men are not part of the discussions then who will try to understand our needs, someone has to.  It is not easy for someone outside the community to fully understand, it is hard work for these people, they need our help.

 

An example of this kind of ineffective practice is a situation where men would be telling women about what being pregnant is like.  They can talk about it and have an understanding of the concept of pregnancy but they can never know pregnancy the way a women can.  The women often involved in gay health research, know their limitations, want to understand and want to help gay guys live a healthy life.  I have always felt welcomed and my comments as a gay guy are always greatly appreciated, but ultimately most policy and procedural decisions about treating gay guys are made not by gay guys but by straight women and straight men.

 

HIV education needs to acknowledge as a basic truth that sex for gay men isn’t just a collection of physical practices to be modified.  It’s how we relate,  how we connect, and yes, love.  Understanding that is where HIV education needs to start.  I modified this quote from:

http://www.dailykos.com/story/2010/9/3/896919/-WGLB-presentsYou-Cant-Handle-the-Truth%21:-Gay-Men-and-HIV-Education  It is an interesting article that examines some of these issues in more depth.

 

Gay guys are the largest group of new infections of HIV, by far!  Gay guys are the largest group of group of new syphilis cases by far.  If gay guys are such a large group of the sexual health clients then where are they in being included in part of the solution.   It seems like HIM (Health Initiative for Men), and PWA are well placed to have or develop their expertise in sexual health of gay men, and should be a permanent consultant to all discussions about policies and procedures relating to gay men.  I do not think they are asked for their input and understandings very often.  Gay men should be a main part of all training of sexual health nurses, because they are the main part of the positive syphilis

Stuff that did not make it in the newspaper

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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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Letter about the condom quality article that one person did not like

Author: March 7, 2012 0 Comments

 

 

I have spent over 20 years talking to gay guys about their lives, their sex and HIV. Having shared the pain of HIV with hundreds of guys, I think I am extremely sensitive to the agony that HIV can cause.   I will do what I can to help our community to grow strong and be healthy.  Hence the motivation for my writing a health column in Xtra.  I hope to never attack anyone in our community or any community organization in this effort, however I will criticize the government (and others) and their policies when they are harmful to our community.

I was surprised that there was controversy about my column on condoms.   My intent was to question the quality of condoms the government is providing.   I had expected that both BCCDC and maybe other organizations would come out with statements to the effect that they wanted the best possible condoms for our community and that they would research condom failure rates in an effort to help keep our community safe and healthy.  I researched the facts before I wrote the column, and did more research after it was published.  I stand by what I said in the column in Xtra.  US FDA began to use the same international standards as Canada in 2009, their standards before 2009 were very similar to the international standards Canada uses.  In both countries condoms are medical devices.    I am hoping that the column on condoms will result in the best possible condoms for our community.   It is too bad that we have not seen progress on this issue so far.

Stuff that did not make it in the newspaper

More stuff on Condoms and quality

Author: March 7, 2012 0 Comments

 

 

Who thought condoms could be so exciting?  Here I am again talking about condoms.  I thought that there would not be so much to say about these little guys but I guess there is. There are a few points to talk a bit more about.

 

First of all just about everything you buy inCanadahas some kind of standards that it must pass.  I could not think of anything that didn’t.  At first I thought maybe if you buy dirt for your flower patch it would not be controlled, but no almost everything has to pass standards, this includes condoms.

 

Condoms in Canada must adhere to International Standards.  US also in 2009 began using the same international standards for condoms, before 2009 they only used a US standard that was almost the same as International Standards.   So if you go to theUSand get condoms they too should be equally safe as you good old Canadian condoms that you are used to.

 

I asked Jody Jollymore at HIM about their condom distribution program.  Though they have not done a formal survey of their condom users they hear good things about them.  Jody feels that the current condoms are better than the old ones that they used to provide, in that he gets reports that they are thinner and feel better.

 

All condoms brands will have a few that break in use as Consumer Reports says some brands will break more than others.  Studies of heterosexuals show about 1% of condoms break.  But maybe (it is only a guess) gay guys with more practice and experience have a lower percentage of breakage.  But it is interesting that if HIM gives out 150,000 condoms in a year, 1% breakage would mean 1,500 would break, if we are better at using condom than most and have half the breakage rate then 750 of these condoms would break.  But no one, not one person, reports condom breakage to HIM. Elgin Lim of Positive Living also told me that they do not get reports of condoms breaking.  I personally in social discussion do not hear of condoms breaking, but as a therapist I do hear of them breaking and it affects peoples relationships, and sense of safety and security in having sex.  But it seems people do not talk much about condom breakage socially.

 

Now for some good news.  Jody told me that HIM will respond to requests for larger condoms and non latex condoms by providing these condoms at the Sexual Health Centre beginning next month (he hopes).  (address and opening times here???)

 

Non latex condoms are important for guys who have allergies to latex.  Many guys may not know that they have a latex allergy.  I am told that a non scientific test to explore if maybe you have a latex allergy is if you blow up a balloon or two or three and your lips tingle and feel a little numb you may have a latex allergy.  This maybe something you want to explore further because you do not want your cock or your asshole to feel numb, feeling is part of the fun of fucking.

 

I talked to Elgin Lim at Positive Living Centre about their condom distribution program and he said they get their condoms from Vancouver Coastal Health, he said that they receive comments on their condoms that they are a bit “basic”, guys say they do not fit well or feel good to use.  They are trying to obtain different condoms for their members.

 

I asked BCCDC how they choose their condoms and at press time they could not provide an answer. So there seems to be no more information I can find as to how BCCDC chooses their condoms and how they rate in terms of failure rate to other brands.

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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A year of writing for Xtra Newspaper and what that was like

Author: March 7, 2012 0 Comments

 

 

It has been a year since my first column came out.  It is time to talk what has and has not changed  in that year.

Know the risks of HIV transmission got lots of attention, and some professionals in the field of HIV did not like it.  I only quoted Spectrum Health’s website for the data, but people who did not like what I said about risks attacked me but not the 10 doctors at Spectrum who specialize in the field. Interesting I think.

PEP (Post Exposure Prophylaxes) seemed to stir some interest.  Although BC is generally advanced in addressing HIV issues, we are backward in addressing PEP.    Guys can be kept from getting HIV by going to the Hospital emergency room and getting PEP.  But BC is slow to act, now that is about to change.  In the next few weeks PEP will be available to guys who feel they were exposed to HIV. The wheels move slowly and every day more guys are needless infected by HIV, but finally PEP will be available soon!

What happened with the condoms?  Well I was told by the media person at BCCDC that a committee decides on which condoms will be bought,  I was told that I would not be told who is on that committee and I would not be told what goes into making a decision.  But now there are new condoms provided for the public.  I manufacture of these condoms claims that they exceed the US and International standards for condoms.  The only criticism I have seen about the new condoms it that they may be a bit small.  Now the HIM clinic at 1033 Davie gives out larger condoms and non-latex condoms.

Where is the wart vaccine?   I am told that the BC Cancer XXX will be recommending that the wart vaccine become available for males.  I talked to a doctor in the field and he said that if he were again out on the sex market he would get the vaccine because it has few side effects and help a person immune system cope with the wart virus.  A very nice nurse took the time to review my article and point out places in my article that were unclear and could have presented the issue more accurately.

Loneliness feeling disconnected.  Well this one seemed to get the most positive reaction for people.  It seems though that most people could identify with the problem.  But most people in the helping business seemed to miss my point that though there are many activities for gay guys to participate in, there are reasons they don’t.   People are less likely to attend group discussion than a course where because of shyness (or whatever).   I called for courses to help guys address their isolation but people seemed to respond with the same programs that are out there.

I expected a lot of reaction to HIV immunity but it seemed like interesting information at people took in to use as they might.

How often should you get tested?   Well BCCDC is working on a policy about how often gay guys should get tested.  I think that risk based testing as well as routine testing is the best answer.  IF you have a risk then get tested, if you tend to be a bottom who has lots of sex then your routine might be every 2-3 months, if you tend to be a top than every 3-4 months get tested.  We will see what BCCDC has to say eventually.

Now for some personal reflections about this column.  Not everyone likes what I say here.   I was surprised how intensely some people will react to me voicing my opinion.   I think I am a bit naive about this, but I did not expect some of the reactions I got.   Someone lobbied Xtra to have me fired, I felt bullied by someone.  Some professionals started talking about me being mentally ill in an apparent attempt to discredit me.  One person hit me, though it was not an assault it was harder than necessary just to make a point.  And there were many guys who will come up to me and tell me how much they enjoy what I write about.  I hope it is useful and gets discussion going about important topics for our health. My goal is to create a healthier and happier community for us all.

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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The failure of medical community in delivering HIV messages

Author: March 7, 2012 0 Comments

 

 

It has been more than 25 years that gay guys have been told to use condoms for sex.  Yet many of us still sometime do not do what we are told.  Almost no sexually active gay guys will say “I did not know I should use condoms”.  So why do we still get the same message, for 25 years, that clearly is not working?

Sex is complex and there are a lot of emotions that are part of our sex lives.  But the emotional part of who we are and the importance that sex plays in our lives, is not addressed.  Our originations around the world still shout at us to “USE CONDOMS”.  This message gets old and tiresome, yes we know that.   Where are the messages that help us to understand why we are not using condoms?

HIV has for over 25 years been dominated by the medical profession.  Medicine has done wonders at helping those of us who may be infected to have a healthier and better life.   But medicine tends to take a scientific and logical approach to problems.  Hence the simple message of “use condoms”.  Medicine is not as good at dealing with complex emotional aspects of human behaviour.

I think it is time for medicine to step aside in addressing HIV prevention and give way to the social scientists to explore more effective messaging.  It is also time for our organizations to focus more on messages other than “use condoms”.

If you ask gay guys why they sometimes do not use condoms they often have no more understanding than “I do not like condoms.”  There was an effort to tell us that condoms were fun and sexy but that message did not go very far.  So we may know that sex is better, more fun, easier, and more intimate without condoms.  But we are not assisted much in understanding how we sometimes allow ourselves to not use condoms.

It seems that there has been an underling message of: “be afraid of HIV”, and then by extension that leads to  fear  HIV poz guys.  Many gay guys have become so scared of HIV that they reject HIV poz guys.  Messages of fear are not effective.   Messages of fear have had the effect of marginalizing members of our community, not building a stronger community.  We know too much about stigma in our community; we do not need any messages that promote stigma amongst members of our own community.  We need messages of understanding, acceptance and support.  Where are the messages that a poz guys with undetectable viral load is not going to transmit HIV?  Where are the messages of support and understanding?

I have spent almost 20 years talking to guys about their sex lives and HIV.  I have noticed a few trends in HIV infections.   For over 10 years I would say “Guys are most vulnerable to get infected when a relationship ends.”  In the last few years I have seen that perhaps this message is too narrow.  It seems to me that guys are most vulnerable to get HIV when they are feeling their life is falling apart.  That can be death of a parent or a loved one, job loss, depression,  loss of home and loss of relationship, etc.

I do not pretend to have “the answer” to why we do not always use condoms but I feel I have some understanding of how bare sex happens.  But let’s focus more on why we take risks, when we will take risks and how to support all of us to take better care of ourselves.

Stuff that did not make it in the newspaper

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