Preventing HIV, AIDS and STIs =
Sex and U
Concerns of Men who have Sex with Men (MSM)
Men who have sex with men may identify themselves as homosexual, bisexual, or even heterosexual. No matter what label is used, the fact is that many of these men do not reveal their sexual practices or sexual orientation to their physician or health care provider. Lack of disclosure from the patient, discomfort or inadequate training of the physician, perceived or real hostility from medical staff, and insufficient screening guidelines limit preventive care.
Because of greater societal stresses, lack of emotional support, and practice of unsafe sex, men who have sex with men are at increased risk for sexually transmitted infections (including human immunodeficiency virus infection - HIV), anal cancer, psychological and behavioural disorders, drug abuse, and eating disorders. Recent trends indicate an increasing rate of sexual risk-taking among these men, particularly if they are young. 1
The stigmatization of homosexuality in society, including frequent exposure of homosexual men to discrimination and victimization, is believed to be a causative factor in the development of psychological and behavioral disorders. Communication between men who have sex with men and their physician or health workers may be limited on several levels. Many men, especially young men may be hesitant to disclose their sexual orientation in order to avoid social isolation, discrimination, or verbal or physical abuse.
Although men who have sex with men can be at-risk for preventable diseases and disorders, they frequently do not receive appropriate preventive health care services. Numerous obstacles hinder compliance with screening guidelines. For example, physicians and health workers may feel uncomfortable with the idea of sex between men or may not understand the issues that affect these patients. Patients, in turn, may be afraid to disclose their sexual orientation or practices. In addition, published, evidence-based screening guidelines for men who have sex with men are lacking or inconsistent. Younger men are thought to be at particularly most at-risk for HIV infection and other STIs because of low self-esteem, depression, and lack of peer support. Often, these men do not access the preventive services that are available to men who are more open about their homosexuality.
There is evidence that many men are engaging in dangerous sexual practices that may jeopardize their health. These sexual practices include anal sex without a condom (bare backing), oral sex without a condom, oral stimulation of the anus (rimming) without protection, multiple sex partners at one time, and use of alcohol and other drugs. Some reasons for this are:
- AIDS burnout (tired worrying about HIV and AIDS).
- Outdated or overly simplistic safer-sex messages that do not include content for men who have sex with men
- Belief that treatment will be effective and easy to take if infected.
- New HIV treatments and the potential for a vaccine.
- Lack of exposure to persons who are living with HIV infection or AIDS or who have died from AIDS.
- Belief that STIs "won't happen to me".
- Low self-esteem, depression, or lack of peer support.
- No access to preventive services available to men who are more open about their homosexuality.
Men who have sex with men should undergo routine, straightforward, nonjudgmental risk assessments for HIV infection and other STIs, along with patient-centered counseling on preventive measures to reduce the acquisition or transmission of these infections.
Physicians and health workers should ask questions about sexual orientation in a nonjudgmental manner; furthermore, confidentiality should be addressed and maintained. Office practices and staff should be similarly nonjudgmental, with confidentiality maintained.
To relieve any fears of HIV, AIDS and other sexually transmitted infections, we highly recommend that men who have sex with men regularly get HIV and STI tested that also involves counselling e.g., at three- to six-month intervals at first, followed by annual testing; get vaccinated against Hepatitis A & B; access organisations that are managing programmes that are specific to your needs such as peer support; and use condoms and water based lubricant, each and every time you have penetrative and oral sex with new partners.
