Showing posts with label Men’s Health. Show all posts
Showing posts with label Men’s Health. Show all posts

May 27, 2019

There are Better ways to be Masculine Than to Follow Tradition to an Early Death

Men's groups are coming together to discover the meaning of masculinity in the age of #MeToo.
Leonardo Santamaria for NPR
Sean Jin is 31 and says he's not washed a dish until he was in his sophomore year of college.
"Literally my mom and my grandma would ... tell me to stop doing dishes because I'm a man and I shouldn't be doing dishes." It was a long time, he says, before he realized their advice and that sensibility were "not OK."
Now, as part of the Masculinity Action Project, a group of men in Philadelphia who regularly meet to discuss and promote what they see as healthier masculinity, Jin has been thinking a lot about what men are "supposed to" do and not do. 
He joined the peer-led group, he says, because men face real issues like higher rates of suicide than women and much higher rates of incarceration.
"It's important to have an understanding of these problems as rooted in an economic crisis and a cultural crisis in which there can be a progressive solution," Jin says.
In supporting each other emotionally, Jin says, men need alternative solutions to those offered by the misogynist incel — "involuntary celibate" — community or other men's rights activists who believe men are oppressed.
"Incels or the right wing provide a solution that's really based on more control of women and more violence toward minorities," Jin says.
Instead, he says, he and his friends seek the sort of answers "in which liberation for minorities and more freedom for women is actually empowering for men."
Once a month, the Philadelphia men's group meets to learn about the history of the feminist movement and share experiences — how they learned what "being a man" means and how some of those ideas can harm other people and even themselves. They talk about how best to support each other.

This spring, part of one of the group's meetings involved standing in a public park and giving a one-minute speech about any topic they chose. One man spoke of being mocked and spit upon for liking ballet as a 9-year-old boy; another spoke of his feelings about getting a divorce; a third man shared with the others what it was like to tell his father "I love you" for the first time at the age of 38.

The idea of such mentoring and support groups isn't new, though today's movement is trying to broaden its base. Paul Kivel, an activist and co-founder of a similar group that was active from the 1970s to the 1990s in Oakland, Calif., says men's groups in those days were mostly white and middle-class.
Today, the global nonprofit ManKind Project says it has close to 10,000 members in 21 nations, is ethnically and socioeconomically diverse and aims to draw men of all ages.
"We strive to be increasingly inclusive and affirming of cultural differences, especially with respect to color, class, sexual orientation, faith, age, ability, ethnicity, and nationality," the group's website says.
Toby Fraser, a co-leader of the Philadelphia group that Jin attends, says its members range in age from 20 to 40; it's a mix of heterosexual, queer and gay men.
Simply having a broad group of people who identify as masculine — whatever their age, race or sexual orientation — can serve as a helpful sounding board, Fraser says.
"Rather than just saying, 'Hey, we're a group of dudes bonding over how great it is to be dudes,' " Fraser says, "it's like, 'Hey, we're a group of people who have been taught similar things that don't work for us and we see not working or we hear not working for the people around us. How can we support each other to make it different?' "
Participants are also expected to take those ideas outside the group and make a difference in their communities.
For example, Jeremy Gillam coaches ice hockey and life skills at an after-school hockey program for children in Philadelphia. He says he and his fellow coaches teach the kids in their program that even though the National Hockey League still allows fighting, they should not respond to violence with violence. He says he tells them, "The referee always sees the last violent act, and that's what's going to be penalized."
That advice surprises some boys, Gillam says.  
"One of the first things that we heard," he says, "is, 'Dad told me to stick up for myself. Dad's not going to be happy with me if I just let this happen, so I'm going to push back.' "
Vashti Bledsoe is the program director at Lutheran Settlement House, the Philadelphia nonprofit that organizes the monthly men's group. She says men in the group have already started talking about how the #MeToo movement pertains to them — and that's huge.
"These conversations are happening [in the community], whether they're happening in a healthy or unhealthy way ... but people don't know how to frame it and name it," Bledsoe says. "What these guys have done is to be very intentional about teaching people how to name [the way ideas about masculinity affect their own actions] and say, 'It's OK. It doesn't make you less of a man to recognize that.' "
Meanwhile, the American Psychological Association published guidelines this year suggesting that therapists consider masculine social norms when working with male clients. Some traditional ideas of masculinity, the group says, "can have negative consequences for the health of boys and men."
The guidelines quickly became controversial. New York magazine writer Andrew Sullivan wrote that they "pathologize half of humanity," and National Review writer David French wrote that the American Psychological Association "declares war on 'traditional masculinity.' "
Christopher Liang, an associate professor of counseling psychology at Lehigh University and a co-author of the APA guidelines, says they actually grew out of decades of research and clinical experience.
For example, he says, many of the male clients he treats were taught to suppress their feelings, growing up — to engage in violence or to drink, rather than talk. And when they do open up, he says, their range of emotions can be limited.  
"Instead of saying, 'I'm really upset', they may say, 'I'm feeling really angry,' because anger is one of those emotions that men have been allowed to express," Liang says.
He says he and his colleagues were surprised by the controversy around the guidelines, which were intended for use by psychologists. The APA advisory group is now working on a shorter version for the general public that they hope could be useful to teachers and parents.
Criticism of the APA guidelines focused on the potentially harmful aspects of masculinity, but the APA points to other masculine norms — such as valuing courage and leadership — as positive.
Aylin Kaya, a doctoral candidate in counseling psychology at the University of Maryland, recently published research that gets at that wider range of masculine norms and stereotypes in a study of male college students.
Some norms, such as the need to be dominant in a relationship or the inability to express emotion, were associated with lower "psychological well-being," she found. That's a measure of whether students accepted themselves, had positive relationships with other people and felt "a sense of agency" in their lives, Kaya explains. But the traditional norm of "a drive to win and to succeed" contributed to higher well-being.  
Kaya adds that even those findings should be teased apart. A drive to win or succeed could be good for society and for male or female identity if it emphasizes agency and mastery, but bad if people associate their self-worth with beating other people.
Kaya says one potential application of her research would be for psychologists — and men, in general — to separate helpful ideas of masculinity from harmful ones.
"As clinicians," she says, "our job is to make the invisible visible ... asking clients, 'Where do you get these ideas of how you're supposed to act? Where did you learn that?' To help them kind of unpack — 'I wasn't born with this; it wasn't my natural way of being. I was socialized into this; I learned it. And maybe I can start to unlearn it.' "
For example, Kaya says, some male clients come to her looking for insight because they've been struggling with romantic relationships. It turns out, she says, the issue beneath the struggle is that they feel they cannot show emotion without being ridiculed or demeaned, which makes it hard for them to be intimate with their partners.
Given the findings from her study on perceptions of masculinity, Kaya says, she now might ask them to first think about why they feel like they can't show emotion — whether that's useful for them — and then work on ways to help them emotionally connect with people.

March 15, 2019

Chiseled Abs 6 Packs and ....Meaningless? Not?

Related image
 I can't count yet. Do they look like 6?

In 2019, our lives are ruled by meaningless “likes,” Pete Davidson is PDA-ing hard with Kate Beckinsale, and if you’re a gay man, you still face a number of superficial and inane guidelines that, if crossed, would merit shame or ostracizing. For starters, you must be infatuated with Robyn. You also have to possess very strong feelings about Call Me by Your Name, and if you read the book first, it’s a rule that you make that very clear to everyone you’ve ever met. And perhaps the biggest gay guideline that reigns supreme, the one the culture seems to agree on, the most important one of all: You must, must, must, MUST have a perfect six-pack. If your six-pack is anything other than perfect in every way, shape, and form, you might as well start wearing baggy T-shirts and move into a cave.

That’s how it feels, anyway. It’s like washboard abs have morphed into the barometer that determines whether or not one is truly hot and, with that in mind, is a gauge to tell if one is worthy of your attention, love, and—oh yeah—sex. Since the dawn of time, or at least since the beginning of modern gay culture (and the sexualization of men across orientations, while we’re at it), the six-pack has been the Holy Grail of fitness. If there was ever a gay Moses, he surely held up a stone tablet stating that having a rockin’ six-pack was a sexual commandment.

We’re the generation that grew up with Abercrombie and Calvin Klein models, and while Abercrombie has since literally fallen out of fashion, Klein’s most recent ad campaign spotlights gay catnip Shawn Mendes, with his chiseled bare stomach rippling on billboards around the world. Every issue of any fitness magazine has some variation of the words “Get” and “Abs” and “Now.” All of Zac Efron’s movies feature at least one scene in which the actor removes his shirt, even in the recent trailer for a movie in which he plays the serial killer Ted Bundy. We can all agree that the best part of any superhero movie isn’t the explosions, it's when the lead hero changes into his superhero spandex. Even in artistic depictions of Jesus Christ himself when he’s on the cross literally being crucified, we see the Son of God with a perfect six-pack. Every which way we turn, it’s beaten into our heads. Abs: good and godly. And gay men seem to be most affected by the cultural view of male beauty.

What’s the result of all of this abdominal fixation? It means a never-ending quest for a taut stomach that may as well lead some to bring a cot and a toaster into the gym, since tons of us practically reside there already. In uniforms of Nike high socks and Airpods, we’re all sweating away, kicking our legs up like we just dropped PCP and strapping weights to our chests like some self-induced Game of Thrones–style torture technique. The wheat industry has to be in a tailspin, because nobody even nibbles on bad carbs anymore. A gulp of air counts as dessert. Party!

From there, dating apps like Grindr aren’t filled with headshots but instead amount to scrolling grids of torsos. It’s a clichéd facet of gay dating by now, but ruminate on the weight of that thought for a second: In this twisted world, someone’s actual face has become a secondary body part, and sometimes even a complete afterthought. It all almost amounts to a gay episode of The Twilight Zone, where faces don’t exist and everyone speaks out of their navels. (Jordan Peele, you may take this idea.) 

The insanity of this mental culture perfectly crystalized for me last summer during a delightful day at the beach with some friends of mine. At least, it should have been delightful, since some of them started dieting weeks and months beforehand for this very moment. As we were all quote-unquote relaxing, I found myself adjusting in my chair so my lower stomach wouldn’t protrude as much as I could help it. But when I looked around, other guys were doing the exact same thing, even the leaner ones who I assumed wouldn’t have a care in the world about how they looked. On top of it all, everyone was only worried about their own stomachs. Like in an inverted episode of Judge Judy, we were only judging ourselves. (Insert Lady Gaga’s guttural “Shallow” scream here.)

Even the fittest guys have body issues, and that isn’t hyperbole. Searching for answers to my abdominal conundrums, I did what anyone searching for answers would do: Googled “ab issues,” which was stupid. Then I spoke to Ian Holloway, an associate professor at UCLA who specializes in LGBTQ health and well-being. “I see both gay individuals and couples, and for 90 percent of my clients, body-image issues are at the top of the list of things they struggle with,” explains Holloway, who also has a private practice in West Hollywood (the epicenter of the six-pack madness if ever there was one). “The vast majority of my clients, despite what their external appearance might be, whether they have a six-pack or not, wrestle with this ideal image of themselves.”

So how, then, are we supposed to rise above it all? “Well, I help guys define what's ideal or acceptable for them, and how that lines up with what's attainable for them.” In other words, do what’s right for you, not what’s right for Shawn Mendes. “It’s important for guys to get a clear idea of what's attainable and realistic and work towards that, as opposed to trying to achieve the impossible ideal we're bombarded with.”

Adjusting expectations and maintaining personal happiness is easier said than done. At least we can agree this gay six-pack fantasy that surrounds us on all sides takes it all a bit too far. Will I ever have a phenomenally rigid, deeply defined, wildly tight, insanely solid, sculpted-by-the-gods, Mark Wahlberg–resembling, underwear-model-worthy, bulging and muscular, intricately carved, professionally chiseled, wildly shredded, totally fatless, definitely chubless, righteously rippled, abdominally perfect, super jacked, lean, blessed, #blessed, yolked, yerked (okay, I made that one up), expertly cut six-pack? Probably not. And that’s just fine by me.

 Originally posted on  GQ

April 5, 2018

I’m a Gay Psychiatrist and Here’s Why I Went on Grindr to Survey Men {What is Grind'r Doing to Our Gay Men?}


This story originated at VOX and it has the adamfoxie🦊blog taste

When I open the Grindr app on my smartphone, I see there’s a 26-year-old man with tanned abs just 200 feet away. He’s called “looking4now,” and his profile explains that he wants sex at his place as soon as possible.
Scrolling down, I find 100 similar profiles within a one-mile radius of my apartment in Boston. I can filter them by body type, sexual position (top, bottom, or versatile), and HIV status.
As a gay psychiatrist who studies gender and sexuality, I’m thrilled with the huge strides we’ve made over the past decade to bring gay relationships into the mainstream. The Supreme Court ruled that same-sex marriage is a constitutional right. Today in Boston, two men can walk down the street holding hands without consequence.
But I’m worried by the rise of the underground digital bathhouse. Apps like Grindr, with 3 million daily active users, and others like Scruff and Jack’d, are designed to help gay men solicit sex, often anonymously, online. I am all for sexual liberation, but I can’t stop wondering if these apps also have a negative effect on gay men’s mental health.
Since there’s little published research on the men using Grindr, I decided to conduct an informal survey and ask men why they’re on the app so much and how it’s affecting their relationships and mental health. I created a profile identifying myself as a medical writer looking to talk to men about their experiences. I received about 50 responses (including propositions). 
It’s a small sample size, but enough to give us some clues about how Grindr is affecting gay men. And it doesn’t look good.

Apps like Grindr are designed to make finding sex easy. And that can make them hard to stop using.

The most common reason users gave for going on the app is that sex feels great and Grindr makes it accessible, right at your fingertips. The screen full of half-naked men excites users. With a few clicks, there’s a possibility of meeting a sexual partner within the hour.
Neuroscientists have shown that orgasm causes activation of pleasure areas of the brain like the ventral tegmental area while deactivating areas involved with self-control. And these patterns of activation in men are strikingly similar to what researchers see in the brain of individuals using heroin or cocaine. So when a neutral action (clicking on Grindr) is paired with a pleasurable response in the brain (orgasm), humans learn to do that action over and over again.
This can be a normal pleasure response or it could be a setup for addiction, depending on the situation and individual.
Grindr, intentionally or not, also leverages a psychological concept called variable ratio reinforcement, in which rewards for clicking come at unpredictable intervals. You may find a hookup immediately, or you may be on your phone for hours before you find one.
Variable ratio reinforcement is one of the most effective ways to reinforce behavior, and it makes stopping that behavior extremely difficult. Slot machines are a classic example. Because gamblers never know when the next payout will come, they can’t stop pulling the handle. They hold out hope that the next pull will give them the pleasurable sound of coins clanking against a metal bin, and they end up pulling for hours.
Now imagine a slot machine that rewards you with an orgasm at unpredictable intervals. This is potentially a powerful recipe for addiction and may explain why one user I spoke with stays on Grindr for up to 10 hours at a time, hoping to find the perfect partner for casual sex.
The phrase “addiction” continues to be controversial when it comes to sex and technology, But as John Pachankis, an LGBTQ mental health expert at the Yale School of Public Health, described the impact of Grindr to me: “I don’t know if it’s an ‘addiction,’ but I know it causes a lot of distress.”
For now, it’s hard to know just how many Grindr users feel their use of the app is problematic. Early research on app use and health has focused only on sexually transmitted infections, for instance, rates of HIV among Grindr users, using Grindr to get people tested for STIs, etc. 
Just last week, Grindr announced that it will start sending users HIV testing reminders and the addresses of local testing sites (on an opt-in basis). In less pleasant news, BuzzFeed revealed on Monday that Grindr has also been sharing the HIV status of its users with third-party companies. (The company later said it would stop sharing the information.)
Though there is this new attention to sexual health, both Grindr and the research community have been silent on mental health. Yet since 2007, more gay men have died from suicidethan from HIV. 
This suggests it’s time we start thinking about Grindr’s health effects more broadly. Other dating apps, like Tinder, for example, are now the subject of early research looking at mental health implications. It’s time to do the same for gay hookup apps. 

Grindr may provide men with some relief from their anxiety and depression. But it’s temporary.

For some users I talked to, the allure of Grindr was not just the rush to feel good. It was to stop feeling bad. Users told me they log on when they feel sad, anxious, or lonely. Grindr can make those feelings go away. The attention and potential for sex distract from painful emotions.
A staggering number of gay men suffer from depression, with some estimates as high as 50 percent. Because gay men’s anxiety and depression often stem from childhood rejection for being gay, messages of affirmation from other gay men are particularly appealing. Unfortunately, these messages are typically only skin-deep: “Hey man, cute pic. Looking to ****?”
A recent survey of 200,000 iPhone users by Time Well Spent, a nonprofit focused on the digital attention crisis, showed that 77 percent of Grindr users felt regret after using the app.

 The users I interviewed told me that when they closed their phones and reflected on the shallow conversations and sexually explicit pictures they sent, they felt more depressed, more anxious, and even more isolated. Some experience overwhelming guilt following a sexual encounter in which no words are spoken. After the orgasm, the partner may walk out the door with little more than a “thanks.” 
And yet they keep coming back for that temporary emotional relief. One user told me that he feels so bad after a hookup that he jumps right back on the app, continuing the cycle until he is so tired he falls asleep. Every once in a while, he deletes the app, but he finds himself downloading it the next time he feels rejected or alone.
“We see patients like this almost every day,” Pachankis told me. “Apps like Grindr are often both a cause and a consequence of gay and bisexual men’s disproportionally poorer mental health. It’s a truly vicious cycle.”
Not all Grindr users are addicted and depressed, of course. Some users I interacted with seem to use Grindr in a healthy, positive way. One man I interviewed met his fiancé there; they are excitedly planning their wedding. Some I spoke with said they use the app for sex but haven’t suffered any negative consequences and have control over their use.

Using Grindr may keep men from finding lasting relationships

Why do so many of these men turn to Grindr to begin with? Perhaps Grindr’s popularity is a sign we haven’t made as much social progress as we think for same-sex relationships. The general population seems comfortable with the idea of gay marriage, but it’s still difficult for a gay man to find a partner.
One 23-year-old user told me that the only places he can find gay men are clubs and Grindr, and both are hypersexualized. The cultures of both intimidate him. According to Pachankis, gay culture is often “status-focused, competitive, hierarchical, and exclusionary.” He explains that these traits are common among men generally, but in the gay community, they become amplified in a group that “both socializes and sexualizes together.” 
The 23-year-old is afraid of rejection, and Grindr shields him from the pain of in-person turndowns. “My framework now is sex first. I don’t know how to date people in person.” 
His relationships, he says, start with casual sex on Grindr. They first meet at 2 am for a hookup. He’ll try to schedule the next sex date a little earlier, maybe 11 pm. Then the next step may be drinks.  
But this sex-first approach hasn’t led to lasting relationships for the men I interviewed and is affecting their self-worth and identity. “My self-esteem now is all about my sexual ability,” the 23-year-old said. “I don’t feel confident about myself as a partner in any other way.” 
Another user told me he downloaded the app hoping to find a husband. Now he says that when he and a boyfriend (he’s gone through several) fight, his natural response is to open Grindr to “find an alternative” instead of working through problems. He can’t maintain a monogamous relationship because he is constantly cheating.

There may be ways to treat men with problematic Grindr use

The mental health professionals I spoke to are seeing problematic Grindr use in their clinics. And there is little published guidance on how to help those who are struggling.
Doctors I spoke to say the best available tools for treating problematic Grindr use are the ones they use in general sex addiction treatment. Citalopram, a common antidepressant, was shown in one small study to be helpful with sex addiction in gay men. Naltrexone, a drug commonly used for other compulsive behaviors, may work as well. 
For more extreme cases, patients could request hormonal implants that turn off testosterone signaling, making sexual cravings less intense. However, even these treatments have modest empirical support at best, and none have been studied for hookup app use specifically.
Dr. Shane Kraus, the director of the behavioral addictions clinic at Bedford Veterans Hospital and an assistant professor of psychiatry at the University of Massachusetts Medical School, says the most promising treatment for problematic Grindr use is likely talk therapy techniques like cognitive behavioral therapy (CBT). CBT can teach patients to engage in other behaviors that are more productive (though often more difficult and time-consuming than Grindr) to help them feel loved or supported. 
Another psychotherapeutic technique known as acceptance and commitment therapy (ACT) can help teach patients how to better tolerate the feeling of being alone without logging on to Grindr.
The dynamics of Grindr, though, are complicated, and it can take time to work through all the angles. Are you self-soothing anxiety? Are you addicted to sex? Have you lost interest in your monogamous relationship? Do you think you can’t attain love, so you’re settling for hookups? Did your parents tell you being gay is wrong and you’re searching for acceptance? Ultimately, Kraus explains that therapy can help clarify these kinds of thoughts and feelings, and lead to insights that bring about a healthy change.
He also believes it’s only a matter of time before states and the federal government sponsor research exploring Grindr use and mental health. Grindr did not respond to our request for comment on this piece. But if future data supports what I suspect about the link between Grindr and mental health problems, even small interventions like advertising mental health resources on the app may help to address these users’ suffering.
As we continue to fight to bring gay relationships into the mainstream, we need to keep an eye on Grindr and how it both reflects and affects gay culture. The bathhouse is still around. It’s now open 24/7, accessible from your living room.
By Jack Turban a physician and medical writer at Harvard Medical School, where he researches gender and sexuality. His writing has appeared in the New York Times, Scientific American, and Psychology Today, among other publications. Find him on Twitter at @jack_turban.

It is adamfoxie's 10th🦊Anniversay. 10 years witnessing the world and bringing you a pieace whcih is ussually not getting its due coverage. 4.9 Million Read

September 28, 2017

See What is Being Done To Save HIV Gay and BI Men from a Cancer Epidemic

The medical and scientific language is just as it appeared at the Medical Press study page. If you have a question about anything on this posting please don't hesitate to ask by using the comment section. You can also email the publisher at his email page included on the main page (left and down)of the blog.

Almost 620,000 gay and bisexual men in the United States were living with HIV in 2014, and 100,000 of these men were not even aware of their infection. These men are 100 times more likely to have anal cancer than HIV-negative men who exclusively have sex with women. Yet, no national screening guidelines exist for anal cancer prevention in any population.

Anal cancer is predominantly caused by chronic or persistent human papillomavirus (HPV) infection. HPV infection can lead to the development of anal precancer which, if remains undetected or not adequately treated, may lead to anal cancer. Likewise, HPV infection is also responsible for causing cervical, vaginal, vulvar, oropharyngeal, penile and rectal cancers.

The objective of screening is to identify and treat these precancers to prevent occurrence of anal cancer. However, one of the reasons for the lack of screening guidelines is that anal precancer treatment has not yet been shown to prevent invasive cancer. Our study, published today in the journal Cancer, attempts to find a possible solution to prevent anal cancer in HIV-positive gay and bisexual men, using the best available data. We found that age-specific anal precancer management, including post-treatment HPV vaccination, can potentially lead to an 80 percent decrease in lifetime risk of anal cancer and anal cancer mortality among gay and bisexual men.
Anal cancer: the next big crisis

Some in the medical community have identified anal cancer as the next big crisis among HIV-infected gay and bisexual men. Initiation of anti-retroviral therapy in the 1990s greatly reduced the AIDS-related death rate and improved survival. However, this improvement in survival led to an increase in the lifetime risk of developing anal cancer, especially among HIV-positive gay and bisexual men.
Anal cancer is typically preceded by persistent HPV infection that often leads to precancer. HPV is common among U.S. men; about one out of two men in the general population has HPV infection. HPV typically clears naturally; however, under certain circumstances, it might persist longer and might progress to anal precancer. If it remains undetected, untreated or inadequately treated, this precancer can progress to anal cancer.

The American Cancer Society estimates there will be 8,200 new anal cancer cases in 2017. In the absence of national screening recommendations, more than 50 percent of these individuals will be diagnosed at stage III or IV, when five-year survival is less than 40 percent. This creates a major public health concern.

We do not yet know how best to manage anal precancer (also known as high-grade squamous intraepithelial lesions) so that anal cancer could be prevented. A national randomized clinical trial study – Anal Cancer HSIL Outcomes Research (ANCHOR) – is currently determining optimal anal precancer management by comparing treatment and active monitoring.

How the anal cancer epidemic in gay and bi HIV-positive men can be prevented

The question then arises: How do we start managing our patients using the best available evidence? Likewise, it is imperative that these individuals have as much information as possible about anal cancer prevention.

How our study brings insight

Using a mathematical model, we simulated the life course of 100,000 hypothetical HIV-positive men who have sex with men (MSM) who were 27 years or older and were diagnosed with high-grade squamous intraepithelial lesions. In our model, we compared four different management strategies:
(1) individuals were not provided any form of treatment, which is the current practice; 

(2) individuals were actively monitored (followed biannually) and those who developed early cancer were treated;

(3) individuals were immediately treated using surgery (current most popular strategy among clinicians who treat precancer); and 

(4) individuals in addition to surgical treatment received HPV vaccination (potential strategy).

We followed these hypothetical patients over their lifetime in our computer model to estimate harms and benefits of the management strategies. We tracked the number of individuals who developed anal cancer and then estimated their risk of death from anal cancer. We then estimated above outcomes by patient age. For each strategy, we estimated age-specific lifetime outcomes considering cost, quality of life and life expectancy.

We found that HIV-infected gay and bisexual men who are 38 years or older should be treated using surgical treatment of ablation (either infrared coagulation or electrocautery), and that HPV vaccination should be administered at the time of surgery. This strategy is cost-effective and has the potential to decrease the lifetime risk of anal cancer by up to 80 percent in those men.

The model also found that because younger men are more likely to be cured of their precancer without intervention, patients younger than 29 should not be treated and those between 29 and 38 years old should be actively monitored (watch-and-wait approach) in order to prevent treatment-related inconvenience and morbidity that might affect their quality of life.
How the HPV vaccine could help

Currently, HPV vaccination is not recommended for administration among individuals 27 years or older. However, multiple observational studies have shown, and our findings have confirmed, that a practice of vaccinating individuals who have already been diagnosed with precancer may decrease the risk of the precancer coming back after treatment.

Given that the HPV vaccine has minimal side effects, we believe that clinicians can consider adopting this practice. Such practice may have many advantages, such as decreasing the number of treatments a patient needs for precancer recurrence thus decreasing the adverse outcomes of surgical treatment (possibility of scarring, anal stenosis and incontinence). 

In the long run, post-treatment HPVvaccination also has the potential to decrease the lifetime risk of anal cancer, save health care costs for treating patients for recurrence and cancer, and improve their life expectancy and quality of life.

August 5, 2017

In NY Insurance Has Denied HIV Med To a Gay Man Because His 'High Risk of Homosexual Behavior'

A patient applied for Truvada, FDA's only approved drug to prevent HIV infection, in July

The New York man received a denial letter citing his 'high risk homosexual behavior' as the reason
However, Truvada criteria state the drug should be covered for adults 'at high risk of sexually acquiring HIV-1'

HIV activism groups claim this is hardly the first case of a baseless denial
They also slam the language of the letter and 'down right discrimination'

United Healthcare has overturned the decision amid uproar over the letter
Dr Anthony Fauci, head of HIV at the NIH, told Daily Mail Online 'it seems like an inherent contradiction: PrEP was approved to prevent HIV for people at risk' 

An insurance company refused to cover a gay man's HIV-prevention drug because he 'engages in High risk homosexual behavior'.

The man, who lives in New York, applied for Truvada's PrEP in July to protect himself from the life-threatening disease. The drug is the only FDA-approved antiretroviral treatment to block HIV from infecting cells. 

But days later he received a denial letter from United Healthcare, which stated: 'The information sent in shows you are using this medicine for High risk homosexual behavior'.

The company claimed health plans only cover Truvada for patients who have HIV or have been exposed to the virus, adding that his request for coverage 'is not medically necessary under New York State Law'.

However, the letter also includes a list of United Healthcare Truvada criteria, which state that the drug - which costs $1,450 a month wholesale - should be covered for adults 'at high risk of sexually acquiring HIV-1'.

HIV activism groups have slammed the denial as illegal, and the phrasing of the letter as 'homophobic and discriminatory'.

Dr Anthony Fauci, director of the HIV/AIDS department at the National Institutes of Health, told Daily Mail Online: 'It seems like an inherent contradiction.

'PrEP is made for people who are actually at risk for HIV infection, not for people who are not at risk. 
'It has been proven that PrEP is a highly effective way of preventing HIV infection. That is the reason Truvada was approved.'

After receiving the letter on July 11, the patient, who remains anonymous, went to HIV activism groups for support to appeal the decision.

He sent the document to Jeremiah Johnson, of Treatment Action Group (TAG), who has led calls against the insurance company and the state health department to acknowledge the denial as a violation of guidelines.

'At best, it's gross incompetence of the insurer to carry out their own policy,' Johnson told Daily Mail Online. 'At worst, it's down right discrimination and it's illegal. 
'The patient was shocked by the language, as we all are.

'The words they use were stigmatizing terms on their own, but when you send that on UHC letterhead, saying "you're being denied this essential medication because you're homosexual"... We were just horrified.

'It's a clear violation of policy, it's unethical and it's malicious to deny people who are vulnerable.' 
The patient appealed to overturn the decision through his doctor, and has now been issued PrEP.
However, activism collectives have launched a petition to New York State Health Department to condemn United Healthcare's denial letter.

James Krellenstein, of ACT UP NYC which is behind the letter and petition, said this is hardly the first case of a baseless denial.

'We are hearing story after story of patients being denied Truvada coverage despite being fully in compliance with CDC, federal and state guidelines,' he told Daily Mail Online. 
'Often you can appeal the decision and get approved, but studies show these kinds of denials deter people and led to lower overall coverage.

'The language in this letter shows that this case is a black and white case of discrimination based on the patient's sexual orientation.'
Krellenstein pointed out that last year the New York City Health Department issued guidelines to doctors, highlighting gay men as candidates for PrEP.

And federal guidelines from the National Institutes of Health say the LGBT community is one of the most vulnerable populations to HIV infection, and therefore should receive PrEP. 
'United Healthcare endangered a patient's health because of his sexual orientation,' Krellenstein said.
'Every time this happens, insurance companies are endangering the health and well-being of the entire LGBT community.'

United Healthcare has not responded to Daily Mail Online's request for a comment.
The CDC last year said that 1.5 million Americans could benefit from taking PrEP to lower their risk of contracting HIV sexually or through intravenous drug use.

Contradiction: The letter included Truvada's criteria, which states that the drug is meant for adults at high risk of sexually acquiring HIV. It is the only FDA-approved drug for that purpose
Currently, figures suggest just over 100,000 people take the drug.
Krellenstein urged insurance companies to make contact with HIV activism groups to discuss coverage, criteria, and costs.

'We are interested in solving this problem, we're willing to sit down with UHC or any insurance company to work this out,' he said.

'But we are not going to remain silent while they endanger the health and well-being of our community.'

Johnson urges people who have been denied PrEP to visit the National Coalition for LGBT Health, which allows patients to anonymously share their stories and get support to appeal the decision if necessary.

'Don't shame yourself if you were denied,' Johnson adds.

'This is a stigmatized medication, like the contraception pill was years ago. Anyone taking a stigmatized medication needs to be very persistent.

'Work with your doctor to keep appealing the decision, and do what you can to make HIV activists aware if you were denied.'

By Mia De Graaf For 

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