High Anxiety

    For three hours the finger never stopped.  It grabbed a lock of dark hair, expertly spun it around four or five times, rolled it between thumb and finger for a few seconds, released it, and then began the process all over again.  I witnessed this strange behavior from my airplane seat, captive to the nervous antics of the passenger in front of me.  Only the top of his tortured head was visible, along with that relentless finger.

    The poor guy was in the throes of an anxiety disorder called Trichotillomania (use that in a sentence and impress your friends!), an irresistible urge to pull one’s hair.    And he wasn’t the only one with symptoms of anxiety.  We were all traveling on a recent day when yet another financial giant had collapsed, there was a general mood of uneasiness, and it seemed that we were all being pulled helplessly into very frightening territory.  At the airport the mood was somber, people were unusually quiet, and many stood around watching the television monitors broadcasting endless bad news and dire warnings.

    It seemed that Mel Brook’s joke about the very, very nervous really captured what we were all experiencing and it reminded me of some basic skills I teach patients to help them deal with anxiety.  I thought it would be useful to list a few of them here.
    

    1. What can I control?
     A great deal of energy gets consumed compulsively worrying about things in the past, things in the future, and generally things over which we have no control.  This is frustrating as well as emotionally and physically harmful. It is very useful to determine where you actually have some influence over any given situation.  It may be that choices are truly limited, but there is usually something we can do to assert a sense of empowerment.  Even the act of making lists to organize our plans can help us regain a sense of control.       

    2. Take action, then let go of the results
     Once you determine where you can be effective take deliberate action.  Don’t shoot from the hip, but also be wary of becoming paralyzed, a trap experienced by many people experiencing anxiety.  Remember that doing nothing is in fact an action, and the results may not be in your best interest.  Once you’ve done what you can do, monitor the results and re-evaluate where you go from there.  Twelve step programs utilize the Serenity Prayer which captures this beautifully: 

         God grant me the serenity 
         to accept the things I cannot change; 
         courage to change the things I can;
         and wisdom to know the difference.     

    3. Identify your safe place
 Think of this as your “safe word” when life’s scenes gets a little too intense.  Select a place you can imagine in your mind that is soothing, calming, and comforting.  It can be the beach, or the woods, or a mountaintop – whatever works for you.  Anchor this spot in your imagination with as many specifics as you can: What time of day is it? What is the season and the temperature?  Is there a breeze?  What colors do you see? Are there sounds?  Can you smell grass, or leaves, or the sea?  Once you have determined your safe place, practice going there until it becomes effortless.  It works because your mind can only focus on one thing at a time and it’s easily distracted.  Spending a few seconds there can have remarkable physiological and emotional effects, actually calming nerves, reducing blood pressure, even averting panic attacks.  I use this when working with patients who have experienced trauma – it’s powerful. 

     Like it or not, anxious situations seem here to stay.  The more tools we have to deal with them, the more we’ll be able to move through life with some sense of serenity, not to mention (at least for some) a full head of hair. 
 

SOUTHEAST REGIONAL GAY MEN’S HEALTH SUMMIT TO BE HELD IN FORT LAUDERDALE

Gmhs2003_altlogo     While all eyes were on Denver in recent weeks, nearby Boulder was approaching the tenth anniversary of another historic convention: the first National Gay Men’s Health Summit. In 1999, hundreds of gay men gathered in Colorado for workshops and community-building that focused on gay men’s health and wellness. The Summit was a grassroots effort bringing together like-minded gay men and their allies to both acknowledge our problems and find solutions that drew on our creativity and honored our ability to help each other when nothing or no one else was forthcoming, as we famously did when AIDS struck our communities.

The gay men’s health movement grew out of resistance to a national trend of increasing moralistic condemnation of gay men and lesbians. This was further compounded by an unintended consequence of the AIDS crisis: a persistent reframing of gay men, their sex, and their lives in negative, pathological terms. This negativity pervaded even well-meaning efforts, such as HIV prevention programs, which were often based on fear and control, and which, ironically, have been rejected by many gay men resulting in a rapid increase of high risk sexual behavior.

The image of the flawed homosexual is both internalized by gay men themselves and is expressed in all types of media. Out-of-control gay men are often inaccurately portrayed as a menace to the society (remember the new strain of drug-resistant HIV set off by the promiscuous gay meth addict in New York? Or the panic about MRSA carried by gay men and spreading into society-at-large in San Francisco? Both proved false.)

The gay community certainly has serious problems ranging from addiction to epidemics of sexually transmitted diseases, but portraying us and everything we do as pathological, or at best sadly pitiful, is increasingly destructive. The LGBTQ community has an amazing gift for healing both ourselves and our communities. The gay men’s health movement seeks solutions grounded in affirmative concepts of health and wellness.

At the closing in Boulder back in 1999, a call went out to continue these gatherings both at a national and regional level. The call was heeded and now the seventh Southeast Regional Gay Men’s Health Summit will take place in Fort Lauderdale from November 7–9.  Nearly 200 men from around the southeastern United States are expected to converge for networking, workshops, and a lot of fun during this exciting weekend.

 

These are gay and bisexual men of diverse backgrounds, who share a common interest in promoting better physical, spiritual and mental health. Participants will represent urban, suburban, and rural areas from throughout the southeast. Men of color, gay youth, and gay men who have never before participated in formal health promotion efforts are especially invited to join the Summit.  The program will include plenary sessions, workshops, and social activities designed to increase health awareness and a greater sense of community.

 

Break out sessions will be organized around four conference tracks: health and prevention, community building, relationships, and personal development. Workshop topics range from serious to light, including sex and intimacy in crystal meth recovery, living with HIV, spirituality and the gay community, and one called “You call that a swimmer’s build?” about “creativity” in Internet profiles. There will be several plenary dinners with nationally-known speakers, including Chris Bates, Director of Health and Human Services Office of HIV/AIDS Policy in Washington, D.C.

Would you like to participate? Workshop proposals can be submitted online until September 22. There are a number of scholarships available to make the Summit affordable to everyone. See the website for registration and scholarship details.

In my practice I hear a nearly-universal complaint about a lack of community outside bars and clubs. Here is an opportunity to have a great time and experience other gay men in an affirmative and powerful weekend. Join us!

Southeast Regional Gay Men’s Health Summit

November 7-9, 2008

Embassy Suites Hotel

1100 Southeast 17 Street

Fort Lauderdale, Florida 33316

 

 

Does Getting Older Mean Becoming Invisible?

“At 50, I don’t exist
socially in the gay community anymore. Having a drug connection has made me “cool’ although it’s temporary. But it’s better than being invisible when I
want to get laid.”

Steve was
more surprised than anyone that he had ended up in my office for therapy. He was a handsome, fit, financially secure
man who had a good job, a nice home, and a supportive circle of friends. Despite these, Steve had increasingly turned
to drugs, and especially meth, to “connect” with other men, and this had
quickly spiraled out of control. Drugs
helped Steve numb the troubling emotions that arose as he grew older and with
each passing month felt a little less attractive, less energetic, and less like
he fit into a gay community that emphasizes youth and looks.

While
Steve’s comments are based on a narrow view of sex appeal and contain more than
a little self-pity and rationalization, the notion of invisibility and aging is
shared by many gay men. It is true that
both straight and gay culture value physical beauty and youth. Observing change in our bodies as we grow
older can be difficult if we rigidly define ourselves by our looks alone. Steve spent a lifetime classifying himself based
entirely on externals such as physical appearance and his career. Throughout his adult life they buffered him
from shame and other uncomfortable feelings and when those became less
effective he used drugs and alcohol to push discomfort aside. With time, however, nothing really numbed his
fear that he was no longer valued and he found himself in a growing crisis of
identity and self worth.

In therapy,
Steve was able to intellectually understand that getting older didn’t
necessarily mean becoming less attractive. Sexual templates (who you are attracted to) vary greatly among
individuals and, for many, include older men as well as diverse body shapes and
sizes. The real problem was how Steve
viewed himself.

It is
critical at any age to define yourself more broadly than by outward appearance
alone. Otherwise, you miss the inner
spirit that truly defines who you are. Self
image can be enhanced in many ways. Practice
developing an awareness of your unique skills, personal gifts and talents. Get in the habit of identifying positive personality
traits as well as positive physical characteristics (not just what you dislike
about your body –for some that is a real challenge). Develop gratitude on a daily basis and remember
to nurture all of you: body, mind, and spirit.

Connecting
to the community in a variety of ways is vital to this process. You are not alone. SAGE (Senior Action in a Gay Environment – www.sagewebsite.org)
has many activities and supports. The
GLCC (www.glccsf.org) hosts a variety of groups that provide social interaction
outside of bars and clubs, as do many organizations in the faith
community.  It may take a little research, but many
alternatives exist.

Once free of drugs, Steve took a
hard look at his core beliefs and sense of self. To his surprise, he found that the wisdom he
had gained through a successful career and a variety of friendships and
relationships was eagerly sought by a community hungry for role models and
elders. Once he began to value himself
more, Steve felt more confident both socially and sexually.  By valuing more
than just his physical appearance, Steve not only became visible but liked what
he saw.   

 

Speaking of Sex

   Good sex involves more than technical skills. Despite a lot of experience, many people
don’t feel very competent with one important component of sex: speaking up
about it. Sexual competence must
include the ability to be comfortable with sexuality, discussions of sex, and
especially, expressing sexual needs. It
is one of the great ironies of a sex-drenched culture that sex, if it is spoken
of at all, is too often described with a buffer of code words and cute metaphors.

 There are
many situations where this can be a problem. Couples (gay or straight) often have trouble speaking frankly about
their sexual needs or concerns in their relationship. Revealing serostatus to a date or sex partner
is a big concern for many gay men. And
others, even after seeking out a gay physician, are reluctant to talk about
their sexual practices honestly with them, which jeopardizes their health. I have had clients who prefer to get tested
and treated for STDs at an anonymous clinic rather than at the office of their
gay doctor. This is not for insurance
reasons but because they are embarrassed about their sexual behavior.

 Sex still
carries shame for many people. This is
true of professionals, as well. I have
had clients who completed inpatient substance abuse programs tell me that while
in treatment they never spoke of their sexual practices, most of which were critically
linked to their drug use. Why wasn’t
this discussed? In many cases it was
because the counselor was uncomfortable speaking about sexual practices. When I train other therapists we pay close
attention to their sexual competence: the ability to be comfortable speaking
about sexual concerns and make it safe for their clients to do so as well.

 How is your
sexual competence? Here are some tips
for speaking up about sex:

1. Respect
yourself. Gay men and women need to work
at self love even harder than society at large simply because we are
consistently bombarded with negative messages, both overt and covert. You have a right to your feelings, a right to
speak up and be heard, and a right to have your sexual limits honored.

2. Minimize
embarrassment or shame when speaking about your sexual needs, concerns, or
problems. You’re not the first to have
such feelings and not speaking up could have fatal consequences. That goes for discussions with your doctor,
as well. I know one man who didn’t want
to speak to his physician about his anal warts which consequently went
untreated and developed into rectal cancer.

3.  Speak your
truth, whether it’s your HIV status, the need to use condoms, or your concern
that your sex life might be a little out of control.  Don’t keep it to yourself.  Speak up and be willing to listen to the
feedback you receive.

 4. Make your healthcare provider an ally. Be certain that you can frankly discuss your
sexual practices and concerns in a safe, non-judgmental atmosphere. Even if you want to ask what you might think
is a naive question, speak up, Believe
me, they have heard it before.

 Sex should
be fun, but anxiety, anger, or other negative feelings resulting from unspoken
concerns can quickly destroy the mood. When
discussing something as important as sexual needs or sexual health, everything
should be on the table. Your life depends
on it.   

   

METH 911: A New Option for Help

Index1_05
We’ve all
seen the scary images of methamphetamine’s toll on the body: the remnants of a
handsome face reduced to a visible skull with sunken eyes, withered skin and one
really bad case of meth mouth.

   Such visuals,
at one time widely used in drug prevention campaigns, may have had some value. For one thing, they certainly got our
attention. Until recently, many gay men
in our area were naïve about meth’s downside and its potent and destructive addictive
power.

   Florida arrived late at the meth party and
we were able to learn a great deal about the epidemic and what to expect from
gay communities on the west coast. But
even treatment professionals were unprepared and uninformed about meth’s unique
properties.

   These grisly
illustrations, however, also had unintended consequences. Men struggling with meth took one look and
went deeper underground. The images did
little to assist them in stopping the drug, but did a lot toward increasing their
shame about using it. Others in the
community who never tried meth were appalled that anyone would use a drug that
could do that, and a rift opened
resulting in further polarization.

   The South
Florida Meth Task Force, founded in 2003, responded to this knowledge gap by
providing “Meth 101” for over one thousand front-line professionals, including
therapists, substance abuse counselors, EMTs, law enforcement officers,
teachers, physicians, and HIV prevention workers.  The
Task Force, through the cooperation of multiple agencies and the volunteer time
of many individuals, helped get the word out about the risks of meth and other
substances among gay men as well. Soon the
meth problem became increasingly obvious.  People we cared for were crashing and burning
all around us and many were asking (as tweaker.org noted) “remember when sex
without speed did the trick?”

   Now, no one
can claim they are unaware of meth’s inherent risks. But knowledge itself, unfortunately, is
ineffective at fighting dopamine-fueled drug cravings. Scary skull pictures do little except remind
users about the harm they are causing for themselves. While self-help groups have become
increasingly available, south Florida has needed additional meth resources, and fast.

Enter Meth and Men South Florida (M&M), a
new program of Sunserve (www.methandmen.org)
that grew out of the South Florida Meth Task Force. M&M is dedicated to the support of men
in our community struggling with the crystal meth epidemic. Their website already lists resources in
south Florida,
and will soon grow to include other informational pages. M&M is dedicated to filling gaps in
services and in the near future will begin a therapy group focused on sexual
issues in meth recovery, sliding-scale individual counseling, and a variety of
other events like town hall meetings.

   Sometimes,
however, the near future is just too far away. Good news!  On Monday, July 14,
M&M will begin offering METH 911, a free weekly drop-in
group. METH 911, a
collaboration of Sunserve, Broward House, and the GLCC,
is a confidential and non-judgmental gathering
for anyone affected by crystal meth: individuals, partners, family, and friends.

   It will be held at the M Project (2645 North Andrews Avenue, Wilton  Manors) every Monday evening from
6:30pm to 8:00pm. More information is
available at from SunServe at
954-548-4602 or by e-mail to .

  Save
the creepy pictures for Halloween. With
groups like METH 911 we can
face a really scary problem together and discover that action and community
trump fear every time.

The Truth About Gay Men’s Health

“Gay men are healthy,
happy, and life affirming. We’re creative, strong, and resilient; more than
almost any other male population, we think outside the box, take responsibility
for our actions, and care for ourselves and others. We know how to get what we
want and we know how to create lives that are satisfying and fulfilling.”

 With these
words Eric Rofes, the late gay health activist, began an article on the gay
men’s health movement in the White Crane
Journal
just three years ago Are these words still true? Were they true then? Today we are bombarded by grim statistics on
rising HIV rates, alarming amounts of syphilis and other sexually transmitted
diseases, the lives of partners and friends ruined by meth and other
substances, and a disquieting acceptance that its okay not to talk about our
health status with our sex partners. 

 Are we
healthy, happy, and life affirming? I
admit that one can easily get discouraged. After twenty plus years of AIDS crisis mode, much of the celebration of
gay life and gay sex that began after Stonewall has been diminished. Gay sex today is often seen as something to
be feared, contained and controlled. Many
gay men are viewed by society at large (and unfortunately by some other gay
men) simply as vectors of disease who are hypersexual, tweaked-out, and
potentially destructive to themselves and anyone around them. Society views many of us as complacent at
best, and pathetic at worst.

 We need to
reject this narrative of pathology. Like
any stereotype, it is simplistic, polarizing and personally destructive. Are there gay men who are sexually reckless? Of course, but judging and shaming accomplish
little. Much of this behavior was caused
by feelings of separation in the first place. Let’s start sharing information about issues that are important to all
of us, such as how to discuss serostatus, or use a condom, or know the facts
about safer sex, or how to heal “taught shame.” It’s happening already, at forums like those sponsored by Out in the Open or at groups at the
GLCC, or at many other locations.

 What about
Tina’s rampage? I probably have worked with more individuals caught in the
vortex of crystal meth than anyone in this community, yet of all the men I have
been privileged to know, not one planned to venture into the darker realms they
experienced on meth.  Like most of us, these men sought to increase
their confidence, feel sexually desirable, overcome their inhibitions, or
experience increased sexual intensity. Sound
familiar?  Pretty normal?  It’s not the person who is bad or shameful; it’s
a very nasty drug that hijacks sexual desire and clear thinking, often with
disastrous personal consequences.

 There is,
of course, a need for responsibility and accountability. Both personal and community health and
wellness are something that each of us must create. Solutions can’t be found in avoidance or
demonizing. As a community we experience
way too much divisiveness: negative versus positive; older versus younger; those
who “party-and-play” versus those who don’t. By identifying what unites us as gay men, what we all share, we can
generate strength and healing.

 Are gay
men really creative, strong, and resilient? Absolutely, yes. Can we think outside
the box? Of course. Many of us have witnessed such resilience in
other times and places and it’s happening here again. Gay men, our allies, agencies, churches, and
a host of other organizations are actively working together to create a
healthier and stronger community. I’ll
be writing about some of these challenges and solutions in the months to come
and I invite you to join us in creating personal lives and communities that are
not only satisfying and fulfilling, but in Eric Rofe’s words, healthy, happy,
and life affirming.

Rising Rates of HIV Among Gay Men – What Does That Mean For Me?

HIV infection rates occur in the United
States at a far greater rate than previously thought,
according to a special HIV issue of the
Journal of the American Medical
Association
released to coincide with the XVII International AIDS Conference in Mexico City. The CDC utilized new methodology and
technology which differentiates new versus long-standing infections. They determined that in 2006, an estimated
56,300 new cases of HIV infections occurred, significantly higher than the
prior estimate of 40,000 cases.

Men who
have sex with men accounted for 53% of these new cases, and African Americans,
while only 13% of the U.S. population, accounted for 45% of the cases. These statistics represent a discouraging
trend for both populations, especially for gay men who for many years saw a
steady decline in new rates of infection.

Abstract
numbers are difficult to personalize and it’s extremely easy to disconnect our
daily routines from this deadly trend. But every gay man needs to ask himself “what do these numbers mean for
me?” Here are some things to consider:

1. Do I know
my status?
A significant number of
new infections occur because men who are HIV positive (but don’t know it)
inadvertently infect others. Having
unprotected sex with someone who claims to be negative is foolish. Many men don’t get tested because they don’t
want to know. Others may have not yet
converted or worse, they’re not being honest. Take charge of your health – get tested.

2. Do I
engage in safer sex?
Practicing
safer sex takes a little more thought and effort, but doesn’t necessarily rule
out an erotic experience.  It is
important to be informed about specific high risk behaviors, and with a little
creativity something like putting on a condom can turn into a two-man operation
that enhances the mood.  Use your
imagination!

3. Do I
party a little too much?
A major
factor behind the rise in HIV rates among gay men is substance abuse,
particularly methamphetamine. Meth
increases sexual desire while, ironically, causing erectile dysfunction. It also results in less impulse control and
inhibition which translates to risky sexual behavior. There are many men who first used “Tina” and
ended up with HIV. If you think you
might have a problem, check out Crystal Meth Anonymous (www.southfloridacma.org) or Meth and
Men South Florida (www.methandmen.org).

4. What’s
the big deal?
  Life with HIV isn’t
always as thrilling as it appears to be for the guy doing the rock climbing in
that medication ad. While living with the
virus has changed dramatically over the years, it remains a life-threatening
illness that cannot be cured. The
medications themselves can cause serious physical problems, including long term
damage to the heart, liver, and kidneys. People continue to die from AIDS. It is a big deal.

5. So what
can I do about it?
Make HIV your business,
whether you are negative or positive or not sure. HIV/AIDS affects us all. Whether it’s advocating for better public
policy, or giving service to the community, or being sexually responsible,
every one of us needs to get active. Let’s make it the community norm to stay involved with the issue of HIV.  This
is life and death, and we have the power to make a difference.