On September 26 David was honored to receive the 2015 Koch Professional of the Year award in recognition of his service to the recovering community. This award was presented in recognition of Broward National Alcohol and Drug Addiction Recovery Month celebrations.
This article was originally posted on TheBody.com on David's blog "Riding the Tiger: Life Lessons from an HIV-positive Therapist"
Public apprehension about recreational drugs, especially those that impact HIV, seems to come in waves that swell with increasing alarm and then peak and fade away, always to be replaced by the next "drug du jour." Heroin, cocaine, and methamphetamine, each with a well-deserved reputation for putting people at risk for HIV or, if HIV positive, for interfering with their ability to properly manage their health, have all gained notoriety in recent years.
While the popularity of various illegal substances rises and falls, alcohol consistently remains the granddaddy of recreational drugs. New forms of alcoholic drinks began appearing in the 1980s, first with wine coolers and then flavored alcoholic beverages (that's FAB, for short) and energy drinks. They have gained popularity, especially among youth. Now, just months after the FDA urged the removal of caffeine from alcoholic drinks such as 4Loko, beverage companies are once again shape-shifting their fruity-tasting concoctions and they're literally bigger than ever: they've been supersized. The new packaging, still largely targeting young (and often underage) drinkers, features a 23.5 ounce can with a 12% alcohol content. That's equivalent to four or five beers. They're cheap, accessible, and highly potent.
Why is this a concern? The numbers tell the story. 10.7 million underage youth drink alcohol, and about 70% of those youth binge drink, resulting in harmful physical consequences, poor judgment, lower inhibitions, and an abundance of high risk sexual behaviors. And the concerns extend beyond youth. Excessive consumption of alcohol is a significant health concern for everyone, but especially for those at higher risk for, or living with HIV.
Some speculate that if alcohol were introduced today it would never be legalized. It is, of course, here to stay. Because it is so easily available, socially acceptable, relatively cheap, and widespread, it's easy to forget its risks, which are really worth a second look. It's not fair, however, to demonize alcohol. There is little evidence that moderate drinking (described in most literature as one drink per day) impacts persons living with HIV. Excessive drinking, however, can be destructive for persons living with HIV for a number of reasons. Here are a few:
Excessive Alcohol Weakens the Immune System
The physical toll of too much alcohol is expressed in a number of ways. It taxes the liver, which is already working overtime metabolizing medications. This situation is made even worse, of course, when someone is also dealing with Hepatitis. Alcohol also interferes with the body's ability to create white blood cells and is disruptive to other factors necessary for health such as hydration, nutrition, motivation for exercise, and sleep.
Interactions with medications
As noted above, alcohol can affect the absorption of medications necessary to fight the virus. This can result in reduced efficacy, more unanticipated reactions, and alteration of the effects of some drugs. Alcohol also results in medication adherence problems due to altered states and inconsistent behavior.
Speaking of inconsistent behavior, alcohol impacts reflexes, inhibition, and judgment, which can clearly compromise the health and wellness of the drinker. This can lead to poor sexual choices and a loss of motivation for safer sex. Despite that fact that alcohol impairs physiological sexually functioning, people under the influence can still engage in enough risky sex to get them in trouble!
Alcohol is a central nervous system depressant which directly affects mood. It can be misused to numb feelings of sadness, anger, and fear, and can quickly become a crutch on which people depend to avoid uncomfortable emotions. Persons living with HIV are at greater risk for addictions of all kinds, and it is incumbent on anyone who is HIV positive to be vigilant about their alcohol consumption.
"I'm recovering from drugs and alcohol isn't my problem!"
I have patients in recovery from amphetamines who question why they need to abstain from alcohol. Many proclaim their dislike of an alcohol high: slow and sluggish. They prefer the perceived clarity of amphetamines and see no reason why they can't indulge in a beer or glass of wine with their friends. After all, they say, alcohol isn't the problem, it's meth (or cocaine). Unfortunately many discover that a few beers in the bar with friends reduces their ability to resist the impulse to use their drug of choice (such as cocaine and meth) and their resilience and sometimes their recovery crumbles after a few drinks.
Despite the numerous risks, excessive alcohol consumption remains a common problem that requires routine monitoring. Most people won't volunteer this information unless specifically asked, and even then their responses may be less reliable until a level of trust is established. There are quick screening tools for alcohol such as the MAST (Michigan Alcohol Screening Test) that are effective and easy to administer. Of course it is dangerous for a heavy drinker to just stop using alcohol, but with proper medical supervision there is no reason for excessive drinking to jeopardize anyone's health.
This article was originally posted on TheBody.com on David's blog "Riding the Tiger: Life Lessons from an HIV-positive Therapist"
Getting the level of new infections down to zero will require breakthroughs not only in medications and improved interventions, but also a broadening of our understanding about the underlying causes of high-risk behaviors which can increase vulnerability for HIV, specifically, mental health concerns.
The emotional impact of diagnosis is clearly understood. After all, who wouldn't be depressed upon hearing they have HIV? Can we be surprised that a positive test result can be traumatic? But what about the impact of depression or trauma on the risk of acquiring HIV? Increasingly, we know that depression not only occurs after diagnosis, but actually significantly increases the risk of becoming infected. It is natural that trauma can result from seroconversion, but we now know it is a major risk factor for HIV long before dangerous behavior takes place. The earlier we identify and intervene on these conditions the better chance we have of reducing the number of new infections.
The following are just a few of the issues I feel should become increasingly integrated into our research and programming.
Numerous studies have documented the impact of depression on high-risk behaviors such as unprotected sexual intercourse, multiple sex partners, trading sex for money or drugs, and contracting sexually transmitted diseases, yet mental health is rarely a component of the design of HIV prevention and intervention programs. Depression can lead to substance abuse, itself a high risk behavior, but even when studies control for substance abuse, depression alone remains a significant factor. It leads to a sense of hopelessness and guilt, and severely impacts one's emotional resilience and self-esteem. Depression leads to high risk behaviors which effectively distract or numb an individual from symptoms, but also greatly increase the risk of acquiring HIV or other sexually transmitted infections.
Defined as the need for thrilling, adventuresome, novel, and often dangerous experiences, sensation seeking is increasingly being identified as a separate phenomenon which can increase HIV-risk. Sensation seeking can, of course, lead to substance abuse, but it can independently impact sexual behaviors (multiple partners, risky sex). Men and women who seek increased stimulation appear to have a low tolerance for boredom, and contrary to common assumption, sexual compulsivity is not impulsive or pleasure-directed, but is associated with lower levels of self-esteem. I have had clients, for example, who "act out" sexually not for pleasure but to manage emotional pain. They seek to numb painful feelings by repeatedly having risky sex, and despite numerous sexual encounters, they end up feeling sad and "empty."
Childhood Sexual Abuse
Such abuse has been in the news recently and the statistics are truly shocking. Prevalence studies of adults estimate that between 6 to 62 percent of women and 3 to 31 percent of men were sexually abused before the age of 18. Many experts believe these numbers may actually be low. Clearly, such a childhood experience is devastating both at that time and in later life. The effects of trauma can lead to increased rates of addiction, sexual dysfunction, depression, post traumatic stress disorder, and other significant concerns. But what about risk for HIV?
Childhood victims have a higher risk of becoming infected because of the long-lasting impact of abuse. Such men and women are significantly more likely to become involved in sex work, to change sexual partners frequently, and to engage in sex with casual acquaintances. They use larger quantities of addictive substances, and use them more frequently, and experience a disruption in the development of appropriate sexual behaviors. Cleary, safer sex messages alone are largely ineffective for individuals whose lives have been disrupted by sexual assault.
Intimate Partner Violence
Research has begun to document a correlation between risk of HIV and intimate partner violence (IPV). Although both sexes can be vulnerable, the majority of persons experiencing IPV are female. Possible mechanisms of increased risk include the consequences of forced sex and injury to the mucous membrane as well as an impeded ability to negotiate safe sex behaviors such as negotiating condom use or refusing sex. IPV can predispose an individual to engage in sexually risky behaviors which in turn increase the risk of HIV infection. A history of IPV can also negatively impact one's willingness to engage in voluntary HIV testing due to shame, stigma, or fear. Once infected, a history of IPV, which is known to have immunosuppressive effects, can lead to a faster progression of the disease. There are very few programs that address HIV and intimate partner violence risk reduction simultaneously, making this an area needing urgent attention.
Redefining the Epidemic
To be truly effective, HIV prevention and intervention programs must broaden their scope to include a variety of other issues that directly impact the risk of acquiring HIV. "Syndemics," or simultaneous epidemics, is a useful approach that more realistically reflects what I see in my office and in the community. There are issues of HIV, other sexually transmitted infections, mental health disorders, addictions, trauma, and maladaptive behaviors such as sensation seeking that increase an individual's risk. The HIV community, largely due to accidents of history, is divided by funding streams and professional training into separate silos that too often lack an integrated understanding of what any one individual is or has experienced that could put him/her at increased risk.
We need to be certain our outreach and prevention efforts incorporate the effects of mood disorders and behavioral concerns on sexual behaviors. We need to understand that all sexual behavior is not the result of free will but may, in fact, be driven by coercion or survival. We need to understand that high risk sexual behavior or addictions may result from a history of childhood sexual abuse and integrate this information into our interventions. To truly get to zero, we need to broaden our reach to all of the varied settings where vulnerability for HIV is born.
Every spring, on the white, sandy beaches of the Florida Panhandle, an unlikely gathering takes place. On that narrow strip of land, between the Gulf of Mexico and Choctawhatchee Bay, 450 HIV-positive men and women from around the country, but mostly from the Southeast, come together amidst occasional spring breakers for a weekend of socializing, education, some silliness, a few tears, and just plain fun.
This year, the Positive Living conference turned 14, an extraordinary success by any measure, but even more poignant because it is the only remaining large-scale conference for persons living with HIV. It is a remarkable blend of individuals: Those who are well-known for their work in the field mix easily with positive men and women who may never have seen the ocean, or been able to spend a weekend by themselves at a hotel, or (most certainly) been around so many other positive individuals in one place.
I am always struck by the rich amount of valuable information available for both attendees and presenters. Tom Liberti, Florida's HIV/AIDS Bureau Chief, gives an annual review on the state of affairs, especially poignant this year because of the AIDS Drug Assistance Program crisis. There are medication updates and workshops on mental, physical and spiritual health. There is a daylong AdvocacyU workshop, where attendees learn how to use their voices to advocate on their own behalf.
And there is history. Until his death, Martin Delaney never missed Positive Living. And this year, as Martin Delaney did in years past, Paul Kawata, the executive director of National Minority AIDS Council, gave a keynote that captured a long-term view of HIV — where we have been, our successes, our setbacks, our power, and the many struggles to come.
The heart of the conference lies with the participants, and it is here that the immense benefit for one's clients living with HIV can be clearly seen. Most receive scholarships, which pay for the beachfront hotel rooms and meals. Many are from the rural South and simply don't have adequate access to medical resources — or, for that matter, each other. Positive Living fosters the formation of networks for both medical and social support; but mostly, at least for a few days, it normalizes the stigma of living with HIV. For one brief weekend, everyone is HIV positive (or a very close ally). One can feel a sense of joy and freedom in sharing this physical and emotional space.
The very existence of this conference is a tribute to the vision and hard work of Butch McKay, the executive director of a relatively tiny agency, Okaloosa AIDS Support and Informational Services, Inc. McKay and a handful of staff raise the necessary funds and organize this event with a mastery and focus that have a sense of life or death. And there is no doubt that Positive Living enhances, and even saves, the lives of persons living with HIV.
But the conference itself, like others before it, is at risk. Every year, fundraising is more difficult even as the need grows. Across many states vital programs are being cut, individuals are struggling with fewer resources, and bureaucratic shifts resulting from budget cuts make maneuvering the system, and surviving, that much harder. We witness our clients struggling with these issues every day.
It's easy to see why such events have disappeared. They require extraordinary determination to bring them to life, and the costs are daunting. But their demise represents one more great loss attributable to this virus. Without such gatherings, persons living with HIV have one less resource by which they can remain educated, connected, empowered and even sustained.
Too often we allow ourselves to focus on the objective data of HIV: CD4 counts, viral loads and years since diagnosis. Events such as Positive Living heal at a deeper, more subjective level: the spirit. They renew our determination as providers and they reenergize our clients' ability to integrate healing at multiple levels. For all this and more, they are well worth fighting for.
David Fawcett PhD, LCSW, has been honored with the "Who's Who in Florida Prevention Award" in recognition of his leadership in both substance abuse and HIV/AIDS prevention. The Florida Office of Drug Control named individuals recognized for their leadership at the annual statewide Prevention in Florida Conference in Orlando in early October. This award acknowledges the accomplishments and dedication of individuals and groups within Florida’s prevention community. Dr. Fawcett's nomination specifically recognized a decade of leadership working to strengthen individuals and families, especially within the LGBT community.
Dr. Fawcett has worked on a number of community projects, including serving as Chair of the South Florida Methamphetamine Task Force, which fostered community partnerships to address the methamphetamine crisis through training of professionals and creation of an infrastructure for prevention and treatment. He was a founder of Meth and Men South Florida, a program of Sunserve, which continues to provide sliding-scale individual and group therapy for substance abuse within the LGBT community. He also serves on the Board of Governors of the Broward County Commission on Substance Abuse; the Clinical Advisory Board of Sunserve; and recently was Program Co-Chair of the 2010 National Gay Men's Health Summit, a five-day event that drew nearly 500 people from around the nation to address concerns related to the health and wellness of gay men.
Dr. Fawcett frequently makes presentations on topics of HIV and substance abuse both locally and nationally, most recently at the US Conference on AIDS. He has been in private practice and created and now facilitates the "Connections" group for gay men at Fusion, a drop-in center funded by the Broward County Health Department. The weekly "Connections" group is open to all and provides a rare opportunity for gay men to discuss a variety of topics, including body image, self-esteem, intimacy, relationship skills, stress reduction, and many more.
It was 1982 when my friend Andrew developed an odd pneumonia that put him in the hospital and ran through his body with such ferocity that he was dead in three days. My friends and I were stunned, until it soon happened again – this time with another acquaintance who survived longer, but ultimately succumbed to an illness the New York Times called “GRID,” gay-related immune deficiency. GRID soon became AIDS, and one by one almost all of my friends became sick.
Thus began a journey that continues to this day, first marked by terror, then sadness, then overwhelming grief, and then by sheer determination as we stepped up to care for each other. My life as a thirty-something gay men in New York was quickly transformed from exuberance in the aftermath of Stonewall to determination marked by caretaking and political advocacy.
The energy on streets in the Village and the Upper West Side, once both high-spirited and sexually charged, became heavy with sadness. Many men simply disappeared as the disease confined them to their homes, or their friend’s homes, or hospital wards. Many died. Others were out using the patchwork of services that began to develop in response to the crisis. The streets were filled with the odd sight of thin men with wide terrified eyes walking awkwardly with canes. I vividly recall one very cold winter day when I helped one frail young man struggle across Seventh Avenue through slippery frozen slush on his way to St. Vincent’s.
Despite persistent optimism and a strong sense of spirituality, for me the eighties became a human tragedy. My life was entwined with AIDS at every level: intimate, social, and community. As we lost one friend after another there was nothing to do but go forward, caring for those who were dealing not only with physical illness but also struggling with the emotional pain of rejection and stigma. And AIDS kept coming.
One price we paid, among many, was never really stopping to grieve because so much needed to be done. We hardened our emotions and our resolve – there was simply too much to do. Men of my generation live with a great wound that, for many, remains unacknowledged and unexpressed. We need to heal, even in the face of the ongoing epidemic.
Now, nearly thirty years later, AIDS continues to create suffering. For many, it has lost its urgency. A new generation has grown up with the disease and new medications, and view it as a manageable illness, but it is relentless and continues to demolish lives. Long term survivors have developed an acceptance of the unknown. They have given their bodies to drug trials and dealt with multiple losses, either through the death of partners and friends, or alienation from family. Ironically, they now face a new wave of heart, liver and kidney disease as a result of the medications that have kept them alive.
We need to remain vigilant about AIDS. We need to advocate for new treatment alternatives like rectal microbicides and redesigned prevention efforts. We need to remain informed and fight complacency. We need to end the stigma that surrounds AIDS to this day, undermining both prevention and treatment. Mostly, on this World AIDS Day, we need to remember the pain, the lessons, the courage, and the successes of the past and use them to renew and reenergize our continued work to end AIDS once and for all.
Every year between 7500 and 8000 men in the United States are diagnosed with testicular cancer. About 1 in 250 men will receive such a diagnosis over the course of their lifetime, but it is most common in men between the ages of 15 and 35, and particularly for men in their twenties. The good news is that is has an extremely high cure rate of 90%, a rate that is even higher if the cancer hasn't metastasized.
The alert editors at Gaywisdom.org have found a video on Youtube that, while humorous and to a certain extent uncomfortable, is extremely important both for information and for overcoming the embarassment of this form of cancer. The video is of British origin. Unfortunately the level of prudishness and even homophobia in the US makes such a home-grown piece unlikely.
This clip is entertaining but vital. Watch it and go help a friend!
Gaywisdom is the blog for the White Crane Institute, an important organization that publishes books and journals related to gay mens' health, art, and spirituality. They sponsor the Gay Men's Health Movement Leadership Academy (of which I am a proud graduate), the Queer Spirit conference, and other events such as the White Crane/ James White Poetry Prize for excellence in gay men's poetry.
Imagine receiving this email: “No one wants to be the bearer of bad news but I got diagnosed with STDs (sexually transmitted diseases) and you might have one too.” This email might be from someone you know, or it could be anonymous. While unpleasant, such a message has tremendous benefit because it notifies you of possible exposure. With such knowledge you can seek early treatment and hopefully avoid having to send such an email yourself. This new service is available through Inspot, a not-for-profit agency funded by the Florida Department of Health.
New options for notifying sex partners couldn’t come at a better time. Last week a CDC (Centers for Disease Control and Prevention) report announced that syphilis cases in the US were up a staggering 15.2% over the year before, and worse, gay and bisexual men (including a disproportionate number of African-American men) accounted for a whopping 65% of those cases. These numbers represent an unfortunate continuation of a seven year rising trend in syphilis rates.
Syphilis, untreated, is dangerous enough, but it also increases exposure risk for HIV by causing breaks in the skin, giving these statistics an ominous significance. While there is a simple blood test for syphilis, the symptoms (sores on the genitals or in the mouth) often go undiagnosed and the disease is easily spread. The CDC recommends annual testing for those in a partner relationship, and every six months for others.
Why are these numbers so high for gay and bisexual men?” The CDC speculates that we are suffering from prevention fatigue (certainly true) and being less vigilant with safer sex. Dr. John Douglas, head of STD Prevention for the CDC, also suspects that a rise in serosorting, the practice of choosing sex partners with the same HIV status, plays a role. Such unprotected sex leaves men exposed to other sexually transmitted diseases like syphilis.
I suspect an additional factor: substance abuse, particularly methamphetamine. Meth is the perfect storm for STDs: it increases risky sexual behavior, leads to multiple sexual partners, and eliminates cares about protected sex. The clients I see in the Meth and Men program at Sunserve bear this out: tina, out of control sex, and STDs go together.
No one wants to tell a friend or even a trick that you have exposed them to an STD. And realistically, you may not even know his name or phone number. But chances are that if you hooked up online you can find that profile and send him (or them!) an email that can be anonymous or personalized. In Florida, you can do this knowing that no governmental authority is involved, and that there will be no reporting or follow up by the health department.
Inspot provides six templates with sharp graphics and catchy phrases (“It’s not what you brought to the party, it’s what you left with”). If you wish you can add a personal message. The site also has links for information about sexually transmitted diseases and testing locations.
Getting tested for HIV and other sexually transmitted diseases is essential. Most infections occur not because people lie (although some do) but because they don’t know their status. When you get bad news don’t let embarrassment keep you from notifying someone you might have infected. Use these Inspot notification emails to help stop this cycle and keep our community healthy.
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.
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.
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
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).
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.
From the Blog
- Fawcett Chairs SunServe Conference on HIV/AIDS and SeniorsApril 10, 2017 - 8:20 pm
Individuals over the age of 50 represent half of all people living with HIV and they face challenges from both aging and HIV. On Friday, March 31st Dr. Fawcett attended and presented at the 2017 HIV/AIDS Seniors Conference sponsored by SunServe and AIDS United. Serving as conference chair, he assembled a panel of nationally known […]
- “Lust, Men, Meth” event is standing-room only in SeattleFebruary 18, 2016 - 10:49 am
On February 9, Dr. David Fawcett presented a reading and discussion on reclaiming sex and intimacy after methamphetamine based on his book “Lust, Men, and Meth: A Gay Man’s Guide to Sex and Recovery” in Seattle. The event was a held in collaboration with Gay City and was moderated by local Seattle therapist Peter Jabin, […]
News & Events
- Learn more about David Fawcett's upcoming appearances:
- Learn more about Dr. Fawcett’s upcoming workshops and presentations.
- February 23, 2015 - David Fawcett and Kris Drumm begin an ongoing therapy group. Participation is limited - a 12 week commitment is required. Group meets Tuesday evenings 6:30 pm - 8:30 pm. For more information contact firstname.lastname@example.org.