HPV: a Hidden Epidemic that’s Killing Gay Men

   David Fawcett, PhD, LCSW



    Albert, a gay man, came back to my psychotherapy office for the first time in three months.  He looked thinner, pale, and depressed.  He was still on a significant amount of pain medications after suffering three painful rectal surgeries in an attempt to treat aggressive anal cancer.  His prognosis remained uncertain and he was tired and discouraged.

    Albert is also not alone.  There is a largely-unrecognized epidemic of gay men, many also HIV positive, coming down with anal cancer.  Several of my own clients have been diagnosed and I hear of other cases with disturbing frequency.

    Anal cancer is caused by exposure to HPV (Human Papillomavirus) and can usually be successfully treated when discovered early.  While there is no definitive diagnostic test, a simple annual screening with a Pap smear can be highly effective at finding cellular irregularities before they become cancer.  Even gay-friendly physicians often don’t think to offer a Pap, and gay men don’t know to ask for one.  This needs to change.

What is HPV?

    HPV is the most common sexually transmitted infection.  At least half of all sexually active individuals get HPV at some time in their lives. These infections frequently create no symptoms and resolve on their own, but a few of the more than 40 types of HPV can have serious and even fatal consequences.  Some strains cause cervical and anal cancers; others cause genital warts. 

How common is HPV among gay men?

    One study reported that 95% of gay men with HIV also have HPV, and 60% of HIV-negative men have HPV.  Gay and bisexual men are 17 times more likely to develop anal cancer than heterosexual men. 

How is it contracted?

    HPV is contracted skin-to-skin – no penetration is required.  This can include genital to genital contact, touching someone else’s genitals and then your own; sharing sex toys, and (rarely) oral sex.  Condoms offer minimal protection but some risk remains because of exposed skin. 

What can go wrong if I am exposed to HPV?

    Cervical cancer in women is the best-researched consequence of HPV, but the virus can also result in significant, lesser- known concerns for gay men.  The same HPV strains that cause cervical cancer in women can cause anal cancer (and rarely penile cancer) in men.  Gay men who practice receptive anal intercourse are at high risk; if they are HIV positive they have even higher risk.   If undetected, anal cancer is very dangerous.  In HIV positive men its progression appears unrelated to taking antivirals, length of time since HIV diagnosis, or CD4 counts.  It is treated with advanced forms of radiation, chemotherapy, and surgery, although a combined UK/US study found survival rates of just 66% for the first year which declined thereafter. 

    Another, less virulent consequence of exposure to HPV is genital warts.  These are highly contagious and caused by an HPV strain that doesn’t lead to cancer.  They need to be treated by freezing with liquid nitrogen, cauterizing, or surgically removing them.

What about Prevention?

    An HPV vaccine called Gardasil, shown to prevent cervical cancer and genital warts, has been introduced and approved only for girls ages 9-26.  It protects against four types of HPV, including the two that cause 70% of cervical cancer.  It is administered in three shots and is usually not covered by insurance (cost around $300).  The vaccine will not offer protection for prior exposure to specific strains, although studies indicate it might slow progression of warts or cancer. The vaccine is not approved for men although (finally!) there are studies underway to test its safety and efficacy in men.

     We don’t have to wait for the vaccine.  There is an easy and effective screening tool that every sexually active gay man should have every year: a Pap test (also known as a Pap smear).  This can detect abnormal cells that could become cancer and which can be removed.  The CDC doesn’t recommended Pap tests for men because there is not yet enough data on how HPV leads to cancer in men, although other leading gay men’s health organizations such as Fenway in Boston recommend annual Pap test screening.  

    If a Pap test is negative you’re in good shape.  If it’s positive your doctor will conduct a biopsy, remove suspicious cells with a laser, and monitor through regular follow up.   

    As gay men we need to take charge of our health care.  Ask your doctor about a Pap test – if you detect surprise at the question you may need to evaluate how knowledgeable he or she is about gay men’s health.




Did you ever wonder about the LGBTQ population where you live? How many of us are there? How old (or young) are we? What races and ethnicities do we represent? What is the status of our health, or our households, or our finances?

Today it is impossible to determine the answers to these questions, but if you live in Broward County that’s about to change. This summer you will be able to participate in an online census for the gay, lesbian, and transgender community called “The Count.” The collected data will finally give us a statistical presence that not only provides an awareness of our numbers but also assembles information that can be used for public policy and funding decisions. The census is a collaborative effort that includes the United Way, Sunserve, the GLCC, Broward House, and the Broward County Department of Health. This is the first effort to quantify and document information about our community.

Why is this important? One key reason is that it will enable better funding for health care, social services, and other vital resources. For example, as Chair of the South Florida Methamphetamine Task Force, I have been frustrated in applying for funds that could provide additional treatment services because there is no specific data on the pervasiveness of substance abuse among Broward’s LGBT population. In the case of meth, we know there is a serious problem but grant makers want specifics, and documenting how many people are affected, their other health concerns (like HIV or Hepatitis), or their treatment needs is impossible because there is no data. This seriously affects our ability to get funding to help the community. If we aren’t seen or heard, we will be overlooked.

Many of my psychotherapy clients express frustration about what they perceive to be a lack of community. This census is an important step in affirming that we are not only here, but that we will be seen, heard, and counted.

“The Count” will go live this summer, but you can register now on the site to be notified about updates.

Crystal Meth Intervention: the Spoof (NSFW)

For anyone who has ever seen the show Intervention on cable and who is familiar with crystal meth, this is hysterical.

The Gay Men’s Health Agenda 2009: Making our Voices Heard


As the new administration in Washington massively shifts national priorities, an opportunity has presented itself for the LGBTQ community to speak up and to be certain that our long-neglected healthcare needs are both recognized and addressed.

The Gay Men’s Health Agenda   is a significant document which grew out of a grassroots effort within the gay men’s health movement. After soliciting comments from gay men around the country, a draft was presented for feedback at the Gay Men’s Health Summit in Seattle in October, 2008, and the final version has now been published.

The Agenda is significant because it urges policy makers to recognize that the health care needs of gay men extend far beyond HIV/AIDS, and include mental health, substance abuse, external and internalized homophobia, and a sometimes appalling lack of cultural competency of many health care providers in recognizing and appropriately treating the health of the gay, lesbian, and trans community. This is even more vital as the federal government is now drafting "Health People 2020," which will serve as a roadmap for spending priorities over the next decade. Gays and lesbians have been virtually absent from federal health priorities. This Agenda pushes for change.

Recommendations specific to gay men’s health include funding and expanding social, behavioral, and biomedical research; developing and collecting data on sexual orientation and gender identity in federal research; funding campaigns to combat homophobia, biphobia, and transphobia; and eliminating bans on "promotion" of any type of sexual behavior, which impairs effective health campaigns. Other recommendations include creating strategies to combat health disparities, funding sexual health and wellness, and removing barriers to health care for transgender people.

Similar efforts for lesbian health include the Lesbian Health Fund of the Gay and Lesbian Medical Association. Health care disparities continue to grow for all of us in the LGBTQ community. These efforts are an important step in making our voices heard. Whether you participate by contributing to a similar document or by calling or emailing your representatives, be sure yours is among them!

Where are your hands? Self exams and testicular cancer

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.

“Inspot” website lets you anonymously notify others about your STD


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.

For more information visit Inspot at http://inspot.org/florida.


Bikers, Bears, or Beauties: Are We More than Labels?

Labels lifelube Gay men have perfected the art of labeling themselves in ways that are creative, yet at times, constraining to our identity. After fighting to move beyond stereotypes imposed by straight culture, there is something slightly disquieting about self-imposed categories typically based only on external characteristics and sexual behavior. This is a logical outgrowth of life online, especially social (well, sexual) networking sites where we package ourselves as commodities for quick review by the outside world.

The list of gay labels is long and ever-changing, but provides us with a common lexicon by which to classify ourselves and each other: bears, daddies, boys, twinks, tops, bottoms, barebackers, clubkids…even labels related to drug culture such as PNPers and slammers. Some categories are broad and general, and some are more obsessively developed such as the bear codes, which cleverly quantify characteristics such as furriness, the grope factor, and even the slut factor.

Are these useful? They certainly make finding a compatible sex partner as easy as finding a great shirt on the sale rack at Macy’s. But such labels are also valuable helping gay men forge an identity in the relatively hostile environment that we call gay life. Labels provide guidelines for many men both during the coming out process and beyond, laying out a rich menu of sub-cultures which provide both identity and a sense of belonging.

While labels provide a level of comfort in a homophobic world, I wonder if they don’t confine us as well. I sometimes get concerned that people too often define themselves by externals alone and don’t push themselves to completely discover who they might be as individuals, daring to express that to the world. Labels too often provide cover for ignoring the internal thoughts and feelings that make us unique and, ironically for someone seeking to fit in, for what makes us both likeable and lovable as individuals.

I don’t mean to imply that people are simply slaves to whatever category they have adopted, or that they are confined to just one label, or even that what we call ourselves doesn’t change as we age. I do feel, however, that too often we are complicit in oversimplifying the identity we express to the world which reinforces the stereotypes about our community such as hypersexuality and superficiality.

Another downside of labels is their power to polarize. Too often they reinforce what keeps us separate instead of allowing us to experience what we all share in common. It is as if we have created our own little ghettos by which we limit ourselves from recognizing our strength as a gay community. We can find unity, however, as evidenced recently by the turnout at rallies against Proposition 2. It was truly moving to see a diverse group of gay men and woman as well as our allies coming together as one community to express our unified voice.

Do labels reflect who you want to be? Next time you consider how you fit in or how you are perceived by others, don’t be limited by pre-packaged descriptions. Customize your identity and express yourself in a way that reflects who you really are, inside and out.

Interested in finding out more about this topic and others related to how we connect with other gay men both socially and sexually? Check out my “Connections” group as well as two other groups, “Becoming Mr. Right” and “Finding your Inner Artist,” beginning in January at Fusion Wilton Manors).

The Power of Gratitude

The holidays, and especially Thanksgiving, are supposed to reflect the principle of gratitude, being thankful for the people, places, and things that have blessed our lives. But, ironically, in these uncertain times blessings may appear to be in short supply. Most of us are bearing extra tension that can be amplified by the approach of the holidays themselves. Many LGBT persons experience significant emotional stress during this time, and for good reason. Money problems may seem overwhelming and emotional stress may result when our friends, and sometimes even our partners, aren’t welcomed by our families of origin.

So how can we achieve an attitude of gratitude? Or should we, as one client of mine pointed out, "save it for the greeting card companies?" No, I don’t think so. Gratitude, the practice of being grateful, is increasingly being recognized not as a cliché or as something to be cynically ridiculed, but as a powerful tool that can actually change our outlook and our moods.

I know from personal experience that there is nothing harder than being grateful when things are difficult. Whether due to personal illness, a major loss, or even worry generated by watching too much cable news, the idea of having gratitude when you are experiencing pain or fear seems ludicrous, if not offensive. I have had many clients stare at me in disbelief when, during a painful period, I suggest they try and find even a few things for which they might be grateful.

Most simply ask, "why?" The reason is because it not only makes you feel better, it may even change the world (more on that in a minute). The shift in personal consciousness created by the act of identifying gratitude can move us from a state of need and resistance to one of acceptance and healing. I recognize this is sometimes easier said than done. In the past year I have experienced sadness and pain around the declining health of a parent. I certainly haven’t yet found a way to be grateful for that situation, but even on the worst days I can be grateful for a ground orchid in my yard, or my dog’s relentless playfulness, or the steady support of my partner. Taking a few minutes to consciously acknowledge those things somehow breaks a spell and brings me back into balance.

While many spiritual traditions have long recognized the wisdom of gratitude, its power is now being increasingly documented in scientific literature. For example, one study by Emmons and McCullough in the Journal of Personality and Social Psychology used a double blind study to demonstrate that a conscious focus on blessings has empirical emotional and interpersonal benefits. Many other studies link gratitude with numerous positive effects ranging from well-being to goal attainment.

Even if being grateful can help us feel better, can our personal expression of gratitude have an impact on the world? Increasingly, many people think so. A number of metaphysical traditions (as well as quantum physics) acknowledge the power of our thoughts to change our very cells and even our reality. Today there is a heightened awareness about the potential of shifting human consciousness based on what we as individuals think about and what we do.

The internet is increasingly being used to facilitate such shifts. I recently learned of one free site (www.gogratitude.com) which is attempting to create a wave of gratitude that will sweep the globe. One can sign up to receive 42 brief, daily messages that help develop such awareness. To date, over one million people have signed up.

Thanksgiving and the other holidays can be inherently stressful, but we do have the power to choose where we lavish our attention. Personally, I feel a lot better if I can find at least something to be grateful for. And when I can’t, there is help – here comes my dog with a toy in his mouth.

Life After Meth: Reclaiming Sexuality and Intimacy

GMHS Oct 2008 s

This is the presentation I made at the recent Gay Men’s Health Summit in Seattle.  It addresses the intersection of meth’s sexual effects with gay men’s concerns around desire, intimacy, self image, and identity.  Various interventions from sex therapy are explored as they pertain to sexual recovery after meth.


GMHS Oct 2008