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, M. Div, LMHCA. Following a 45 minute presentation based on critical information about recovery from the book, Dr. Fawcett led a lively discussion and answered questions from attendees about meth use in the gay community. Over 50 people were in attendance, filling the Calamus Auditorium to standing-room only. The number of participants is an indicator of the intensity of the meth epidemic among gay men nationwide, as well as the need for solutions. To order a copy of “Lust, Men, and Meth,” or to learn more about the book and Dr. Fawcett’s upcoming appearances, visit david-fawcett.com.
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.
“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.”
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.
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.
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
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.
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
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
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.
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.
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:
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.
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.
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
From the Blog
- The Gifts of GratitudeOctober 23, 2018 - 6:30 pm
The Gifts of Gratitude Gratitude, and the many means by which it can be practiced, is a powerful resource for anyone working to build emotional and physical resilience in their lives, whether in recovery from an addiction, struggling through a difficult period, or managing a physical illness. READ MORE HERE. (This is a repost from […]
- 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 […]
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.