Taking Care of Men
Noted physician and author Frank Spinelli, who speaks in Houston this month, has plenty to say on gay men’s health.
By Nelson Vergel
Nelson Vergel, well-known local AIDS educator, advocate, and author, speaks to Frank Spinelli, M.D., by telephone, in advance of Spinelli's June 30 Houston appearance at an event hosted by Legacy Community Health Services. Spinelli, who maintains a private practice in the Chelsea neighborhood of New York City, is the author of the recently published Advocate Guide to Gay Men's Health and Wellness (Alyson) and writes a health column for Instinct , the gay man's answer to Cosmo.
Nelson Vergel: Could you give us a very brief background of who you are and what you do in New York?
Dr. Frank Spinelli: I've been living in the city for over 12 years. I'm from New York, originally. I'm a Brooklyn boy. And I was raised in Staten Island. I ended up in private practice in Manhattan, in New York, about eight years ago. So I've been in solo private practice in internal medicine with a sub-specialty of HIV in the gay community.
And what made you decide to write a book about gay men's health?
I've always wanted to write. I've always kept journals. Even when I was in practice, even in early periods, I would write into the local gay magazines. I would write in questions and answers, and see if they had many health columnists, and if they were interested, and how would I apply. They were very receptive. So I was attached to certain publications, like New York Blade and then HX. Then finally, I ended up with Instinct magazine, and I've been doing a Q&A for them.
Ultimately, I was feeling the same thing would keep coming up. It was these feelings of isolation and depression and loneliness. I thought, even though we are speaking now in 2008, it's amazing to me how we can still feel so isolated from our community, even being within our community. So I started to look beyond that and say, “What's going on? What are these key points that I want to address?” And that was internalized homophobia, HIV, and what that meant as a gay man. And why would gay men's health be different than men's health?
Nobody wants to talk about a few things that really concern gay men, especially aging gay men. In your book, you mention the higher suicide rates and depression and issues with GLBT youth. I really wonder what we can do as the older generation to mentor the younger generation of gay and lesbian and transgender youth to make their lives a little easier.
What I wanted to do is organize ourselves as a group and to reach out to the younger gay men, and even the older gay men, because we have a real big disparity there. The HIV epidemic really did inflict itself upon us, and it did wipe out a generation. There has been that devastation that occurred, and I think we're all kind of just wallowing in the aftermath of that. I want to say to the younger guys—because there are so many issues with complacency, where they think there [are] these new one-pill, once-a-day [treatments], and HIV is not so bad. They don't remember what the epidemic was like at the height of the epidemic. So you have to be able to address them without scaring them, because you don't want to become frightening. You want to attract your audience.
The other thing is how we deal with the older population, especially those over 50 who are breaking up with boyfriends and then going back and doing crystal meth or going back into the life of singlehood and dating. There are so many opportunities. I wanted to really explore them on a case-by-case basis. That's one of the things I'm going to do when I come to Houston. I really want to talk about these personal stories that I think are indicative of what's going on across the country.
You mention in your book that 800,000 men per year are raped or assaulted by their partner. I was really shocked by that number.
This week, I had a patient who had been attacked viciously outside his apartment, and he's in the ICU. He almost lost a kidney from being kicked and the result of what we thought was maybe a gay bashing . . . well, we researched further with the police and the investigators. We found out that it was his partner, his lover. Domestic violence—it still exists.
And you say it's very under-reported because of shame issues.
Because of shame and guilt of isolation. Because as gay men, we feel we don't have the cause to say, “Oh, I've been violated” or “I've been attacked.” There's a lot of disparity when we talk about men being attacked—like we should take care of ourselves. It's really sad, because men can be victimized, and that needs to be addressed, definitely.
Something that you also talk about a lot is our over-compulsion, our body consciousness. We get bombarded by the media — not only gays but straights, women, men — to consume more and then feel a lot more inadequate so we can consume more. How do we take care of our bodies while keeping the balance?
I was like a chubby kid when I was in school. I wasn't good at sports, and I hated to go to gym. So here I was, a gay kid. I was fat. I didn't want to go to school because I didn't want to have to play sports. . . . In the gay community, we do it to ourselves. It's like high school all over again. When I went to the bars, everybody was like, “Oh, you've got to be pretty. You've got to look good.” And I was thinking, Oh, my God. I gotta go to the gym! It comes right back down to your sense of self, who you are, and who you want to be in the community—and not just some image or some stereotype that's depicted on television, or to the camera in magazines.
You also address the sexual addiction and compulsion. We're always wondering, How much sex is too much sex? What is a healthy sexual appetite versus an unhealthy one? That's always a hot topic.
A healthy sexual appetite is great. I think sex is great. I recommend it highly. But I think anything can become an addiction when it interferes with your regular, routine life, when it just really becomes part of your routine and you cannot function without it. So when men are on the phone, texting men to arrange for sex, and they are not even talking to you at the table because they're arranging for sex afterwards, then there's a problem.
Sexual addiction speaks to something deeper. Is there underlying depression? Or is there isolation? There again, what is the void you're filling? We speak of the necessity to fill the void with sex or food or drugs or alcohol or smoking. The addictive potential for gay men is incumbent upon the fact that maybe they just feel really hollow inside because they don't accept who they are. So I wanted this to be an inspirational book for men to say, “We're gay and we should be very proud that we are here.” I hope that I put a face to gay men's health and we can just be here for one another.
In talking about meth addiction . . . I'm seeing a lot of problems not only in 20-somethings, but like you said, older gay men.
Oh, it's a huge concern. I'm going to actually speak at the Gay and Lesbian Center in New York next week. And we're talking about crystal meth. You know, crystal meth has not gone away. It's here. And it's actually very pervasive because of the way it's made and the fact of what it does to you. We talk about the effects it has on the reward system, and that it's like 50 times more powerful than cocaine. The addiction potential is so high, and what that leads to ultimately is unprotected sex and HIV. We don't talk about it enough. And I think it's like one of those things where we have to approach it in different ways, because it just gets tiresome—because everybody's like, Well, I don't want to talk about crystal meth anymore. But it still exists, and it's still around.
Something else I'm concerned about — because I've been working in the HIV field for a long time as an educator — the fact that we're still not talking enough about anal cancer, and issues with the human papilloma virus. People are not getting themselves checked. Fortunately, we now have two doctors now trained in Houston for anoscopies. Hopefully, you can talk to us about this when you come to Houston.
Yeah, well, who wants to talk about that? It's scary. I mean, I'm scared just to hear the word anus. Now, everybody is scared. You say the word anus —everybody runs. But you know what? We have got to talk about the anus. You have got to be in touch with your body. People think I'm crazy because I'm, like, You have to get a mirror. I grew up with women, so I feel very in touch with the feminine side. Do you remember in an episode of Sex and the City when they tell her [the character Charlotte] to look at her vagina in the mirror? I recommend that men look at their anuses in the mirror! Look at your body. You really have to know everything there is to know about your body.
If I had it my way, I'd have a bathroom with mirrors on every wall, so I can see everything that's going on, all over me. Because I want to know what's on my back, on my tushy, on my foot—everything. And instinctively, I examine myself all the time. But when you don't know what you're looking for, you're afraid and you ignore it. So how scary is it to find something going on in your butt? That would be frightening. So I just give in the book some tips on how to take care of yourself, because obviously this is being used as a sexual organ. We're not talking about it enough, but it is.
I don't think a lot of primary-care doctors are well-trained on doing Pap smears in men. Sometimes even the gay doctors don't want to deal with it. So it's kind of embarrassing and a problem that when it is diagnosed, it is usually in later stages that require chemotherapy or radiation.
Wait till I come to Houston with a big picture of an anus.
You are funny! Can't wait to listen to your lecture! Let me see what else I have here. Can you tell us more about what dysthymia means? Because I think a lot of us may be walking around with that underlying depression and not really know it.
I think there's a lot of underlying depression and anxiety across America period. People neglect to think that we're going through a war right now, and this has an effect on us, the economy, and everything. Add to the fact that you might be a minority, or gay, and how that influences your life, your decisions. It's a lot just to get up in the morning. That's tough.
I think addressing one's health is breaking it down into “How do I just find me? What works for me?” What I really wanted in this book was for someone to just look through it and say, “Look, I read this book and I have some questions.” That's what I wanted—to provoke a discussion between you and your doctor.
Frank Spinelli speaks on June 30, 6–8 p.m., at the Ensemble Theatre (3535 Main). There is no admission charge for the event, which is underwritten by Abbott Laboratories. Legacy will serve complimentary hors d'oeuvres, soft drinks, wine, and beer at the event.
Nelson Vergel is the co-author of Built to Survive! (with Michael Mooney) and edited the book How to Manage Side Effects, published by the Houston Buyers Club. He writes frequently on health and HIV/AIDS issues for the media, including for TheBody.com , the New York-based HIV information website. Vergel is the founder of PoWeR, the Program for Wellness Restoration, a nonprofit organization that provides educational information for HIV-positive people, and the founder and moderator of Yahoo.com PozHealthGroup, an HIV listserve.