HIV/AIDS and Sexually Transmitted Infections
Topping the list of health issues among MSM in the Philippines is HIV/AIDS. While in most parts of the globe, HIV/AIDS cases are said to be decreasing, the Philippines remains one of seven countries in the world with a steady increase in cases. This year, the number of cases recorded by Philippine HIV/AIDS Registry of the Department of Health – National Epidemiology Center since 1984 has surpassed the 10,000 mark. As of October 2012, a total of 11,125 cases have been diagnosed, but of course, this total is just the tip of the iceberg because not everyone has been tested. Sexual contact still showed as the leading mode of transmission, but unlike in the past, men having sex with men has now become the predominant type of transmission in recent years.
Dr. Robert Baytan, an openly gay HIV/AIDS prevention advocate, said that two decades to less than a decade ago, he would proudly tell his audiences in seminars, communities and classrooms that MSM or male-to-male transmission comprised, at most, 20% of HIV infections in the country. He said that the recent surge in MSM transmission is curious and is worth looking into, HARD.
Baytan practices Medicine in Marilao, Bulacan. He is a founding individual member of Task Force Pride, Philippines, a health columnist of the now-defunct gay magazine "L," and is a member of the Board of Trustees of Action for Health Initiatives.
Aside from HIV/AIDS, other sexually transmitted infections (STIs) – including gonorrhea, chlamydia, syphilis and genital warts – are health concerns that confront MSM. Protecting yourself from STIs is the best way to stay healthy. There is still no cure for HIV/AIDS and many STIs, such as the human papillomavirus (HPV) that causes genital warts, and genital herpes.
According to Baytan, public health reports list chlamydia as one of the leading, if not the leading, STI in the Philippines. In his practice, “tulo” (discharge) is the most common STI. He said, "Tulo, generally in the local setting, is either chlamydia or gonorrhea. Since many patients prefer treatment without going through rigorous lab tests, treatment regimens are tailored for both kinds of tulo. Tests are expensive and are not very practical in poverty-stricken communities." He added that while there is no cure for HPV, one is likely to be symptom-free for a long time, if not for life, if there has been no recurrence for at least a year. This does not mean, though, that one can no longer transmit the virus to others."
Protect yourself by doing the following:
• Get tested and have your partner tested. Don’t have unprotected sex unless you are certain you and your partner are not infected with HIV or other STIs. Testing is important because many people do not know they are infected, and others might not be honest about their health.
• Use a condom or other protection. Use a latex or polyurethane condom every time you have sex — especially during anal sex. Use only water-based lubricants, not petroleum jelly, hand lotion, cold cream or oils. Oil-based lubricants can weaken latex condoms and cause them to break.
In the issue of oral sex, sexual health advocates ideally advise to use a condom, if doing oral sex could not be prevented at all. Baytan, however, noted that using condom in oral is not exactly enticing. Rubber does not taste good. Flavored condoms taste good for less than a minute. Also, the lubricant in condoms can irritate the internal lining of the mouth, and this can cause pharyngitis.
Do not also share sex toys, and keep them safe by protecting them with a condom and cleaning them before and after every use.
• Be monogamous. Another reliable way to avoid sexually transmitted infections is to stay in a long-term mutually monogamous relationship with a partner who isn't infected.
• Get vaccinated. Vaccinations can protect you from hepatitis A and hepatitis B, serious liver infections that can spread through sexual contact. Also consider the human papillomavirus (HPV) vaccine which is now available for men aged 9 to 26 years old to help prevent genital warts.
• Limit the amount of alcohol you drink and don't use drugs. If you are under the influence of alcohol or drugs, you are more likely to take sexual risks. If you use injectable drugs, don't share needles and syringes.
• Know the risks associated with sexual venues. Sexual venues such as bathhouses, sex parties and the Internet can facilitate multiple sexual partnerships and anonymous sexual encounters, as well as higher risk sexual behaviors.
And when you are diagnosed with STIs, follow doctor’s orders in taking medications. Antibiotic use for certain STIs has been beneficial when prescribed and taken correctly. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective. Remember that a drug-resistant infection may kill, can spread to others, and imposes huge medical costs to patients.
For those who have been diagnosed with HIV, although here is no cure for AIDS at this time, a variety of treatments are available that can help keep symptoms at bay and improve the quality and length of life for those who have already developed symptoms.
According to the US Center for Disease Prevention and Control, studies have shown that, when compared with the general population, gay and bisexual men as well as lesbian, and transgender individuals are more likely to: use alcohol and drugs; have higher rates of substance abuse; are less likely to abstain from alcohol and drug use; and are more likely to continue heavy drinking into later life.
Alcohol and drug use can be a reaction among some MSM to homophobia, discrimination, or violence they experienced. Substance abuse is also associated in some MSM's reliance on bars and clubs for socializing and peer support. However, substance abuse can lead to a wide range of mental health and physical problems as well as it can disrupt relationships, employment, and threaten financial stability.
If you or someone you know has a problem with alcohol or drug addiction, go to a substance abuse treatment facility for help. Civic and health organizations also may provide referrals.
The risk of depression and anxiety may be higher for MSM, especially the adolescents and young adults who try to hide their sexual orientation or those who lack social support. The contributing factors to depression include: social alienation, discrimination, rejection by loved ones, bullying, and other forms of abuse and violence.
Left untreated, depression can lead to risky sexual behavior and a downward spiral of emotional, behavioural and health problems. Depression may also lead to suicide. If you think you might be depressed, talk to your doctor or seek help from a mental health provider. If you are reluctant to seek treatment, confide in a trusted friend or loved one. Sharing your feelings might be the first step toward getting treatment.
Domestic violence can threaten an intimate relationship for MSMs who live together. The Mayo Clinic website lists the warning signs specific to gay men which might include a partner who: threatens to tell friends, loved ones, colleagues or community members your sexual orientation or gender identity; tells you that authorities won't help a homosexual, bisexual or transgendered person; tells you that leaving the relationship means you are admitting that homosexual relationships are deviant; and tells you that domestic violence is a normal part of homosexual relationships or that men are naturally violent.
Staying in an abusive relationship might leave you depressed, anxious or hopeless. If you do not want to disclose your sexual orientation, you might be less likely to seek help after an assault. Still, the only way to break the cycle of domestic violence is to take action, the sooner the better. Consider creating a plan to leave your abuser. If you suffer from domestic violence, tell someone about the abuse.
On the other hand, Baytan said there are people who continue to engage in a violent relationship but they are not necessarily suffering. Some are sadomasochistic. A sadist likes to inflict pain. A masochist likes to receive pain. While generally considered a deviant sexual behavior, sadomasochism works for some people, but it does not exclude them from practicing safer sex.
Body image concerns are constant throughout human history, that is why there is a continued quest for immortalizing potions and proliferation of anti-aging products. Gay men are more likely to experience body image problems and eating disorders, such as anorexia and bulimia nervosa, than are their straight counterparts. One potential explanation is that gay men identify with the cultural value placed on an ideal – yet often unattainable – body image. Gay men might also be more likely to view their bodies as sexual objects, which can lead to dissatisfaction and poor body image.
If you are struggling with body image concerns or an eating disorder, get help. Talk to your doctor or a mental health provider about treatment options.
Routine Health Care
Do not let the fear of homophobia or the stigma associated with homosexuality prevent you from seeking routine health care. Instead, take charge of your health. Look for a doctor who puts you at ease. Identify yourself as gay or bisexual, and ask about routine screenings recommended for men in your age group – such as blood pressure and cholesterol measurements and screenings for prostate, testicular and colon cancer. If you are not in a long-term or a mutually monogamous relationship, then you should schedule regular screenings for STIs. Share any other health concerns you might have with your doctor as well. Early diagnosis and treatment help promote long-term health.
Baytan lamented that routine health care is a must but is easier said than done, especially in the country where majority of the people are poor. He said, "Who can blame them? Why spend for lab tests if one will go hungry and suffer from hyperacidity?"
However, he was quick to add, there are public clinics and hospitals where medical services are free or are not very expensive. The one thing that must change, though, is the behavior of Filipinos – whether straight, lesbian, gay, bisexual, transgender – that prefer to postpone a clinic visit until it is too late.
Photo from an HIV/AIDS prevention leaflet produced by USAID and DOH-Philippines