Young sexual minority men — including those who are gay, bisexual, queer or straight-identified men who have sex with men — do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.
Doctors need to expand communication on risks and the importance of vaccination, Rutgers researchers say
A Rutgers study published in the Journal of Community Health, examined what young sexual minority men — a high-risk and high-need population — know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.
About 79 million Americans are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention. As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.
“Particularly in light of the decades-long focus on gay men’s health care as HIV care, there is a missed opportunity for HPV prevention in the community,” said study co-author Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health.
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Victor Claros knows the ugly realities of war. The El Salvador-born immigrant fled his country after being captured and nearly killed by guerrillas when he was 15. But the young man’s spirit never died.
Despite having grown up in a religious and homophobic family, Claros found the strength to come out twice: first as gay to his then-wife, and later telling the world he’s living with HIV. What happened next prompted him to take the first step towards becoming a staunch activist.
Activist Victor Claros
“I felt guilty, I was really afraid and ashamed,” remembers Claros, who was working as an HIV educator at a nonprofit at the time of his diagnosis. “I think, sadly, it took me being diagnosed to realize how much stigma and discrimination people living with HIV face on a daily basis. What made it even harder is the fact that way too often the stigma came from individuals, providers, and workers who were helping people with HIV.”
One of Claros’s a-ha moments came when he overheard providers making negative comments about their own HIV-positive clients, an experience that made him realize he needed to fight harder for the people they were serving. So, he joined ranks with Bruce Richman and the Prevention Access Campaign to further promote undetectable equals untransmittable (U=U), a consensus that states when you are HIV-positive, undetectable, and on meds, it is impossible to transmit the virus.
Claros says, “The only way I was going to help others was by becoming vocal and openly start talking about these people I was testing on a daily basis. That’s kind of the thing that pushed me to come out [positive].”
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Bruce Richman, the renowned activist and founder of the Prevention Access Campaign, the organization that launched the undetectable equals untransmittable (U=U) message, is on a return flight from Greece where he joined local advocates in sharing the news that when you’re living with HIV, on meds, and undetectable, it is impossible to transmit the virus to others.
For the last several years, Richman has united activists in efforts to end both the HIV epidemic and the stigma that many people living with HIV face. A growing network of health experts, professionals, teachers, siblings, spouses, parents, and friends have changed perspectives on what a positive diagnosis means. Through hard-hitting research and tenacious activism and lobbying, U=U has become a global consensus, recognized by the Centers for Disease Control and Prevention and numerous other agencies, doctors, and organizations around the world.
But despite the immense impact U=U has already had on the esteem, relationships, and overall wellness of those living with HIV (and the people who love them), the rest of the country’s general perception of HIV is still outdated. This is what drives Richman’s pursuit to change hearts and minds.
“U=U is my calling,” Richman, a lawyer-turned-activist, says. “It grabbed me by the gut and yanked me forward. I’ve never felt such a compulsion and clarity. I knew that undetectable equals untransmittable, but millions of people were suffering because they were not being told and people in positions of great influence to alleviate that suffering were sitting on their hands. I had no choice.”
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Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction.
Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality.
Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35-68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake.
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Extensive evidence from HIV prevention research studies has firmly established that “Undetectable Equals Untransmittable,” or U=U. This means that people living with HIV who achieve and maintain an undetectable viral load — the amount of virus in their blood — by taking antiretroviral therapy (ART) as prescribed do not sexually transmit HIV to others. The U.S. Centers for Disease Control and Prevention estimates this strategy is 100% effective against the sexual transmission of HIV.
Now, a new study of nearly 112,000 men who have sex with men in the United States has found increasing acceptance of the U=U message in this population. Overall, 54% of HIV-negative participants and 84% of participants with HIV correctly identified U=U as accurate. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Study results were published online in the Journal of Acquired Immune Deficiency Syndromes.
“U=U has been validated repeatedly by numerous studies as a safe and effective means of preventing the sexual transmission of HIV,” said Anthony S. Fauci, M.D., NIAID Director. “The increased understanding and acceptance of U=U is encouraging because HIV treatment as prevention is a foundation of efforts to end the epidemic in the United States and around the world. This public health message has the power to reduce stigma, protect the health of people living with HIV and prevent sexual transmission of HIV to others.”
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