HIV/AIDS can be sexually transmitted by anal, penile-vaginal, and oral intercourse. The highest rate of transmission is through anal exposure.
From: Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention
June 12-13, 2000 Hyatt Dulles Airport Herndon , Virginia
This summary report was prepared by the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services.
July 20, 2001
Accessed June 22, 2011
Are condoms strong enough for anal intercourse?
The Surgeon General (C. Everett Koop, Surgeon General 1982-1989) has said, "Condoms provide some protection, but anal intercouse is simply too dangerous to practice."
Condoms may be more likely to break during anal intercourse than during other types of sex because of the greater amount of friction and other stresses involved.
Even if the condom doesn't break, anal intercourse is very risky because it can cause tissue in the rectum to tear and bleed. These tears allow disease germs to pass more easily from one partner to the other.
Condoms and Sexually Transmitted Diseases, Brochure
[accessed June 22, 2011]
What causes a person to have a particular sexual orientation?
There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation.
American Psychological Association. (2008). Answers to your questions: For a better understanding of sexual orientation and homosexuality. Washington, DC: Author. [Retrieved from http://www.apa.org/topics/sexuality/sorientation.pdf.] Retrieved on June 22, 2011
Ten Things Gay Men Should discuss with Their Healthcare Provider
[Gay and Lesbian Medical Association]
[downloaded June 22, 2011]
(Download .pdf Version)
Following are the health issues GLMA's healthcare providers have identified as most commonly of concern for gay men. While not all of these items apply to everyone, it's wise to be aware of these issues:
1. HIV/AIDS, Safe Sex
That men who have sex with men are at an increased risk of HIV infection is well known, but the effectiveness of safe sex in reducing the rate of HIV infection is one of the gay community's great success stories. However, the last few years have seen the return of many unsafe sex practices. While effective HIV treatments may be on the horizon, there is no substitute for preventing infection. Safe sex is proven to reduce the risk of receiving or transmitting HIV. All health care professionals should be aware of how to counsel and support maintenance of safe sex practices.
2. Substance Use
Gay men use substances at a higher rate than the general population, and not just in larger communities such as New York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate ("poppers"), to marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however current wisdom suggests potentially serious consequences as we age.
Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions.
4. Hepatitis Immunization
Men who have sex with men are at an increased risk of sexually transmitted infection with the viruses that cause the serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious long-term issues such as cirrhosis and liver cancer. Fortunately, immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all men who have sex with men. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C Virus.
Sexually transmitted diseases (STDs) occur in sexually active gay men at a high rate. This includes STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is available (HIV, Hepatitis A, B, or C virus, Human Papilloma Virus, etc.). There is absolutely no doubt that safe sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key.
6. Prostate, Testicular, and Colon Cancer
Gay men may be at risk for death by prostate, testicular, or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be negatively impacted because of issues and challenges in receiving culturally sensitive care for gay men. All gay men should undergo these screenings routinely as recommended for the general population.
Although more recent studies have improved our understanding of alcohol use in the gay community, it is still thought that gay men have higher rates of alcohol dependence and abuse than straight men. One drink daily may not adversely affect health, however alcohol-related illnesses can occur with low levels of consumption. Culturally sensitive services targeted to gay men are important in successful prevention and treatment programs.
Recent studies seem to support the notion that gay men use tobacco at much higher rates than straight men, reaching nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use.
9. Fitness (Diet and Exercise)
Problems with body image are more common among gay men than their straight counterparts, and gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for cardiovascular health and in other areas, too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can adversely affect health. At the opposite end of the spectrum, overweight and obesity are problems that also affect a large subset of the gay community. This can cause a number of health problems, including diabetes, high blood pressure, and heart disease.
10. Anal Papilloma
Of all the sexually transmitted infections gay men are at risk for, human papilloma virus —which cause anal and genital warts — is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in gay men. Some health professionals now recommend routine screening with anal Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high.
Author: Vincent M. B. Silenzio, MD, MPH, Former Member Board of Directors, GLMA and Former Co-Editor, Journal of the Gay and Lesbian Medical Association.
Ten Things Lesbians Should discuss with Their Healthcare Provider
[Gay and Lesbian Medical Association]
[downloaded June 22, 2011]
(Download .pdf Version)
Following are the health issues GLMA's healthcare providers have identified as most commonly of concern for lesbians. While not all of these items apply to everyone, it's wise to be aware of these issues:
1. Breast Cancer
Lesbians have the richest concentration of risk factors for breast cancer than any subset of women in the world. Combine this with the fact that many lesbians over 40 do not get routine mammograms, do breast self-exams, or have a clinical breast exam, and this cancer may elude early diagnosis, when it is most curable.
Lesbians have been shown to experience chronic stress from homophobic discrimination. This stress is compounded by the need that some still have to hide their orientation from family and colleagues at work, and by the fact that many lesbians have lost the important emotional support most others get from their families due to alienation stemming from their sexual orientation.
3. Heart Health
Smoking and obesity are the most prevalent risk factors for heart disease among lesbians; but all lesbians need to also get an annual clinical exam because this is when blood pressure is checked, cholesterol is measured, diabetes is diagnosed, and exercise is discussed. Preventing heart disease, which kills 45 percent of women, should be paramount to every clinical visit.
4. Gynecological Cancer
Lesbians have higher risks for many of the gynecologic cancers. What they may not know is that having a yearly exam by a gynecologist can significantly facilitate early diagnosis and a better chance of cure.
Research confirms that lesbians have higher body mass than heterosexual women. Obesity is associated with higher rates of heart disease, cancers, and premature death. What lesbians need is competent and supportive advice about healthy living and healthy eating, as well as healthy exercise.
Research also indicates that lesbians may use tobacco and smoking products more often than heterosexual women use them. Whether smoking is used as a tension reducer or for social interactions, addiction frequently follows and is associated with higher rates of cancers, heart disease, and emphysema — the three major causes of death among all women.
Alcohol use and abuse may be higher among lesbians. While one drink daily may be good for the heart, more than that can be a risk factor for cancer or osteoporosis.
8. Substance Use
Research indicates that lesbians may use illicit drugs more often than heterosexual women. This may be due to added stressors in lesbian lives from discrimination. Lesbians need support from each other and from health care providers to find healthy releases, quality recreation, stress reduction, and coping techniques.
9. Domestic Violence
Domestic violence is reported to occur in about 11 percent of lesbian homes, about half the rate of 20 percent reported by heterosexual women. But the question is where do lesbians go when they are battered? Shelters need to welcome and include battered lesbians, and offer counseling to the offending partners.
The rates and risks of osteoporosis among lesbians have not been well characterized yet. Calcium and weight-bearing exercise as well as the avoidance of tobacco and alcohol are the mainstays of prevention. It is also important to get bone density tests every few years to see if medication is needed to prevent fracture.
Author: Katherine A. O'Hanlan, MD, Former President, GLMA, Co-Founder, Lesbian Health Fund, Gynecologist, Portola Valley, CA