Last year, the New York City Department of Health and Mental Hygiene (NYCDOHMH) terrorized us with their prevention campaign “It’s Never Just HIV.” My colleagues at Gay Men’s Health Crisis, who recognized the inflammatory nature of this prevention effort, held a community forum where leaders of the health department argued their perspectives — while many members of the community expressed their outrage.
In this HIV public service announcement, we were warned about many complications of HIV infection — including the increased risk for anal cancer among gay HIV-positive men (a fact that medical science supports). It was not the message with which we took issue, but the manner in which the message was portrayed. Recall the television ad! It was a graphic image of a luminescent, radioactive ass that scared the heck out of ALL gay men. For me personally, it made my annual anal Pap smear an event of great anxiety, one that I considered canceling at least a dozen times.
Many of us know that genital human papilloma virus (HPV), of which there are more than 40 types, is the pathogen that can cause anal or genital warts (HPV types 6 and 11 may cause warts). What is less known, however, is that there are certain types of HPV (such as HPV types 16 and 18) which can serve as the causes of anal cancer. National and local health efforts have been undertaken to educate the population about the link between HPV and cervical cancer in women. However, associations between HPV and anal cancer — which as we know may affect more than gay men — remain few and far between. There are clearly articulated policies for women’s health, including recommended immunizations against HPV for women and young girls as described in the city’s health bulletin urging vaccination (Volume 7, Number 1). For men, particularly gay men who may be most at risk for contracting a form of HPV that may cause anal cancer, the recommendations are less clear and definitive. In fact, this message is all but absent.
While the NYCDOHMH guidelines recommend anal Pap smears for HIV-positive men on a routine basis, the NYCDOHMH Sexually Transmitted Infections (STI)Screening Guidelines for Sexually Active Patients lists the Pap as “N/A” (not applicable) for other men who have sex with men (MSM). Although the risk for anal cancer may be less for HIV-negative men, one still is left to wonder how a health commission — focused on warning about the dangers of anal cancer in their HIV prevention campaign — is somewhat aloof and silent in its recommendations for gay men regarding HPV (both in terms of screening for anal cancer and routine vaccination of young men and boys before they become sexually active).
To make matters worse, some doctors treating HIV-positive gay men also do not routinely undertake Pap smears of their patients. According to Dr. Stephen Goldstone of Mount Sinai Hospital in New York City, author of “The Ins and Outs of Gay Sex: A Medical Handbook for Men” and one of the world’s leading authorities on anal cancer in gay men, “There is a real embarrassment on the part of both patients and healthcare providers to deal with sexual health issues and anal health issues. Most patients don’t even get a rectal exam let alone an anal Pap smear. It is unfortunate that many anal cancers I see are quite large and would have been picked up much sooner had the patient just had a rectal exam.”
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