By Bob Roehr
“Optimizing primary care for men who have sex with men” is a prominent commentary in the Nov. 15 focus issue of JAMA, the Journal of the American Medical Association. The focus of that edition is men’s health.
“Primary care for gay men has all too often focused on HIV and sexually transmitted diseases,” but there is also the larger context of delivering health care to gay men, said Ken Mayer in an exclusive interview. He is one of the three coauthors of the commentary and a physician at Fenway Community Health in Boston, which primarily serves the GLBT community.
Mayer said it is important that your health care provider “be sensitive and open to your concerns as a gay man or a man who has sex with men.” The patient needs to be “empowered to interview their doctor” and pick up on signs in the waiting room and in the way the doctor asks questions as to whether or not they are inclusive and capable of meeting your medical needs.
“If a doctor is uncomfortable talking about sex, that may be an issue. You don’t have to have a gay doctor to get good health care; you need somebody who is knowledgeable,” said Mayer.
The Gay and Lesbian Medical Association offers a listing service of medical professionals who are comfortable working with GLBT patients. You can search for a provided by city, state, telephone area code, and medical specialty.
Mayer said that he and others are working on a textbook for the American College of Physicians called the Fenway guide to LGBT health.
The article was directed towards physicians and noted that the last US Census identified same-sex households in 99 percent of the counties in the country. Some jurisdictions only have a few such households but in urban areas the figure can go as high as 5-7 percent.
Another study has found that “2.8 percent of men identified themselves as gay, whereas 9.1 percent described having had same-sex sexual behavior, desire, and identity in the course of a lifetime.”
Behavior can be as important as identity and the “coming out” process can occur at any age. It is important that men understand how disease can be spread through sexual activity and how those risks can be reduced.
Another article in JAMA explored how mental health issues differ between men and women. While women are twice as likely to be diagnosed with depression, men are four times as likely to commit suicide.
Societal pressures contribute to the under treatment of depression and other psychological disorders because men are less willing to even acknowledge that they may have such a problem. There is an expectation that men will be stoic and just suck it up.
However, researchers also are discovering that symptoms of depression often differ in men. Rather than feeling blue, they are more likely to feel irritable, stressed, and not sleep well.
While some patients will benefit from medication, often times a finite program of cognitive behavioral therapy–in which patients comes to understand how distorted views of themselves contribute to their problems and how to overcome them–can be just as effective as drugs.
A review of recent research has found physical and functional differences in the brains of men and women. That is reflected in the fact that some 14 percent of actively expressed genes appear to be expressed or function at different levels in the two sexes.
That is starting to help explain how men and women process certain information differently; how they experience pain differently; and how they react differently to certain kinds of drugs. It may eventually be correlated with expressions of sexual orientation and identity.
Gay and bisexual men may be more prone to compulsive gambling, according to a small study in the Nov-Dec issue of Comprehensive Psychiatry. The study involved 105 men who sought treatment for addictive gambling; 15 were gay and seven bisexual, numbers that are several times higher than what one would expect to see in a cross-section of the population.
The researchers, from Yale and the University of Minnesota, readily acknowledged that the size of the study was small and it only included those who sought help, so it might not be representative of the overall population.
And it leaves unanswered the question of whether the gambling compulsion is tied to a portion of the brain associated with greater risk taking, or whether it is a response to the stress of living in a homophobia society.
Some have asserted that use of crystal meth and Viagra (and other erectile dysfunction drugs) has become a risk factor for HIV infection. But a multi-disciplinary conference supported by the NIH and published in the Journal of Sexual Health did not find convincing evidence to support that charge.
“Health care providers should be reminded that individuals infected with HIV frequently have erectile dysfunction from their disease or from pharmacologic agents commonly used in its treatment,” said Journal editor Irwin Goldstein.
However, another concern to be aware of is a recent finding that sildenafil, the active ingredient in Viagra, can worsen obstructive sleep apnea. That condition is the temporary blockage of breathing while sleeping. While it is only rarely fatal, it deprives one of a good night’s sleep and contributes to a general sense of malaise and lack of focus during waking hours.