For 26 years, members of the Gay and Lesbian Medical Association (GLMA) have gathered to network, share cutting-edge research and, perhaps most importantly, fight the good fight against homophobia in the health care system.
Some 250 health care professionals are in attendance here in Seattle, WA; dozens of them will be presenting cutting-edge new research aimed at improving the mental and physical health of the LGBT communities they serve.
SATURDAY, OCTOBER 25
The Gay Brain
Is there such a thing as a gay brain?
"There should be no doubt in anyone's mind," says Jerry Goldstein, MD, a neurologist and Director of the San Francisco Clinical Research Center, "that we're born that way."
Goldstein gave a lively presentation on the history of research of the gay brain ("Freud's answer to being gay was to become straight") and looked at the wide array of theories as to what determines sexuality (handedness, birth order, finger length and even eye blinking!) but ultimately points to a renowned study by Swedish researcher Ivanka Savic-Berglund. "No one can argue with her data," he says.
In a nutshell, Berglund found that the brains and pheromonal responses and patterns of connectivity of gay men and straight women and of gay women and straight men were very similar: "It's been verified time and time again in her studies," said Goldstein, who recently gave a fascinating interview to Salon.
"We are the way we are and are going to be the best we can be," he concluded.
"And The Winner Is..."
Neal Rzepkowski, a family medicine physician specializing in HIV care in rural health clinics in western New York state, received the GayHealth.com/Gay and Lesbian Medical Association “Provider of the Year” award by Dr. Stephen Goldstone, FACS, Medical Director of GayHealth.com.
Rzepkowski provides exceptional care for HIV positive patients in western New York by tapping into his own knowledge and life experience as an HIV positive gay man.
"I tell my patients that I've been HIV positive for 25 years and that there's a life after the diagnosis, and of course there is," said Rzepkowski. "If you're accepting of yourself you naturally project an air of confidence. That's how I live my life."
ABOVE: Dr. Stephen Goldstone and Neal Rzepkowski
Bend Over for Anal Health
The prevalence of anorectal disease among gay men and MSM is very high, but so is the fear and embarrassment that comes with it. "Everyone is uncomfortable when the patient is bending over," says Dr. Stephen Goldstone, a surgeon in New York City and Medical Director of GayHealth.com.
But a physician is just as responsible as the patient when it comes to looking for, asking about and recognizing any anorectal problems--anal fissures, hemorrhoids, pain, bleeding (toilet paper or stool), discharge, etc.
"It may be awkward, but you should discuss such complaints as well as any prior issues and of course your sexual history with your physician," says Goldstone.
Regular anal pap smears and cultures for gonorrhea and Chlamydia should be routine parts of your health care, says Goldstone. Sitz baths, bulk agents, increased fluids and Docusate sodium are conservative therapies for hemorrhoids.
Cleanliness is always a huge concern for gay and MSM men, but Goldstone doesn't mince words when it comes to what he calls 'over-wiping' as the most effective method. "A lot of them wipe the hell out of their ass, and they're basically digging a hole," says Goldstone.
"If there's blood on the toilet paper one common reason is that you're probably wiping too hard," says Goldstone, who suggests taking a quick shower as the best and safest way to keep the area clean.
In short, don't be afraid to ask your doctor about any discomfort you're experiencing, and be aware that even if you're asymptomatic, you still need to have regular check-ups and tests to ensure anal health.
FRIDAY, OCTOBER 24
Gay Marriage: Saying "I do" is Healthy!
The joke goes like this: upon being told that gays are fighting for the right to get married, an astonished woman exclaims, "On, those poor people, haven't they suffered enough?"
It's a great line, but leading experts such as the American Psychiatric Association, the American Psychological Association and the National Association of Social Workers all say that denial of marriage rights can negatively impact the health and well-being of gay men and lesbians.
It's up to all health care providers, associations and individuals to know and understand the facts about the positive health benefits of gay marriage as they advocate in their communities.
"We should get the same right as everyone else to have the problems or whatever else that comes with marriage," said Joel Ginsberg, the executive director of the Gay and Lesbian Medical Association. "It's the inequality that's associated with the stress."
To find the latest news, research, petitions and more on gay marriage and Proposition 8, go to www.glma.org and look for the big blue "Fairness in Marriage" button on the homepage.
The HIV prevention landscape
HIV patients can now turn to once-a-day treatments, new classes of CCR5 inhibitors, and new classes of integrase inhibitors, but what about the ultimate treatment--an HIV vaccine?
"People are ultimately looking for a silver bullet, that magic thing that tells them we have it under control and you don't have to worry," said Steven Wakefield, an HIV advocate with the Legacy Prevention project, but "thats not the reality. We're still at a crossroads."
Wakefield summarized the current prevention climate this way: Research and progress for HIV vaccines, HSV suppression and microbicide development have been negligible, while male circumcision in Africa and PrEP (pre-exposure prophylaxis) have been effective.
Wakefield noted that more attention should be paid to concurrency, the decisions people make about choosing their partners, as well as something rarely discussed when it comes to HIV prevention: monogamous committed relationships as a strategy to lowering HIV rates. "We talk a lot about gay marriage, but what about monogamy as a health and harm-reduction strategy?" asked Wakefield.
But getting tested for HIV is still at the top of the list when it comes to prevention: "We realize that we need to design strategies to reduce new infections," said Wakefield, "but people that know their status tend to make decisions that protect those they care about."
For more information on HIV prevention you can send an email to firstname.lastname@example.org
FAST FACT: The NIH's research budget for an HIV vaccine is $750 million a year, the same cost of producing about five recent Hollywood movies.
UPDATE: Routine HIV Testing
If HIV is now falling into the chronic but manageable disease category, is it still a big deal?
It's because of that manageability that routine HIV testing is more important than ever, says Kenneth Mayer, MD, a Professor of Medicine and Community Health at Brown University and Medical Research Director at Boston's Fenway Community Health Center. Mayer reviewed the CDC's revised recommendations for routine HIV testing and how health care providers can implement them.
"We have to get the message out about routine testing, that even though HIV is manageable it is chronic and infectious, so knowing your status is essential," said Mayer.
Mayer points to several alarming statistics to back up the need for routine HIV testing: the substantial number of people--250,000 Americans--who are infected and unaware of it, and that up to 40 percent of people who find out they're positive already have AIDS because they tested so late. "If you wait, it's harder to treat and it's more expensive."
Mayer said that because many infected people are not in high-risk groups--even though they regularly interact with the heath care system (at least once a year)--they are being missed.
"Traditional risk-based testing doesn't always work because some people who feel they aren't risky and in monogamous relationships end up being unknowingly infected by their partner."
The CDC now recommends all 13-64 year olds get routine HIV testing, with testing protocol including opt-out testing, no separate consent for HIV, pretest counseling is not required, and repeat testing is left to the discretion of the health care provider.
THURSDAY, OCTOBER 23
Cutting Edge: Going Online to Reach At-Risk LGB Youth
Can modern technology be used to help reach at-risk LGB youth?
It certainly should, given the fact that 90 percent of self-identified LGB youth aged 16-24 are online every single day (according to recent research).
This group also suffers notoriously high suicide statistics, so self-described "online archaeologist" Dr. Vince Silenzio, a mental health researcher at the University of Rochester, is intent on using the internet to identify and ultimately reach this group with potentially life-saving PSAs and other online health resources, sites and messaging.
His research model--which mined public information via online profiles on the popular site My Space--indicates the potential to identify and reach up to 20,000 at-risk youth via a single message, via tapping into each person's 'friends' network.
Silenzio says that mining public data on sites like My Space can result in a sort of health care push-pull approach--to not only pull in information that's essential for prevention studies, but also to push out prevention messages and peer-driven interventions.
"I'm still looking into ways to deliver that health information," says Silenzio, "we don't have an idea yet on what the optimal way to reach them is, we're just learning how to actually identify them, which he admits is "a thorny ethical issue" due to privacy issues.
The ultimate scenario is to "recognize warnings signs from someone and help direct them to helpful information, web sites or other information that are targeted for them and their issues," says Silenzio.
Fit or Fat? The Benefits of Health at Every Size
Does fat really equal death? Is an obsessive need to lose weight and engaging in endless yo yo diets more destructive to your overall health than, well, just being fat?
That's the question researchers Lauren Brown, MD, a resident at Michigan State University's Department of Psychiatry, and Jennifer Schwartz, AD, a media and theater professional, were asking during this morning's Health at Every Size Plenary session.
"If there's one word that stereotypically gets attached to the lesbian community, it's the word "fat" -- and all the studies show that weight issues are one of the biggest health issues for lesbians," said Brown.
Higher rates of depression, body issues and being less likely to visit a physician also plague the lesbian community, says Brown, and the HAES movement emphasizes the psychosocial benefits of size-acceptance and the positive effects of esteem on persons of size.
"You know that your fat patients have the will to be thin, but then why are there still fat people? We need to examine that," added Schwartz. "It's not like the person isn't aware of it, or a light bulb suddenly goes off that says, 'hey, I should lose weight.'"
"Body consciousness is a significant issue for everyone in the LGBT community and we want to shake things up and look at weight in a different way."
Some quotes that stood out included:
"Fat is not just a matter of saying you've got to get healthier, these are people who also feel the weight of stigma on their shoulders,"says Brown, "and we think it's negligent to not be aware of that."
"Fat is a big scary, ugly, not very nice word," says Schwartz, "be aware that your fat patients are experiencing oppression every single day."
"We want to re-frame what we're thinking about diet and what other options there are," says Brown. "We need to be consistent in our desire to decrease stigma, and focus on things that make patients feel better and more comfortable in their bodies."
With 57 percent of U.S. women currently engaged in weight control behavior, a recent Health at Every Size study had one group of participants focus on increased body acceptance, living a full life regardless of BMI, disentangling self-worth from weight, increase sensitivity to food cues, and engage in habitual activities allowing them to enjoy their bodies (anything like walking or swimming that makes you feel good)
"This group increased their activity levels, lowered susceptibility to hunger, improved self esteem and improved their self image," said Brown, who noted the group participating in traditional dieting actually suffered decreased self-esteem.
"Diets don't usually work, statistics prove this, yet we continue on tell people to lose weight for better health outcomes. I take issue with that because were recommending something that we know is going to fail."
Lifestyle shifts that include exercise that makes your body feel good, rather than a focus on weight loss, is one shift that can work, says Brown. "Make sure you're doing something you enjoy, rather than suffering on the Stairmaster."