Health for gays
In a health service that too often hits the headlines for the wrong reasons,
it is pleasant to come across a service that is not only immensely popular with
its patients, but also delivers a greater and more expanded range of services
year on year.
The Gay Men's Health Project, based at Dublin's Baggot Street hospital, has
been providing health clinics and outreach health services to Dublin's gay community
for nine years. One of very few health board-funded initiatives to happily marry
the provision of clinical services with successful outreach work, the project
has appointed a consultant in infectious diseases and expanded its clinic hours
to two nights a week.
Revellers at this
year's Gay Pride parade in Dublin.
"The sexually transmitted infections (STI) clinic is an important part of the
project and it remains the only specific service in Ireland that caters for
gay and bisexual men", according to the GMHP's co-ordinator, Mick Quinlan. "This
is reflected in the increasing number of clients presenting to the service".
Over 80% of GMHP work is in the field, informing the gay community about health
issues in the clubs, bars and saunas where they gather. The success of such
a pro-active policy was seen when the recent syphilis outbreak occurred. GMHP
personnel distributed information to gay men throughout the capital and hundreds
came forward to be tested.
The GMHP is also heavily involved in research work in the area of gay health
and regularly advises and contributes to policy documents on issues such as
HIV or male prostitution. The organisation provides training to health board
staff and university employees and other agencies on engaging with and providing
services to the gay community. With the GMHP's track record, one could be forgiven
for thinking that at least one community is receiving the health service it
But Brian Sheehan disagrees, however. As director of Gay HIV Strategy, he is
involved in trying to ensure that health providers recognise that some of the
people accessing their services are gay. He believes that, while the work of
the GMHP is positive, it is unfortunate that gay people who live beyond the
confines of central Dublin do not have access to services of a similar nature.
"There are specific problems for gay men and women in accessing the health
service", he says. "Firstly, gay people do not feel that they have access to
services that recognise and support their lifestyle. People feel that they are
going to be judged. Men want to go somewhere that recognises and supports their
sexual practices. Lesbians are often thought of as asexual and are not offered
cervical smears and so on".
He believes that the growth of the GMHP merely proves that the service is struggling
to cope with the health needs of the estimated 50,000 to 100,000 gay people
in the greater Dublin area. However, he laments the fact that there are no similar
projects in other regions of the country.
"There needs to be more information in all the health boards and in all parts
of the country about gay health issues. Services outside Dublin are generally
awful, with notable exceptions in Cork and Waterford. Galway, which has a large
gay community, does not even have a single outreach worker. A whole range of
important services are not being provided".
Sexually transmitted infections
Sexually transmitted infections are unfortunately on the rise in Ireland and
certain STIs seem to be particularly affecting the gay community. HIV is not
the only sexually transmitted infection to be affecting the gay community and
with the rise in hepatitis B and syphilis in the last year, it is more important
than ever to practice safe sex and go for regular check-ups.
Despite public information
campaigns, gay men are not heeding safer sex messages.
Since an outbreak of syphilis was first noticed among gay men in the US about
four years ago, a number of urban areas here have reported serious rises in
the disease among gay men. Indeed, there has been a rapid rise in the number
of cases reported in Ireland over the last year and gay men are being urged
to come forward for testing. The disease, if ignored, can ultimately lead to
mental illness and death, but fortunately can be treated even at an advanced
stage. The Gay Men's Health Project, along with STD clinics around the country,
offer confidential syphilis testing.
Gays and lesbians are no different to heterosexuals in terms of the causes
and reasons they become depressed. However, because of the stress associated
with 'coming out', the difficulty of dealing with prejudice and the discrimination
and rejection often targeted at gay people, the homosexual community is reportedly
more prone to depression than other sections of society. Studies suggest that
rates of depression, suicide and parasuicide are higher among gay people, especially
young gay men, than other groups, according to organisations representing gay
Continual discrimination and a lack of support systems can help to erode gay
people's sense of self-worth and self-esteem. Homosexuality itself is not a
cause for depression but the rejection and discrimination experienced by gays
and lesbians often leads to depressive symptoms.
A further complication is that many gay people who experience depressive episodes
are unwilling to seek professional help and can be left in a limbo where they
feel depressed and are unable to get relief for their pain. "In areas like the
psychiatric services, a lot of people attending are afraid to say they are gay
because their sexuality is so often treated as the cause of their complaint",
explains Brian Sheehan of Gay HIV Strategy.
Hepatitis is a word used to describe certain kinds of viral infections of the
liver. While there are around seven kinds of hepatitis, only three could be
considered common. Gay people are at risk of contracting hepatitis A, B or C.
Hepatitis B is of particular concern, as it is 100 times as infectious as HIV
and can cause lasting liver damage. Hepatitis A is less serious but infected
people need to be carefully monitored while they have the illness.
While hepatitis C is generally passed via infected blood, for example when
needles are shared, it can also be transmitted through unprotected sex. Gay
men are at risk from all forms of hepatitis due to the risk of rupturing the
anal wall during penetrative sex.
Thankfully, HIV/AIDS is no longer seen as the 'gay plague', but it still continues
to affect a disproportionate number of people in the gay community. The number
of people infected with HIV in Ireland continues to rise each year and record
numbers of gay people, drug users and heterosexuals were identified as having
the virus last year. Research shows that most people are aware of the importance
of safe sex, but it seems that the message is not necessarily changing people's
"Studies throughout the world indicate that gay men are aware of safer sex
practice but yet some continue not to practice it", explains Brian Sheehan.
"The question is why? Issues of self-esteem and self-identity are involved and
for some older gay men, they have lived under the shadow of HIV for so long
perhaps they feel it is inevitable so why bother trying to protect themselves".
With the help of the latest antiretroviral medications, people infected with
the virus can expect to live for many years. However, quality of life will inevitably
be affected. HIV/AIDS is no longer the sudden death sentence it might have been
twenty years ago, but it is still a fatal disease with no known cure. It is
essential that gay people either practice safer sex, or restrict themselves
to monogamous relationships with partners who have tested negative.
One myth worth exploding is that HIV positive people who have no detectable
levels of HIV in their blood cannot transmit the disease to others. A study
published by the New England Journal of Medicine found that HIV positive
men with undetectably low levels of HIV in their blood still had HIV DNA in
cells within their semen. This semen-based HIV provirus could be transmitted
to sexual partners, who would then become infected with HIV.
Studies worldwide have shown that members of the gay community are more likely
to experiment with illegal substances. Obviously, many of these substances can
have a deleterious effect on health and it is important for anyone who takes
drugs to inform themselves about the risks and to adopt harm prevention measures.
The popularity of amyl nitrate (poppers) among gay men is of particular concern
given the recent rise in recreational use of the impotence drug Viagra. Taken
together, these two substances can interact, affecting the heart. People have
already died in the United States as a result of mixing these substances either
before or during sex.
Orthorexia nervosa is a recently diagnosed eating disorder that, unlike anorexia
or bulimia, does not pose an immediate physical threat to the body. In fact,
it can be considered more as an obsessive-compulsive disorder. It has already
been found to be particularly common among gay men in urban United States. In
a nutshell, orthorexia can best be described as obsessively eating healthily.
Why, one might ask, is this a problem? Mostly because many people are not adequately
informed about the true ramifications of the kinds of diets that orthorexics
find so attractive.
Veganism and raw foodism are not bad for the body in themselves. Nevertheless
such extreme diets should always be assessed by a family doctor to ensure that
essential nutrients are not being forgotten or ignored in the drive to be ideological
about what you eat. Also, any form of obsessional behaviour is hardly ideal,
even if that obsession happens to be with something healthy.
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