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".

Syphilis outbreak

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 deserves.

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.

Depression

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 people.

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

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.

HIV/AIDS

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 sexual behaviour.

"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.

Drug use

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

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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