Monday, November 15, 2010

STDs, AIDS, Anal Cancer, and Half-truths

Since I've received several emails regarding all three of the conditions in the title, I thought it might be a good idea to inject some scientific facts into the matter. There is clearly a lot of misinformation floating around out there – most of it perpetuated by anti-gay evangelical groups – and if there's one thing I hate it's misinformation that contradicts science and demeans a group of people; in this case LGBT people.

Misinformation #1:
State-sanctioned gay relationships could have negative health consequences for a nation, because an increase in STDs and HIV/AIDS is seen in countries where same-sex marriages are legal.

Fact-based response:
European statistics indicate no rise or spike in HIV/AIDS transmissions since the legalization of same-sex unions. In Norway, for example, our HIV rate is less than 0.1%. The rate is the same in Iceland, Finland, and Sweden, while Denmark and the Netherlands' rates stand at 0.2%. Other Western European countries have similarly low rates, except for Italy at 0.5%, which, ironically, is one of the only European countries that does not have same-sex unions yet.  Spain also has a rate of 0.5% while Portugal stands at 0.4%, and in those countries the Catholic Church has traditionally been against safe sex education and condom distribution.  Today, however, the two governments have fortunately decided that public health is more important than trying not to upset the bishops.

In Eastern Europe, Russia, Ukraine, and Estonia have the highest HIV rates at 1.1%, 1.3%, and 1.6% respectively.  None of those countries recognize same-sex unions, and they also happen to be the most homophobic countries in all of Europe.

Statistics from Canada (0.3%), and from states in the U.S. (0.6%) and Australia (0.1%) that have same-sex unions, show similar statistical trends: no rise in HIV/AIDS among the LGBT or straight community. The misinformation that there are higher incidences of HIV/AIDS in countries with same-sex unions actually goes in the opposite direction when the facts are checked.

And for information's sake, the majority of HIV transmissions worldwide are from unprotected heterosexual sex.  So every time you hear some fire-and-brimstone preacher or politician saying that AIDS is God's wrath, based on the statistics God must be pretty angry at all of us straight people, because we're the ones getting and spreading AIDS the most!

As far as other STDs go, the trend holds true as well. There has been no increase, save for occasional ups and downs in chlamydia and gonorrhea cases, which are normal and can be found anywhere human beings are.

Public health and well-being is always of great concern, which is why I fully support reproductive health and comprehensive sex education. Where condoms are common, diseases diminish – where condoms are rare, diseases are there. If we want to halt the spread of disease, forbidding people from entering into faithful, monogamous relationships isn't the way to do it. It is counter-intuitive in fact. We should be encouraging monogamy rather than forbidding it or condemning it. Teaching people how to protect themselves, and providing the resources to do it, is the way to go.

Misinformation #2:
Male-male sex causes anal cancer.

Fact-based response:
It's not hard to come across volumes of fear-based misinformation out there perpetuated by so-called “family values guardians.” One article I read two years ago stated in bold letters: “Gay anal sex leads to anal cancer.” The article, with the heading “The Dangers of the Homosexual Lifestyle,” which happened to be put out by a conservative Catholic group, was so grotesquely unscientific that, as a biologist, it made me cringe. That article is still circulating around in cyber space, and it has been recycled as "proof" by other right-wingers.

The impression given was that if men have anal sex they'll get anal cancer. Period. Conveniently left out of the article, however, were the facts.

HPV under electron microscope
Anal sex can lead to anal cancer, yes, if you have unprotected anal sex with a partner infected with HPV, or Human Papilloma Virus. There are approximately 200 types of HPV, and the highest-risk types (types 16 and 18) are responsible for 70% of anal and cervical cancers. HPV can also cause an STD called genital warts, which is spread by types 1-4, 6, 10, 11, 26-30, and 40-45. 

Since HPV is a virus, there's little that can be done once you have it. Viruses cannot be treated with antibiotics, so once you've got one, you've got it for life.  There is a possibility that, if you contract type 16 or 18, and to a slightly lesser degree type 6 or 11, it can develop into anal cancer over time, just as it can lead to cervical cancer in women under the same conditions.  This is why pap smears are so important for women, and why anal pap smears are so important for women and men who have had receptive anal sex.  (Unless your physician recommends otherwise, you usually don't need your first pap smear until you've reached age 25.  However, if you were 18 or younger when you first had sex, you should have your first pap smear 6 years after that time.)

Naturally the article failed to mention that straight people can just as easily contract anal HPV too, through unprotected anal sex, as well as cervical, vulvar, and vaginal HPV through unprotected vaginal sex.

This is why I so strongly encourage all young people to receive Gardasil, the four-type HPV vaccine, before they begin having sexual relations. It is marketed toward young girls, but boys can get the vaccine as well. The vaccine is not gender-specific, and neither is HPV. Gardasil is actually a routine part of the national immunization program for girls age 11-13 in Norway, and the Health Ministry is currently considering making it routine for boys as well. Many parents in Norway are already opting to voluntarily vaccinate their boys, and the Health Ministry has given it a thumbs-up.  Gardasil has been shown to prevent 78% of pre-cursor lesions to anal cancer and penile cancer.

Anal cancer, and HPV altogether, can be avoided of course by monogamy (as long as you've both been tested and are HPV-free), the same of which is true for cervical cancer.  Also, condoms reduce the risk of HPV transmission by 70%.*  But the article didn't care to mention those "little" facts. It simply stated that gay men will get anal cancer if they have sex. Brilliant. Flagrant misinformation, and most conservative Christians eat it up, believe it wholeheartedly, and then regurgitate the ignorance.

The simplest way to put it is this: if you're a human and you have unprotected sex with another human, you are automatically at risk of contracting whatever bacteria, viruses, or parasites that person may have, whether you can see them or not. That applies for straights, gays, and bis alike, and it applies for vaginal, anal, and oral sex. If you're a human, if you sleep with more than one person, and if you don't like condoms, be prepared to accept the possible consequences.

To recap:
Unprotected straight vaginal sex:  risky
Unprotected straight oral sex:  risky
Unprotected gay oral sex:  risky
Unprotected straight anal sex:  risky
Unprotected gay anal sex:  risky

Clearly, there's always a risk when humans have unprotected sex, regardless of race, age, gender, sexual orientation, the position you use, whether you're drunk or sober, etc. etc.

The answer is simple: do the best you can to wait until you find the right person for you, and once you find him or her, be monogamous and faithful to each other. It really is that simple. And if you absolutely cannot wait, condoms are essential. Gambling may be fun, but not when you're doing it with your life.

* While condoms are extremely effective at preventing STDs carried in seminal and vaginal fluids when used properly, their effectiveness against HPV is slightly less potent because virions can be found on genital skin which is not covered by a condom.  Regardless, a 70% risk reduction is very impressive.

NB:  Additionally, since the subject of anal sex has been breached, I'll toss in an observation here.  It's funny to me how Filipino physicians respond to the topic of anal sex compared with how Western physicians respond.  For example, most Filipino doctors will say "it's bad, it's dirty, it's dangerous, and it goes against nature."  Whereas most doctors in Western countries say the exact opposite.  Why?  How can that be?  Either it's dangerous or it isn't -- it can't be both harmful and perfectly all right.

I think it all boils down to culture.  Most locally-trained physicians and medical professionals in the Philippines are, of course, influenced by their upbringing and their culture, which, in general, disapproves of anal sex on so-called "moral grounds."  That's also towing the official line of the Catholic Church.

Doctors and health professionals in Europe, however, don't see anything wrong with anal sex.  The official word from the Norwegian Health Institute, for example, states:

"Many people enjoy anal sex as a pleasurable and meaningful part of their sex life.  The anus is packed with many pleasure-giving nerves, the same which are connected to other erogenous areas (penis, vagina, clitoris).  Anal sex is not dangerous as long as it's done responsibly, respectfully, and with a condom if you're not doing it with your monogamous partner."

Additionally, the National Health Directorate's Youth Health Services, which answers health and sex questions from teenagers, states:

"Just follow your body's signals and find out what's pleasurable for you and your partner.  Fingers, an erect penis, or a dildo will not damage or 'stretch out' the anal muscles.  As long as you both enjoy it, anal sex is perfectly all right."

A night and day difference from what most health practitioners in the Philippines say.

Perhaps if you would have asked a European doctor the anal sex question 50 or 60 years ago, he or she likely would have said something similar to what many Filipino doctors say today.  Time changes concepts and ideals, especially when medical knowledge and research increase.  If you don't like the idea of anal sex that's perfectly fine, you don't have to do it.  But don't tell everyone else it's bad just because you personally disapprove of it.   In the Philippines the "it's bad" answer is little more than cultural and personal aversion.  Modern medicine has shown that no short-term or long-term pathological tissue damage results from consensual anal sex.  Period.

Bottom line:  Anal sex is fine.  Just don't forget the lubrication, be sure to be patient and respectful, use a condom if you're not with your one-and-only, and don't force it or get too rough with it -- the same rules that apply for vaginal sex.  

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