The Pitt Men's Study

Health Alerts for Gay and

Bisexual Men

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Men who have sex with men (MSM) continue to face dangerous and widespread health issues, many of which are ignored by the local media. As a response, the Pitt Men’s Study and the Pennsylvania Prevention Project provide free Health Alerts to the community via an email listserv.

Those who sign up for the Health Alerts will receive a brief email written by experts in the field and containing links to trusted sites with additional information.

Individuals interested in subscribing to the service can do so by sending an email to PMS@stophiv.pitt.edu with the word subscribe in the subject line. You will then receive a confirmation message to verify your email address. After you respond to the verification, you will be added to the list automatically. Members can unsubscribe at any time, and email addresses will be kept private and confidential – they will NOT be sold to another organization or business. Health Alerts can also be found on...

and

Past Health Alerts

Testicular Cancer

Potential heart risk when combining HIV drugs

N1H1 (Swine) flu * Hepatitis C

Condoms * Nonoxynol-9 * Syphilis

MRSA * HPV * HIV * Anal Cancer * Genital Herpes

Top Ten Health Issues for Gay and Bi Men

July 2010 - Testicular Cancer

Testicular cancer is the most common cancer in men between 20 and 34 years old. It is a disease in which cancer forms in one or both testicles. The testicles are 2 egg-shaped glands inside the scrotum (a sac of loose skin that lies directly below the penis). They are the male sex glands that make testosterone and sperm.

Risk Factors

There are factors that raise a man’s risk of getting this disease:

An undescended testicle - One or both testicles don’t move from the abdomen into the scrotum during fetal development.
Certain types of moles - An unusual condition that causes many spots or moles on the back, chest, abdomen and face.
HIV Infection - Men infected with HIV have an increased risk, especially true for men who have AIDS.
Carcinoma in situ (CIS) - CIS is a condition in which germ cells grow into a tumor but does not yet invade normal tissues. CIS in the testicles may become cancer over a number of years and does not cause a lump or any symptoms.
Young age - Young men have a higher risk of getting testicular cancer. It is the most common cancer between the ages of 20 to 34, the second most common cancer between the ages of 35 to 39, and the third most common cancer between the ages of 15 to 19.
A personal history of testicular cancer - Men who already had testicular cancer have a higher risk of developing a tumor in the other testicle.
A family history of testicular cancer - Men with a family history of testicular cancer may have a higher risk of developing testicular cancer.
Congenital abnormalities - Men born with abnormalities of the testicles, penis, or kidney, as well as those with a hernia in the groin area, where the thigh meets the abdomen, may be at increased risk.

Signs

Possible signs of testicular cancer include:

a painless lump or swelling in either testicle
heaviness or aching in the abdomen or scrotum
pain or discomfort in a testicle or in the scrotum
dull ache in the lower back, abdomen, or groin

Treatment

If testicular cancer is found, the treatment depends on the stage of the cancer. Three standard treatments are used:

Surgery. Surgery removes the testicle and some of the lymph nodes (organs that fight infection). Tumors that have spread to other places in the body may be partly or entirely removed by surgery.
Radiation therapy. High-energy x-rays or other types of radiation kill cancer cells.
Chemotherapy. Drugs are used to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.

Find testicular cancer early: do a self-exam

Most men find the cancer in their testicles themselves. This fast and simple exam can help you find this cancer early. Do the exam after a warm bath or shower every month. Also ask your health care provider to do a testicular exam as part of your regular checkup.

The Testicular Cancer Resource Center provides information about how to do a testicular cancer self examination. Go to http://tcrc.acor.org/tcexam.html for more information.

For more information, go to…

National Cancer Institute:

http://www.cancer.gov/cancertopics/factsheet/sites-types/testicular

March 2010 - Potential heart risk when combining HIV drugs

The Food and Drug Administration issued a warning recently that potential heart risks when combining two HIV drugs. The agency said preliminary data suggest Roche's Invirase and Abbott Laboratories' Norvir can affect the electrical activity of the heart when used together. Changes to the heart's electrical activity can delay the signals that trigger heart beats. In some cases the problem can cause irregular heart rhythms, leading to lightheadedness, fainting, and even death.

You can read the full Reuters article here.

January 2010 - Hepatitis C found in Gay Men

Recent outbreaks of the hepatitis C virus among gay men have been reported in Europe and the United States. Doctors believe that a significant number of cases were transmitted through sexual contact. Information posted on the Website Stopaids.org suggests the high rate of infection may be the result of rough anal play.

What are they symptoms and what is the danger?

Symptoms of Hepatitis C include jaundice, fatigue, abdominal pain, dark urine, loss of appetite and nausea. It is also possible to have no symptoms at all. Hepatitis C affects the liver and can cause liver cancer in extreme cases.

What can I do?

There’s no vaccine and treatment is difficult and not always successful. So it’s especially important to use a condom during anal sex. It’s also important to get tested for Hepatitis C so that you can learn how to avoid spreading it to others.

Hepatitis C infection is determined by a simple blood test. If it comes back positive, that means you have been infected with the virus. It’s also important to note that some people recover from it without treatment. However, some people can be chronically infected, which means the virus is in your system permanently. These are the folks that can go on to experience problems with liver function.

Form more information about Hepatitis C, you can go to these helpful links:

http://www.thebody.com/content/art6050.html

http://www.stopaids.org/news/hepc.pdf

September 2009 - N1H1 (Swine) Flu

Here’s what to look out for…

Common signs and symptoms of N1H1 infection are similar to the ones associated with seasonal influenza. Some of the signs are fever, cough, sore throat, runny or stuffy nose, headache, body aches (such in muscles and joints), chills, fatigue, diarrhea, and vomiting.

Here’s what you can do…

A vaccine for the H1N1 flu may be available in your area. You can check with your doctor or local clinic for more information. You should know also that the vaccine for the seasonal flu does not work against H1N1 flu.

In any case, the CDC recommends taking these precautions to guard against infection from N1H1 virus:

Cover your nose and mouth with a tissue when you cough or sneeze and then throw the tissue in the trash.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizers are also effective.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Avoid close contact with sick people.
If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone (except to get medical care or for other necessities). Your fever should be gone without the use of a fever-reducing medicine. Keep away from others as much as possible to keep from making others sick.

Treatment for H1N1 includes two antiviral drugs called Relenza (zanamivir) and Tamiflu (oseltamivir). Treatment is most effective if started within 48 hours of the onset of symptoms.

HIV/AIDS and N1H1…

HIV infected individuals may experience more severe effects and complications with H1N1 flu, as evidenced by effects to previous seasonal influenzas. HIV infected individuals are more vulnerable to flu effects because of the low number of CD4 cells or healthy white blood cells that can fight off infection. As a result, it is vital that HIV infected individuals rigidly follow the guidelines listed above. If you do have flu symptoms, see your doctor immediately.

If you are HIV positive and come into close contact with H1N1 infected individuals, you should receive antiviral chemoprophylaxis (antiviral prevention medication). For more information about this precaution, follow this link: http://www.cdc.gov/h1n1flu/guidance_HIV.htm

If you have any questions, you can follow this link for more information:

http://www.cdc.gov/h1n1flu/qa.htm

September 2009 - Using a Condom Correctly

Practicing safer sex involves using a condom. You may think there’s nothing to it—just rip it open and slide it on. No need to fuss, especially if it’s pre-lubed. Right? Well, just to test your condom experience, here are a few tips that can make safer sex even safer:

Use only latex or polyurethane condoms.
Check the expiration date on the condom package. Old condoms can break easily.
Condoms are easily torn, so be careful when opening the package.
If you’re uncircumcised, roll the foreskin away from the head of the penis before putting on the condom.
Wait until your penis is hard before you put it on.
Squeeze the reservoir tip closed before rolling it down, to give the semen a place to collect.
Unroll the condom down the shaft of the penis, while holding the tip.
Use only a water-based lubricant.
Do NOT use lubes or spermicides that contain nonoxynol-9 (or N-9), as in can increase the risk of HIV infection.

If the condom breaks, pull out and replace it immediately. If there is an exchange of bodily fluids, after the condom breaks, talk to your doctor immediately about post–exposure prophylaxis (PEP), which can prevent HIV infection.
After you ejaculate, hold the condom at the base of the shaft to keep it from slipping off when pulling out.
Gently peel off the condom and throw it away.

For more detailed information about how to use a condom, you can go to to

The Body.com

For more information about post–exposure prophylaxis (PEP), go to:AIDS.org

July 2009 - Nonoxynol 9 and HIV

Nonoxynol-9 (or N-9) was created in the 1980’s as a spermicide—a method of contraception. The substance was also thought to prevent sexually transmitted diseases and it even killed HIV (the virus that causes AIDS) in test-tube studies. As a result, many gay and bisexual men who engaged in anal sex adopted the use of condoms and lubricants containing N-9 as a means to prevent HIV.

Increased Risk for HIV Infection

More recently, however, researchers have discovered N-9 can damage the lining cells of the rectum during anal sex, making a person more susceptible to contracting HIV.

What’s so troubling is that men who have sex with men are either unaware of this danger or don’t believe the danger actually exists. In fact, a study performed in San Francisco found that one quarter of respondents reported using lubricants containing N-9 despite repeated warnings from the Centers for Disease Control and Prevention, the World Health Organization and the Gay and Lesbian Medical Association to not use N-9 when engaging in anal intercourse.

What Can You Do?

Don’t use lubricants, condoms, or any other product that contains N-9. If the package says “spermicidal lubricant” on the box avoid it!

The best way to prevent HIV infection when engaging in anal intercourse is to use latex condoms and water-based lubricants.

More Information

To learn more about N-9, go to:

http://gaylife.about.com/cs/physicalhealth/a/nonoxynol.htm

April 2009 - Top Ten Health Issues of Gay and Bi Men

1. HIV/AIDS, Safe Sex

That men who have sex with men are at an increased risk of HIV infection is well known, but the effectiveness of safe sex in reducing the rate of HIV infection is one of the gay community’s great success stories. However, the last few years have seen the return of many unsafe sex practices. While effective HIV treatments may be on the horizon, there is no substitute for preventing infection. Safe sex is proven to reduce the risk of receiving or transmitting HIV. All health care professionals should be aware of how to counsel and support maintenance of safe sex practices.

2. Substance Use

Gay men use substances at a higher rate than the general population, and not just in larger communities such as New York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate ("poppers"), to marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however current wisdom suggests potentially serious consequences as we age.

3. Depression/Anxiety

Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions.

4. Hepatitis Immunization

Men who have sex with men are at an increased risk of sexually transmitted infection with the viruses that cause the serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious long-term issues such as cirrhosis and liver cancer. Fortunately, immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all men who have sex with men. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C Virus.

5. STDs

Sexually transmitted diseases (STDs) occur in sexually active gay men at a high rate. This includes STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is available (HIV, Hepatitis A, B, or C virus, Human Papilloma Virus, etc.). There is absolutely no doubt that safe sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key.

6. Prostate, Testicular, and Colon Cancer

Gay men mar y be at risk for death by prostate, testicular, or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be negatively impacted because of issues and challenges in receiving culturally sensitive care for gay men. All gay men should undergo these screenings routinely as recommended for the general population.

7. Alcohol

Although more recent studies have improved our understanding of alcohol use in the gay community, it is still thought that gay men have higher rates of alcohol dependence and abuse than straight men. One drink daily may not adversely affect health, however alcohol-related illnesses can occur with low levels of consumption. Culturally sensitive services targeted to gay men are important in successful prevention and treatment programs.

8. Tobacco

Recent studies seem to support the notion that gay men use tobacco at much higher rates than straight men, reaching nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use.

9. Fitness (Diet and Exercise)

Problems with body image are more common among gay men than their straight counterparts, and gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for cardiovascular health and in other areas, too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can adversely affect health. At the opposite end of the spectrum, overweight and obesity are problems that also affect a large subset of the gay community. This can cause a number of health problems, including diabetes, high blood pressure, and heart disease.

10. Anal Papilloma

Of all the sexually transmitted infections gay men are at risk for, human papilloma virus —which cause anal and genital warts — is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in gay men. Some health professionals now recommend routine screening with anal Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high.

From the Gay Lesbian Medical Association Website at http://www.glma.org

Author: Vincent M. B. Silenzio, MD, MPH, Former Member Board of Directors, GLMA and Former Co-Editor, Journal of the Gay and Lesbian Medical Association

October 2008 - Genital Herpes

What is it?

Genital herpes is a sexually transmitted viral infection caused by
herpes simplex virus type 2 (HSV-2) or herpes simplex virus type 1
(HSV-1). The latter usually causes oral cold sores. Most infections
occur without symptoms. When symptoms do occur, they usually develop
within 2 to 20 days following infection and can last up to 2 weeks.
After the initial infection, genital herpes is characterized by
recurring symptoms and lesions at the same site as the initial
infection. Recurrent symptoms are usually less severe than the first
infection and usually last less that one week.

What are the symptoms?

Symptom of the first infection include itch, burning, or tingling and
the appearance of multiple blisters that burst and form shallow
painful ulcers. Other symptoms include swollen lymph glands,
headache, muscle ache, and fever. However, up to 60% of people who
have genital herpes have no symptoms.

Recurrence of symptoms my occur and can be triggered by certain
factors such as stress, fatigue, poor health, friction due to sexual
intercourse, and drinking alcohol.

How is it spread?

Herpes is spread through direct contact with an infected area,
usually when the infected person has no symptoms. You can contract
herpes by kissing or touching actively infected areas, or through
sexual contact. Giving oral sex while you have a cold sore can infect
your partner with HSV-1.

What can I do?

The risk of transmitting the virus is reduced by using condoms and
contraceptive foams. Other safer sex practices to reduce transmission
include external ejaculation, washing thoroughly after sex with soap
and water, and keeping body fluids away from cuts and abrasions of
the skin which would allow the virus to enter the body. However,
couples should try to avoid sexual intercourse during an active
outbreak as this is when the virus is most likely to be transmitted.

Although there is no cure for genital herpes, it is manageable.
There are very effective antiviral medications that can be taken
intermittently, at the time of an outbreak, or constantly as
prophylaxis to stop herpes recurrence and viral shedding.

July 2008 - Anal Cancer

Recent studies have shown that gay and bi men are at a high risk of developing anal cancer.

In response, the Pittsburgh AIDS Center for Treatment (PACT) at the University of Pittsburgh, with the guidance of Dr. Ross Cranston, has opened an Anal Dysplasia Clinic. Anal Dysplasia is a precancerous condition in which there are abnormal changes in the cells that comprise the anal canal.

“As gay men, we run the risk of serious health issues because we don’t pay enough attention to our butt’s,” says Dr. Ross Cranston. “Anal health has yet to emerge as an area to which it is deemed appropriate to direct our attention. As a result, gay men in particular are unaware of their increased risk of many anal diagnoses including those related to sex.”

Anal Dysplasia is caused by HPV – human papillomavirus – which can be transmitted by both receptive anal intercourse and close physical contact. However, not everyone with HPV gets cancer. One study shows that 95 percent of gay men with HIV and about 65 percent of gay men without HIV have HPV in their anal canal or the surrounding skin.

HPV can be divided into two groups: low-risk HPV that can cause anal or genital warts, and high-risk HPV that is associated with the development of anal dysplasia.

So what can you do?

Use a condom during intercourse. It can’t always protect you (coming in contact with HPV infected skin outside the condom can also spread the virus), but using a condom can greatly reduce your risk of infection.

You should also have a test to look for precancerous cells called anal cytology, also known as the anal Pap. Catching the condition early on may prevent anal cancer from ever happening.

Recommendations for routine testing of gay and bisexual men have yet to be determined, given the on-going research in this area. However, Dr. Cranston recommends that men over the age of 40 who are HIV negative get an anal Pap test about once every two or three years. HIV positive men should get tested once a year.

What is an anal Pap test?

In this procedure, a health care provider passes a swab into the anal canal and collects cells. These cells are then examined by an experienced pathologist in a lab under a microscope.

What happens if the test is positive?

It takes many years for anal dysplasia to develop into cancer. If the cells show HPV related changes of the kind that could lead to cancer, the patient should undergo a procedure called high-resolution anoscopy where the anal canal is examined using magnification, and a biopsy taken of any abnormal areas. Anal dysplasia can be divided into low-grade and high-grade, with high-grade being the lesion considered most likely to progress to cancer and this is the lesion that should be treated.

Treatment for these anal lesions most commonly involves getting rid of the abnormal cells. This may be done as an office procedure using an infra red probe, but other methods such as surgical excision have also been used. Treatment is very effective in removing lesions, but as they may come back in the same or other areas, it is important to continue to have regular screenings.

What are the symptoms of anal cancer?

The most common symptoms of anal cancer include persistent bleeding, pain or lumps in the anal area. Anyone with these symptoms should be examined by a healthcare professional.

How is anal cancer treated?

If anal cancer is diagnosed, it is most commonly treated with a combination of radiation and chemotherapy. The type of treatment may depend on whether the tumor has spread, and on the size and location of the tumor.

More information:

For more information about the anal dysplasia clinic, you can call 412-647-0996.

For more information about HPV, Anal Dysplasia, and Anal Cancer, you can go to the American Cancer Society’s website by clicking here.

April 2008 - Syphilis and MSM

Officials at the Centers for Disease Control and Prevention (CDC) recently reported that syphilis rates continued to rise in 2007. The disturbing fact is that the surge is being driven by cases among men who have sex with men (MSM), who accounted for 64 percent of the known syphilis infections last year. That's up from five percent in 1999.

Why? Symptoms of syphilis can go unnoticed or misdiagnosed. The CDC's website notes: "Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. [...] Thus, transmission may occur from persons who are unaware of their infection."

What is the danger?

Syphilis is especially worrisome because, if it goes untreated, it can lead to serious health conditions later on in life. It can also complicate other infections such as HIV. It is also important to note that Syphilis can be transmitted through a variety of sexual acts, not just intercourse. So a condom won’t necessarily protect you.

Signs of Syphilis

Syphilis usually begins with the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days. The chancre is usually firm, round, small, and painless. The chancre lasts 3 to 6 weeks, and it heals on its own. Note, however, that the infection doesn’t' go away without proper treatment.

As the disease progresses, it may include fever, swollen lymph glands, rash, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs of this "secondary stage" of syphilis will resolve with or without treatment, but, again, it doesn’t go away.

In its later stages, many years after the initial infection, the disease can cause damage to internal organs, the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the "late stage" include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

What can you do?

Get tested. All sexually active MSM should receive testing for a wide range of sexually transmitted diseases at least once a year (as recommended by the CDC).

You're not going to hear much about this in the mainstream media and, chances are, your doctor isn't going to recommend being tested for an STD. So it's up to you to take matters into your own hands. Syphilis is easily cured in its early stages. A single injection of penicillin will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available.

Your doctor can perform the test for syphilis. The Allegheny County Health Department also provides free testing. You can find other local testing sites (some will maintain your anonymity) at www.stopHIV.com in the drop-down resources menu, under “PA Service Providers.”

For more information about MSM and syphilis, you can go to the CDC's website at:

http://www.cdc.gov/std/syphilis/STDFact-MSM&Syphilis.htm

Don't risk your health or the health of the community. Get tested now.

February 2008 - MRSA and MSM

A recent New York Times article reported a drug resistant strain of MRSA (Methicllin-resistant Staphylococcus aureus) being spread among gay men in San Francisco and Boston. MRSA infections typically occur in hospitals or other healthcare facilities. However, MRSA can also cause infections in persons who have not recently been hospitalized. This is referred to as community acquired MRSA, and has received a lot of press coverage as of late.

Although the study cited in the Times article noted a disproportionate number of MRSA skin infections among gay men, it is important to note that MRSA is not specific to one population or group of people. Regardless, it is important to understand the risk factors, signs and symptoms, prevention methods and possible treatment options. Community-acquired MRSA is spread through close skin-to-skin contact, openings in the skin such as cuts and abrasion, crowded living conditions, and poor hygiene.

A person who has a MRSA skin infection often has redness, warmth, swelling, pus, and/or pain at the site where a sore or cut is present. Typically, it may resemble a boil or spider bite. MRSA skin infections my also occur at sites covered by body hair or where clothing or towels cause skin irritation or increased rubbing.

Hand washing is key to preventing the spread infection-being sure to use warm water and soap. In addition, covering cuts and scrapes with a bandage until they are healed, avoiding contact with other people's wounds and bandages, and avoiding sharing personal items such as towels or razors serve as prevention methods as well.

If you are concerned about a possible MRSA skin infection, contact your health care provider for treatment. MRSA infections are treatable with antibiotics, despite their resistance. Remember it is important to complete the full course of antibiotics, even if the infection seems to be getting better, unless directed by your physician. In addition, do not share antibiotics or save unfinished antibiotics to use at another time.

To read the New York Times article, click here.

For general information concerning MRSA, click here.

January 2008 – HPV and Men

What is HPV?

Human papillomavirus (HPV) is a sexually transmitted disease that infects the genital area of both men and women (including the skin on and around the anus). Over half of the men in the United States will have HPV at some time in their lives. Often the virus clears up on its own without a health problem but, depending on the strain of HPV, it can cause genital or anal warts. Some strains of HPV can also cause abnormal changes in cells which can become precancerous and result in cancer of the penis or anus. HIV positive men are more likely to get severe and prolonged cases of genital warts which may be resistant to treatment.

How is HPV spread?

HPV is passed through vaginal or anal intercourse but can also be spread through simple skin to skin contact. Because HPV infections often don’t have symptoms, they can be passed on unknowingly.

What are the symptoms?

Genital warts are the first symptoms seen with low-risk strains of HPV infections. They are soft, raised growths that are usually painless. These lesions can also appear in the mouth and throat, although this is rare. Warts usually take 3 weeks to 6 months to appear after exposure but, in some cases, can also take years.

What can I do?

If you are diagnosed with HPV, it is important to tell your sexual partner(s). Transmission of HPV can be minimized by finding alternative ways to express intimacy and avoiding contact with a wart. Condoms are also effective for preventing infection with HPV if they are used correctly and consistently. However, genital warts not covered by a condom can still transmit the virus.

November 2007 - HIV Health Alert

MSM are still being infected with HIV. Here’s why:

Some men become infected because they mistakenly believe their partner is HIV negative. You should treat every sexual partner as if he is HIV positive and only engage in sexual activities that you would perform with someone you knew to be HIV positive.

Depression and alcohol/drug use lead otherwise cautious men to engage in risky sexual behaviors. It is important to be especially cautious during sex when you are feeling down or under the influence of drugs and/or alcohol. If you are feeling depressed or have problems with addiction, get help. You can go to the referrals section of this website to find counseling services.

Not using a condom during anal sex is the most significant risk factor for HIV infection. If you engage in anal intercourse, use a latex condom with a water-based lubricant. Also, withdrawing prior to ejaculation provides even greater protection for receptive sex partners.

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