Health

^{Sexual Health and HIV
Choosing a Physician
Being Gay in Rural Areas}

Sexual Health and HIV

Unexplained pimples on your penis. Burning sensation during urination. We are sometimes left with a souvenir of good or bad sex in the form of a sexually transmitted infection (STI) also called a sexually transmitted disease (STD). It would be difficult to talk about sexual health without talking about the basic concepts related to STIs. STIs are part of the sexual landscape and the best way to protect yourself against them is to be well informed. HIV/AIDS requires special attention. This epidemic is steadily growing and men who have sex with men are still the most affected in Canada. 

HIV/AIDS

Despite scientific progress and the accessibility of medication, there is no treatment that cures HIV/AIDS. Acquired immune deficiency syndrome (AIDS) is characterized by a set of symptoms resulting from damage to the immune system (the body’s natural defence system) caused by the attack of a virus called the human immunodeficiency virus (HIV). Primary infection occurs in the initial weeks following the entry of HIV into the body by symptoms similar to the flu or to mononucleosis—fever, headache, sore throat, fatigue, muscular pain, swollen lymph nodes, etc. Then after a few weeks (from 6–10 weeks), these symptoms disappear. About 30% of newly infected people experience no symptoms.

HIV can be present in the body for years, sometimes even up to 10 years, before the symptoms occur, symptoms such as fever, night sweats, weight loss, swollen lymph nodes, persistent diarrhea, nausea or vomiting, fatigue, candidiasis (fungal infections in the mouth), zona, pharyngitis, etc. These are symptoms that can also be associated with other health problems.

Over time, the immune system becomes so weakened that it can no longer defend itself against simple infections called opportunistic infections. The AIDS phase is one of alternating major periods of disease, sometimes requiring hospitalization, and periods of health. It is the last stage of the evolution of this disease, and it can last several years.

Transmission

HIV is transmitted by blood, semen, pre-ejaculatory fluid, vaginal secretions, and breast milk. For transmission to occur, these body fluids must be infected with HIV and must then come into contact with broken skin to reach the circulatory system of an uninfected person. Anal penetration is considered a high risk for HIV transmission because even if it is not always obvious, rubbing the penis against the anus can cause irritation in the anal region and can break the skin, promoting access to the circulatory system and the transmission of HIV.

HIV is not transmitted by saliva, sweat, tears, urine, or feces, unless these body fluids contain blood. There is also no risk to you of getting it by sharing clothing, utensils, dishes, or a toilet seat with an HIV-positive person.

Testing

HIV testing is carried out by a blood test. It is generally suggested that you have yourself tested once or twice a year, and three times if you have many sexual partners, or after risky sex or a broken condom with an HIV-positive partner or with a partner of unknown HIV status. For example, if you have anal penetration without a condom today, or if the condom breaks, you or your partner can go (preferably within 48 hours of risky sexual relations), to a specialized clinic or to a hospital Emergency Room. This way, you or your partner may have access to what we call post-exposure prophylaxis (PEP) (more information in the “The condom broke!!” section). The HIV test verifies the presence of HIV antibodies in the blood. The presence of HIV antibodies means that you are HIV-positive, thus a carrier of HIV. If there are no HIV antibodies, you are HIV-negative. To undergo testing, you must consult a physician or go to a medical clinic or health institution that provides this service. To take the HIV test, you must ask for it specifically. An HIV test must not be carried out without your consent or request.

When you are in a couple, testing for HIV must be done by evaluating whether you are ready to assume the possible negative impacts of a positive result (possible rejection, anguish, etc.). You have to go at your own pace based on your needs and capacities. One of you may be ready to take the test, yet the other one may refuse. In such a case, the decision may be postponed. Partners may need a little more time to think about it before bringing it up with their partner as a question that concerns them as a couple.

At first glance, taking the HIV test may seem frightening. But, when you think about it, it has definite advantages. It enables you to free yourself of the anxiety of not knowing your HIV status, to free yourself from certain fears connected to your state of health, to question some of the sexual practices that are less safe, and to make plans for the future. As well, it now enables you, if the result is HIV-positive, to begin the appropriate medical follow-up as soon as possible.

Treatment for HIV infection

There is very powerful medication available that interferes with the replication of the virus and slows down the arrival of the AIDS phase. The result? HIV-positive people live longer. Nevertheless, these medications are extremely expensive and can result in certain severe side effects including vomiting, significant diarrhea, headache, neurological problems, nightmares, and changes in physical appearance. We are a long way from the miracle pills announced by the media with regard to treatment against AIDS. In addition, treatment must be administered as prescribed, preferably without lapses, otherwise HIV could develop a resistance to the medications. In this case, the treatment options become rather limited. 

Choosing a Physician

It may take months to get your first doctor’s appointment. Furthermore, the shortage of known treating physicians in some regions of Canada makes the choice even more difficult. For this reason, it is preferable to begin this procedure when you feel well, not when you are concerned about your state of health.

As well, you must also not choose a physician simply because his or her office is close to where you work or live. Ask your friends and acquaintances if they can recommend a physician. The idea is to get a few names or better yet, to be referred to a physician by more than one person, which is a very good sign! Everyone hopes to be able to count on a competent, empathic physician. Aside from these qualities, what characteristics should I look for?
•    A man or a woman?
•    A “no-nonsense” physician or one with a more personal and friendly approach?
•    Someone who would give instructions or someone who gives information and explanations?

The next step is to “interview” the physicians and to choose the right one for you.

I have an appointment…

As soon as the door closes, the clock is ticking. Physicians are overloaded and have no time to lose. You have to get the most out of this time. For a first appointment be sure:
•    to have a list of the medications you take, if you do take medications;
•    to have your medical history: major illnesses, sexually transmitted infections, major wounds, surgeries, allergies, etc.;
•    to share all the relevant family history (cancer, cardiovascular illness, etc.).

Also list your symptoms and your questions. In addition to writing down your symptoms, try to describe them. For example, if your testes hurt, the pain locations, the kind of pain (constant but tolerable or intense shooting pain), when the symptoms appeared or disappeared, can you identify the cause of these symptoms, and so on. Don’t wait for the last minutes of the appointment to talk about important symptoms. Mention them at the very beginning.

If you have consulted other physicians for the same problem and if it persists, you must mention this, as well as the treatments administered. It would not be a bad idea to disclose the names of the previous physicians so that your physician can contact them.

You must also follow your intuition. As soon as you enter the physician’s office, you can tell if you feel comfortable or not. The first impression is often the best. If you have a good feeling and you feel like saying you are gay or bisexual, you can ask a question which will tell you whether the physician is open to your sexual orientation:
•    “Do you have male patients who have sex with men?” Hopefully, the answer will be YES.
•    Remember also to observe his non-verbal reactions (discomfort, avoiding eye contact, etc.). These will tell you as much as his verbal answers.

Take notes or bring a friend

A medical appointment often goes by quickly; you feel the pressure of time. There can also be some nervousness involved. The language used by a physician is not always easy to understand. You may also forget important information. Taking notes can help you to remember the information you get, in addition to showing that you are serious about the procedure.

Bring a friend with you. While the person with you takes notes, you can focus all your attention on listening and asking questions. The person with you can also act as a “checklist” if you forget to mention major symptoms or forget to ask for specific information. Two heads are better than one.

Being Gay in Rural Areas

The experience of being gay or bisexual is not the same in the regions as in urban settings, especially if other people around you don’t know. In small municipalities or villages, everyone knows someone who knows someone... and people talk, even gossip. On the other hand, if you divulge your sexual orientation to the physician in his office, he is bound by his professional code to maintain confidentiality.

In this context, it becomes all the more difficult to find a physician to whom you would reveal that you have sex with men and with whom you would discuss sexual health questions. In this case, you would consult your local physician for general health matters, and find a physician in another municipality or in the nearest urban centre with whom to discuss your sexual health.

It is important to find someone with whom you can speak openly in complete trust of your sexual practices, without fear of being judged or of being perceived differently.