Box Turtle Bulletin

“Over 28 times more likely to get anal cancer”

When traveling this year, consider the following:

• The second largest weather killer in the United States is a lightning strike.
• You are over 100 times more likely to be hit by lightning in Florida than California.

Makes ya think, doesn’t it? Perhaps vacation should be at Disneyland rather than Disney World.

But would it help you put things in perspective if you knew that the odds of getting struck by lightning in the US are about 1 in 500,000 and that only 40 to 50 people per year are killed here by a lightning strike? When you know the facts, then all of the above ceases to give you concern and instead you feel manipulated.

Keeping that in mind, look at the following condom awareness psa being aired by New York City:

When you get HIV, it’s never just HIV. You’re at a higher risk to get dozens of diseases, even if you take medications. Like osteoporosis, a disease that dissolves your bones; and dementia, a condition that causes permanent memory loss; and you’re over 28 times more likely to get anal cancer. It’s never just HIV. Stay HIV free. Always use a condom.

Scary!!

But is it true? And, as importantly, is it in perspective?

Osteoporosis is directly related to bone mineral density (BMD) and it is the measurement of BMD that is used to identify and – more or less – define who has or does not have osteoporosis and likely future fractures. And it is, indeed, true that HIV positive persons have higher rates of both osteoporosis and osteopenia (a similar but less sever condition). The reasons are, at present, undetermined.

So, yes it is fair and accurate to warn that HIV can, on average, increase one’s likelihood of osteoporosis (as can being a short white woman). And this condition is common enough that an increase in incidence is material and worthy of discussion.

But it’s not quite all of the story. The handsome young man whose bones were dissolving before our eyes is rather unlikely to have osteoporosis for decades, if ever. Osteoporosis (which primarily effects those over 50) is fairly easy to both treat and forestall, so this young man may need to take extra precautions (e.g. adequate calcium and vitamin D) but he is not going to wake up one morning and find that his skeleton has dissolved to soup.

Dementia is more common in people with HIV than without. Indeed, before HAART, dementia was a common consequence of HIV infection and was often the first qualification for an AIDS diagnosis. Currently it is less common, but still a major concern, especially as HIV infected persons age. (caregiver.org)

Before the arrival of highly active anti-retroviral therapy (HAART) in the second half of the 1990s, estimates of the percentage of people with AIDS who would develop HAD ranged as high as two-thirds. Many specialists, however, believed that the true figure was closer to 20 to 30 percent. More recently, experts have estimated that less than 10 percent of people on HAART develop HAD. However, because people with HIV are living longer than ever before, a greater number could ultimately develop the disorder, perhaps in its milder forms.

So far, I don’t necessarily quibble with accuracy of the psa, though the imagery suggests that these possible consequences are likely to be onset in early life, a false implication. But now let’s turn to one of my pet peeves, the ooky-spooky (and mostly bogus) anal cancer scare.

Yes, anal cancer exists. And yes it has higher rates in gay men than straight and even higher in HIV positive men. But the inclusion of anal cancer as a “higher risk” and the “28 times more likely” language tells me that this psa has no credibility whatsoever. It is not designed to inform, but to frighten.

The anal cancer scare is a favorite tactic of anti-gay activists. And it is irresponsible and immoral behavior when they seek to demonize gay men by claims that “”homosexuality is by its very nature dangerous to those who practice it.” It is no less irresponsible and immoral to use this scare tactic in the advance of a noble cause like encouraging condom use.

Anal cancer is very rare. In the US, about 5,260 people per year get this disease, of which about 40% are men (so, as you can see, women are 50% more likely to get anal cancer. Beware!!). About 720 patients die. Anal cancer is highly associated with HPV infection (though the vast majority of those infected with the HPV virus never develop anal cancer) and a vaccine is available which eliminates this risk factor.

Gay men, who are more likely to have become infected with HPV in their anus than are heterosexuals, experience anal cancer incidence of about 35 in 100,000. HIV infected persons, as are other persons with a suppressed immune system, are more likely to develop this cancer, but we still are talking tiny tiny numbers, maybe around one tenth of one percent.

Yes, HIV seroconversion is a life-changing experience. While most HIV positive people live relatively the same life as HIV negative people, there are more risks, rules, and precautions. Drug regimens must be adhered to, lifestyle choices have to be made, and health complications of some sort are almost unavoidable.

There are, indeed, many many good reasons to avoid infection with HIV. But fear of anal cancer is not one of them.

I support the dissemination of information that clarifies and warns about avoidable health risks. But I do not support bogus fear tactics that seek to deceive and manipulate, even if the goal is admirable. And this psa is one of the most deceptive manipulation tactics that I’ve seen.

And we cannot blithely suggest that the end justifies the means, when there are real victims of this false impression of HIV. This psa stigmatizes HIV positive persons in ways that are unnecessary and cruel. Viewers leave with the impression that HIV positive persons are about to fall over dead or go stark-raving mad.

And, in the mind of many, the ails of HIV positive people reflect on gay people as a whole. Psa’s that warn of dementia or anal cancer in HIV infected persons translate to many viewers that gay people are diseased and insane. We all, HIV positive and HIV negative alike suffer the consequences of such presentation.

And, besides, they are wrong. Yes, most people with the virus will also have other issues that result. But it is not true that “It’s never just HIV.” For some few, an HIV infection will not result in any medical consequences. I can’t say exactly how many, but it may be more than those who get anal cancer.

GLAAD and Gay Men’s Health Crisis have joined forces to ask the city to pull the ad. I wholeheartedly agree.

HPV vaccine effective in preventing anal cancer

Anal cancer, a very rare condition, impacts gay men to a greater extent than heterosexuals (about 0.35% of gay men get anal cancer). The most significant contributor is infection with the Human Papillomavirus (HPV), the same virus that contributes to cervical cancer in women, causes genital warts, and is linked to some rare oral cancers in straight men. HPV is very common and most sexually active adults will be infected at some point in their life.

In October, the FDA approved the use of Gardasil, a vaccine, for males ages 9 through 26 for the prevention of genital warts. Now Merck has release testing results showing that the vaccine is significantly effective in the prevention of anal cancer in gay men.

Merck & Co., Inc. announced today that in new Phase III data, GARDASIL® [Human Papillomavirus Quadrivalent (Types 6, 11, 16 and 18) Vaccine, Recombinant] was 77.5 percent (95 percent CI: 39.6, 93.3) efficacious against anal intraepithelial neoplasia (AIN) associated with human papillomavirus (HPV) types 6, 11, 16 and 18 in 16-to-26 year-old men who have sex with men.
…
In this PPE analysis, GARDASIL prevented 77.5 percent (95 percent CI: 39.6, 93.3) of HPV 6, 11, 16, and 18-related AIN and anal cancer. A total of 29 men were diagnosed with HPV 6, 11, 16 or 18-related AIN during the study, with 24 cases in the placebo group and five in the vaccine group. No cases of HPV 11 or 18-related AIN were observed in the vaccine group. No cases of anal cancer were seen in either the placebo or vaccine group.

Most sexually active adults have been or will be infected with HPV. In most cases, the infection goes away naturally. But Merck also found that the vaccine efficacious in preventing infection in women aged 27 to 45, a demographic that is not yet approved by the FDA. It is easy to surmise that the next step will be to test men in this age group with the eventual goal of marketing to everyone.

Although the odds are low of getting HPV related cancer, it is probably to the advantage of all women and gay men to reduce those odds even further by getting vaccinated, if possible. While this may not be covered by your insurance, the $360 for the three shots may save your life.

HPV Vaccine OKed for Males

Hardly an anti-gay activist can keep the excitement from their voice when they breathlessly declare that Gay Men Die From Anal Cancer!! And, indeed, gay men do die from anal cancer. In fact, about 0.35% of gay men do get anal cancer (a higher rate than non-gay men) and, if not treated, some of them die.

The primary contributor to anal cancer is infection with the HPV virus, the same virus that contributes to cervical cancer in women, causes genital warts, and is linked to some rare oral cancers in straight men. HPV is very common and most sexually active adults will be infected at some point in their life.

But some day that may no longer be true.

As we told you in June, a vaccine for the virus – which the CDC has been urging to be provided to all girls – is also effective in preventing infection in boys. And now the FDA has approved the vaccine for such use. (NYTimes)

The vaccine was approved last week by the Food and Drug Administration for use in boys and men ages 9 to 26. Wednesday\’s action, by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, is intended to guide national policy on use of the vaccine; its recommendations are typically adopted by professional medical associations and set the standards of practice for physicians.

But it probably won’t lead to universal vaccination. After all, it would be mostly appropriate to boys who may some day engage in sex with someone of the same sex, and we aren’t so foolish as to assume that public health policy will be directed by what is beneficial to future gay citizens.

The new recommendation means, in effect, that doctors and clinics may now administer the vaccine at their discretion to boys and men ages 9 to 26, but they are not expected to offer it. Parents may consider the vaccine as an option for their sons, but some health insurers may choose not to cover the shots.

Yet this is good news. And it is important that we spread the news to gay-straight alliances and gay youth groups and to parents of kids that are a bit gender-nonconforming and even those parents who put their kids’ health above their dreams of a daughter-in-law. This simple step could possibly save a life.

And in the process remove one more bullet from the arsenal of those who attack our lives and freedoms.

Vaccine for HPV Effective in Men

Just ask any anti-gay activist and they’ll tell you: the gays get anal cancer!! In 1997 the anti-gay group Concerned Women for America, in support for their claim that “homosexuality is by its very nature dangerous to those who practice it”, declared

Homosexual men’s practice of anal sex has left many of them victims of anal cancer. One article in the New England Journal of Medicine commented, “Our study lends strong support to the hypothesis that homosexual behavior in men increases the risk of anal cancer: 21 of the 57 men with anal cancer (37 percent) reported that they were homosexual or bisexual, in contrast to only one of 64 controls.”

And even the CDC warns

Gay and bisexual men are 17 times more likely to develop anal cancer than heterosexual men.

You may find this surprising. Looking at your friends you may wonder, “Who has anal cancer here? Why are they keeping this a secret from me?”

Well fear not. Your friends aren’t lying to you. While anal cancer is far more frequent in gay men than heterosexuals (and even more common to HIV politive men), it is still very very rare – and about to become rarer still.

HPV, the human papillomavirus, is sexually transmitted and very common. According to the CDC, “Most sexually active people in the United States (U.S.) will have HPV at some time in their lives.”

Although the virus may never present symptoms, it’s most known for causing genital warts. At any given time 1% of sexually active men in the US have genital warts.

More seriously, a number of cancers have been shown to be associated with HPV including cervical cancer, penile cancer, and anal cancer. Each of these are fairly rare.

The rate of anal cancer in men is 9 out of 100,000. In gay men that rate soars to 35 out of 100,000.

Although 0.035% is hardly the sort of occurrance rathat argues that “homosexuality is by its very nature dangerous”, we should not dismiss or treat lightly the pain and misery brought about by this disease.

Fortunatly there is a vaccine for the type of HPV that causes cancers. It is nearly 100% effective in reducing infection in women. However, the vaccine has not yet been approved for use on men.

A new study may lend support to the vaccination of men as well. (xtra)

“The numbers right now look not quite as good as the girls\’ but still very, very good,” says Palefsky. “The vaccine was nearly 100 percent effective [in women] so you obviously can\’t do better than that.”

Palefsky says the vaccine would still make an effective preventative health tool for everyone because the same strains of HPV that cause most cervical cancers in women also cause a majority of anal cancers in men.

“They\’re entirely the same,” he says. “That\’s why we\’re optimistic that if boys do get vaccinated with the same vaccine that girls are using, it should prevent a substantial number of anal cancers.”

Conservatives have opposed the application of this vaccine for girls under the logic that it presumes that their little Suzy is going to be a promiscuous slut. And since they are good Christians kids wearing their purity ring they will never be exposed to a sexually transmitted virus. (In my experience, Christian kids tend to experience miracle babies – those who show up fully devoloped and health about seven months after a rapidly planned wedding.)

We can expect an even higher level of objection to vaccinating little Johnny who is undoubtedly going to give up his desire to be church organist when he grows up, develops an interest in sports, and marries a nice Christian girl.

But as a matter of policy, every child in the country should be vaccinated, regardless of sex. I care about Suzy and Johnny’s heath even if their parents do not.