SAN FRANCISCO — A federal appeals court on Tuesday declared California’s same-sex marriage ban to be unconstitutional, putting the bitterly contested, voter-approved law on track for a likely appeal to the U.S. Supreme Court.

A three-judge panel of the 9th U.S. Circuit Court of Appeals ruled 2-1 that a lower court judge correctly interpreted the U.S. Constitution and Supreme Court precedents when he declared in 2010 that Proposition 8 – a response to an earlier state court decision that legalized gay marriage – was a violation of the civil rights of gays and lesbians.

However, the appeals court said gay marriages cannot resume in the state until the deadline passes for Proposition 8 sponsors to appeal to a larger panel of the 9th Circuit. If such an appeal is filed, gay marriages will remain on hold until it’s resolved.

“Although the Constitution permits communities to enact most laws they believe to be desirable, it requires that there be at least a legitimate reason for the passage of a law that treats different classes of people differently. There was no such reason that Proposition 8 could have been enacted,” the ruling states.

Backers of Proposition 8 said they would ask the Supreme Court to overturn the 9th Circuit ruling.

“No court should presume to redefine marriage. No court should undercut the democratic process by taking the power to preserve marriage out of the hands of the people,” said Brian Raum, senior counsel for the Alliance Defense Fund, a Christian legal aid group based in Arizona that helped defend Proposition 8.

“We are not surprised that this Hollywood-orchestrated attack on marriage – tried in San Francisco – turned out this way. But we are confident that the expressed will of the American people in favor of marriage will be upheld at the Supreme Court,” he said.

American Foundation for Equal Rights President Chad Griffin, who formed the group along with director Rob Reiner to wage the court fight against Proposition 8, called the panel’s ruling “a historic victory.”

“The message it sends to young LGBT people, not only here in California but across the country, (is) that you can’t strip away a fundamental right, and gay marriage is a fundamental right that no one can strip away,” Griffin said. “Now that Proposition 8 has been declared unconstitutional, the people of California will very soon be able to once again realize their freedom to marry.”

More than 50 people who gathered outside the federal courthouse in downtown San Francisco greeted the ruling with cheers. They held signs and waved rainbow flags.

“Today’s ruling is a victory for fairness, a victory for equality and a victory for justice,” said California Attorney General Kamala Harris.

The appeals panel crafted a narrow decision that applies only to California, even though the court has jurisdiction in nine western states. California is the only one of those states where the ability for gays to marry was granted then rescinded.

“Whether under the Constitution same-sex couples may ever be denied the right to marry, a right that has long been enjoyed by opposite-sex couples, is an important and highly controversial question,” the court said. “We need not and do not answer the broader question in this case.”

The panel also said there was no evidence that former Chief U.S. Judge Vaughn Walker was biased and should have disclosed before he issued his decision that he was gay and in a long-term relationship with another man.

The ruling came more than a year after the appeals court heard arguments in the case.

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Despite advances in the treatment of HIV, one huge challenge still lingers in the medical community: getting people tested in the first place.

The stigma associated with being tested and potentially exposed in a public clinic has prompted scientists at the Research Institute of the McGill University Health Centre to evaluate the efficacy of an oral HIV self-test, a method they believe can serve as an effective but much more private alternative to clinical testing.

Compared to a traditional blood screening, the saliva test OraQuick HIV1/2, the only oral fluid test approved for use in a health-care setting by the Food and Drug Administration, was 99 percent accurate in detecting HIV antibodies in high-risk populations and about 97 percent in low-risk populations, according to study findings published in the journal The Lancet Infectious Diseases.

To evaluate this saliva test’s potential for worldwide use, researchers analyzed real-life field research data from five global databases. High-risk groups include injection drug users, men who have sex with men, and people who have unprotected sex.

Much like home pregnancy tests, researchers believe that oral HIV self-tests can serve as an effective preliminary method of diagnosis.

“Getting people to show up for HIV testing at public clinics has been difficult because of visibility, stigma, lack of privacy and discrimination,” the study’s lead author, Dr. Nitika Pant Pai, said in a release announcing the study findings. “A confidential testing option such as self-testing could bring an end to the stigmatization associated with HIV testing.”

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 Hate the Gays? Imagine the World Without Us

by Kergan Edwards-Stout

Author, ‘Songs for the New Depression’, and an HRC 2011 Father of the Year

In our current political discourse, right-wing politicians continue to demonize the LGBT community in sad and desperate attempts to rally their base. While, happily, their efforts have not been as effective as in the past, any attempt to make gay, lesbian, bisexual, or transgender people feel anything less than equal can lead to devastating consequences, as the ongoing string of youth suicides so painfully highlights.

Any preventable loss of dignity and human life must be stopped. The question is, “How?”

While prior efforts have focused on the issue of harassment, it is time for the LGBT community to take the dialogue one step further. When you are a teen, simply waiting for your next birthday can seem like an eternity. Telling our youth that life will indeed get better, some years into the future, is not enough. We must instead create a world in which there is no longer any shame in being gay. We must show that each and every one of us has something of value to contribute to this world, period.

The first step is creating discussion with the haters around where their anti-gay beliefs come from, and challenging those beliefs with facts. But we then need to take that dialogue even further and examine more closely what they hope that such convictions will ultimately achieve.

Typically, those who hold negativity toward those who are LGBT can be placed into two main camps: those who believe that being gay is unnatural, going against nature, or those who believe it goes against religious teaching.

With either group, the case can be made to counter such beliefs with facts. For example, those who believe that being gay is unnatural may be surprised to learn that homosexual activity has been observed in close to 1,500 species, and that such scientific certitudes should be spotlighted. For those who believe that homosexuality violates religious principles, pointing to texts such as the Bible as justification, and dialogue around translation issues, intent, and historical context, might be beneficial.

However, in both situations, while factual evidence might change some minds, most will still be unwilling to let go of long-held beliefs. My question to them then becomes, “What do you hope these beliefs will achieve?”

Most have never looked holistically at their views, nor tried to fit their beliefs into a larger framework. They were simply told by others that being gay is less than ideal, for whatever reason, and have not challenged that assumption.

If they truly believe that being gay is a sin or abnormal, what then? Does that mean they support the harassment of LGBT individuals? Do they hope to “convert” LGBT folks to heterosexuality, which no reputable medical or psychological association supports or validates, even going so far as to consider such “conversion therapies” potentially harmful? Do they want us to remain celibate and single, never experiencing love and affection? Do they wish LGBT people would simply disappear? If anything, they are creating an environment where gay youth feel that suicide is preferable to life.

But imagine, for a moment, that there were no LGBT people on the planet. Just what would this world look like?

Imagine the world without the Sistine Chapel ceiling, painted by Michelangelo, a gay man. Imagine the world without that famous Mona Lisa smile, or the iconic painting of Jesus and his disciples at the Last Supper, both by Leonardo da Vinci, another man who was probably gay. Imagine the world without the music of The Nutcracker or Swan Lake, by Tchaikovsky, also gay. More recently, imagine the world without the music of Johnny Mathis, Joan Armatrading, Elton John, Melissa Etheridge, George Michael, or the Indigo Girls, among countless others.

Imagine the world without the plays of Edward Albee, Tennessee Williams, Paula Vogel, or Stephen Sondheim. Imagine how literature would look without the writings of Virginia Woolf, Truman Capote, Alice Walker, or Augusten Burroughs. Imagine sports without such legends as Martina Navratilova, Greg Louganis, Johnny Weir, or Billie Jean King. Imagine the world without the comedic brilliance of Lily Tomlin, or Andy Warhol’s groundbreaking Campbell’s Soup Cans painting, or Roland Emmerich’s smash hit movie Independence Day. Imagine Glee without Jane Lynch and Chris Colfer. Oh, wait — you’re right! There wouldn’t even be a Glee without gay creator Ryan Murphy.

Read more.

More about the author.

 Are Our Future Doctors Receiving Enough Training to Care for LGBT People?

Andrew Silapaswan
Public policy intern, Gay Men’s Health Crisis (GMHC)

After relocating halfway across the country to New York City, finding an LGBT-friendly and culturally competent doctor was not high on my priority list. However, my priorities changed when I required medical services in November. I quickly realized I would have to find a new primary care physician who is both knowledgeable in LGBT health care, and who will treat me with understanding and respect.

My experience is not unique, as many others in the LGBT community face similar challenges. In a 2005 survey 22 percent of lesbian, gay, and bisexual patients reported having experienced some form of discrimination in a health care setting. So why are so many health care providers ill-equipped to handle the health care needs of LGBT people? As a medical school candidate with my sights set on starting medical school in fall 2012, I am cross-comparing prospective M.D. programs and actively examining components of medical school curricula.

A medical school’s curriculum must meet rigorous standards established by the Liaison Committee on Medical Education (LCME) to receive accreditation. Nonetheless, recent studies and testimony on behalf of medical school administrations indicate that there are significant gaps in curricular content. More specifically, the quality and breadth of LGBT health-related content is lacking and remarkably uneven across medical schools.

One of the most comprehensive studies examining the incorporation of LGBT content in medical education was recently published in the Journal of the American Medical Association. The report indicated that the median time dedicated to teaching LGBT-related content was five hours (during the entire four years of medical education) in the 132 U.S. and Canadian medical schools that were surveyed. Additionally, nine schools reported zero hours taught during the preclinical years, and 44 schools reported zero hours of clinical training.

In terms of overall assessment of quality, the results are equally discouraging. A majority of medical school administrators revealed that their coverage of LGBT-related content was fair or worse. Thirty-two deans responded that their school’s coverage of LGBT health care was “good” or “very good,” while 58 reported that it was “fair,” and 34 indicated that it was “poor” or “very poor.”

The results are especially problematic given the fact that LGBT people have historically faced barriers in accessing competent medical care in addition to having specific health care needs.

Research findings reported by the American Psychological Association indicate that LGBT individuals may be at an increased risk for negative health behaviors and outcomes and experience a number of health disparities compared with their heterosexual peers. For example, gay men and lesbians report higher rates of smoking. Cardiac and cancer risk factors are also more prevalent among lesbians compared with heterosexual women. A large-scale study published in 2000 found that breast cancer rates and several associated risk factors are higher among lesbians and bisexual women.

Furthermore, men who have sex with men (MSM) continue to face disproportionate rates of HIV and are the only demographic in which new infections are rising in the U.S. According to the Centers for Disease Control and Prevention (CDC), MSM represent 2 percent of the general population yet accounted for 61 percent of all new infections in 2009. Clearly, the health care needs of LGBT individuals, which are largely complicated by stigma, homophobia, and other structural factors, underscore the necessity for comprehensive LGBT-related content in medical school curricula.

Read more.

LOS ANGELES — The Los Angeles City Attorney’s office has filed a lawsuit to keep the June 2012 ballot free of a measure that would require porn actors to wear condoms during film shoots.

In a lawsuit filed Thursday in Los Angeles Superior Court, city attorneys say the AIDS Healthcare Foundation’s proposed measure is unnecessary and will waste taxpayer money.

According to the lawsuit, there are already state laws mandating workplace safety which address the need for protective barriers to be used when workers are exposed to blood borne pathogens, such as HIV and other sexually transmitted diseases.

The filing urges the court to take immediate action rather than wait until after the election to invalidate the measure by finding it “patently illegal” because that “would undermine the public trust.”

The AIDS Healthcare Foundation has already collected more than 71,000 unverified voter signatures and has submitted them to city officials for verification, said Michael Weinstein, the advocacy group’s president.

“I think it’s extraordinary to attempt to thwart the will of 71,000 voters who under the laws of the city of Los Angeles wish to see this measure put before the voters,” said Weinstein.

To get on the city’s ballot, advocates must get 41,183 verified signatures from Los Angeles voters. If passed, the measure would require porn producers to agree to have their actors use condoms in adult films shot in Los Angeles in order to obtain permits to film in the city.

Weinstein said it shouldn’t cost taxpayers any money to include the proposition since the election will be held no matter what.

“I’m not an elections scholar but I’m not aware of prior restraint on voter’s ability to have their voices heard on an initiative,” said Weinstein.

Read more.

A new study conducted by George Mason University, Indiana University, and Online Buddies, Inc. polled 24,787 gay and bisexual men between the ages of 18 and 87 in the US.

The study aimed to “document the sexual behaviors that gay and bisexually identified men report during their most recent male-partnered sexual event and to describe the situational characteristics and participants’ evaluation of these events.”

The majority of the participants were white (84.6%) and identified as gay (85.9%). 57.4% received a bachelor’s degree or higher.

To read more and see a summary of the results, click here.

Phoenix Suns president reveals he’s gay

By Dan Barry
The New York Times

Last month, in a Midtown office adorned with sports memorabilia, two longtime friends met for a private talk. David Stern, commissioner of the NBA, sipped his morning coffee, expecting to be asked for career advice. Across from him sat Rick Welts, president and chief executive of the Phoenix Suns, who had come to New York not to discuss careers, but to say, finally, I am gay.

In many work environments, this would qualify as a so-what moment. But until now, Welts, 58, who has spent 40 years in sports, rising from ball boy with the Sonics to NBA executive to team president, had not felt comfortable enough in his chosen field to be open about his sexuality. His eyes welling at times, he also said that he planned to go public.

By this point, Welts had already traveled to Seattle to share his news with another friend, Bill Russell, one of the greatest basketball players ever and the recent recipient of the Presidential Medal of Freedom. He had also met with Val Ackerman, the founding president of the WNBA, in New York, and would soon be lunching in Phoenix with Steve Nash, the point guard and leader of the Suns and twice the NBA’s most valuable player.

In these meetings and in interviews with The New York Times, Welts explained that he wants to pierce the silence that envelops the subject of homosexuality in men’s team sports. He wants to be a mentor to gay people who harbor doubts about a sports career, whether on the court or in the front office. Most of all, he wants to feel whole, authentic.

“This is one of the last industries where the subject is off limits,” said Welts, who stands now as a true rarity, a man prominently employed in professional men’s team sports, willing to declare his homosexuality. “Nobody’s comfortable in engaging in a conversation.”

Richard Lapchick, founder and director of the Institute for Diversity and Ethics in Sport, and the son of the basketball legend Joe Lapchick, agreed.

“The fact that there’s no other man who has done this before speaks directly to how hard it must be for Rick to do this now,” he said.

Stern did not find the discussion with Welts awkward or even surprising; he had long known that his friend was gay but never felt that he had license to broach the subject. Whatever I can do to help, the affably gruff commissioner said. He sensed the decades of anguish that had led the very private Welts to go public.

After what needed to be said had been said, the two men headed for the door. And for the first time in their 30-year friendship, they hugged.

The very next day, Los Angeles Lakers star Kobe Bryant, one of the faces of the NBA, responded to a technical foul by calling the referee a “faggot.”

A feeling of isolation

Rick Welts always knew.

Growing up in Seattle, he was the industrious kid who landed a coveted job with the SuperSonics, first as a ball boy, then as an assistant trainer. By the time he went to the University of Washington, he had enough goodwill clout to have Lenny Wilkens, then coach of the Sonics, visit his fraternity for a chat.

After college, Welts returned to the Sonics as assistant director of public relations, a position that came with a desk but not an office. His diligent omnipresence, from early morning to late evening, impressed the team’s coach at the time, the intimidating Bill Russell. “Hey!” Russell would call. “White boy down the hall!”

And Welts would hustle up to do whatever was asked. The mutual respect that developed between the demanding basketball legend and the earnest employee gradually grew into a friendship close enough for Russell to judge him “a good teammate.”

Immersed in a business where manhood is often defined by on-court toughness and off-court conquest, Welts rose to become the public-relations director for the Sonics, at a time when the team won its only championship, in 1979.

Welts was eventually recruited by Stern, then a rising star in the NBA’s front office, to become the league’s director of national promotions. That is, to ask businesses to invest marketing dollars in what was then, arguably, the least popular professional sport.

Read more.

Don Lemon Comes Out: CNN Anchor Reveals He’s Gay In New Book

CNN anchor Don Lemon has come out. In a new book, “Transparent,” Lemon talks about his life and his sexuality, and he revealed that he is gay in an interview with the New York Times. In a tweet on Sunday night, Lemon, who has anchored in a variety of roles for CNN, linked to the Times article and wrote, “wanted to be the firs to share with u. thanks for your support!!!”

By coming out, Lemon becomes one of a tiny number of openly gay anchors on television; the list also includes Rachel Maddow and Thomas Roberts, both of MSNBC.

In the interview, Lemon said that he has never hid his sexuality from his co-workers at CNN, but decided to take a more public step after he felt that he could not write an inspirational book without being open about who he is.

Lemon also said that he was “scared,” because he was talking about things that “people might shun me for.” He said that he was particularly concerned about what the reaction in the black community would be. At one point, Lemon got so nervous that he thought about removing the parts of the book that dealt with his sexuality, but he changed his mind.

Read more.

It Gets Better Because We Grow Stronger: An Interview With Leading Gay Men’s Health Expert Dr. Ron Stall

By Jim Pickett
LifeLube.org/Director of Prevention and Gay Men’s Health, AIDS Foundation of Chicago

In 1981, severe illness in a group of young gay men caught the attention of federal public health officials who could not explain the cluster of rare, deadly cases of pneumonia. This ominous medical mystery is widely regarded as the start of the HIV/AIDS epidemic, which continues to rage on every inhabitable corner of earth.

Over the past 30 years, HIV/AIDS in the U.S. has spread to many other populations, particularly low-income women of color and injection drug users. While no longer a singularly “gay disease,” gay, bisexual and transgender people remain severely impacted by HIV/AIDS in the U.S. For young gay, bi, and transgender youth of color, alarming rates of HIV rival those of some Sub-Saharan countries. What can we learn from the 30-year history of the HIV/AIDS epidemic in order to forge a better, future response?

These are just some of the questions the AIDS Foundation of Chicago (AFC) is posing this year as it reflects on lessons learned from the past 30 years of HIV/AIDS. Chief among these questions is why, 30 years into the crisis, are rates of HIV highest among young gay men, particularly men of color? According to federal officials, rates of HIV among gay men are 50 times higher than any other group and, while new cases have plateaued for other groups, among gay/bi men and transgender, they continue to climb.

To help inform AFC’s 2012 strategic plan, I interviewed Dr. Ron Stall, Professor and Chair of the Department of Behavioral and Community Health Sciences in the Graduate School of Public Health at the University of Pittsburgh, a leading HIV prevention expert. He began researching AIDS-related topics in 1984 on the AIDS Behavioral Research Project, one of the first longitudinal studies of AIDS risk-taking behaviors in the world.

Since that time he has published more than 140 peer-reviewed scientific papers on many different aspects of the AIDS epidemic, including research on determinants of risk-taking behaviors and HIV transmission, co-occurring epidemics, life-course issues important to AIDS-related risk-taking, and a portfolio of research on global AIDS issues. He is currently co-director of a certificate program in LGBT Health and is collaborating on several National Institutes of Health research projects focused on gay men’s health.

Ron and I recently had the opportunity to check in and talk about the needs of gay men and youth. Only by understanding and responding to the epidemic among gay youth and adults can efforts to end the epidemic in the U.S. have any chance of success.

JIM: Your work concentrates on co-occurring health concerns that conspire to fuel the HIV/AIDS epidemic. Can you briefly describe this concept of “syndemics” and explain why it is so important to consider in terms of gay men’s health and efforts to meet their HIV prevention needs?

RON: The term “syndemics” describes interacting and intertwining epidemics, or synergistic epidemics. Syndemics are found in many different human populations, but are very commonly found in populations that are at high risk for HIV. Syndemics research studies why HIV is so closely intertwined with epidemics of substance abuse, depression, violence and other psychosocial health problems. More important, syndemics research also studies how we can interrupt syndemic production by starting a larger health movement that works to lower risk for HIV by addressing multiple psychosocial health problems in a community.

I’m part of a research group that has conducted a set of investigations into syndemic production among gay men, and we were able to show that epidemics of substance use, depression, childhood sexual abuse and violence victimization are intertwining and making each other worse and in the process raising risk for HIV transmission. Our study was the first to show that this phenomena exists among gay men, but this analysis has now been replicated in several different studies, including one among MSM in Thailand. One implication of our analysis is that there is a lot more to gay men’s health than a simple focus on HIV and that addressing these multiple health risks may work to lower HIV risk among gay male communities.

There has been a lot of talk about bullying these days, thanks to the brilliant “It Gets Better” campaign. Do you see bullying as something that feeds into syndemic production? What kind of research do we have around bullying and health outcomes for gay men, or more broadly, for LGBT people?

RON: Once you buy the idea that syndemics exist among gay men, the next question would be why is that so? We think that a very important piece to this puzzle is that gay men not only suffer far greater rates of violence victimization as adolescents, but that nearly all young gay men watch schoolmates being publicly victimized for having the same sexual orientation that they do. This sets gay men up early on to have a sense of being different, of being less than, of not being deserving, of being alone — in short, for internalized homophobia at a very early age. And these experiences predispose young gay men to be more depressed, to have greater substance abuse profiles at a very early age, to have higher rates of having sex under the influence of alcohol or drugs and to suffer greater rates of violence victimization, each of which raise HIV risk profiles among young MSM. Dr. Mark Friedman in our group published an analysis to show the associations between the experience of violence victimization and bullying during adolescence and poorer health profiles — including HIV seropositivity — among adult gay men. We are conducting additional analyses from a separate cohort study to measure how the experiences of violence victimization at a young age predict syndemic production among middle-aged gay men.

“It Gets Better” speaks to the transience of being harassed and bullied — that we won’t be in that situation all of our lives, so we basically just need to hang on. You just explained how bullying can have negative health outcomes for people, so while the bullying may end, the consequences can continue. But there is another side to this story — yes, it gets better, but you also get stronger. And coming out the other side of bullying can make people stronger, and more able to address challenges in their lives. This speaks to strength and resilience, which I know you have been thinking about. Tell us what we know about resilience and strength in terms of gay men’s health and HIV prevention.

RON: While it is true that there are important health disparities that cluster and make each other worse among gay men, once you start looking for resilience to fight health problems among gay men, you start seeing it everywhere. For example, gay men may use more drugs than straight men, but for all of that drug use, we don’t have comparable increased rates of behaviors that look like addiction. This suggests that there is an important, but unstudied, self-regulation process at work that men use to monitor their drug use and avoid addiction. And when gay men do get addicted to dangerous drugs such as tobacco and stimulants, we have very high rates of being able to resolve these addictions on our own.

And, of course, there are many, many men who’ve enjoyed full sex lives for decades on end and have not become HIV seropositive, not to mention the large numbers of seropositive men who’ve led full, healthy and productive lives even while battling a serious viral infection. We also exhibit important strengths in the way that we’ve always managed to build families, communities and political movements in very unfriendly contexts. Once you start looking at the data this way, you could be excused for concluding that resilience and strength in the face of adversity may be the two most important characteristics that distinguish gay and heterosexual men.

Why do you think we have focused so singularly on weaknesses and deficits? Why haven’t we flipped this script and focused efforts on building the resilience of gay men, particularly toward improve their health? Why haven’t we taken the collective wisdom of men — young and old — who have successfully avoided HIV infection to inform better HIV prevention responses?

RON: I think that our focus on deficits among gay men has to do with the long term effects of the shock of the discovery of the AIDS epidemic among gay men. We had this terrible new epidemic that seemed to miss most other populations. The questions of why we were so vulnerable to AIDS, and the study of our unique risk factors for this disease naturally followed. And, to be fair, this research frame has resulted in some important insights around HIV prevention and care.

That said, over time, it has also become clear that there are lots of men — indeed the majority of gay men — who’ve exhibited significant resiliencies when it has come to dealing with the HIV epidemic. The time has come to understand more about these resiliencies so that we can learn how better to respond to the many health problems affecting our community. Put another way, if we are interested in finding effective ways to treat substance abuse among gay men, are we better off studying men who became addicted or men who became addicted and quit on their own? Or men who use and don’t become addicted? Each group is important, but it may be that the men who resolved substance abuse on their own are the experts from whom we can learn the most valuable lessons.

Read more.

Doctors have their own opinions about who should be tested for which sexually transmitted disease (STD), but it’s really up to you.

When official recommendations are made, they’re based on research statistics about sexual activity and infection rates. But experts say the best strategy is for individuals to educate themselves and then ask for tests based on their own sexual history and level of concern.

That said, here are some basic STD testing guidelines.

If You’re Sexually Active
The federal Centers for Disease Control and Prevention (CDC) recommends HIV tests for all sexually active adults and pregnant women. Urine tests are available now for chlamydia and gonorrhea, making testing easier than ever before. Some doctors recommend regular testing for both infections if you fall into one of a few high-risk groups, but anyone can request these tests.

If You’re Under 24
According to a 2006 CDC surveillance report, young people ages 15 to 24 represent just 25 percent of the sexually active population but they also represented almost 50 percent of new STD cases that year.

“Young people ought to get tested once a year for HIV, syphilis, chlamydia, and gonorrhea,” says H. Hunter Handsfield, M.D., a clinical professor of medicine at the University of Washington and a nationally recognized STD expert who has helped develop HIV testing guidelines for the CDC.

However, he adds that depending upon a person’s sexual behavior, testing might be as frequent as once every few months, or as rare as once every two years in the case of a monogamous relationship.

Chlamydia is a crucial test for young women (though you probably have to ask for it) since it’s so common and so destructive. “That’s the single STD that is most likely to be present in someone who doesn’t show symptoms — and that can do a lot of damage,” says Dr. Handsfield.

More From Health.com:
What to Do if Your Sex Partner Refuses to Wear a Condom
The Top 10 Myths About Safe Sex
How Safe Are Vaginal Beautification Trends?

If You’re A Man Who Has Sex Only With Women
Most doctors don’t test heterosexual men for STDs other than HIV unless they have symptoms. That’s partly because women get more severe health problems from HPV and chlamydia, and also because until recently STD tests have involved painful swabbing.

But chlamydia can affect male fertility, and now that there are painless urine tests for both chlamydia and gonorrhea, it may make sense to ask for these tests when you visit the doctor.

Depending on your sexual activity, the infection rates in your community, and your level of concern, you may want to be tested for syphilis as well.

If You’re A Man Who Has Sex With Men
Testing for HIV and syphilis is especially important in this group because there are high rates of both infections among the men you’re likely to have as partners. Depending on the number of partners you have, you may need to consider screenings more than once a year, says Dr. Handsfield.

Chlamydia and gonorrhea are also prevalent, and you can request the new urine tests instead of having to undergo an uncomfortable swabbing of your urethra.

Read more.

Visit the Manhunt Cares’ Testing Resources page.

The New York City Department of Health’s “It’s Never Just HIV” advertising campaign, targeted to encourage HIV negative gay and bisexual men to use condoms, has prompted a conversation that is profoundly important and speaks directly to the heart of the problems with HIV prevention.

The ad features doleful, frightened or ashamed young men who are so attractive they look like characters from the television program Lost , set against a soundtrack appropriate for a horror film. The ad’s message is that HIV doesn’t exist in isolation; it also brings other serious health problems.

www.youtube.com/watch?v=d0ANiu3YdJg

X-rays of badly broken bones, an MRI of an atrophied brain and, most shocking, a close-up photograph of a man’s cancer-encrusted anus graphically make the point. The voiceover sounds like a poor man’s Don Lafontaine (he’s the legendary “voice of God” who often starts movie trailers with “In a world… “), evoking an apocalyptic end-of-the-world feeling.

GMHC and GLAAD share the concern of many people with HIV, prevention experts and activists and rightly issued a press release calling for the ad to be pulled, asserting it is sensationalistic and stigmatizing.

UK-based journalist Gus Cairns, who has HIV, commented on Michael Petrelis’ blog:

I hate this ad because it’s sadistic and bullying… It’s horrified by gay men and gay sex in general, using images of bodily corruption and disease to ram home things that — despite 50 years of gay lib — we still feel about ourselves: look at the suicide, depression and drug use statistics. The message it gives — not factually, but with all the visceral power of that 5-frame shot of a ruined ass — is that if you’re out on the scene, death and decay are stalking you and serves you right if they get you.

Others have questioned its presentation of facts. The horrible conditions noted are typically found only in some older people with HIV, or those who are not diagnosed until later stages of the disease; anal cancer is caused by an entirely different virus, osteoporosis is likely as much a function of anti-retroviral treatment as it is HIV itself, etc.

The lion of AIDS activism, Larry Kramer, loves the ad, has congratulated the NYC Department of Health and called for even more frightening ads to be produced. Larry has written:

… these nyc department of health public service announcements are in fact not strong enough! How about trying this one on for size (pun intended): LETHAL WEAPON men, what you carry between your legs is a potential lethal weapon! it can murder people. Before you stick it anywhere PUT A CONDOM ON IT! i bet you’ll get better results with this one.”

Larry believes in fear as a strategy to change people’s behavior; he cites it as key to the success of ACT UP and other community-mobilizing efforts. There are many who share this view, as is clear by reading comments posted online in response to coverage of the controversy.

Many of those comments express concern that gay men are complacent, unaware of how awful HIV can be and, at least in Larry’s case, too concerned with their own pleasure to worry about protecting their partners.

The debate over these ads has largely been amongst people who have devoted much of their lives to combating the epidemic, which makes me hesitant to write in terms of the different “sides” of the issue. Everyone is on the side of finding the best ways to reduce HIV transmission, but we have differing thoughts on whether this particular campaign will help reach that goal.

I think this advertising campaign is terrible, mostly because it may contribute to further spread of the virus. The only good it has accomplished is that it has provided a brief moment when a few more people are thinking about and paying attention to HIV-prevention issues. That is an opportunity that I hope we will not waste.

Supporters of these ads claim HIV prevention has been a failure, and they are angry that the epidemic has disappeared from the media and fallen off the list of priorities for LGBT organizations and others who once were leaders in the fight against AIDS.

I share that anger. It is profoundly frustrating, disempowering and, quite frankly, depressing to see so many one-time activists, caring friends and neighbors, concerned journalists, political and public policy leaders disappear like a puff of smoke once combination therapy brought a relative cure to those with the privilege of healthcare access.

As the epidemic settled into communities of poverty, communities of color and amongst the young, the milieu that once made combating AIDS their priority has acquired a collective amnesia.

Nowhere do we feel that frustration more than when we see young gay and bisexual men put themselves at risk, either unknowing or uncaring about the consequences.

At times I want to shake and scream, Larry Kramer-style, to young gay and bisexual men: “You don’t want to get this virus! It screws up your life, creates a never-ending series of health battles, makes it vastly more difficult to have intimate relationships, decimates your self-esteem and stigmatizes you beyond what anyone who is HIV negative can ever understand!”

At the same time, I proselytize to those who do have HIV: “You may have HIV, but you can still lead a happy, productive, and vital life, you can fall in love, pursue a career and find purpose, and with careful attention, stay mostly healthy, even while managing the tremendous burden of a life-long viral infection.”

We can and should tell young people that HIV is very bad and they don’t want to get it, but we can do that without condemning or stigmatizing people who already have HIV. And we can and should tell people with HIV that a diagnosis is not the end of their lives, that they can still pursue their dreams and seek everything anyone else can extract from life without sending a message to young people that HIV is no big deal.

We need to convey both of these messages, at the same time, and not let one negate or diminish the other. That requires a more nuanced messaging, one that doesn’t assume the intended audience can be manipulated by over-the-top fright messages, doesn’t speak down to them and doesn’t assume they are presently not caring whether or not they get HIV.

The messaging must also be fact-based. That means including the difficult truths about what untreated HIV can do to one as well as about what is and is not known about the side effects of long-term anti-retroviral therapy. And it means talking honestly and practically about risk-reduction techniques rather than rely on the overly simplistic “use a condom every time” message to which few gay and bisexual men adhere.

Much of the support for the NYC DOH campaign is an expression of frustration, a desire to see the epidemic discussed, to get the attention of young gay and bisexual men and others at risk. Many of my generation recall how terrified we once were and how that fear affected our behaviors. There is a sense today that “nothing else works, so let’s try terrifying them” as the epidemic did to our generation.

Gus Cairns also noted on Petrelis Files that “the problem is not that young gay men are ‘complacent’ and don’t fear HIV: the problem is that they do fear HIV, but don’t fear it enough. And the reality is that, no matter how horrifying the ads, they are never going to fear it enough again.”

I agree with Gus — young gay men who have the comfort of knowing they can access treatment if they get ill will never fear HIV the way my generation feared it. Manufacturing fear through media manipulation is tricky, and the research indicates it can just as easily compound as help the problem.

Another poster on Mike Petrelis’ site noted:

Here’s the problem fear-based tactics face. They are countered each and every time you meet someone with HIV who’s leading a normal, happy and productive life and not wallowing in a pit of despair and disease and clothed in sackcloth bemoaning his former, evil ways. In the modern gay community, that happens all the freaking time. Which means that people you are trying to scare will write you off as a lying hysteric. And your safe sex message gets tarred with the same brush. As a bonus, all of the people who don’t know people living with HIV (basically, most of the population) actually will get your message loud and clear: that people with HIV are scary, disease-ridden lepers who must be shoved out of society.

This is what the DOH ads accomplish. They certainly will instill fear, but they do so at the expense of further stigmatization of people with HIV, and at the expense of turning off the young gay and bisexual men whose sexual behavior they seek to change.

As AIDS advocates, we have demanded evidence-based approaches; this is what I ask for in considering HIV prevention efforts. There are a number of credible and serious studies of the use of fear-based messaging in the context of HIV; it is not an unexamined topic. I hope those who have instinctively felt favorably towards the DOH ads will take a look at several of them. If they do, I suspect their opinion on the matter may evolve.

Fear in the Context of HIV

Two studies summarize research on the use of fear in the context of HIV. One is by London-based Sygma Research, a part of the faculty of Humanities and Social Scientists at the University of Portsmouth. Sygma has earned an international reputation as one of the most important and innovative sources of new social scientific information in the area of sexual health and HIV. Their six-page brief, “The Role of Fear in HIV Prevention,” is clear, concise and spot-on relevant to the “It’s Never Just HIV” campaign in question.

The other study is “Applying Persuasion Strategies to Alter HIV-Relevant Thoughts and Behavior,” by Loraine Devos-Comby and Peter Salovey at Yale University. This one is especially important because Larry Kramer claims its author supports Kramer’s enthusiastic endorsement of the DOH campaign, while I cite it in support of my position, which is quite different from Larry’s.

Salovey’s research and response is important. He endorses “loss-framed” messaging (in effect, fear-based) for “early detection behaviors” (i.e. HIV testing). However, despite repeated requests for clarification, he has declined to endorse “loss-framed” messaging in pursuit of long-term changes in sexual behaviors.

His published research notes that:

Fear arousal does not necessarily lead to the adoption of health recommendations. In some cases, it can produce the reverse effect, as illustrated by a study in which a cohort of Australian gay men exposed to the “grim reaper” advertisement subsequently reduced safer sex behaviors.

Salovey’s Yale study specifically addresses the defensive avoidance or resistance triggered by messages that cause a high level of fear, noting that the stronger the emotional reaction following threat appeals, the greater the resistance to persuasion that results in behavioral change.

Fear-based messaging is more supported by those who are older and who already practice the desired behaviors (in this case, safer sex). Fear-based message can be effective at increasing HIV testing (although it may not increase testing amongst those at greatest risk).

The Sygma study notes that:

… fear appeals are more favored by individuals who are already engaging in the desired, health-protective behavior than they are for individuals not already doing so… there may be a role for fear to help reinforce existing safer sex behavior, but that arousing fear is not necessarily an effective means of facilitating change among those who engage in risky behaviors.

The bottom line is that fear-based messaging is more effective in raising awareness, changing attitudes and behavioral intent and possibly reinforcing existing safer sex behaviors than it is in actually changing sexual behaviors amongst those who engage in the riskiest behaviors.

More from the Yale study: “campaigns that focus solely on the negative consequences of HIV infection may serve to disempower men with HIV by making them appear weak, helpless or diseased; depictions of visible symptoms reinforce commonly held beliefs… ” The NYC DOH campaign certainly focused solely on the negative consequences.

Sygma also notes “it is important not to always present target populations with the ‘worst case scenarios’ that are in fact unlikely to arise for the majority of individuals”; yet presenting the worst-case scenario is exactly what the NYC DOH campaign does.

The studies also indicate that the targeted audience — those whose behavior the campaign is seeking to affect — can feel threatened by fear-based messaging, which triggers avoidance (ignoring the fear-arousing message), denial (believing the harmful consequences are unlikely), counter-arguing (rejecting the risk presented, believing it to be exaggerated by authorities) or deflecting (believing the message is intended for someone else).

When experiencing fear-based HIV prevention messaging, older gay men believe it is intended for younger gay men. Younger gay men believe it is intended for “scene-oriented, promiscuous gay men.” These reactions lead to rationalizing or defending one’s present behaviors, rather than a change in behavior.

Loss Framed vs. Gain Framed Messaging

The Yale study makes an enormously important distinction between “loss framed,” focused on what one has to lose (getting sick and being miserable) vs. what they call “gain framed,” focused on what one has to gain (being healthy, and happy).

“…participants expressed greater intentions to engage in the preventive behaviors when the information was gained framed than when it was loss framed; loss framed messages were more effective at encouraging the detection behaviors.”

The DOH ad is clearly “loss framed,” which is not the strategy proven most effective for actually changing sexual behaviors amongst the targeted audience.

Further more, “threat appeals” that lack ways to avoid the negative consequences depicted in the message produce a “boomerang effect, in that participants were less likely to adopt the recommended behavior.”

Use a Condom Every Time?

The only part of the DOH ad that suggests a way to avoid the negative consequences is the generic and, at this point, largely useless “Use a condom every time” message tacked onto the end of the ad. The ad does not provide the information young gay men need and want to help them avoid contracting HIV.

I call “use a condom every time” message largely useless because at this point in the epidemic repeating this to young gay men is as helpful as hectoring teenage girls to “don’t get pregnant.” Young gay men know they don’t want to get HIV and they know condoms are effective at preventing its transmission. Like virtually every young woman who suffers an unwanted pregnancy; they know exactly how not to become pregnant.

What enables gay men to protect themselves and young women to avoid unwanted pregnancies is not hectoring them with a catchphrase, but providing empowering information, practical strategies and solutions that they can integrate into the reality of their sex lives and cultural milieu.

For the NYC DOH to base a campaign on the slogan “Use a Condom Every Time” is likely to be as effective as Nancy Reagan’s “Just Say No to Drugs” campaign.

All sexual behaviors are not of comparable risk of HIV transmission. We know that receptive anal intercourse accounts for the vast majority of new infections amongst gay men and is exponentially riskier than other sexual activities.

Sharing the truth about the relative risks of different kinds of behavior will do more to help young gay men avoid acquisition of HIV than will hitting them over the head with “Use a Condom Every Time.”

Focusing our prevention efforts on these riskiest activities, rather than generic messages that have become part of the background noise to our lives, will result in greater success.

We also need to stop saying that using a condom every time is the only way to avoid acquiring HIV. Most gay men have already permanently rejected the “use a condom every time” message. At the peak of the crisis, many were willing to forego skin-to-skin contact for a period of time. But over the long haul, many gay men (and perhaps most younger gay men), have identified situations where the risk of transmission is so low or nonexistent that sex without condoms becomes, for them, an acceptable risk.

If they feel certain someone is of the same sero-status, if they are engaging in oral sex, or as the active partner in anal sex, or if they are certain an HIV positive partner is on treatment and has an undetectable viral load, or in other circumstances, they may skip the use of condoms. We need to recognize that different individuals will tolerate different levels of risk.

Some of those people will make decisions most of us might find foolish, but our task is to give gay men is the education and tools to make their risk assessment processes as informed as possible. Those who will accept no risk can choose abstinence. Everything else involves some level of risk, and where the line is drawn is ultimately a personal decision.

The Role of Treatment in HIV Prevention

We also have failed in recognizing the role treatment plays in reducing risk. A person with HIV on treatment who has been undetectable for six months or more is unlikely to transmit the virus. It is not impossible, but the chance of transmission is dramatically reduced — for many that chance is reduced to the extent they are comfortable having unprotected sex with a person who is undetectable.

Our community’s failure to have an honest discussion about this has resulted in people making judgments that are often poorly informed. We need to recognize the reality of how treatment does reduce transmission risk, even while also communicating that it does not eliminate such risk.

Condoms sometimes fail — the most responsible studies generally put the failure rate between 2 percent and 8 percent — but we as advocates have been slow to acknowledge this fact, in part because we have had to fight the Catholic Church’s propaganda that claims condoms “don’t work.”

But it may be that the risk of transmission due to condom failure is comparable to, or even greater than, the risk of transmission from a person with HIV on treatment with an undetectable viral load. That discussion is happening in my quarters of the community, in bars and at dinner tables, but it has not been undertaken by our public health establishment or AIDS service providers and that silence is damning.

Post-Exposure Prophylaxis

Another damning silence concerns post-exposure prophylaxis. The culture of the epidemic, amongst gay men, was based in a time when most people who got ill did not know when or by whom they were originally infected. Many of us assume we were infected more than once.

Today that is much different. Young gay men who are diagnosed often know exactly when and by whom (the individual, if not their name) they were infected. I have been struck by how often I have been told by recently infected gay men that they knew at the time they had just been potentially exposed, either because a condom broke or they did something in a weak moment that they quickly came to regret.

But what is appalling — and the blame for this must rest with the public health and AIDS service establishment — is how few of them knew that there was something they could do shortly after the potential exposure to avoid sero-conversion.

Post-exposure prophylaxis (PEP) has been a standard procedure for persons in a healthcare setting who accidentally get stuck with a needle. They are put on a 28-day course of anti-retrovirals immediately (it must be within a couple of days to be effective) and in almost all circumstances that prevents them from becoming HIV positive.

For several years, the Centers for Disease Control has recommended post-exposure prophylaxis in a non-occupational setting (read: sexual context) as well. So why don’t gay men know about PEP and why can’t they access it easily?

One big reason is that PEP is seen by some as a potential “disinhibitor” and will enable gay men to be sexually irresponsible and use PEP as a sort of “morning after” pill. The research doesn’t support this premise, but that doesn’t stop those who are uncomfortable with gay male sexuality, especially anal intercourse, to operate from a conscious or subconscious desire to discourage sexual expression.

The truth is that those who go to the effort to access PEP — and it is not easy — are the guys who really do not want to get HIV. They aren’t those who don’t care or are indifferent to risk; they are those who will go to a lot of effort to avoid acquiring the virus.

Last year, I helped launch a site to provide information about accessing post-exposure prophylaxis; now we’re trying to get providers to register their information so it is available.

And for several years, I have been giving out “starter kits” to young gay men that include three days of anti-retroviral treatment and some instructions for use. I tell them to put the kit in their medicine chest or dopp kit so it is available in the event they need it. The kit buys them some time, to give them a chance to talk to their doctor or another expert to evaluate their risk and whether they should pursue the 28-day treatment protocol.

Risk episodes most often happen at night or at a time when one can’t quickly reach a medical professional to assess one’s exposure risk; the starter kit gives them the chance to start treatment immediately and not lose the opportunity to avoid infection. Emergency rooms, in theory, should provide this service but in practice they remain a nightmare.

Hospitals are often unfamiliar with PEP for use in a sexual exposure or the cost is prohibitive; typically $1,500 or more, which isn’t a practical consideration for most young men who have sex with men. When faced with the long wait typical at most emergency rooms in New York, and the uncertainty of whether or not they really need or will ultimately receive PEP from the ER as well as the enormous expense, it is easy to say “nuts to it” and just cross one’s fingers and hope for the best.

If the Department of Health wanted to provide a real tool to young gay men to avoid infection, they would educate the community about PEP and make it convenient and available without cost. That goes for hospitals, AIDS service organizations, physicians and others.

The Whitman Walker Clinic, in Washington, D.C., has a “red carpet” program for people who think they might have been exposed to HIV. Upon presentation at the clinic, they are processed on an expedited basis. They promote this service throughout the community so people know that if a condom breaks or they do something they regret that they can go to Whitman-Walker and quickly and discreetly have their risk assessed and, if necessary, put on the 28 day preventive treatment without cost.

Educating about the relative risks of various sexual activities, for those who are negative, and those who are positive on treatment or not on treatment, and promoting PEP are practical and useful strategies that will do much more to prevent new infections than a scaremongering campaign that may ultimately drive new infections rather than avoid them.

HIV prevention is a process, not an advertisement or given campaign. We can alert people to the dangers of HIV without resorting to fear that risks losing the very audience we most need to reach.

Respecting the Rectum

Our success in preventing HIV transmission has been hampered by an unwillingness to recognize and celebrate sex between men as something beautiful, admirable and morally equivalent to sex between men and women.

In 1983, very early in the epidemic, Joseph Sonnabend, MD, famously and courageously said, “the rectum is a sexual organ and it deserves the respect a penis gets and a vagina gets.” Eric Rofes, Walt Odets and other pioneering thinkers about gay male health and sexuality have subsequently explored similar themes.

I couldn’t help but think of this when I saw the close-up image of a man’s anus, covered in cancerous lesions, in the NYC DOH ad. Anal cancers are preceded by genital warts, which are caused by strains of HPV, the Human Papiloma Virus. Last year, 4,000 women in the U.S. died of cervical cancer; in virtually every case the cancer was caused by HPV.

If the NYC Department of Health pursued a campaign to combat transmission of HPV, does anyone think they would, for a moment, consider using a close-up image of a horribly diseased vagina?

The bodies and sexuality of gay and bisexual men are seen as dangerous and our sexuality as threatening. We are so little respected that it is acceptable to show an exceptionally intimate part of a gay man’s body, one visibly riddled with cancerous lesions, and put it on television as a tool to frighten us.

We need to respect anal intercourse and recognize the important role it plays in the sexuality of many gay and bisexual men.

In this context, “gain-framed” could communicate how protecting one’s self and one’s partner from HIV transmission can provide peace of mind, is socially responsible and enable the person to live a long, healthy and happier life, free of the tremendous burdens that come with an HIV diagnosis. In this context, risk reduction strategies have more meaning and will resonate more strongly with gay and bisexual men, resulting in the behavioral changes that will reduce HIV transmission.

That’s HIV-prevention messaging that may not please Larry Kramer and those who are hell-bent to use fear to bludgeon the psyches of young gay and bisexual men — and in the process, further stigmatize those of us with HIV — but it will change sexual behaviors and result in less HIV transmission.

Crossposted with Poz.com.