Gay men and Sex(uality) and Drug Use

Gay men and Sex(uality) and drug use
Drugs are people substitutes – People are drug substitutes 1

When most people talk about drug use and sex, they think of addiction. So I should preface my comments on this subject with my take on “addiction”. First of all “addiction” is not a word I use. I believe that when people use the word addiction they are only describing what they see as “bad behaviour”. We have many repetitive behaviours that we do daily and perhaps compulsively but the word addiction would not be used to describe these behaviours. Some examples of such behaviours may be: I may wish to kiss my partner every day or a few times a day and have a negative feeling if it does not happen, I may like to cuddled daily, I may enjoy a few glasses of cold water daily etc. Often when the term “addiction” is used it seems to only provide a way of describing behaviour one is critical of, the label of addiction is not helpful and does not add to understanding.
Beginning a counselling relationship without acceptance and disempowering (http://www.pearsoned.ca/highered/showcase/shebib/pdf/samplechapter_ch07.pdf) an individual is a poor way to begin a counselling relationship. (http://www.ccpa-accp.ca/blog/?p=2996 ) One of the main characteristics of counselling is acceptance without judgment. (http://infed.org/mobi/helping-relationships-principles-theory-and-practice/) Starting counselling with a label describing the person as engaging in bad behaviour can be counterproductive. This is especially true when it is implied that “the person has no control over their behaviour.
People use drugs for a reason. There is an emotional need that is being met by the drug that is being used. Given this, the best way to begin to help an individual is to explore what they get out of using the drug. The next step is to help them to find other ways of meeting those emotional needs that more fully rewarding.
One drug that is popular with many gay men is Chrystal Meth. (http://www.wehoville.com/2013/12/02/crystal-meth-gay-men-start-load-road-addiction/ ) For some of those gay men crystal meth use can be problematic. Therefore without judgment I begin to explore with gay men what emotional needs does crystal meth allow him to satisfy. It often becomes apparent that most gay guys will use crystal meth to allow them to be the “sex pig” (http://cbrc.net/resources/2013/desire-and-defiance-pig-sex-project) that they would like to be, but do not allow themselves to explore without drugs. I was once asked to do a workshop on “Pig Sex” (http://www.realjock.com/gayforums/16537 ) . (Pig sex, is like pigging out at a Christmas dinner – that is eating too much, and a bit of everything.) The main point that came out of this workshop was: “We may not have the same kinks, but I know I will not be judged”. This lack of judgment allowed for a freedom in “pigging out”. Many gay guys have sexual needs/fantasies that they cannot fulfill without crystal meth. The use of that drug allows a person to explore many aspects of sexuality that may not be explored without some drug use, due to of internal and/or external inhibitions. It follows then that part of the motivation for crystal meth use may be because of sexual inhibition, and fear of judgment. If this true, than the goal is to help him to become less sexually inhibited, and be free to explore his sexual desires, without the problems caused by drug use. (I would suggest the therapist also must NOT be sexually inhibited.)
In addition many gay guys who use crystal meth are often looking for a feeling of being emotionally connected (at least for the moment) with the other guy(s). Many gay men grow up denying their sexual and emotional feelings. This denial of sexual and emotional feelings often happens because as the gay guy is growing up he will often have feeling of being different than other boys, of “not belonging”, and also questioning if they are lovable if parents and others knew they were gay. This sense of separation, being different, and questioning if they are lovable has a profound on most gay men.
Given that crystal meth allows a gay man to achieve feelings of connectedness, sexual openness and a feeling of freedom from judgment, it is not surprising that many gay men would be attracted to use crystal meth. Many gay men find great pleasure in what crystal meth can bring them. It is only because crystal meth is meeting these deep personal needs of a gay man that he uses this drug again and again and again. Often crystal meth users do not know of another way to feel sexually free and emotionally connected. Therefore, the goal is not, to stop crystal meth use, but to find ways to be sexually uninhibited and emotionally connected with other gay men. Stopping or reducing crystal meth use may be a byproduct of a happier more fulfilled life.
Craig Sloane reports that “By using gay affirmative treatment,” and “Promote self-acceptance, create safe and non-judgmental environments. We have to set up treatments that don’t pathologize gay sex.” (http://www.addictionpro.com/article/crystal-meth-and-its-use-among-gay-men )
Counsellors need to begin laying the foundations of a nurturing therapeutic relationship that refrains from labels and judgments that disempower a person. The therapist must recognize that drug use is meeting a person needs. Explore those needs and seek alternative ways of meeting those needs if drug use if problematic.

1. (Blachly, 1970) Seduction: A Conceptual Model in the Drug Dependencies and Other Contagious Ills, Paul H. Blachly, M.D., 1970, Charles C. Thomas, Springfield, Illinois

 

Most of my career has been working with criminals, and much of that with sexual criminals, I also work in the area of sexual health.  Much of my work has been with gay men at BC Centre for Disease Control, and in private practice.  I wrote a column in the local gay newspaper, Xtra, on gay men and health.  I tend to see the “problem behaviour that is presented” as the symptom,  (for example:  Sex, drug use, violence etc.) the goal is to discover what are the many facets that are pushing that behaviour.  Gay men have generally grown up emotionally alone, afraid of discovery, being taunted-bullied or teased with a constant fear of rejection from parents, family, friends, and classmates, this provides a unique obstacles later in life. (For more info: www.bcoleman.ca)

Kink in private life

RCMP officer targeted for being kinky
SEXUAL FREEDOM / ‘This will push a lot of people back into the kink closet,’ community members worry
Jeremy Hainsworth / Vancouver / Saturday, July 07, 2012

The RCMP should judge its officers by their professional conduct, not their sexual preferences, BDSM activists are saying after leaked photos of an officer on a consensual fetish website have caused a public uproar and led to calls for the officer’s resignation.

The photos became public when Vancouver Sun columnist Ian Mulgrew published them July 5 and described them as “sexually explicit torture images reminiscent of the pig-farmer’s crimes.”

The photos allegedly depict Coquitlam Corporal Jim Brown, a veteran RCMP officer who played a purportedly minor role in the Robert Pickton serial killer investigation when he referred a tipster to investigating officers in 1999.

According to Mulgrew, the officer in the “graphic pictures . . . appears to wear only his regulation-issue Mountie boots and an erection as he wields a huge knife and a bound naked woman cringes in terror.”

Leatherwoman Tillie King tells Xtra the case is a perfect example of why people feel pressured to hide their sexual preferences.

“It highlights why people stay in the closet,” she says. “They could lose their jobs or their children. Those are pretty high risks to take in life.”

King says people are judged the moment they step outside the norm sexually.

“For straight people, what they do in bed is never brought into the public light as to whether or not they can do their job,” she points out.

She likens the situation to the RCMP witch-hunts in the 1950s and ’60s when queers in the RCMP were seen as security risks.

“People in his position often stayed closeted for a reason, and we all know the price of that,” King says. “This will push a lot of people back into the kink closet. That could be potentially tragic.”

Gay Vancouver psychotherapist and leatherman Bill Coleman agrees. The officer should be judged on his ability to do his job, not by photos of him in a sexual situation.

“Now you see a picture of him and now he can’t do his job?” Coleman asks. “It doesn’t change peoples’ behaviour; it just becomes more closeted, and we know how dangerous being closeted can be.”

“He should be judged on his record as a police officer and not on a picture of him,” reiterates Coleman, who testified as an expert witness on BDSM at the Little Sister’s vs Canada Customs trial about BDSM book seizures.

“I am a sexual being and people can’t pretend that I am not. If they don’t like that, that’s their problem,” Coleman says.

Black leatherdyke Kona agrees. The officer’s ability to do his job has nothing to do with his sexuality, she says. “Every single person in this world does something sexually that offends someone else.”

Both Kona and Coleman say the situation could put a chill on the BDSM community.

Kona fears Vancouver’s BDSM community could be tarred and play spaces could become harder to find. “People are going to step back. How many people are going to go underground?” she asks. “How many people are going to go hunting for perverts in Vancouver?”

Ironically, both Coleman and Kona note, it’s people in the BDSM community who tend to have a greater understanding of the dynamics of power in human relationships — something Coleman says would inform how well a police officer does his job.

Coleman points out that BDSM practitioners engage by consent. That’s a long way from the mainstream media depiction of the officer sadistically subjugating and torturing a woman against her will.

Kona thinks someone with an axe to grind against the officer deliberately leaked the photos. She is concerned that members of the fetish website not expecting to be outed or judged will now face judgment from those without an understanding of the nuances of BDSM.

“Now there’s going to be a lot of tourists on there uninvited,” Kona says. “There’s going to be a huge onslaught of people
. . . that are going to pick apart the way the community speaks about itself, the way they talk about relationships.”

Kona does not exempt the officer from criticism. “As a steward of public trust with a sophisticated knowledge of the law, he was stupid. He did not manage his personal life well,” she says.

The officer has been placed on administrative duties pending a code-of-conduct investigation — despite his commanding officer’s apparent reluctance to pursue the matter.

“The alleged issue was deemed to be off-duty, non-criminal, adult consensual activity during which the individual was not representing himself as a member of the RCMP, and thus it did not appear to legal services to meet the threshold for a code-of-conduct violation,” Superintendent Claude Wilcott reportedly told Mulgrew.

“Despite this legal opinion, a code-of-conduct investigation is underway to determine if there are any additional facts and ensure the fullest review possible,” Wilcott reportedly continued.

“While I agree the staged images are graphic, it’s important to note that they appear only on an adult site catering to those who seek them out,” he added.

In a statement issued July 5, RCMP BC Assistant Commissioner Randy Beck says the Coquitlam detachment commander “first became aware of the existence of some graphic staged photos in December 2010. However, at that time, the detachment commander believed they existed only on the officer’s personal flash drive and thus, after consultation, he did not believe it met the threshold for a Code of Conduct violation.”

When the commander discovered in March that the photos were also online, Beck says, another investigation began. The Richmond RCMP is now leading that investigation, he says.

“While we must strike a balance between an individual’s rights and freedoms when off duty and the RCMP Code of Conduct, I am personally embarrassed and very disappointed that the RCMP would be, in any way, linked to photos of that nature,” Beck says.

Kona tells Xtra she is “horrified” by the situation.

She says it reminds her of Jack McGeorge, a US ex-marine, ex-Secret Service agent with a doctorate in the field of chemical and biological terrorism. McGeorge, who died in 2009, was a UN weapons inspector in Iraq. He, too, came under fire for his involvement with the BDSM community when, in 2002, a Washington Post article attempted to discredit McGeorge as the hunt for supposed weapons of mass destruction was underway.

McGeorge tendered his resignation to chief weapons inspector Hans Blix, but Blix refused to accept it. UN Secretary General Kofi Annan’s office also supported McGeorge. The US National Coalition for Sexual Freedom said news agencies targeted McGeorge because he was a respected SM community leader and educator.

PEP Coming to BC Finally

 

 

Accessing HIV post-exposure drugs
GAY MEN’S HEALTH / BC launches nPEP pilot project
Nathaniel Christopher / Vancouver / Wednesday, April 11, 2012
Gay men in Vancouver will soon have expanded access to a drug therapy that can prevent them from becoming HIV-positive after exposure to the virus.

Next month the Ministry of Health and the BC Centre for Excellence in HIV/AIDS (BC-CfE) will implement an 18-month pilot project called non-occupational post-exposure prophylaxis (nPEP).

Right now PEP treatments, which are initiated within 72 hours of exposure to HIV and cost between $1,000 and $1,500, are publicly funded only for victims of sexual assault or people exposed to the virus in the workplace. Under nPEP the government will cover the costs for treatments following other high-risk exposures to HIV, such as unprotected sex and intravenous drug use.

“Non-occupational post-exposure prophylaxis will be rolled out in the next few weeks,” confirms Dr Val Montessori, co-chair of the therapeutic guidelines committee at BC-CfE. “If the individual is assessed as having been in a high risk situation, nPEP, which includes three medications active against HIV, will be prescribed. A physician is the only one who can prescribe these HIV medications. The cost of the medications will be covered for this pilot by PharmaCare.”

Bill Coleman welcomes the nPEP pilot project, but he wonders why it took so long to launch and says it will leave gay men outside Vancouver at risk.
(Nathaniel Christopher photo)

NPEP will soon be available at St Paul’s Hospital’s emergency department, the John Ruedy Immunodeficiency Clinic at the BC Centre for Disease Control, the Bute St Clinic, Spectrum Health Clinic and the Vancouver Coastal Health Downtown Community Health Centre.

“We are in the process of carefully reviewing the necessary information for the pharmacy, the pilot sites and the individuals who may access nPEP,” Montessori says. “We anticipate that the pilot will be ready to roll out in May.”

NPEP is not the “morning-after pill” for unsafe sex, but it can be an effective tool to prevent infection, says Jody Jollimore, project manager for the Health Initiative for Men (HIM).

“PEP is not a silver bullet,” he notes. “It’s not going to prevent HIV infections in our community completely, but certainly in certain instances it can be an effective tool. Our key will be to promote it not as the end of condom use but something that can be used in addition to a condom.”

PEP can have mild to severe side effects for many people, he adds.

“This is not a walk in the park,” he says. “In fact, the research says that over 80 percent of guys who access PEP once never return for a second course. So guys aren’t using this as a morning-after pill. And they won’t.”

HIM has been pushing for PEP to be more accessible to gay men for years. In 2010, the organization released a position paper titled “Post-Exposure Prophylaxis for Consensual Sexual Activity in British Columbia” which argues that gay men are becoming HIV-positive because they can’t access PEP.

The paper describes three Vancouver-area men who attempted to access PEP after having unprotected receptive anal sex with other men. One of them was “able and eager” to pay for the PEP himself; the other two were not given the option of paying. All three were denied the treatment and subsequently seroconverted.

Bill Coleman, a Vancouver therapist who has worked with the HIV community for more than 25 years, says inaction from provincial HIV policymakers led to many needless HIV infections.

“They are slow and backward in their policy,” Coleman says “That is just really unforgivable. I still see people who, if they would have known about PEP, might not be infected and may not have infected other people. I just think it’s quite unforgivable that they didn’t take any action for years.”

Jollimore notes that some gay men are able to access PEP with the right health insurance, a doctor who will prescribe it and knowledge of the treatment itself. “Without that it’s a bit of a patchwork as to who can get it and who can not,” he says. “Certain third party health insurance companies already cover these medications. For instance, we had a flight attendant contact us about a year ago and we directed him to the appropriate health care providers, he got a prescription, submitted the prescription to his insurance company and they covered the medications for him.”

Coleman says some gay men in the community, unable to access PEP, have taken matters into their own hands by taking their HIV-positive friends’ medication. “But most people wouldn’t know enough about PEP to do it.”

Jollimore believes the nPEP pilot project was implemented in response to growing pressure from the gay community, as well as studies that show PEP is an integral component of HIV prevention, especially among people at higher risk of HIV infection such as gay men and intravenous drugs users.

“There are a number of factors I think that are influencing why it’s happening now,” Jollimore says. “One of them is the Stop HIV/AIDS pilot project which of course is touting a treatment-as-prevention model, which is saying that having people on medication can prevent transmission of HIV. So PEP fits within that model, of course, but also there’s been a growing pressure that comes from the community onto the various health authorities to make this prevention available.”

Montessori agrees that nPEP “dovetails nicely with the efforts currently underway in BC to expand HIV treatment as prevention, which is aimed to curb AIDS-related morbidity and mortality, as well as new HIV infections. BC is currently leading the country regarding the rate of decline of AIDS-related morbidity and mortality, as well as new infections, and this trend has remained apparent over the last decade.”

Coleman wonders why the project is limited to just Vancouver. He believes the action being taken is halfhearted and still leaves much of the population at risk.

“Why would it be a pilot project and why isn’t it available everywhere in the province?” he asks. “What if you live in Victoria or Prince George and need PEP? Many provinces  provide it so why is this place so backwards?”

Access to nPEP varies by province and territory. It is covered only in Quebec, Prince Edward Island, Newfoundland and Labrador and on a case-by-case basis in Alberta, according to Jim Pollock, communications director at the Canadian AIDS Treatment Information Exchange.

NPEP has been available to Quebec residents since 1999 and is funded there by the provincial drug plan regardless of how the patient was exposed to HIV.

It’s also available at every hospital and health centre in Newfoundland and Labrador.

“It’s all covered here,” says Gerard Yetman, executive director of the AIDS Committee of Newfoundland and Labrador. “We’re also in discussion to have PEP available with our needle exchange van that actually operates in two centres in the province. PEP is available basically for anybody who requires it.”

Montessori says the BC-CfE will share the results of the pilot project with the BC government, which will ultimately decide how readily available nPEP will be in the future.

My Evolution as a Counsellor

 

 

My search for a counselling model has been long and circuitous: there were many models and theories that did not resonate with me, but finding a friendly fit was difficult.   I liked what Rogers, and Maslow had to say, but this did not feel like the whole story to counselling.

 

I learned more about being a good counsellor after school than in school. In my practice, I have always been seen as an enigma, because for most counsellors theory or tools of a theory was more important than the client and relationship. In spite of not focusing on theory  I was usually seen as effective.  The feedback I received from clients and other therapists who saw clients I had seen was that I was the most non-judgmental person they had met, and so they felt free to tell me anything.  Much literature in the field of counselling reports relationships as being more important than any theory.   This concept I embraced fully.

 

When I started teaching counselling, I became acutely aware of my personal style of counselling.  Later, I was given the task to train peer counsellors, an opportunity that helped me articulate principles that informed my own counselling approach.  It was especially important that I understand my own counselling approach to clearly develop an effective approach to peer counselling. I felt that a clear simple approach was necessary, as I did not want to  inundate peers with theories, and rules about minutiae, such as how to sit or how to move; I have always felt that if you are really empathic, you will naturally convey that interest and concern.

 

I eventually developed a simple approach to peer counselling that could be fully explained in just 15 words.  The concepts are simple, but counselling using this model is difficult to carry off at first.

 

No judgment

Acceptance

No fixing/no advice

No questions

It is not about you

Empathy

(You may notice the first letters spell out NANNIE)

 

I believe that the above model is just a 21 century operationalization of Rogers’ concepts of client-centred therapy.  Rogers spoke of a “person centred” approach to counselling. These six simple concepts are merely an operationalization of a person centred approach.  The client is in control of the content and direction of the counselling. This approach is designed to give the client all the power.  Counselling sessions are the client’s time and space to explore/process/think out loud I believe this approach emphasizes the importance of building an empowering and accepting relationship with the client which is one of the goals of good counselling.

 

For counsellors, these six concepts are simple, but deceptively challenging to apply. Despite our training, too often our own needs get in the way of helping a client.  When we tell clients how they should live their life, it is too often ultimately done more for ourselves: to make us feel good, helpful, and that we are “providing a service”.  I believe that what we as counsellors give to our clients are safety, security, and freedom to be, and freedom to explore.  By creating a safe space to explore ideas and feelings the client can express himself more deeply and explore feelings and emotions that he may otherwise hide from.

 

No judgment

No judgment is about not having a personal reaction so someone else’s actions.  Such reactions might be, “Oh good, you stopped drinking”, or “It is too bad they could not stop drinking”.  We are often unaware of our judgments of others.  We see praise not as judgment, but of course if you think about it, praise is judgment. We are not there as a counsellor to provide a cheering section for what we think is appropriate behaviour.  It is not about you and your judgment, as a counsellor, of what is good and what is bad for a person.  Sometimes, more often around abuse of someone else by a client we find it hard not to judge our client.  It is important at these times to remember that we are all trying to get through this life the best way we know how.  Our clients come to see us because they are having trouble, they do not need our judgment (criticism) to help them grow.  They need our support and acceptance, not our praise or criticism.

 

Acceptance

The difference between acceptance and no judgment is sometimes difficult for counsellors to understand.  Acceptance is more about not trying to change someone, taking them as they are; it is not having a “therapeutic plan” for them to change.  Most frequently it is a plan to help them stop drinking, stop them doing drugs, a plan for ridding them of depression etc.  Acceptance is accepting a person as they are without expectations of them changing, growing, or becoming something else.  

No fixing/no advice

The question often comes up about giving advice.  If you the counsellor have important information that the client needs then providing the facts without directing an action is respectful and helpful.  If a client says “My driver’s license expired, Is it important that I renew it?”  The counsellor could talk about the process of renewing and the consequences of not renewing, all without directing the client to take a specific action.

 

No questions

Most counsellors feel lost without being able to ask questions.  Just the act of asking a question puts the counsellor in control by demanding answers to the counsellor’s needs and not the client’s needs.  The counsellor tells himself that he is doing it for the client but it is detracting from the client being in control, questioning may get in the way of having a safe and free space to explore.  Asking questions is more about the counsellor’s needs and curiosity/voyeurism and less about the client’s need to tell his story.  Much of what counsellors do, they do to keep themselves in control and look knowledgeable and helpful.

I once worked with a guy for about 4-6 months and he kept referring to “the accident”.  He never talked about what this accident was or how it happened, but about almost dying, his families reaction, and him feeling scared because of surgery.  I was very curious about what the accident: What was it that he did? Did he cause it? Did he hurt others? All of these questions.  But that was all about me, and this is his story, so I never asked.  One time when he was going into more discussion about the accident, I commented that it seemed like he still had unresolved issues about this accident.  After a long pause he really opened up about how he felt, his fear of dying, being crippled, his family reaction, his feelings of guilt or stupidity in the accident.  He could see how he had just compartmentalized the experience, but never dealt with his feelings about what happened.  By not asking for a recitation of what happened but offering an opportunity to explore feelings about what happened he could begin to address unresolved issues.

 

It is not about you

Counsellors often violate the “It is not about you” rule. For too many of us, counselling is too much about us, our attitudes, our knowledge, our expertise etc.  How often has it happened that clients have told us they went to a different counsellor and that other counsellor kept talking about themselves?  Though this may not be what actually happened, it was how the client experienced the counselling.  Letting go of our ego is not easy.

 

I am often taken aback at the end of counselling relationship with someone they tell me how helpful it was and how much they got out it, and how much I did for them.  I always think “you did all the work, you made your choices, you took the risks, you made changes in how you behave, I just was here, but “you did the work”!   The counsellor cannot begin with a plan of: “This is how you need to change …”.  That is not respectful, it is not accepting, it is not empathic, and it is often more about the counsellor than the client.  We should not be developing a plan for someone else’s life.  It is a big megalomaniacal to think at our role as counsellors is to develop a life plan for anyone.

 

Empathy

 

Empathy is not always easy.  To often we put our own spin on our client’s experience.  I remember a client who was gay telling me that when he was 12, his mother told him that she was lesbian.  My empathic response was, “So you felt like she would understand your attraction to boys.”  He told me, “Oh no, I made her promise that she would never date a woman and not be a lesbian.”   He then added that he knew if his mother could not fight these feelings, then he was doomed to be gay all his life.  He was not ready to face that at age 12.   Well I really got it wrong, but he told me so much more about himself and his development by correcting my misunderstanding I was much more able to empathically understand him by being wrong and sharing my mistaken understand of his experience.  If I would have not said noththing, and just “know” the truth of my perception I would have not understood him and his journey to adulthood.  I have found that it is often very helpful when I make mistakes and am not really empathically in tune with my client.  Much too often counsellors are afraid to be “wrong” in their understandings of their clients.  I have never had a client be offended by my not getting it, but they only work harder to help me understand their feelings.

 

Empathy and understanding is not enough.  When teaching these counselling techniques, I give an example to show clients sometimes need more than empathy and understanding.  I give the example of the most empathic, understanding counsellor response to the person who asks where the WC is.  Such a counsellor may empathically understand the need to find the WC, and empathically reflect the frustration and not getting any answer to the question, and accurately reflect the urgency and discomfort the client is feeling.  But the empathy is not what the “client” needs; factual information is what is needed here.  To often we tell ourselves that we “know” things that we must impart to our clients, often that is for our ego not for the client’s growth.  One has to be very careful when giving information, that we are only giving factual information without directing an action.

 

 

This approach to counselling means having no personal or ego investment in your client and his future, but making a professional space that supports your client.  We as counsellors are most helpful when we let our clients grow in their direction and not try to force our beliefs of how they should live their life.  This is very hard for most counsellors.   The only place we as counsellors know about having influence over others is when parenting, and we are most likely trying to hard to control our kids. One of the biggest challenges in parenting is letting children make their own mistakes.  Counsellors also face this challenge in letting clients make their own decisions and go in their own direction: as counsellors, we often fear the consequences.

 

In our own childhood, we, like most others, were likely not allowed to grow in our own direction.  Maybe we as counsellors have never experienced the kind of acceptance, trust and non-judgmental space presented in this counselling model.  It can be hard to learn how to be accepting and non-judgmental when we may have never experienced it ourselves.

 

When I was a psychologist in a federal prison in Canada, I felt like my job was to help these guys find their path in life, which may not always be staying out of prison.  Many times guys said my office was the only place they could really talk and explore their feelings, fears, and fantasies.  They were generally guys who never experienced much acceptance and understanding.  When working with drug users, my job is not to help them get off drugs but to help them to understand their lives with drug use and support them in planning the future they choose/makes for themselves.  I am not afraid when they use drugs again; generally we look at it together as a learning experience for them to understand more about themselves.  I feel that often drugs are not the problem but the symptom of someone who cannot find a way to live that works better for them.   I assume the drug users who are happy with their situation do not seek out counselling.

 

 

I think our counselling methods are an expression of our beliefs and feelings about ourselves.  It seems like often the best counselling approach is one what resonates with us.  I think more of variability in the effectiveness of a counselling approach comes from our ability to embrace the theoretical principles, but not in how effective a counselling approach/theory may be.  If a theory of counselling feels foreign to us, then likely we will not be very effective in using it once we learn the basic skills of that theory.  If you lean toward a client-centred approach, then some of these methods may be useful in developing your approach to counselling.

 

Why no one speaks for Gay Men’s Health concerns

 

 

IT may be time to explore the systematic causes for the reasons that gay men’s health is being generally ignored by governments.  Before our health needs will be addressed appropriately we need a strong lobbing or advisory group who is not government funded and it free to take a strong stand on important issues.

An example of poor government action on gay men’s health is PEP.  PEP will effectively halt HIV infection in persons who have had a risk the previous day (or two).  PEP has been made available by many governments around the world.  Even in what some may think of as a slow and backward country like South Africa has made PEP available for years.  But, not in BC.  Why are we so slow?  Why have gay men become infected by HIV for years when they did not need to be?  I believe that it is because we have not had a strong independent voice to harass the government and force change.   HIM over a year and a half ago wrote a paper on the benefits of PEP and quietly lobbied the government.  An influential gay physician wrote a strongly worded letter to the government body responsible for PEP, pushing for PEP.  Yet still we have only a local trial of the use of PEP that begins this month.  If you do not live in Vancouver you are out of luck.

A local gay agency has had some of its funding withheld because this Conservative government did not approve of their actions.  We cannot count on our non-profit agencies to take strong stands against government.  If they do embarrass governments then we risk them losing funding, and us losing these effective agencies in our community.

In the early 80s the agency which preceded Positive Living (PWA) was loud and unrelenting in forcing proper care and treatment for persons with HIV.  Guys were literally fighting for their lives, and it is because of this that they were able to force governments to address the needs of those with HIV.  We now have no group who can forcefully stand up to the government to demand proper policies and services for gay men.

When profit is part of the equation then policy advancement slows dramatically.  It took almost 20 years of research to “prove” that cigarettes cause cancer.  Everyone admitted that there was a link of cigarettes and cancer but no real proof of the cause for over 20 years.   In our case we have a study that was done that saw that people who used water based lube for anal sex were three times more likely to get HIV or STIs.  Upon exploring this relationship more it was found that likely most water based lube damages anal lining.  Now we are two years after the original research but no authority will advise you to consider not using water based lube, until it is further understood.  Though there may not be “proof” of water base lube causing HIV and STI transmission you should know there is an apparent link and you can choose lube according.  Who is advocating for us?

Another example of poor government policy came to light when I was writing about condoms provided to our community.  I was told that the Ministry of Health formulates it policy for the entire province.  They would not tell me what criteria was used to select “proper” condoms, or who was on the committee that is charged with this task.  If 10% of the population is gay, then 5% of the provincial population are gay men yet they account for over 50% of the HIV!  It seems only sensible that the most useable and effective condoms be made available to gay men.  No changes will come about until the government is forced to take action.

I am calling for the Provincial government to formulate a committee of gay men who are not part of the government or government agencies who are not afraid to ask difficult questions and push for effective public policies for our community.  Current policy that is formulated seems to come from persons who read about gay men and their sexual behaviour, but I wonder if any of them making policy affecting gay men really understands the complex dynamics that are part of our sexual community.  It seems only reasonable to ask “the experts” – in this case the experts are not those who read about gay men’s sex but those who know and understand the complexity of gay sex.

 

This is my last regular column in Xtra, but you can follow some of my thoughts on my blog – bcoleman.ca where you can find writing that did not make it into print and other random thoughts.

Don’t stigmatize the poz guys

 

 

 

This one tends to continuation on from my last article in Xtra on 15 Dec 2011, but from a new angle.

 

I recently talked to an MD who works for the government in the field of HIV and s/he said that we need a nuanced message to deal with the new information out there about undetectable viral load reduces the risk of transmitting HIV.  S/he feels we need new messaging because s/he see people every day coping with viral load questions.  My response was that the CDC does not know the meaning of nuance they only know short messages with an all or nothing message, Later I talked with one of those bureaucrats that is part of developing those all or nothing messages. (S/he does not see patients in real life, and I wonder if s/he only knows about sex from journals and books.)  S/he confirmed s/he likes the all or nothing short simple messages.  Short and simple seems to be more important than how accurate the message is.

 

 

 

What if you wanted to go skiing and wanted to make sure you would not get injured in an accident on the dangerous highway 99.  You could decide to drive only between 2AM and 3AM, when there are fewer cars, you can get the best snow/ice tired there are, you can get the safest car with the most air bags, you could decide to only drive on days when there is no snow or rain.  But likely this would not be practical or fun – but safer.  Likely you will just drive to the ski hill when you want to ski and tell yourself to be careful.  After all you did it for two years and had no problems so just tell yourself to be careful.  Well it is a lot like fucking.  There are things you can do to make it safer but they may not all be fun or practical.

 

The Journal Science has declared that the scientific breakthrough of 2011 was a study (HPTN 052), this study found that a person with an undetectable viral load reduces transmission of HIV by 96%.  One article said “Having an undetectable viral was as effective as condoms.

 

That is like going to buy a pair of jeans for $100.00 but finding out they are reduced by 96% so they now cost $4.00.  That is a huge difference.

 

So lets look and what this means for fucking without condoms.  If you are getting fucked raw by a HIV poz guy with and undetectable viral load the chance of getting infected goes from 1 in 200 (no HIV treatment) to 1 in 5,000.  If you are fucking a poz guy raw with undetectable viral load the chances of getting HIV goes from 1 in 1,538 (no treatment) to 1 in 38,461.

 

So if you have sex with a poz guy with an undetectable viral load and if you use a condom that reduces it a further 96%.  So it is like those $100 pair of jeans go to $4.00, and then are deduced again by 96% and now they cost 16 cents.

 

We are told that BC government is spending $50,000,000 to get as many positive persons as possible to have an undetectable viral load.  They call it “Treatment as Prevention”, but that is just the marketing to the government.  It is not preventing HIV transmission but it is reducing the risk of getting HIV by 96%.

 

The risk of fucking without condoms changes dramatically – yea it is reduced by 96%!.  What do us as gay guys do?  Do we take more risks?  Do we decide that maybe we play more in the sandbox with the poz guys with undetectable viral load because they are not so scary now?

 

Do negative guys become scarier to play with because 2.5% of them may be poz and not know it and therefore may be 20 -25 time more likely to pass on HIV. For the guys who think they are negative but are newly positive then getting fucked by them changes the risk from 1 in 200 for a (poz guy with detectable viral load) to 1 in 10 for newly poz guy.

 

You may ask a negative partner if he get tested on a regular basis.  If he does it likely is because he is concerned he is maybe positive.  So why would you think he is negative if he thinks he may be poz and gets tested regularly to find out.

 

So if you decide to have sex only with guys who believe they are negative what is the chance of getting HIV?  We know 2.5% of those guys who think they are negative are really positive.  If we assume that those 2.5% are newly infected and that is why they do not know they are poz then the chance of becoming poz is about 1 in 200 if you choose only guys who think they are negative.   An interesting number – it is the same number as getting fucked by a poz guy with detectable viral load.

 

Where do all these numbers leave us.   Well poz guys with undetectable viral load are a lot less likely to infect someone then if they did not have an undetectable viral load.   Negative guys who will take risks with you will take risks with others also, – did you think you were special – so he may be poz.

 

A number of negative guys have told me that often poz guys are just more fun to have sex with than negative guys.

 

So where does the leave us?  Are poz guys (with undetectable viral load) sought after now, and are the “negative” guys shunned as having the potential for infecting others?  The science may say there is a good case for this.  But after all it is fear and prejudges that made many negative guys shun poz guys in the first place, – it was not science!  Our prejudges against poz guys as sex partners will not change easily.

 

What we do not need is the institutional marginalization of poz guys.  Many organizations will tell us we are at higher risk if we have sex with a poz guy.  Surveys ask “do you have sex with poz guys?”, they then tell you are at more risk if you do have sex with poz guys, this is not true if the viral load is undetectable. The institutional response should be: “ know your partners viral load” not his HIV status!

 

Well this is my last regular column in Xtra,   I plan on doing a retrospective piece next month outlining what I have learned while writing these pieces and bring up a few points to consider.  I may be back with the occasional writing on gay men’s health.

Women have to make gay helath policy – where are the gay men?

 

 

Gay sexual health policy driven too much by women

 

For years I have been at meetings where discussion of sexual health messaging, policy and procedures is taking place.  Too often these meetings are dominated by women. Few men and often I am one of the only or few gay guys there.  Of course many meetings happen that I am not part of but it seems like most of these meetings are dominated by women.

 

I was told by a gay guy that he attended a half day meeting about spending the $50 million dollars for BC HIV “prevention” (this is another story for next time, 50 million for what?), he said the presenters never mentioned the words gay, MSM, homosexual.  But there was discussion on mother to child transmission,  which has happens much less than one time a year.  I must add that the women try hard to understand gay men’s issues.  Not long ago I was at a meeting (the only gay guy in the room), it was about gay men’s sexual health issues.  There was discussion about a new term “pig sex”, and this was being explained to all assembled.  It feels strange to be sitting with a bunch of straight females talking about gay guys having “pig sex” (as a new phenomenon). Where are the gay men in these discussions?  If gay men are not part of the discussions then who will try to understand our needs, someone has to.  It is not easy for someone outside the community to fully understand, it is hard work for these people, they need our help.

 

An example of this kind of ineffective practice is a situation where men would be telling women about what being pregnant is like.  They can talk about it and have an understanding of the concept of pregnancy but they can never know pregnancy the way a women can.  The women often involved in gay health research, know their limitations, want to understand and want to help gay guys live a healthy life.  I have always felt welcomed and my comments as a gay guy are always greatly appreciated, but ultimately most policy and procedural decisions about treating gay guys are made not by gay guys but by straight women and straight men.

 

HIV education needs to acknowledge as a basic truth that sex for gay men isn’t just a collection of physical practices to be modified.  It’s how we relate,  how we connect, and yes, love.  Understanding that is where HIV education needs to start.  I modified this quote from:

http://www.dailykos.com/story/2010/9/3/896919/-WGLB-presentsYou-Cant-Handle-the-Truth%21:-Gay-Men-and-HIV-Education  It is an interesting article that examines some of these issues in more depth.

 

Gay guys are the largest group of new infections of HIV, by far!  Gay guys are the largest group of group of new syphilis cases by far.  If gay guys are such a large group of the sexual health clients then where are they in being included in part of the solution.   It seems like HIM (Health Initiative for Men), and PWA are well placed to have or develop their expertise in sexual health of gay men, and should be a permanent consultant to all discussions about policies and procedures relating to gay men.  I do not think they are asked for their input and understandings very often.  Gay men should be a main part of all training of sexual health nurses, because they are the main part of the positive syphilis

How HIV agencies marginalize HIV+ guys

 

 

Many HIV organizations will tell people to “know the HIV status of your sex partners”, I think this is bad advice.   There is now at study that shows it is bad advice.

 

It seems that anyone who tells you to know the status of your sex partner is setting you up for risk for becoming  HIV+.   The first question is why do you want to know the HIV status of your sex partner?  If you are fucking with condoms, then their HIV status does not matter.  If you are not fucking then HIV status will not matter.

 

When you compare the amount of HIV virus a person has, the guy on effective treatment likely has an undetectable load, (meaning <40), the guy who is most likely to have 200,000 time more HIV virus in them is the guy who thinks he is negative, not the poz guy.  He may have 200,000 times more virus than the poz guy on treatment for 4-26 weeks.  This makes the guy who thinks he is negative much more likely to pass on HIV.

 

Well lots of us guys fuck without condoms at times.  We know this happens, a lot.  By playing with the stats, we are trying to find ways to make fucking without condoms ok.   Well it is not easy to do.  Monogamy is one possibility, but I have talked to too many guys who say “my boyfriend thinks we are in a monogamous relationship.”  Only fucking with negative guys is another but we cannot know if they are truly negative.

 

Why would anyone tell you to know the HIV status of your partner, it seems beyond reason to me.  A person can only know their HIV status if they are HIV+, or not having anal sex and had a negative test.   Someone you meet for sex will almost for sure not be able to know they are negative.  They can say they had a negative test last month, last week or yesterday, but that does not mean they are truly HIV negative. (Positive results do not show for 10 – 90 days depending on the test.)

 

Talking about HIV status as a screening device to decide who you will have sex with goes a long way to marginalize and stigmatize HIV+ guys.   Do we really want to isolate and discriminate against 20-25% of our own population?  A study in the last year, explored anal sex contacts of 2623 gay guyswho do not always use condoms. The results showed that serosorting , that is: assuming, knowing,  or being by a sex partner that they are HIV-  -only gave a person a “small decrease in risk of getting HIV”.

 

How do we make the decision to fuck without condoms?  We know it is a risk to become HIV+.  So, some of us will drink too much to really think about it.  Some of us will do other drugs to “not care” at the time they are fucking.  Some will tell themselves he is so nice, so hot, in such good shape he cannot be HIV+.  I often think if someone wants to fuck with me without a condom, do I think I am special and the only one he does this with?  If there are other guys he fucks with then there is a bigger chance he may be positive without knowing it.  Some guys will ask if he is negative and then feel the chance is lower.

 

So we have a widely accepted practice of telling guys to “know the status of their partners, we now know this is bad advice.  This advice will further divide our community into HIV+ and HIV- guys.   We need to support each other, have sex together, and accept our differences.

Letter about the condom quality article that one person did not like

 

 

I have spent over 20 years talking to gay guys about their lives, their sex and HIV. Having shared the pain of HIV with hundreds of guys, I think I am extremely sensitive to the agony that HIV can cause.   I will do what I can to help our community to grow strong and be healthy.  Hence the motivation for my writing a health column in Xtra.  I hope to never attack anyone in our community or any community organization in this effort, however I will criticize the government (and others) and their policies when they are harmful to our community.

I was surprised that there was controversy about my column on condoms.   My intent was to question the quality of condoms the government is providing.   I had expected that both BCCDC and maybe other organizations would come out with statements to the effect that they wanted the best possible condoms for our community and that they would research condom failure rates in an effort to help keep our community safe and healthy.  I researched the facts before I wrote the column, and did more research after it was published.  I stand by what I said in the column in Xtra.  US FDA began to use the same international standards as Canada in 2009, their standards before 2009 were very similar to the international standards Canada uses.  In both countries condoms are medical devices.    I am hoping that the column on condoms will result in the best possible condoms for our community.   It is too bad that we have not seen progress on this issue so far.

More stuff on Condoms and quality

 

 

Who thought condoms could be so exciting?  Here I am again talking about condoms.  I thought that there would not be so much to say about these little guys but I guess there is. There are a few points to talk a bit more about.

 

First of all just about everything you buy inCanadahas some kind of standards that it must pass.  I could not think of anything that didn’t.  At first I thought maybe if you buy dirt for your flower patch it would not be controlled, but no almost everything has to pass standards, this includes condoms.

 

Condoms in Canada must adhere to International Standards.  US also in 2009 began using the same international standards for condoms, before 2009 they only used a US standard that was almost the same as International Standards.   So if you go to theUSand get condoms they too should be equally safe as you good old Canadian condoms that you are used to.

 

I asked Jody Jollymore at HIM about their condom distribution program.  Though they have not done a formal survey of their condom users they hear good things about them.  Jody feels that the current condoms are better than the old ones that they used to provide, in that he gets reports that they are thinner and feel better.

 

All condoms brands will have a few that break in use as Consumer Reports says some brands will break more than others.  Studies of heterosexuals show about 1% of condoms break.  But maybe (it is only a guess) gay guys with more practice and experience have a lower percentage of breakage.  But it is interesting that if HIM gives out 150,000 condoms in a year, 1% breakage would mean 1,500 would break, if we are better at using condom than most and have half the breakage rate then 750 of these condoms would break.  But no one, not one person, reports condom breakage to HIM. Elgin Lim of Positive Living also told me that they do not get reports of condoms breaking.  I personally in social discussion do not hear of condoms breaking, but as a therapist I do hear of them breaking and it affects peoples relationships, and sense of safety and security in having sex.  But it seems people do not talk much about condom breakage socially.

 

Now for some good news.  Jody told me that HIM will respond to requests for larger condoms and non latex condoms by providing these condoms at the Sexual Health Centre beginning next month (he hopes).  (address and opening times here???)

 

Non latex condoms are important for guys who have allergies to latex.  Many guys may not know that they have a latex allergy.  I am told that a non scientific test to explore if maybe you have a latex allergy is if you blow up a balloon or two or three and your lips tingle and feel a little numb you may have a latex allergy.  This maybe something you want to explore further because you do not want your cock or your asshole to feel numb, feeling is part of the fun of fucking.

 

I talked to Elgin Lim at Positive Living Centre about their condom distribution program and he said they get their condoms from Vancouver Coastal Health, he said that they receive comments on their condoms that they are a bit “basic”, guys say they do not fit well or feel good to use.  They are trying to obtain different condoms for their members.

 

I asked BCCDC how they choose their condoms and at press time they could not provide an answer. So there seems to be no more information I can find as to how BCCDC chooses their condoms and how they rate in terms of failure rate to other brands.