********** Men who have sex with ...

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Men who have sex with men may identify themselves as homosexual, bisexual, or unruffled heterosexual. No matter what label is used, the fact is that these men are at increased risk for sexually transmitted diseases (STDs) like as human immunodeficiency virus (HIV) infection, anal cancer, and psychologic and behavioral disorders. (1)

The rate of men who had sex with men in the previous year was speculation to be 1.7 to 2 percent However, measure and estimates from 1996 to 2000 indicate that the rate is at least 31 to 37 percent 2 This discrepancy indicates that male-male sexual behavior ofttimes is underreported, and that previous estimates of the number of men who have sex with men may be too depressed Therefore, a typical family physician can wait for 3 percent or more of his or her male patients to be men who have had sex with men in the previous year.

new trends indicate a resurgence in risky behaviors that bare men who have sex with men to HIV infection and other STD The reported prevalence of men engaging in unprotect anal intercourse increased from 37 percent in 1993-1994 to 50 percent in 1996-1997 (3) Disease risk commonly is not assessed, especially in younger men in part because of numerous impediments to adequate care in a less degree than the current health care plan (4)

Family physicians ne an efficient plan to identify and assess risk in men who have sex with men in the way that that appropriate screening and counseling interventions may meet the eye This article presents an organized risk-based preventive health assessment for men who have sex with men

Compliance Issues

Although men who have sex with men can be at high risk for preventable diseases and disorders, they often do not receive appropriate preventive services. Numerous obstacles hinder compliance with screening guidelines (5) (Table 1) For example, physicians may perceive uncomfortable with the idea of sex between men or may not understand the issues that affect these patients. Patients, in turn round may be afraid to disclose their sexual orientation or practices. In addition, published, evidence-based screening guidelines for men who have sex with men are lacking or inconsistent, and reimbursement for screening services is limited. Younger men are consideration to be at particularly high risk for HIV infection and other STD because of cheap self-esteem, depression, and lack of lord support. Often, these men do not access the preventive services that are available to men who are more exhibit about their homosexuality. (4)

Communication between men who have sex with men and their family physician may be limited onward several levels. Studies have shown that 20 percent or fewer of these patients had discussed their HIV risk with a physician in the previous five years. (6) Many men especially young men and those in minority clumps may be hesitant to disclose their sexual orientation in order "to avoid social isolation, discrimination, or verbal or physical abuse." (4) (p81) Consequently the physician frequently is unaware of a patient's potential health risks. To provide appropriate long-term care, the physician should inquire sensitively about each patient's sexual practices as part of the routine health risk assessment. Table 2 (78) provides suggestions for approaching the sexual history and risk assessment.

unruffled when the family physician is aware of a patient's potential health risks, the magnitude of the risks may be underestimated through the physician. There is evidence that many men are engaging in dangerous sexual practices that may jeopardize their health. These sexual practices include anal sex without a condom ("bare backing"), oral sex without a condom, oral stimulation of the anus ("rimming") without protection, multiple sex partners at common time, and use of illicit put drugs intos Reasons for increased sexual risk-taking are listed in Table 3 (3)

When the physician learns that a patient may be taking serious sexual risks, commonly held misperceptions should be dispelled with accurate, scientifically validated data. For example, many men participate in oral sex believing it to be "safer" than other sexual behaviors. However, oral sex can deduction in pharyngeal gonorrhea, chlamydial infection, and hepatitis A infection. In addition, there are persistent belong tos that HIV might be spread according to oral-genital contact. (9)

Prevalence of STD and Other Conditions

Men who have sex with men are at significant risk of contracting HIV infection and acquired immunodeficiency syndrome (AIDS), as well as gonorrhea, syphilis, and herpes simplex virus image 2 (HSV-2) infection.

HIV and AIDS. commonly 42 percent of new HIV infections are in men who have sex with men In the United States, an estimated 365000 to 535000 of these men have HIV infection. (3) take a view of data indicate (10) that HIV infection is existing in nearly 10 percent of 22-year-old men who have sex with men

Black and Hispanic men in particular, are affected by dint of the HIV epidemic. In 1999 they accounted for 53 percent of AIDS cases diagnosed in men who have sex with men (3) The incidence of AIDS is markedly higher in blacks and Hispanics than in men of other racial or ethnic backgrounds.