Viagra May Raise STD Risks in Gay Men

But there's debate over whether the drug is to blame

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By
HealthDay Reporter

WEDNESDAY, June 1, 2005 (HealthDay News) -- Researchers have called on the federal government to impose new restrictions on Viagra because studies suggest it makes gay men more likely to use illegal drugs, have unprotected sex and become infected with sexually transmitted diseases.

But a prominent physician said the findings of the researchers, based on a new analysis of 14 studies, don't prove that Viagra is responsible for changing anyone's behavior.

"To blame the drug is foolish," said Dr. Abraham Morgentaler, associate clinical professor of urology at Harvard Medical School. "Just because two things happen to go together -- in this case, risky behavior and Viagra -- doesn't mean Viagra caused the risky behavior."

Since the introduction of Viagra in 1998, health advocates have worried about its impact on the gay community. Viagra and its newer rivals -- Cialis and Levitra -- are designed to treat men who can't sustain erections, but they've also gained a reputation as basic sexual enhancers.

Researchers at the San Francisco Department of Health examined 14 studies that looked at Viagra use among gay men. Their findings appear in the June 2005 issue of the American Journal of Medicine.

Most of the studies surveyed gay men in San Francisco; many of the studies polled men at sexually transmitted disease clinics. All the studies were published between 1999 and 2004.

Eleven of the studies looked specifically at gay and bisexual men; seven of them reported that 10 percent or more of gay men said they used Viagra.

Five studies reported that gay men who used Viagra were 2 to 5.7 times more likely to have put themselves or their partners at risk by having unprotected sex with a person whose HIV status they either didn't know or was the opposite of their own.

Studies in San Francisco suggested that Viagra users were 2.5 times more likely to test positive for HIV than other gay men, two times more likely to get diagnosed with a sexually transmitted disease other than HIV, and 3.5 times more likely to have used methamphetamines within the past four weeks.

Viagra "is the only sexual health product that's associated with increased risk for STDs," said study co-author Dr. Jeffrey Klausner, director of STD prevention and control services at the San Francisco Department of Health. "Condoms, birth control, emergency contraception -- they've all been shown not to be associated with increased risk of STDs."

It's possible that Viagra increases the risk of STDs by prolonging sexual contact during intercourse, Klausner said. However, Morgentaler, the Harvard urologist, pointed out that Viagra "doesn't affect how you think or how you reason and make judgments."

Klausner acknowledged that it's possible that Viagra users are just risk-takers in general. "But even if it were true that more risky people were more likely to use Viagra, shouldn't those people be protected as well, and offered education and opportunities to reduce their risk?"

On that front, the study authors are calling on the government to mandate more extensive warning labels to alert consumers that their risk of STD infection may go up if they use Viagra. The authors also want the government to consider making Viagra a controlled substance.

According to Klausner, the latter move would eliminate free samples and make it harder for drug traffickers to sell Viagra.

While the study didn't look at use of Cialis and Levitra, the government should examine those drugs too, the investigators wrote.

Pfizer Inc., the maker of Viagra, did not respond to a request for comment.

Morgentaler, author of The Viagra Myth: The Surprising Impact on Love and Relationships, opposes further restrictions based on "poor scientific conclusions."

"Viagra has been a tremendous boon for millions of men," he said. "The fact that there's a small population that abuses it should by no means penalize the rest of the population."

More information:

To learn more about erectile dysfunction drugs, head to the American Urological Association.

SOURCES: Jeffrey Klausner, M.D., director of STD prevention and control services, San Francisco Department of Health; Abraham Morgentaler, M.D., associate clinical professor of urology, Harvard Medical School, Boston; American Journal of Medicine June 2005

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