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Activists Applaud New HIV Test Guidelines

U.S. health officials recommend annual screening for gay men

TUESDAY, May 14, 2002 (HealthDayNews) -- Doctors and gay activists are applauding new federal guidelines that recommend annual HIV tests for gay men, and suggest doctors ask all male patients about the genders of their sex partners.

Studies have shown that doctors often ignore or downplay sexual health issues during routine exams. The new guidelines are designed to put pressure on physicians to ask "difficult questions," says Dr. Tri D. Do, a researcher at the University of California at San Francisco's Center for AIDS Prevention Studies.

"There are a lot of [gay or bisexual] people who don't identify themselves as gay, and may even be married, who never get tested," he says.

Every four years, the Centers for Disease Control and Prevention issues new guidelines about the treatment and screening of sexually transmitted diseases (STDs). The CDC released the latest guidelines last week.

Federal officials now recommend that sexually active gay men undergo annual screening for HIV and three other STDs that commonly infect gay men -- syphilis, gonorrhea and chlamydia.

The CDC also is now recommending that gay men get vaccinated for hepatitis A and hepatitis B, two liver diseases that can be spread through homosexual acts, and undergo extra screening if they engage in especially risky sexual acts.

Outbreaks of syphilis among gay men have struck several major cities in the past two years. Public health experts who track STDs fear a growing number of gays are abandoning safe-sex practices out of a sense of "condom fatigue" or a belief that AIDS has become an easily treatable disease.

Sometimes, however, men don't get HIV tests because they fear the results.

"A lot fewer men go in for testing than we would think," says Marty Algaze, spokesman for Gay Men's Health Crisis, a medical advocacy group in New York City. "Very often, people don't want to know because of the emotional reaction they will have if they find out they're HIV positive."

The CDC is further recommending that men who have a high number of anonymous partners to get screened every three to six months, regardless of whether they engage in safe sex. Do, the San Francisco HIV expert, says many doctors who treat gay men generally follow such guidelines already.

The CDC is clearly trying to make a distinction between gay men who are at risk of HIV, the virus that causes AIDS, and those who aren't, Do says.

"They're not taking an approach of, 'Every gay man should get tested,'" he says. "It stigmatizes the community to say that every gay man is at risk for HIV, instead of looking at who is at risk based on their behavior."

Federal officials estimate that 15 million Americans become infected with STDs each year, or about one in every 20 people.

However, doctors appear to be hesitant about bringing up the topic. In a study released last October, the Kaiser Family Foundation found that only 57 percent of the doctors it surveyed -- and just 54 percent of gynecologists -- discussed STDs with female patients who were pregnant. Only four of every 10 gynecologists discussed HIV with most of their sexually active patients.

No one knows what percentage of homosexual and bisexual men will become infected with HIV or other STDs during their lifetimes. Part of the problem, Do says, is that it's difficult to survey a sample of gay men that accurately represents that part of society. Researchers often seek out gay men at clubs and bars, and miss other gays who aren't attracted to such venues.

Then there's the matter of honesty.

"We never know whether someone is telling the truth about what their risk behaviors are," Do says. "Only they know what goes on behind closed doors."

What To Do: Learn about HIV tests and what they mean from this San Francisco AIDS Foundation fact sheet. From infection to the full-blown disease, AIDS usually follows a specific pattern in patients. Read about what happens and when from Boston University.

SOURCES: Tri D. Do, M.D., M.P.H., clinical instructor, San Francisco General Hospital, post-doctoral research fellow, University of California at San Francisco'S Center for AIDS Prevention Studies; Marty Algaze, spokesman, Gay Men's Health Crisis, New York City.
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