Gay Today: Health

STD Risks Dangerously Underestimated
Poll: Only 1 in 7 Concerned about Disease
STD Rates Have Risen 70%, Says Survey

Compiled by Badpuppy's GayToday
From NLGHA & K-Y Brand Ž Reports

Most gay men and lesbians feel they are at little to no risk of contracting a non-HIV sexually transmitted disease, despite the fact that certain STD rates have risen more than 70 percent in the gay community in recent years, according to the results of a major survey.

Conducted by the makers of K-YŽ Brand Liquid personal lubricant and the National Lesbian and Gay Health Association (NLGHA), the survey analyzed attitudes and behaviors of more than 2,100 gay men and lesbians in Denver, New York, Los Angeles and San Francisco. The poll was fielded via pencil-and-paper questionnaires at Pride events in the four cities.

Besides a certain false sense of security, the K-YŽ Liquid/NLGHA study revealed a troubling lack of communication between gay men and lesbians and their health care providers about non-HIV STDs, which include chlamydia, gonorrhea, hepatitis, herpes, human papilloma virus (HPV), and syphilis. Equally disturbing were findings showing few gay men or lesbians are regularly tested for STDs, less than half have been vaccinated for hepatitis, and many have insufficient knowledge of the consequences of STDs, including the role they can play in the transmission of HIV.

Rate personal risk of non-HIV STD: high or very high

"These findings should serve as a wake-up call to the gay and lesbian community and the health care professionals who serve them," said Beverly Saunders Biddle, executive director of the NLGHA. "Not only are gay men and lesbians largely unaware of -- and unconcerned about -- the threat of STDs, but their health care providers are not giving them the information they need to protect themselves."

Only 14 percent of survey respondents rated their own personal risk of contracting a non-HIV STD as being high or very high. Eighteen percent of the gay male respondents did so, while fewer than one in 10 lesbians (9 percent) rated their risk level that high. In fact, two-fifths (40 percent) of lesbians believe they are not at all at risk of contracting an STD through sexual contact.

Reported having a non-HIV STD

At the same time, however, more than a third of the gay men (37 percent) and 14 percent of the lesbians, representing 28 percent of the total sample, reported having had a non-HIV STD. Of those who had sexual partners while they were infected, only two-thirds reported informing their partners before having sex, with women more likely to do so than men.

About one-third of the respondents (32 percent) also said they never discuss the risk of STDs with their health care provider. Although respondents said a private physician was their preferred source of health care services, 36 percent of gay men and 44 percent of lesbians said their doctor never raised the subject of STDs with them.

"This survey points to the need for education targeting doctors and health care providers in the proper way to take a sexual history and proactively raise the issue of STDs with their patients," said Howard Grossman, M.D., a New York City internist with a large gay practice. "Communication is vital to the success of STD prevention efforts and that dialogue must begin with doctor and patient."

Overall, only one-third of the respondents think the STD threat for all Americans has reached crisis levels, despite the fact that 12 million new cases are reported each year in the U.S., rates that far exceed those of any other industrialized nation. In fact, half of the nation's most frequently reported diseases are STDs. Last year, the Institute of Medicine labeled STDs "the hidden epidemic," citing the enormous health and economic consequences ($17 billion in 1994) they pose for the U.S.

The survey findings come in the wake of recent studies showing that rates of some STDs are rising dramatically among gay men. A report released in September 1997 by the Centers for Disease Control and Prevention showed that the incidence of gonorrhea in gay men rose 74 percent between 1993 and 1996. This increase comes at a time when the overall incidence of gonorrhea in the U.S. is declining.

The lack of concern about STDs revealed in the survey is troubling, particularly given the role STDs can play in facilitating the transmission of HIV. For example, people with syphilis, gonorrhea, chlamydia or herpes are three to five times as likely as others to become infected with the AIDS virus. In addition, those who have both HIV and another STD are more likely to spread the AIDS virus during sex.

In fact, the CDC's Advisory Committee for HIV and STD Prevention recommended in July that early detection and treatment of curable STDs should be implemented more widely as an HIV prevention strategy in the U.S., due to "strong evidence" that STDs play a "cofactor role in HIV transmission." Besides increasing the risk of contracting HIV, STDs are also linked to cervical cancer, sterility, pelvic inflammatory disease, and ectopic pregnancies in women, and anal cancer in men.

But, the survey revealed that awareness of these consequences and other facts about STDs was relatively low. In fact, less than half (48 percent) of the respondents considered themselves to be extremely or very knowledgeable about STDs, and a number of specific "knowledge gaps" emerged.

For example, more than a third did not know that:

There is a demonstrated link between contracting an STD and the risk of contracting HIV;

Safer sex practices that help prevent HIV are the same safer sex practices necessary to prevent the transmission of STDs;

It is possible for gay men to contract gonorrhea in the throat from unprotected oral sex;

Lesbians have similar rates of STDs as heterosexual women; and

A routine gynecological examination does not always include a screening for STDs, so it necessary for most women to be specifically tested for STDs.

Similarly, 26 percent of the respondents did not know that one way to reduce the risk of contracting an STD is to examine sexual partner(s) for the physical signs of an STD, such as sores, rashes, or discharges in the genital area. About one in five did not know that symptoms of some STDs are not readily visible at the onset of the disease.

More than two-thirds, however, recognized that using a latex condom or dental dam with a water-based lubricant, such as K-YŽ Brand Liquid, reduces the risk of contracting STDs.

"The K-YŽ Liquid/NLGHA survey clearly shows that gay men and lesbians must take a more aggressive approach in seeking out health care providers who routinely offer STD counseling and testing," said Saunders Biddle. "The health and economic stakes are simply too high to let STDs remain 'the hidden epidemic.'"

Perception of Risk for STDs

Only 14 percent of gay men and lesbians surveyed rate their personal risk of contracting a non-HIV sexually transmitted disease as high or very high. Gay men (18 percent) are twice as likely as lesbians (9 percent) to rate their risk levels that high. In fact, two-fifths of the lesbians surveyed believe they are not at all at risk of contracting an STD.

Only one-third of respondents think the threat for all Americans of contracting STDs has reached crisis levels. Most (62 percent) think it is a moderate to major health threat. Those who have multiple sexual partners are, surprisingly, significantly less likely to classify the threat as a crisis (28 percent) than those in monogamous relationships (34 percent).

Crisis level of STDs

While most think the threat of STDs affects the gay and straight communities equally, gay men are more likely than lesbians (15 percent versus 7 percent) to say it affects the gay community more.

Knowledge and Experience of STDs

Less than half (48 percent) of the respondents consider themselves extremely or very knowledgeable about STDs. Gay men are significantly more likely than lesbians to rate their knowledge that high (51 percent versus 44 percent).

Twenty-eight percent reported having had a non-HIV STD. Gay men were more than twice as likely to have had an STD than lesbians (37 percent versus 14 percent).

Twenty-six percent of the respondents did not know that one way to reduce the risk of contracting an STD is to examine sexual partner(s) for the physical signs of an STD, such as sores, rashes, or discharges in the genital area.

Approximately one in five did not know that symptoms of some STDs are not readily visible at the onset of the disease.

Over two-thirds recognized that using a latex condom or dental dam with a water-based lubricant, such as K-YŽ Brand Liquid, reduces the risk of contracting STDs.

Talking About STDs

Overall, nearly a third of the respondents say they never raise the subject of STDs with their health care providers. Lesbians are much more likely than gay men (42 percent versus 24 percent) to say they never do so.

Similarly, 39 percent say their health care provider never raises the subject of STDs with them. Lesbians are much more likely than gay men (44 percent versus 36 percent) to say their health care providers never proactively discuss the risk of STDs with them.

Reported discussing STDs with partner

Gay men are much more likely than lesbians (35 percent versus 26 percent) to report discussing STDs with their sexual partners always or very often. However, 41 percent of gay men and 57 percent of lesbians say they discuss the risk of STDs with their sexual partners only once in a while, almost never or never.

Of those who had sexual partners while they were infected with an STD, only two-thirds told their partner(s) beforehand. Lesbians were more likely to tell their partners. A third of the gay men did not have sexual partners during this time, while far fewer women abstained.

Screening for STDs

Few gay men or lesbians are regularly tested for non-HIV STDs. In fact, only a third (36 percent) are diligent in terms of being screened, with about a quarter being tested annually, and another 10 percent being screened at every visit to their health care provider.

Gay men are more likely than lesbians to be tested every time they see their health care provider or on an annual basis (38 percent versus 31 percent).

Less than half reported having been vaccinated for hepatitis. Those who have had a STD in the past, those who consider themselves to be more knowledgeable about STDs, and those who have multiple partners are more likely to have been vaccinated than the average.

Sources of Information

Gay and lesbian publications are the most commonly mentioned sources of information on STDs, cited by 56 percent of gay men and 39 percent of lesbians. Safer-sex brochures, friends and safer-sex advertisements are also used by about a quarter of the respondents.

The private physician is undoubtedly the preferred source of health care services, while a gay and lesbian health center becomes more popular for testing or treatment of a non-HIV STD.

For More Information Contact:
Bruce Hayes at (212) 725-3200 for a complete report of survey findings.

Findings are from a survey of 2,363 gay men, lesbians, bisexuals and transgendered individuals, conducted by Spare Parts, Inc. for the makers of K-YŽ Brand Liquid personal lubricant and the National Lesbian and Gay Health Association.

Respondents were surveyed via a paper-and-pencil questionnaire at June 1998 Gay Pride events in Denver (909 respondents), Los Angeles (513 respondents), New York (521 respondents) and San Francisco (420 respondents).