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4 Introduction
6 Safer-Sex and Taking Control of Your Sexual Health
8 The Bully on the Block: HIV/AIDS
Oh, Operator’s Manual
I’d just fall apart without you.
If only I had a mechanic.
Then somehow I know
I’d pull through.
–The Buzzcocks
10 What You Should Know About
HIV Counseling and Testing
12 Gonorrhea
14 Chlamydia
17 Syphilis
20 Human Papilloma Virus (HPV)
22 Herpes
24 Hepatitis A, B, C
29 Pubic Lice and Scabies
31 MRSA
35 A Final Word on STDs
37 When It’s Time to Party, the More You Know
the Better…
40 We Are All in This Together: Tips to Help You
Hook Up Safely
43 Your Toolbox!
46 Looking for Help or a Friendly Face?
Resources You Can Use
2
3
It is ironic that something as devastating as HIV/AIDS
was so instrumental in pulling the LGBT community
together. Now, in a new world where we often enjoy
unparalleled acceptance, new excitement awaits.
As do some old problems—HIV/AIDS and STDs are
still an issue, as are alcohol and substance use. And
despite gains we have made as a community, social
isolation, loneliness, stigmatization, discrimination
and hate are still problems for many.
INTRODUCTION
Welcome to Living Well!
In this Operator’s Manual, you will find
some keys to safer living. Our mission
is to support a stronger community for
gay and bisexual men by providing a
safe, progressive, friendly and engaging
platform to discuss and explore
challenging personal and social issues.
4 Introduction
What does the future hold? Who can say? For now,
let’s look at potential threats to us and our community
and tackle them with knowledge and care. Together,
we can help shape the world for those who follow.
In this booklet, you will find information on biological
threats to our sexual health, like HIV and STDs.
We’ll also take an unflinching look at things like
drugs, and hooking up. This booklet isn’t designed
to tell you what to do. It’s designed to give you
the information you need to make decisions that
support your safety and freedom.
Remember, you are not alone and, as the metaphysical
poet and English clergyman George Herbert (15931633) once said, “Living well is the best revenge.”
Introduction
5
ontrol
Safer-Sex & Taking C
of Your Sexual Health
use condoms when engaging in anal sex. Condoms are
also effective in preventing a number of other STDs.
Sex and relationships can be confusing. Add to that the stress
of protecting ourselves from things like HIV and sexually
transmitted diseases (STDs), and it can seem overwhelming.
But knowledge is power that can help give you control over
your sexual health.
What else can I do to protect myself?
• You can choose not to have sex;
• You can engage in low-risk sexual activities like
STDs range from life-changing things like HIV/AIDS to
annoyances like body lice. It’s helpful when making choices
about what you want to do with a partner to know how
different things are passed from person to person. It’s probably
not realistic to be 100% “safe” when you’re naked with
someone. But how we manage risk can help keep us from
getting into trouble.
Unless you and your partner have been tested together
and are monogamous, anal sex without a condom is
high-risk behavior. Most HIV-positive guys who have male
sex partners got HIV by allowing someone to “top” them
without a condom. The most common way for HIV to be
transmitted sexually is from the insertive partner to the
receptive partner. Being the insertive partner in unprotected
anal intercourse also has some risk. The idea that total tops
don’t get HIV is not true. So, right there you have a basic
tool to keep yourself safe from the most serious STD—
6 Safer Sex & Your Sexual Health
Talking to your partners about HIV status, STDs and what
your limits are also an important part of safer-sex.
mutual masturbation;
• You can reduce your number of partners if you
choose to have sex;
• You can use condoms when you have sex;
• You can reduce or stop using drugs and alcohol
when you have sex;
• You can talk with your partner(s) about HIV and STDs;
• You can talk with a doctor or a counselor about your
risks and about getting vaccines for hepatitis A & B.
If you find that negotiating safer-sex is a challenge, your
HIV counselor, outreach worker, health navigator, doctor
or behavioral health provider can help you come up with
strategies to protect yourself and get the support you need.
When choosing a medical provider, always try to find
someone you trust so you can tell her or him everything that
might matter in regards to your health.
Remember–you are not alone! In our next section,
we’ll look at HIV/AIDS, counseling & testing, and other STDs.
Safer Sex & Your Sexual Health
7
k:
The Bully on the Bloc
HIV/AIDS
What is it?
AIDS stands for Acquired Immune Deficiency Syndrome:
• Acquired means you can get infected with it.
• Immune Deficiency means a weakness in the body’s system that fights diseases.
• Syndrome means a group of health problems that make up a disease.
AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected with HIV, your body will
try to fight the infection. It will make antibodies—special
molecules to fight HIV. A blood test for HIV looks for these
antibodies. If you have them in your blood, it means that
you have HIV infection. People who have HIV antibodies are
called “HIV-Positive.”
What are the symptoms?
Being HIV-positive, or having HIV disease, is not the same as
having AIDS. Many people are HIV-positive but don’t get sick
for many years. As HIV disease continues, it slowly wears down
the immune system. Viruses, parasites, fungi and bacteria that
usually don’t cause any problems can make you very sick if
8 HIV/AIDS
your immune system is damaged. These are called “opportunistic infections.” Without treatment, these opportunistic
infections can kill you.
There is no cure for AIDS. There are drugs that can slow down
the HIV virus, and slow down the damage to your immune
system. There is no known way to “clear” HIV from the body.
How do you get HIV/AIDS?
You don’t actually “get” AIDS. You might get infected with
HIV, and later you might develop AIDS. You can get infected
with HIV from anyone who’s infected, even if they don’t look
sick and even if they haven’t tested HIV-positive yet.
The blood, vaginal fluid, semen, and breast milk of people
infected with HIV has enough of the virus in it to infect other
people. Most people in the United States get the HIV virus by:
• Having unprotected sex with an infected person
• Sharing a needle (shooting drugs) with someone who’s infected
There are no documented cases of HIV being transmitted by
tears or saliva. It may be possible to get infected with HIV
through oral sex, especially if you have open sores in your
mouth or bleeding gums, but it is uncommon.
The bottom line: if you are having sex, using condoms is
the best way to protect yourself and your partners from HIV.
If you are shooting drugs, don’t share needles.
HIV/AIDS
9
About
What You Should Know
ing
HIV Counseling & Test
If you’re a sexually active gay or bi guy with
multiple partners, regular HIV testing is an
important part of maintaining your health.
The more routine it feels, the more likely you are to not put
it off. It’s a normal part of life. Your friendly neighborhood
HIV counselor is your buddy.
Even if you practice safer-sex, a check in with your friendly
HIV counselor every 6 months to a year is like getting the oil
changed in your car. You can go over what’s happened since
your last visit and make sure you’re doing everything you
can to prevent problems.
The type of routine HIV tests most places offer are called HIV
antibody tests. They detect HIV antibodies, not the actual HIV
virus. The human immune system creates HIV antibodies as a
response to HIV infection. It usually takes anywhere from
10 days to 3 months from the day of infection, perhaps longer
in some cases, for the body to create enough antibodies to
be detected in a blood test. Because of this delay, a negative
HIV antibody test result does NOT guarantee that someone
10 HIV Counseling & Testing
is HIV negative. It’s important to understand the process
and limitations of HIV antibody testing, especially when
using the results to make decisions about sexual risk.
In a recent study of men who have sex with men, ages 20-29,
70% who tested HIV positive honestly believed they were
HIV negative at the time. Depending on the test, it can take
6 to 12 weeks after exposure for HIV antibodies to show up.
Early detection of HIV infection increases your treatment
options and protects the health of your sexual partners.
Fenway offers free, confidential HIV counseling and
testing. Please call 617.267.0159 for more information.
So what if you have a possible exposure to HIV and want
to do something about it right away? Well, you should know
about PEP!
Do you think you’ve had a risky exposure
to HIV within the last 3 days?
Call your medical provider or call 617.927.6000 right away
to learn if PEP (post-exposure prophylaxis) is for you. PEP is
a combination of anti HIV medications that may prevent
HIV from taking hold in your body. Call now to learn more.
Outside of the Boston area, call a local hospital or HIV
hotline to get access to PEP in your area.
HIV Counseling & Testing
11
Gonorrhea, aka:“The Clap”
What is it?
Gonorrhea is a bacterial STD sometimes called “the clap”.
Gonorrhea can infect the urinary tract, the vagina, the butt,
or the throat.
What are the symptoms?
Symptoms of gonorrhea infections usually develop within
2 to 10 days after exposure. About 5-10% of men with
urethral gonorrhea will not have any symptoms and the
majority of anal and oral gonorrhea infections will show no
symptoms. When symptoms do appear, they can include:
• Vaginal Gonorrhea: Pain or burning sensation when urinating; increased vaginal discharge or vaginal bleeding between periods
• Urethral Gonorrhea: Discharge from the penis, usually
yellowish; pain or burning sensation when urinating
• Anal Gonorrhea: Anal itching and/or painful bowel
movements; blood or mucus in the feces
• Oral Gonorrhea: Sore throat
12 Gonorrhea
Why should I care?
Gonorrhea makes it easier to become infected with HIV
and also makes someone who is infected with HIV more
infectious to others. Untreated gonorrhea of the penis can
lead to pain and swelling in the testicles, a condition known
as Epididymitis which can lead to infertility. In women,
gonorrhea is a common cause of pelvic inflammatory
disease (PID). Often, by the time symptoms present, they
can be very severe and can include abdominal pain
and fever. PID can damage the fallopian tubes enough to
cause infertility or increase the risk of ectopic pregnancy,
a life-threatening condition in which a fertilized egg grows
outside the uterus, usually in a fallopian tube.
How do you get it?
Gonorrhea is transmitted through unprotected vaginal sex,
anal sex, oral sex and rimming. The best way to protect
against it is to use condoms for insertive sex. Avoid oral sex
if your sex partner’s precum is yellowish and cloudy.
Diagnosis and Treatment
A doctor or nurse will take samples for testing from potentially infected areas. Antibiotics can usually successfully cure
gonorrhea, however, drug-resistant strains of gonorrhea are
becoming more common.
Gonorrhea
13
Chlamydia
and potentially fatal ectopic pregnancy (pregnancy outside
the uterus). Women infected with Chlamydia are up to five
times more likely to become infected with HIV, if exposed
to it.
What is it?
How do you get Chlamydia?
Chlamydia is a common sexually transmitted disease caused
by a kind of bacteria which can infect both women and men.
What are the symptoms?
Chlamydia can cause discharge from the penis of an
infected man, but often symptoms are mild or absent.
Serious complications that can cause irreversible damage,
including infertility, can occur “silently” before a person
even recognizes a problem.
Why should I care?
Untreated, Chlamydial infections can progress to serious
reproductive and other health problems with both shortterm and long-term consequences. Like the disease itself,
the damage that Chlamydia causes is often unnoticed.
In women, untreated infection can spread into the uterus
or fallopian tubes and cause pelvic inflammatory disease
(PID). This happens in up to 40 percent of women with
untreated Chlamydia. PID can cause permanent damage
to the fallopian tubes, uterus, and surrounding tissues.
The damage can lead to chronic pelvic pain, infertility,
14 Chlamydia
Chlamydia can be transmitted during vaginal, anal, or oral
sex. Chlamydia can also be passed from an infected mother
to her baby during vaginal childbirth.
Any sexually active person can be infected with Chlamydia.
The greater the number of sex partners, the greater the risk
of infection. Because the cervix (opening to the uterus) of
teenage girls and young women is not fully mature, they are
at particularly high risk for infection if sexually active. Since
Chlamydia can be transmitted by oral or anal sex, men who
have sex with men are also at risk for Chlamydial infection.
Diagnosis and Treatment
There are laboratory tests to diagnose Chlamydia. Some can
be performed on urine, other tests require that a specimen
be collected from a site such as the penis or cervix. Chlamydia
can be treated and cured with antibiotics.
Lymphogranuloma venereum (LGV) is a type of Chlamydia.
LGV is spread by unprotected sex. Condoms can provide
protection.
Chlamydia
15
LGV is more common in Africa, Southeast Asia, South America
and the Caribbean than in North America and Europe,
however we see some cases every year in Boston.
People with LGV can begin to have symptoms a few days to
a month after becoming infected. LGV can infect the genitals
(penis, vagina) or the rectum. In the genital form, LGV starts
as a painless bump on the penis or vagina, which quickly
turns into an open sore. As the infection spreads, the lymph
nodes in the groin swell, become tender, and may even
rupture and drain pus through the skin. It is also common
to have fevers and feel generally unwell.
LGV can cause an infection in the rectum in people who have
unprotected anal sex. In the US and Europe this infection has
affected mainly men who have sex with men. Symptoms of
this infection may include rectal bleeding or discharge, pain in
the rectum and lower abdomen and pain with bowel movements, in addition to fevers. This form of LGV can be confused
with inflammatory bowel disease or Crohn’s disease.
If left untreated, LGV can cause serious health problems.
It can also increase a person’s risk of getting infected with
HIV. LGV can be cured with antibiotics, but only if your
health care provider suspects it. LGV is difficult to test for,
usually requiring both a blood test and a swab of the
affected area. The most common treatment involved taking
antibiotics by mouth for 21 days.
16 Chlamydia
Syphilis
What is it?
Syphilis is an STD caused by a bacteria that enters the body
through the skin during sex or close physical contact with an
infected partner. Common sites of infection in men occur on
the mouth, penis or the butt.
What are the symptoms?
• Primary Syphilis: The first symptom of syphilis is a
painless ulcer (chancre) which generally appears about
2-4 weeks or so after exposure. This sore can appear on
the penis, the butt, the vagina or the mouth If the chancre
appears just inside the butt, in the vagina or in the mouth.
It can be easily overlooked. This chancre will weep clear,
very infectious fluid for 3 to 8 weeks and then will heal
even without treatment.
• Secondary and Tertiary (Third Stage) Syphilis:
Syphilis bacteria spreads throughout the body, leading to
secondary syphilis. Secondary syphilis symptoms include
fever, joint pains, fatigue, liver problems, enlarged lymph
nodes, eye problems, and a copper colored skin rash on
the palms of the hands and soles of the feet.
Syphilis
17
These symptoms will also disappear without treatment.
A sexual partner in secondary syphilis is STILL VERY INFECTIOUS. Without treatment, tertiary syphilis can occur many
years later attacking the brain and heart, destroying vision
and hearing and leading to insanity and possibly death.
Diagnosis and Treatment
A blood test is required to diagnose syphilis. If treated in a
timely manner, syphilis is easily curable with antibiotics.
Why should I care?
Because many symptoms of syphilis can be overlooked or
misdiagnosed, there is a risk of ongoing syphilis infection
which may not be caught until serious illness and damage
to the body occurs. Either partner having a chancre can
increase HIV transmission 2 to 5 times. Syphilis is highly
treatable with medication if caught early. If not, it can lead
to serious problems. If you have or ever remember having a
chancre, or are having any of the symptoms of syphilis, get
screened! It could save your life.
How do I get syphilis?
Is it time for
a tune-up?
To schedule an
appointment, call
Fenway Health at
617.927.6000.
By having sex or close skin to skin contact with someone
with syphilis sores or rash. Using a condom during anal and
oral sex can reduce the risk but not eliminate it completely.
If a male sex partner has a chancre on the base of his penis,
a condom may not protect you and bacteria can even be
spread during sex play and on sex toys. If you have a chancre
and your sex partner has HIV, your risk of acquiring HIV is
greatly increased. Soap and water can easily kill syphilis
bacteria on the skin, so it’s a good idea to shower after sex.
18 Syphilis
19
HPV, Human Papilloma Virus
How do I get it?
HPV is a very common family of virus that cause warts on
different places on the body, including warts on the hands,
face, neck, genitals, and butt. Genital and anal warts are
caused by specific strains of HPV different than those which
cause warts on the hands or face. We will only talk here
about genital and anal HPV infections.
HPV that infects the genital areas is spread through sex
or even close skin to skin contact with an infected partner.
Unfortunately, someone can be infectious even without
visible warts or bumps. Using a condom may only offer
limited protection since the virus can get onto the skin not
covered by the condom. If your partner has genital warts,
avoid touching them. Don’t share sex toys unless they’ve
been sterilized. Soap and water does not kill the virus, but it
is still a good idea to shower well immediately after sex which
might wash the virus off the skin.
What are the symptoms?
Diagnosis and Treatment
What is it?
Very often, HPV has no symptoms at all. Sometimes, genital
warts can appear on, or just inside the vagina or butt, and
less commonly, on the penis. Someone with HPV infection
may not have visible warts but can still be infectious to others.
Genital warts are generally painless and appear as bumps
or growths on the penis, vagina or butt that can be whitish,
or lighter or darker than the surrounding skin. Genital warts
can be hard to see, but can sometimes be felt as a bump.
HPV infections often go away on their own within a couple of
years. A doctor can visually diagnose genital warts sometimes.
Talk to your doctor about anal pap smears. If you have genital
or anal warts, they should only be removed by a medical
provider. Although HPV may still be present in the body, the
good news is that once the warts are removed, they may not
come back for months or years, if at all.
Why should I care?
There is no cure for genital or anal HPV. Besides being a
nuisance, HPV infection in your cervix or anus can increase
your risk for cervical or anal cancer.
20 Human Papilloma Virus
Human Papilloma Virus
21
Herpes
What is it?
There are 2 types of “alpha” herpes that are very common,
HSV-1 and HSV-2. When active, such as in the form of a
cold sore or genital outbreak, HSV-1 and/or HSV-2 are very
contagious. They are very similar viruses and can both affect
the mouth, genitals and other parts of the body.
There are some misconceptions. HSV-1 is sometimes called
“oral herpes” but about 50% of genital herpes outbreaks
may be caused by HSV-1.
Why should I care?
Herpes is relatively easy to transmit and an infection on your
mouth in the form of a cold sore is annoying and can cause
stigma because it is so visible. Genital outbreaks can be even
more troublesome. Herpes can spread to different parts of
your body, and the type (oral or genital) doesn’t confine
the area where outbreaks can occur, although there is usually
a primary outbreak at the original point of infection.
How can I prevent transmission?
The fist prevention rule is not to touch sores to skin,
Whether the sores are on you or your partner. This includes
kissing, oral sex, etc.
It is likely that more than half of all Americans have HSV-1
and about one-quarter have HSV-2. Herpes is not curable
and can be painful, but if treated, it is seldom serious.
The second thing to remember is that herpes can be transmitted even when a sore isn’t present, though it is much less
likely than when there is a sore. So, if possible, avoid touching
suspected herpes sores/rashes to skin. Showering before
and after sexual contact is also a good idea.
What are the symptoms?
Diagnosis and Treatment
Sores can form at the site of infection (usual mouth or genital
area) and can spread to other parts of the body. There is
often a tingling or itching at the infection site prior to a
sore forming.
22 Herpes
For many infected people, using antiviral medication (Acyclovir,
etc.) at the onset of an outbreak (tingling and itching at the
infection site) can prevent lesions from forming.
Rarely, HSV-1 and/or 2 can lead to significant health issues.
Discuss this with your doctor.
Herpes
23
Hepatitis A,B,C
What is it?
Hepatitis refers to viral infections of the liver that are often
transmitted sexually among men who have sex with men.
There are several types of hepatitis, but here we will discuss
the most common types, Hepatitis A, Hepatitis B and
Hepatitis C.
Hepatitis A is a type of hepatitis that is passed between
people by a fecal/oral route, i.e. getting poop from an infected
person into your mouth such as through rimming (butt licking)
or ingesting contaminated food (this can happen when
people preparing food do not wash their hands after using
the bathroom).
Hepatitis B is a type of hepatitis viral infection that is highly
contagious and usually contracted through sexual activity
with an infected partner or through contact with the bodily
fluids of someone with Hep B.
Hepatitis C is more difficult to acquire than other types of
hepatitis and is most commonly transmitted through blood to
blood contact (such as might happen when sharing needles
during injection drug use).
24 Hepatitis A,B,C
What are the symptoms?
Symptoms of Hepatitis A, B, and C are similar and can vary
in severity from person to person. In general, symptoms of
the three types can include: fatigue, sometime so severe it is
hard to get out of bed, loss of appetite, nausea and vomiting
that gets worse as the day progresses, and loss of desire to
smoke cigarettes. Yellowing of the skin and eyes (jaundice) is
also common as well as darker urine than normal. Dull pain in
the upper abdomen may also be a sign of Hep A infection.
Why should I care?
Hepatitis infections can make you very sick and even lead
to death, but they can often be treated if you seek medical
attention.
Prevention
Hepatitis A and B are preventable with vaccinations. Talk to
your doctor or check out the resource section (pg. 46) of this
Operator’s Manual.
Diagnosis and Treatment
A doctor can do a blood test for Hepatitis A. Treatment is
often “supportive,” which means you will be monitored by a
doctor. Sometimes people infected with Hepatitis A must be
hospitalized to control the symptoms and the disease usually
lasts from 6-8 weeks. Until the disease runs its course, you
cannot drink alcohol.
Hepatitis A,B,C
25
Although most people eventually recover, Hepatitis B attacks
your liver and can put you in the hospital and is sometimes
fatal. Roughly 5-10% of people with healthy immune systems
who are infected can develop chronic active Hepatitis B,
which continues damaging the liver and can lead to cirrhosis,
liver failure and death. In people infected with HIV or who
have other immune disorders, Hepatitis B becomes chronic
almost 90% of the time.
Hepatitis C is more difficult to get than Hep A or B, but is
incurable in most people and there is currently no vaccine
against Hepatitis C. About 90% of people with Hep C
develop chronic infection and continue to be infectious to
others. Hepatitis C infection can increase the risk of liver
cancer, liver failure and even death. Becoming infected with
two types of Hepatitis at the same time, (Hep A, B or C), can
speed up the rate of liver damage so anyone infected with
Hep C should be vaccinated against Hepatitis A and B.
How do you get it?
a
Hepatitis A is transmitted by fecal/oral route.
Rimming, as well as putting your fingers in your
mouth after playing with someone’s ass or touching a used
condom can cause you to become infected with Hepatitis A.
You can also get it from fecal mater in raw shellfish from
contaminated waters or from food prepared by someone
with Hepatitis A. Those with Hepatitis A are usually infectious
26 Hepatitis A,B,C
BEFORE they have any symptoms, so you probably won’t
know if a sex partner is infected.
Hepatitis B is found in the precum, semen,
and blood of an infected person. You can get
Hepatitis B by having sex with someone infected
with it or by coming into contact with any of their bodily
fluids. Oral sex with an infected partner carries a low risk for
infection, however. To reduce your risk, avoid unprotected
insertive sex, and don’t share any personal items that may
have another person’s blood on them, such as sex toys,
needles (including tattoo needles), toothbrushes, and razors.
Use condoms for sex, especially if you think your partner
may be infected with Hepatitis B.
b
c
Although sexual transmission of Hepatitis C is
uncommon, rough sex or any sexual practices
that lead to bleeding may increase the risk. Blood-to-blood
contact is the most common way to become infected, so
avoid behaviors that might allow even a microscopic amount
of someone else’s blood to enter your bloodstream. Avoid
sharing personal items like sex toys, razors, syringes/needles
(including tattoo needles) and toothbrushes. Sharing drug
paraphernalia for snorted drugs like coke, crystal and K also
carries a risk because these drugs are crystallized and have sharp
edges which cause bleeding of the membranes in the nose.
Sharing bumpers or straws or anything used to snort drugs
Hepatitis A,B,C
27
with another person who may be infected can allow some of
their blood (even if you can’t see it) into your nose, putting
you at risk.
Pubic Lice & Scabies
How can I protect myself?
There are vaccines available for both Hepatitis A and
Hepatitis B. To schedule an appointment at Fenway Health
for a free vaccination, please call 617.927.6110.
What are they?
Also called “crabs,” pubic lice are parasitic insects found in
the genital area of humans. Scabies is an infestation of the
skin with the microscopic mite.
What are the symptoms?
For pubic lice:
• Itching in the genital area
• Visible nits (lice eggs) or crawling lice
For scabies:
• Pimple-like irritations, burrows or rash of the skin, especially the webbing between the fingers; the skin folds on the wrist,
elbow, or knee; the penis, the breast, or shoulder blades.
• Intense itching, especially at night and over most of
the body.
• Sores on the body caused by scratching. These sores can sometimes become infected with bacteria.
Why should I care?
Pubic lice and scabies are both very contagious. Infestations
are uncomfortable. Without treatment, pubic lice and scabies
will not go away.
28 Hepatitis A,B,C
Public Lice & Scabies
29
How do I get them?
Pubic lice are usually spread through sexual contact.
Rarely, they can be spread through contact with an infested
person’s bed linens, towels, or clothes.
Scabies are transferred by direct, prolonged, skin-to-skin
contact with a person already infested with scabies. Contact
must be prolonged (a quick handshake or hug will usually
not spread infestation). Infestation is easily spread to sexual
partners and household members. Infestation may also occur
by sharing clothing, towels, and bedding.
Who is at risk?
Pubic lice and scabies affect people from all walks of life.
Having them is not an indicator of hygiene or economic status.
Pubic lice infection in a young child or teenager may indicate
sexual activity or sexual abuse. People with weakened immune
systems and the elderly are at risk for a more severe form of
scabies, called Norwegian or crusted scabies.
How do I get rid of pubic lice or scabies?
Several lotions are available to treat either pubic lice or scabies.
Always follow the directions provided by your physician
or the directions on the package insert. All clothes, bedding,
and towels used by the infested person 2 days before
treatment should be washed in hot water; dry in a hot dryer.
30 Pubic Lice & Scabies
MRSA
MRSA (short for Methicillin-resistant Staphylococcus aureus)
is a bacteria that in the past was largely found in hospitals
and other healthcare settings.
In recent years, a growing number of infections with MRSA
have been seen outside of hospital settings both in the
United States and elsewhere. In some places, MRSA is now
the most common cause of certain infections. Some reports
describe these microbes as multi-drug resistant Staphylococcus
aureus (MDRSA) or as community acquired MRSA.
What kinds of problems does MRSA cause?
Community-acquired MRSA infections typically cause skin
infections such as boils (furuncles), pimples (folliculitis),
or cellulitis. These infections have sometimes been mistaken
for “spider bites.” The skin may get red, painful, and swollen.
The wound may drain pus as well. MRSA skin infections can
occur anywhere on the body, but common sites for infection
include the buttocks and groin.
MRSA
31
MRSA infections can recur and take a long time to resolve
completely in some cases. If left untreated, these infections
can invade deeper tissues, sometimes necessitating more
extensive tissue removal.
In addition to skin infections, MRSA can less frequently
cause other problems such as lung infections (pneumonias),
blood infections, and other kinds of infections.
Who gets MRSA? What can I do to protect
myself from MRSA?
Initial cases of MRSA outside of hospital settings were
reported in a variety of different groups including sports teams,
military recruits, children, prisoners, and men who have sex
with men among others. MRSA is now commonly seen at
Fenway and at other Boston hospitals. Researchers are
currently conducting studies to try to better understand
specific risk factors for MRSA infections.
Current evidence suggests that close contact with an infected
person is an important risk factor for MRSA infections.
Therefore:
• Avoid sharing clothing, towels, or personal items such
as razors;
• Keep open wounds covered with clean dressings and avoid contact with other people’s open cuts and wounds;
32 MRSA
• Wash hands regularly with soap or use an alcohol-based cleaner;
• Condoms are a very important method for reducing your risk of serious diseases such as HIV and syphilis, but they are not likely to protect you from MRSA so it is important to follow the other suggestions listed above.
MRSA, like other Staphylococcus aureus bacteria, can live
in the nose and other skin surfaces of otherwise healthy
people. This does not cause any symptoms. Sometimes for
patients who have had multiple MRSA infections, doctors may
recommend an antibiotic ointment or pill to attempt to get
rid of this MRSA. There is currently insufficient evidence to
support routine nose cultures followed by MRSA eradication
treatments for otherwise healthy people.
How is MRSA diagnosed? What treatments
are available?
MRSA skin infections can be detected by culturing pus from
the wound.
In some situations, MRSA skin infections can be treated
effectively simply by having your doctor drain the infected
site. However, antibiotics are also commonly prescribed, and
MRSA skin infections usually respond well to one of several
medications such as Bactrim (trimethoprim-sulfamethoxazole).
Antibiotics such as Keflex (cephalexin), dicloxacillin,
MRSA
33
clindamycin, or quinolones (like ciprofloxacin) that are often
used to treat skin infections will not treat MRSA. If you
believe that you have a MRSA infection, you should check
with your doctor to see if the antibiotic you are prescribed will
treat MRSA.
Deeper infections may need to be drained by a doctor in
order to heal. Only a doctor should drain these infections.
What should I do if I think I have
a MRSA infection?
Contact your healthcare provider.
It is important to seek medical attention early if you have
a skin infection, because more advanced infections may
require hospitalization and intravenous medications.
Be sure to let your healthcare provider know if:
• You have been in contact with someone with MRSA or another open wound;
• You have had MRSA infections in the past;
• You have used antibiotics in the last year;
• You have been in the hospital or had any medical
procedure in the last year.
34 MRSA
s
A Final Word on STD
Most STDs are easily curable. If not curable, STDs like
HPV (warts) and herpes are usually easy to manage with
treatment. As with HIV, STDs may be more common for
gay/bi guys than other people. If you’re a sexually active
guy and you have sex with other guys, routine STD screenings
are important, and should feel like a normal part of health
maintenance. Since free STD screening isn’t as common as it
once was, you may decide to see your primary care provider.
Tell your medical providers about your sex practices, because
they may order different tests than if you were strictly
heterosexual. For instance, gay/bi men should have throat
and anal swabs for gonorrhea and Chlamydia.
Don’t let shame or fear prevent you from taking control.
A Final Word on STDs
35
rty, the
When It’s Time to Pa
tter...
More You Know the Be
From time-to-time, we all need help
keeping things tuned up and running
along happily and healthily.
Some guys like to supe up their good times by using alcohol
or club drugs like ecstasy and crystal meth and cocaine.
While these drugs do have their attraction, they can also be
very harmful, so use with care. Here are some notes about
common drugs used by gay and bisexual men—more tools
to help keep you safe.
Ecstasy: E, X, XTC, MDMA
Notoriously impure. The real stuff can make you lovey and
swooshie and want to dance or snuggle or chat for hours.
Mixing with the anti-HIV medication Ritonivir can be fatal.
Don’t mix with MAOIs. And don’t use if you have high
blood pressure or heart problems. Try not to take too much,
and remember to drink about a quart of water an hour!
Not enough water: bad, too much water can also over-tax
your body and make you sick!
To find a
Boston-area
resource, flip
to page 46 >
36
Party Drugs
37
GHB: G, Liquid E, EZ Lay, Goop
Crystal: Meth, Tweak, Speed, Tina
This stuff gets you up up up and keeps you up for hours.
Many people use it when they are having sex because it can
spice up the nookie! We call that “party and play” or “PnP.”
Crystal is super addictive and hard on the body. It’s been
the downfall of many gay and bi men (and lots of other
people, too). If you use, try it in moderation. If you can’t
stop, think about getting help because it can really bring
you down. If you don’t use, it’s probably a good thing.
Never using crystal is a way to do yourself and the people
who love you a favor.
Ketamine: K, Special K
K is an addictive tranquilizer. It can make you feel light and
groovy in low doses. Higher doses can trap you in a “k-hole”—
a state of being immobile and helpless. Even higher doses
can make you pass out, puke or even die. If you do it, dose
slowly and don’t mix it with alcohol or other depressants.
Doing that could ruin your night.
G can make you feel lovey and relaxed, but it’s really easy
to accidentally overdose. If you do too much, you might
pass out, puke, even stop breathing. If you do G, dose slowly
and carefully and DON’T DRINK ALCOHOL. Also, if you’re on
antidepressants or sleep aids, lay off the G!
Alcohol: Booze
While we’re on the topic of club drugs, lets take a second
to remember alcohol. It’s the most popular of all the club
drugs. Drinking with your friends can be a fun way to loosen
up. Too much, too often can throw a wrench in the gears of
your life. Booze can make you act like a jackass, say nasty
things to people you love and crash your car. Check in with
yourself about your use and get help if drinking is messing
with your happiness.
Cocaine/Crack: Coke, Blow, Snow, Rock
Coke (and crack–chunks of hardened coke) is an addictive
stimulant. It doesn’t last as long as crystal. Shooting impure
coke can be deadly. Never share needles, and if you feel like
your use is getting out of hand, seek help!
38 Party Drugs
Party Drugs
39
ther:
We Are All in This Toge
Up Safely
Tips to Help You Hook
Going out and meeting people should be fun and exciting.
We live in a great city that has made a lot of progress in
terms of protecting our rights. However, there are people
out there of all sexual orientations who might not have your
best interests at heart. Some might want to take advantage
of you sexually, steal from you, or hurt you. Whatever the
case, there are some things you can do to keep things safe
and fun.
Here are a few safety tips and resources to help our
community feel safer and stronger.
Online
• If you’re hooking up with someone you
met online, tell someone where you’re
going, or leave a record (username,
address, or phone number) at home.
• Be mindful about what personal information you give
to others.
• Show up for the date with an exit plan so that you can leave if things start to feel out of control.
• Consider meeting in a public place for the first time to get a sense of the other person.
At the bars
• Keep your drink in sight at all times and only accept drinks that come directly from the bartender. A drink can be drugged while your back is turned, and many drugs have no color, flavor, or smell to them.
• Go out with friends and check in with each other.
• If you’re out alone, see if there’s anyone you know.
Even acquaintances can watch your back.
• Know your limits and prepare an exit plan if things start to feel out of control. Keep the number of a cab company in your cell phone.
Tips to Help You Hook Up Safely
41
In public places
Your Toolbox!
• Be aware of your surroundings, especially when you’re alone outdoors at night.
• Try not to carry any unnecessary cash or valuables with you, but always carry identification.
• Be prepared—know emergency numbers (a friend, a cab company, 911), just in case. You may want to put some of these numbers into your cell phone for easy access.
If you’re the victim of a crime and need
support, dial 911, and/or:
• If you need medical attention, go to the closest ER.
• Call your local police department and/or the
Violence Recovery Program at Fenway Health to report the incident.
Guys and tools
As we go along in our lives,
we pick up ideas that help us
live healthier lives. These ideas
can be simple like don’t put
your hand in the fire, or
complicated—like building
your boundaries about
what risks you are willing
to take and what risks you
avoid. Some simple tools are
listed on the following pages.
• Use the enclosed resource list to access local services.
• Keep a cell phone on you or enough change to make an emergency call from a pay phone.
• Even if you’ve been out partying, it’s okay to ask for help.
Violence Recovery Program
617.927.6250 / 888.834.3242 (toll-free)
42 Your Sexual Health
Your Toolbox
43
STD testing: If you’re hooking up, an STD test every
The Internet: The Internet is probably the greatest
creation in the history of the human race. It allows
unprecedented access to information and entertainment.
Unfortunately, sometimes there is misinformation on the web.
If you are looking for the truth online, only trust websites
from credible sources. For health information these sites are
government sites, academic sites, sites run from medical
institutions and sites run by trustworthy community
organizations. One great place to get answers from real
medical providers is Fenway’s Ask Doctor Cox site. Visit
www.fenwayhealth.org/doctorcox. Other great sites include
www.gettestedmass.org, www.cdc.gov & www.thebody.com.
Post Exposure Prophylaxis: Do you think you’ve
had a risky exposure to HIV within the last 3 days?
Call 617.927.6440 right away to learn if PEP (post-exposure
prophylaxis) is for you. PEP is a combination of anti HIV
medications that may prevent HIV from taking hold in your body.
Call now to learn more. If Fenway Health is not convenient,
a nearby emergency room should be able to help you.
3-6 months is a good idea. If you practice oral sex or buttsex
(even with condoms) your doc should swab you for Chlamydia
and gonorrhea in addition to the “pee in a cup” test.
Some docs will do anal pap smears. This is not a bad idea.
Sores: Avoid touching other people’s sores and don’t let
people touch yours, This one might seem minor, but you can
save yourself some trouble by not kissing someone when
either one of you has a cold sore. Cold sores can transfer to
a person’s genitals, too, so bear that in mind. There are other
types of sores caused by syphilis. It might sound strange,
but inspect your partner’s body and genitals for sores,
bumps and infections.
Bathe: This one might sound like it’s coming from your
mother, but bathing daily helps prevent infections, including
MRSA—a bacterial infection that is resistant to antibiotics.
Bathing after sex is especially important.
Trust your doctor: He or she can help you best if you
are open and honest.
Condoms: Using condoms for anal sex is an effective
way to prevent HIV. In Massachusetts, over 50% of people
with HIV are men who have sex with men. The majority of
these guys got infected when they let someone top them
without a condom.
44 Your Toolbox
Your Toolbox
45
Friendly
Looking for Help or a
n Use
Face? Resources You Ca
Alcoholics Anonymous
617.426.9444
aaboston.org
Boston GLBT Helpline
Fenway Health
6-11pm, 7 days a week
617.267.9001
888.340.GLBT
Boston Alliance of
GLBT youth (BAGLY)
617.227.4313
bagly.org
Bisexual Resource
Center Boston
617.424.9595
biresource.org
Fenway Health
(Medical and Behavioral
Health, Prevention
and Education, Research)
617.267.0900
Violence Recovery Program
617.927.6250
888.834.3242
fenwayhealth.org
Gay Men’s Domestic
Violence Project
Crisis: 800.832.1901
gmdvp.org
K-Street Recovery
Meeting Space
Dave: 508.450.8695
k-street.com
Latin-American
Health Institute
617.350.6900
lhi.org
46 Resources
The MALE Center
(A program of AIDS Action)
617.450.1987
malecenter.org
Sidney Borum, Jr.
Health Ctr. (young adults)
617.457.8140
AIDS & HIV related
AIDS Action Committee
1.800.235.2331
617.437.1672
aac.org
AIDS Support group
of Cape Cod
800.905.1170
508.778.1954
asgcc.org
Boston Living Center
617.236.1012
bostonlivingcenter.org
Cambridge Cares
About AIDS
617.661.3040
ccaa.org
Cambridge Health Alliance
617.665.1606
challiance.org
Community Research
Initiative of New England
Boston: 617.778.5454
Springfield: 413.734.2264
crine.org
Boston AIDS Consortium
bacboston.com
Community Servings
Meals Program
617.445.7777
servings.org
Boston Buyer’s Club
617.266.2223 or
800.435.5586
bostonbuyersclub.com
East Boston Neighborhood
Health Center
617.569.5800
617.568.4HIV
Resources
47
Health Awareness Services
508.756.7123
1.800.637.5466
hascm.org
Harbor Health HIV
Services, Dorchester
617.282.3200
harborhealthhiv.org
MA Dept. of Public Health
617.624.6000
617.624.6001
mass.gov/dph
Mass. Asian and Pacific
Islanders (MAP) for Health
617.426.6755
Mass. Alliance of
Portuguese Speakers
508.872.2652
maps-inc.org
Multicultural AIDS
Coalition, Inc.
617.442.1MAC
mac-boston.org
48 Resources
New Hampshire AIDS
Response, Seacoast
603.433.5377
aidsresponse.org
North Shore AIDS
Health Project
978.283.0101
Pathways to Wellness
(Acupuncture)
617.859.3036
pathwaysboston.org
Rhode Island Project AIDS,
Providence
401.831.5522
aidsprojectri.org
Search for A cure
617.945.5350
searchforacure.org
AIDS Project, Worcester
508.755.3773
aidsprojectworcester.org
Youth Only AIDS Hotline
(MA only)
800.788.1234
Education, Legal,
Political Action
Bay State Gay &
Lesbian Democrats
718.293.1157
baystatestonewalldems.org
Bisexual Resource Center
617.424.9595
biresource.org
Boston Office of
Civil Rights
617.635.2500
Cambridge Lavender
Alliance
617.492.6393
Gay and Lesbian Advocates
& Defenders—GLAD
Legal: 617.426.1350
800.455.GLAD
glad.org
Gay Officers Action
League—GOAL
617.376.3612
goalne.org
Gay, Lesbian & Straight
Education Network—
GLSEN
617.536.9669
glsenboston.org
Community Dispute
Settlement Center
617.876.5376
communitydispute.org
Freedom to Marry Coalition of Massachusetts
617.482.1600
ftmc.org
Resources
49
Religious, Spiritual
Groups
Human Rights Campaign
202.628.4160
1.800.777.4723
hrc.org
National Gay /
Lesbian Task Force
202.393.5177
thetaskforce.org
Neighborhood
Groups
North Shore Men
northshoremen.org
Dorchester Gay &
Lesbian Alliance (GALA)
617.822.8360
groups.yahoo.com/group/
dorchestergala
Jamaica Plain Men’s Group
jpmensgroup.com
50 Resources
All Saints Parish, Brookline
617.738.1810
allsaintsbrookline.org
American Baptist
Concerned, National
978.745.8259
rainbowbaptists.org/
abconcerned.htm
Am Tikva, GLBT Jews,
Boston
617.232.5543
amtikva.org
Beacon Hill Monthly
Meeting (Quaker), Boston
617.227.9118
bhfh.org
Cambridge Zen, Cambridge
617.576.3229
cambridgezen.com
Congregation Kahal
B’Raira, Boston
kahalbraira.org
Congregational,
1st Church, Cambridge
617.547.2724
firstchurchcambridge.org
Dignity / Boston, Gay,
Lesbian & Bi Catholics,
Boston
617.421.1915
dignityboston.org
Emmanuel Episcopal
Church, Boston
617.536.3355
emmanuel-boston.org
First Baptist Church,
Beverly
978.922.3295
fbcbeverly.org
Follen Community Church
(Unitarian Universalist),
Lexington
781.862.3805
follen.org
Keshet (Jewish GLBT
advocacy), Boston
617.524.9227
boston-keshet.org
Lutherans concerned,
Cambridge
617.876.3256
unilu.org
Metropolitan Community
Church, Boston
617.973.0404
mccboston.org
Central Congregational
Church, Jamaica Plain
617.524.3343
centralcongregational.org
Resources
51
Old Cambridge Baptist
Church Lesbian & Gay
Group, Cambridge
617.864.9275
oldcambridgebaptist.org
Old South Church Boston,
LGBT and Friends, Boston
617.536.1970
oldsouth.org
Paulist Center Gay and
Lesbian (Catholic), Boston
Brian 617.688.7470
paulist.org/boston/index.htm
Rainbow Baptists, National
Jim 978.745.8259
info@raindbowbaptists.org
rainbowbaptists.org
52 Resources
SGI—New England,
Regional
781.642.8887
sginewengland.org
St. John’s Episcopal Church,
Jamaica Plain
617.524.2999
stjohns-jp.org
St. Luke’s/Margarets
(episcopal), Allston
617.782.2029
stlukemargaret.org
St. Matthews and the Redeemer Episcopal Church,
South Boston
617.269.6175
Trinity Church (Episcopal),
Boston
617.536.0944
trinityboston.org
Support, Social
Groups—Women
Bi Rap (bisexual support)
617.354.6394
cambridgewomenscenter.org
Support, Social
Groups—Men
Boston Bears Bar night,
The Alley
617.263.1449
thealleybar.com
Boston Gay Men’s Chorus
617.542.7464
bgmc.org
Easton Mountain
Retreat Center
800.553.8235
518.692.8023
eastonmountain.co
Gay Fathers of Greater
Boston
617.742.7897
gayfathersboston.org
Long Yang Club (gay
asian men and friends)
617.661.9165
longyangclub.org/boston
Mantalk of Southeastern
Mass.
508.884.8264
Newly Diagnosed Group
(HIV support)
617.457.8142
North Shore Men
northshoremen.org
Boston Prime Timers
(older gay men)
617.447.2344
primetimersww.org
Bi Focus
617.697.9244
Gays for Patsy
(country-western dancing)
617.412.5751
gaysforpatsy.org
Resources
53
Greater Boston Business
Council—GBBC
866.594.4222
gbbc.org
MA Area South Asian
Lambda
617.649.2669
bostonmasala.org
MA Teachers Association
Lesbian and Gay Employment and Civil Rights
massteacher.org/inside/
committees/committees_
lesbian_gay.cfm
New England Leather
Alliance
617.876.NELA (6352)
nelaonline.org
Out to Dance (swing,
latin, ballroom)
617.363.0029
outtodance.com
54 Resources
P-FLAG
Greater Boston:
866.427.3524
New Hampshire:
603.772.5169
Rhode Island:
401.751.7571
pflag.org
POZ Social
617.457.8143 x. 326
POZ 20s
617.457.8143 x. 326
POZ 30s
617.457.8143 x. 326
Queer Asian Pacific Alliance
qapa.org
Somos Latin@s LGBT
Coalition
somoslatinoslgbt.org
Sports & Recreation
Beantown North GL
Bowling League
beantownbowling.com
Beantown South GL
Bowling League
beantownbowling.com
Beantown Softball
League (men’s)
617.937.5858
beantownsoftball.com
Beantown Soft-Tip
Dart League
The Alley: 617.263.1449
Fritz: 617.482.4428
Boston Bay Blades (rowing)
bayblades.org/boston/
level1/index.html
Boston Boasts
(squash group)
bostonboasts.com
Boston Gay and Lesbian
Contra Dancers
lcfd.org/jp
Boston Gay Basketball
League
617.937.5858
bgbl.com
Boston Ironside Rugby
Football Club
info@bostonironsidesrfc.org
bostonironsidesrfc.org
Boston Leather Knights
781.598.5974
Boston Pride Hockey
bostonpridehockey.org
Boston Riders
Motorcycle Club
Greg: 617.266.1772
ridersmc.com/about.htm
Boston Strikers (soccer)
617.937.5858
bostonstrikers.com
Boston Union
Wrestling Club
Will: 774.287.9574
bostonunionwrestling.com
Resources
55
Boston Uncommons
(square dancing)
617.926.9267
617.288.8816
lcfd.org/bu
East Coast Wrestling Club
eastcoastwrestlingclub.org
Flag Football
617.397.5858
Frontrunners Boston
(running club)
frontrunnersboston@
yahoo.com
frontrunnersboston.org
Liquid Assets (swimming)
info@swim-lanes.org
swim-lanes.org
56 Resources
Monday Night Bowling
League
603.401.4267
mnbl.net
OutRiders (bicycling)
617.617.9859
outriders.org
OutRyders (skiing
and snowboarding)
brian@outryders.org
outryders.org
Tennis 4 all
tennis4all.org
Volleyball—CBVA
Mike: 617.522.2882
gayvolleyball.net
Yankee Lambda Car Club
info@Yankeelcc.com
yankeelcc.com
PrideSports Boston
617.937.5858
pridesportsboston.com
Swingtime Boston (swing
and ballroom dances)
swingtimeboston.com
57
For HIV & STD testing sites near you:
gettestedmass.org
For free online advice from medical
and behavioral health providers:
fenwayhealth.org/doctorcox
LIVING WELL
is the best revenge!
WEB
58
fenwayhealth.org
59
WEB
fenwayhealth.org