Category Archives: Gay Health

Gay Men’s Leadership Academy 2008 – West Coast edition

Academy_2008Not to brag or anything…but we were a busy Institute this weekend.

This weekend was also the fourth Gay Men’s Leadership Academy, a sponsored program of White Crane Institute.

We alternate the academies between the west coast and the east coast to make attendance and subsequent networking easier. And, you know…we get bored easily.

East coast academies are held at Easton Mountain and the west coast academies are held in Guerneville at the Wildwood Retreat Center. Both beautiful facilities. Add handsome men, cute young guys and a multitude of bright minds…and you’re talking AWE & WONDER!

We invite you to visit the GMHLA blog set up by the Academy alums. And even more importantly, consider attending. We’re moving Gay Men’s Health into the 21st Century.

Equal Treatment

Michigan Interesting the lengths to which institutions that don’t want to discriminate have to go to provide the same coverage to same-sex couples. This circuitous (to avoid actually saying they’re providing this to Gay couples), and admirable language, from the University of Michigan’s personnel policy, was sent to me by my brother who is on the medical faculty there.

I have to say, what’s even more admirable is his note that accompanied it:

"I wondered whether you’d be intrigued by how the U of M is maintaining its commitment to provide employee benefits to same sex domestic partners while remaining "legal" under the recently adopted Michigan law prohibiting this. Mind you, I’m not proud of Michigan’s law governing this issue, but I am pleased that my employer has come up with a way around it.  Screw the evangelicals if they don’t like this.  I’d like to see their faces when they find that their attempt to create a sexual-orientation-apartheid failed."


“Other Qualified Adult”

All of the following eligibility criteria must be met:

1. Employee and Other Qualified Adult currently share a primary residence and have

shared a residence for at least 6 months.

2. Other Qualified Adult is not eligible to inherit from the employee under the laws of

intestate succession in the state of Michigan*;

3. Neither Employee nor Other Qualified Adult is legally married in Michigan.

4. At least one of the following is true:

– Employee and Other Qualified Adult have a joint checking account; or

– Employee and Other Qualified Adult have a joint savings account; or

– Employee and Other Qualified Adult have a joint credit account.

5. At least one of the following is true:

– Employee and Other Qualified Adult have durable power of attorney for

health care for the other; or

– Employee and Other Qualified Adult have durable power of attorney for

financial management for the other.

6. The Other Qualified Adult has been designated as the primary beneficiary for at least

one of the following:

– A life insurance contract held by Employee; or

– The Employee’s will; or

– A retirement contract (including IRA, 401 (k), 403(b), or pension plan)

held by the Employee.

7. Other Qualified Adult and Employee cannot legally marry each other in Michigan.

*The following individuals do not fall within the eligibility criteria for Other Qualified


· Spouse

· Children and their descendents (i.e. children, grandchildren)

· Parents

· Parents’ descendents (i.e. siblings, nieces, nephew)

· Grandparents and their descendents (i.e. aunts, uncles, cousins)

WC75 – Owner’s Manual – Jeff Huyett

Hitting the Pause Button
By Jeff Huyett

Pausing life for a few minutes can be like hitting pause on a DVD. We step out of the story and can reflect on our place within it. Without a narrative telling us what to feel or think, we can listen to what we hear from within. I routinely ask patients about the way they relax. Often, they tell me that they relax by going to a movie, watching television or reading a book. You can rest your body this way but your mind is still engaged with something exogenous. When do I clear my mind to listen to my body? Are there subtle sensations and discomfort I didn’t notice? When I do stop, become physically relaxed with my mind empty of clutter, how do I feel about myself as a person? What outside stressors in my day-to-day living really matter in the bigger picture of who I am?

This summer I had the opportunity to quit my full-time employment and spend most of my time living at Faerie Camp Destiny. Destiny is the Southern Vermont jewel in the necklace of Faerie Sanctuaries around the globe. The faeries there are building a timberframe and strawbale kitchen. I spend as much time as I can laboring, hanging out, and making music on 166 acres of mountainside woods. My days there are influenced by only a few people. The daily chores of living on a rough commune became the ritual of the place. There is always a little tending to daily food preparation, dish washing, gardening, and water hauling. But in a collective groove these tasks dissipate through the numbers and chores become simple.

At Destiny, my body feels relaxed and typically devoid of any tensions in my neck or my mind. When stressors arise, I am very aware of them. I simply attempt to diffuse them and my body and mind are back to their "baseline" place. Things feel well and right. I can cope with any obstacles in my day or my carpentry work. When I  am rested and make music with the faeries, art comes pouring out of me. In sleep, my dreams seem more vivid in sight and sound. I remember them in the morning. Twice this summer I had flying dreams that were so real to me that, when I awoke, I had that woozy feeling of centrifugal force.

In August I started working a few days a week at the queer health center in NYC. I spend two to four days in the city and head back up to Vermont each weekend. The contrast is sometimes startling but very instructive. Drinking coffee before work on the roof of my loft, I look at the view of Manhattan. The vista is breath-taking and gives me such a deep sense of awe first thing in the morning. I get the same open, expansive feeling I have at Destiny. Then, something happens. I become aware of the time and a schedule descends on my self. I tense up as a list of morning accomplishments forms in my head. I need to prepare to leave, get on a subway, call so-and-so, then arrive to work on time and keep on schedule all day. All of the sudden, I’m governed by a sense outside of me that takes my mind out of my body. The expectations of the day seem to compel me from without instead of the desires from within. A sense of irritation begins to bubble within me.

This is just an excerpt from this issue of White Crane.   We are a reader-supported journaland need you to subscribe to keep this conversation going.  So to read more from this wonderful issue SUBSCRIBE to White Crane. Thanks!

Owner’s Manual is a regular feature of White Crane. Jeff Huyett is a nurse practitioner in NYC. His clinical work has primarily been in Queer health with a focus on HIV, rectal and transgender care. He is the Radical Faerie Daisy Shaver and is involved with the development of Faerie Camp Destiny Radical Sanctuary in Vermont and can be reached at

WC74 – Owner’s Manual – Jeff Huyett

74_ownersmanualHealth Dogma or Smorgasbord
By Jeff Huyett

I recently heard a young Muslim man speak about religious plurality. He noted that much of the conflict occurring between the Judeo-Christian and Muslim worlds is based on a religious absolutism that prevents discourse between the religions. Each has the philosophy that its path is the one true path to holiness or the Divine. All others are infidels or non-believers in need of salvation or enlightenment. The work of these religions is, then, to proselytize to those outside their belief system to change their belief to be the same as theirs. Thus, conflict arises because each believes that theirs is the only true way. This young man’s notion was that modern day religions must accept the beliefs of others as possibilities to remove the innate conflict. Were religions to embrace this philosophy, much of the conflict of between monotheistic religions would begin to dissolve as each could embrace the other as heading down a path to the Divine though it may be a different path than their own.
Health beliefs are often similar. We tend to believe that one philosophy is better than others. We adhere to a method and believe that other ways are just not as healthy. Sometimes this absolutism can create conflict with others and strict adherence may actually be causing harm unbeknownst to that person.

In the burgeoning HIV epidemic of the ‘80’s, Western Medicine had limited answers and even less treatment for those living with the disease. In the midst of an emerging “New Age” philosophy, many Gay men and other folks with HIV turned to “alternative and complementary therapies” to find healing and treatment for their disease. In the era when AZT was prescribed in very high doses, many people avoided this treatment which was sometimes as deadly as HIV itself. Desperate for relief and healing, people with HIV energized many of these older philosophies toward healing in this country. This expanded interest in alternative methods has continued and grows even today. The growth of complementary therapies has even stimulated development of regulation of  these therapies through the Food and Drug Administration much the same as pharmaceutics.

Many “alternative” methods for health are older than modern medicine. Their roots come from traditional healers and practitioners who existed long before “medicine” was organized. As a nurse, I honor the importance and place of these methods in patient care. But sometimes users of these methods can adhere to a sort of dogma about health and health practices that collides with the views of doctors or nurses in this country.
There exists today, still, people who do not believe that HIV is the cause of immune suppression that can lead to opportunistic infections that define AIDS. I’m still baffled when I meet patients who refuse to believe that HIV is the cause of AIDS and refuse to test to see if they are infected. Because I believe in the practice of collaboration with my patients, I try hard to relate to patients with these beliefs and find a way for us to hit common ground in our relationship. It’s not always easy.

It is incredibly sad when I provide an HIV-positive diagnosis to someone who has become ill with an opportunistic infection and it is their first knowledge of having HIV. It just doesn’t make sense to me for someone to avoid testing because they don’t believe they will become ill with HIV. An infection, like pneumocystis carnii pneumonia, occurs and can be deadly if treatment is avoided. And the scarring caused by this bug can cause breathing problems for the rest of the person’s life. HIV wasn’t in the patient’s belief system, they wouldn’t get tested, and their immune system failed before they even knew they were ill.

I used to be very touchy-feely with patients like this to honor their beliefs. Today, it’s just too difficult to let this kind of belief slide. I have to confront this denial and ignorance as I cannot watch another person die senselessly by their own misinformation. These patients will tell me that HIV isn’t the reason that people die and that they die from the antiviral therapy that is prescribed. Since I lived through the times when I watched a patient a week be buried, I just cannot keep my cool. I tell them directly, “If HIV is not the cause of AIDS and the meds are poison, why is it that people are not dying like they used to before the ‘cocktail?’” Or, “With your disbelief you dishonor all the men and women who have died before there actually was effective treatment.” Typically, when a patient will not come around to understanding HIV as the cause of AIDS, I have to refer them to another provider. Our relationship just won’t work effectively for either of us. Now, I understand that we don’t have all the answers about HIV and it’s natural history and treatment, but I feel pretty confident that we are heading in the right direction.
This type of extreme belief isn’t especially common but I come across it often enough. I even have providers send patients to me to try to help them work through their disbelief. But this really isn’t the role I like to play. I like the role of collaborator with the patient. I like to work with patients to understand their bodies and the particular illness with which they are bothered and come to some level of healing path that will ensure their health as well as maintain the integrity of their beliefs.

Commonly, I will encounter a patient who needs a particular pharmaceutical to treat their illness but they’ll refuse to take anything. I’m comfortable with recommending non-prescriptions for treatment. I like to have patients adjust their diet and change their lifestyle as a way to improve their health. Prescription medicines are commonly the last thing I recommend. But sometimes, a patient says “I don’t take pills,” or “I won’t use prescription medicines.” At the same time, these patients often use a variety of herbal and supplement preparations that they will take multiple times a day.

They use complex regimens of pills, powders and pastes that can make even a complex HIV regimen look pretty simple. They will adhere to a regimented diet that limits their ability to interact and socialize. They worry about getting in their treatments to such a level that can cause them great anxiety. I’ve never felt that this kind of management was very healthy.  I use the term “health monotheism” to describe patients who completely reject all other methods of health and healing for the path they have chosen.  There is no one path to health that I believe is completely right. And while most complementary therapies are fairly safe, some can be just as dangerous as the medicines that come from big pharmaceutical companies.

One example is a young woman I saw who came to see me because she was feeling fatigued, had a poor appetite, and felt depressed. I spent time talking with her about her health beliefs, assessing health patterns and choices, and doing physical exam. Generally, she had been very healthy through her life. She disclosed that she was taking high doses of chamomile to reduce anxiety she was having. She had heard it was safe and helpful to calm her and had been dosing in this high range for three months. She was pleased with the results but was now concerned about these other symptoms that had arisen. She was working with an energy healer and acupuncturist.

She typically engaged a physician only when she her acupuncturist told her or when her current practitioners could not relieve her symptoms. She voiced distrust of the “big medical machine” and doctors. She had never seen a nurse practitioner and hadn’t had a women’s health preventative exam in over five years. (This is the exam that checks one’s breasts and cervix for early detection and prevention of cancers.) When I felt her liver I noticed that it was tender and mildly enlarged. Assuming she had a hepatitis virus, I did the typical battery of liver tests and immunological tests. There were no signs of infection but obvious liver inflammation. I recommended she stop the chamomile immediately and come see me in two weeks.  She did this and her liver tests came back to normal range. Her presenting symptoms were relieved.

While this clear-cut example isn’t common, the disdain for the US health care system is. Certain personal events or community norms can shape our trust in the people we seek out for advise on healing. One bad experience can color our future with any provider. When one method or clinician fails us we can grasp on to one type of philosophy and then adhere to it religiously. This is when our health monotheism can lead to a dogma that can be harmful.

In my last column, I encouraged readers to find a provider with whom they are comfortable and find it easy to develop a relationship. The primacy of our relationship with a healer is really the most important part of the healing relationship. We work with someone who gets to know us and our beliefs, is familiar with our bodies, and the subsequent recommendations come from this relationship of knowing. For basic wellness and health promotion, there exist many methods within the various philosophies, each with a grounding in history, repetition, and, sometimes, research. When an illness or lack of health creep in, various philosophies tend to diverge on causality and thus, can create discord between the beliefs about the best way to heal.

Since health is individualized, I don’t believe one method is better than another to achieve health. For myself, and for patients, I believe that the best approach to healing is first to be well informed. I recommend that one seek information from various sources to achieve an understanding about what is going on in their bodies. The patient is the one who is best at knowing what is going on since they reside in their bodies. But their information about their bodies may be so skewed as to cause misinterpretation. This is where a consultant can be beneficial. Chinese medicine, for example, is drastically different from Western medicine in causes of illness and treatments. So many of us, then, have an opportunity to seek guidance from two very different modalities in order to be better informed about our experience of our bodies. We don’t have to believe everything about either philosophy in order to gain from its wealth. But each can provide a rich source of information with which to make decisions.

I typically find that the patient who does best is the one who is informed and bases their decisions on that information. So a plurality of beliefs can only benefit us when it comes to our health. If no one method is perfect, then this variety of information sources can only improve our own path to health by providing us with a broader range of health choices and selections. We can take the relevant information from the various philosophies to develop a plan that suits our own personal need.

I encourage the health absolutists to explore a variety of methods. Thus, when a patient is completely sold on one method, I encourage them to talk to another type of clinician for an opinion about where their body is and how it is responding to the current practice the patient is keeping. Since physical assessment varies between philosophies, one clinician may uncover something a clinician from a different paradigm failed to unearth. This disparity of philosophy then provides for a broader range of assessment and method. So gaps in one philosophy can be filled in where another philosophy lacks.

If you have only seen physicians for your health care, consider seeing a clinician from a completely different paradigm. See an acupuncturist or body worker or even a nurse. Expand your notion and understanding of your body and your particular concern. If you see only “alternative practitioners” consider an evaluation with a physician, nurse practitioner, or physician’s assistant to evaluate, in Western terms, the results and consequences of various therapies on your body. Though the research paradigm in Western medicine continues to be questioned, it can give us many valuable answers about the operation of the body that are readily objective and easy to interpret. So when a patient is using a therapy not extensively researched, that patient can use well-proven methods to evaluate outcomes.

The danger of absolutism is what you miss. An example is monitoring labs like the woman doing the chamomile. Though we may feel well, some treatments may have a long-term impact on the body. We do not have to do everything that our healers recommend. But we can enter and continue our path to health and wellness with our eyes wide open. We can use the wealth of information available to make conscious informed decisions as opposed dogmatic adherence.

This is just an excerpt from this issue of White Crane.   We are a reader-supported journaland need you to subscribe to keep this conversation going.  So to read more from this wonderful issue SUBSCRIBE to White Crane. Thanks!

Owner’s Manual is a regular feature of White Crane. Jeff Huyett is a nurse practitioner in NYC. His clinical work has primarily been in Queer health with a focus on HIV, rectal and transgender care. He is the Radical Faerie Daisy Shaver and is involved with the development of Faerie Camp Destiny Radical Sanctuary in Vermont and can be reached at

WC74 Review of American Psychiatry & Homosexuality

Rvu_drescher_4 Book Review

American Psychiatry
and Homosexuality:
An Oral History

by Jack Drescher, MD and Joseph P. Merlino, MD, Harrington Park Press, ISBN: 978-1-56023-738-6
299 pages, $29.95

Reviewed by Joe Kort

Growing up Gay or Lesbian, one of our greatest losses – if not the greatest – is not having any rich stories and instructive tales passed down to us by those before us. Usually parents, grandparents, aunts, uncles and other elders pass on family jokes, fables, and stories about their pasts and our own. They tell us things like where nicknames came from, why last names changed after arriving from the old country, how and why their parents behaved and believed in the old days family lore and family history.

But now bookstores are offering an increasing number of titles archiving past events and the recent evolution of homosexuality. As a Gay psychotherapist, I have an interest in the history of how my profession handled — and mishandled  – homosexuality. American Psychiatry and Homosexuality: An Oral History provides an excellent resource for regaining and more fully understanding this knowledge. This book contains numerous  interviews of  those who pioneered the de-pathologizing of homosexuality and helped remove it as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders, the reference source mental health professionals use to diagnose the clients we treat.

Each time I sat down to read this book, I chose to imagine that I was sitting at the feet of those being interviewed, and that they were telling me stories the way my grandmother and other family elders did with me as I grew up — stories that intrigued me, angered me, made me cry and made me laugh out loud.

Without this kind of oral history, our pasts would be lost, individually and collectively. This book sets the Gay record straight.

The cover illustration is a haunting photo of a man wearing a mask that resembles something from the horror movie, The Hills Have Eyes. Under that mask is Dr. John Fryer, M.D., a psychiatrist who, in 1972, spoke at a psychiatry panel on homosexuality, appearing as “Dr. H. Anonymous,” disguising his true identity — and even his voice. In those days to come out as a Gay psychiatrist meant a ruined career.

Fryer came to this meeting to de-pathologize homosexuality, telling about those Gays and Lesbians who were not troubled and did not seek out therapy. John Fryer took the first public step for us all, clinicians and laymen alike.

I knew that homosexuality was removed from the DSM in 1973, but was aware that Gay political pressure played no role in the APA’s decision to have it removed — as anti-Gay therapists Drs. Irving Bieber and Charles Socarides later claimed. In reality, according to transcripts in American Psychiatry and Homosexuality: An Oral History, the decision was “influenced by the weight of scientific studies” and a vote by the APA’s Board of Trustees, with two abstentions.

I first learned about Bieber when I was in college, writing a paper on why homosexuality was a disorder and should be considered so. I was, then, in my own early stages of coming out and, not wanting to be Gay, sought out literature to support my denial and write that paper. I still have that paper, to keep and archive my own personal journey.

Just as the pioneers transcribed in this book have something to teach those of us coming up — and out — behind them, so do we, the next generations, have something to teach them as well. In an interview, Charles Silverstein, Ph.D., psychologist and well-known author of The Joy of Gay Sex, speaks out against other Gay therapists who, he says, “condemn other Gay people’s sexual behavior” by diagnosing sexual compulsivity. He suggests that Gay therapists using that diagnosis are doing the same to other Gays as heterosexual therapists did, which is to “diagnose these people as suffering from some illness because you’ve identified with society’s rules.”

On this area of expertise, Silverstein could not be further from the truth. Or at least now we know there are gradations and differentiation. As one who specializes in treating sexual addiction and compulsivity, I use this diagnosis very carefully with men and women, both Gay and straight, who suffer from compulsive sexual acting-out, without experiencing pleasure. This is not based on my “moral views” as Silverstein claims, but their own recognition of compulsive, dangerous and life-threatening sexual behaviors resulting from trauma in early childhood, not on being Gay. Still, I appreciate Silverstein’s questioning concern and hard work that resulted in restoring homosexuality to its rightful place of normalcy.

There are details in this book that make me laugh out loud at how insane things were in the 1970s and before. One interview subject — Robert Jean Campbell III, M.D., well-known for Campbell’s Psychiatric Dictionary — recalls how anti-Gay analysts Bieber and Socarides were at it again, trying to keep homosexuality diagnosed as a disorder in the DSM. Asserting that some homosexuals underwent an “identity crisis,” they invented a diagnosis called “sexual orientation disturbance” until someone pointed out that the acronym for “sexual orientation disorder of male youths” is sodomy.

For this reader, one very enlightening interview was with author and psychiatrist Dr. Richard Isay, M.D. who helped openly Gay men and women to be accepted in Analytic Institutes to learn psychoanalysis. Before that, you were rejected if you were openly Gay. Early in my career, Isay’s books, Becoming Gay and Being Homosexual inspired me in developing my work with Gay men, providing psychotherapy to and facilitate retreats, workshops and groups for Gay men. I enjoyed reading how his beliefs about orthodox psychoanalysis changed, and how he let himself grow and re-think the assumptions he had learned and used for years — creating change not only on the outside,  but on the inside as well. I say lived what he preached.

All of the pioneers in this book paved the way for me so that today I could be an openly Gay clinician, publishing books on being Gay by both Gay and non-Gay publishing houses. I feel honored and proud to stand on their shoulders, knowing the pain they went through to help us get to where we are today — liberated!

This is just an excerpt from this issue of White Crane.   We are a reader-supported journaland need you to subscribe to keep this conversation going.  So to read more from this wonderful issue SUBSCRIBE to White Crane. Thanks!

WC73 Owner’s Manual – Jeff Huyett

73ownersmanual_3 This regular column will explore queer health in America today. In the nursing tradition, I view health in the dynamic interplay of mind, body, and spirit within a culture, an environment, and a time. I hope to foster in the reader a sense of understanding and empowerment to move closer to health.

I came out in college, studying to be a nurse when HIV emerged in the early ‘80s. This confluence of events colored my professional and personal life. I’ll share some of my experiences of nursing queer people shaking off dis-ease by changing themselves and the world around them during, through and after that era.

Health cannot be achieved alone. It is not a commodity that someone can provide you. I hope to challenge the readers’ assumptions and encourage health action in a culture, an environment, and a time. 
Like most Americans, I have found myself standing, thirsty and dazed, in front of a convenience store beverage cooler spilling over with choices. There is just so much from which to choose. The confusion starts when I begin to compare price, content, or expected result. Mass marketing impacts my selections, too. I sometimes get exasperated by all the choices, give up and buy water. Health care choices can be just as overwhelming. Flashy media images promote people, services, and “clinically proven products” as readily as grocery store selections. This writing will explore the concepts of health and the current paradigm in which it exists.

Health, the concept, is complex to define. It is experienced individually, so it eludes common description. For discussion’s sake, let’s say that health is “a state of optimal well being of the mind, body and spirit.” Factors that impact health are personal, social, genetic, economic, cultural, and environmental. These systems interact and impact on each other.

Health is multi-factorial requiring on-going upkeep, evaluation, and change in the individual, its family, culture, social structure, and environment. When neglected, health will diminish. When optimized, health will flourish. Health, then, is a practice we follow through life. It’s not static. Upkeep on a healthy path requires consciousness of the individual as well as society. Conceived in this broad sense, health considerations must permeate the individual, its people and ways of being in order to be achieved. Health of a species and its environments is then a dynamic interplay toward balance.

In the American medical model, health is the absence of illness. If we don’t get sick we must be okay. Health is something obtained like a product. If we get ill, we go to the doctor. We’re told what’s wrong and what to do. This interaction, pills or treatment costs money. Americans are set up with the paradox that if one is insured, one has health. When nothing is wrong, you don’t get assessed. Consequently, when you have no insurance, you will engage the system only when you absolutely must. In the midst of a health crisis your overall health will not likely be considered. Wide variations exist in access to health care. This model of disease treatment as health has been ingrained in the American psyche.

Entering the fee-for-service health care system is when the dazed confusion begins. There are lists of plans and lists of providers. How do you choose? Does advertising pressure affect your health choices like it does your beverage selections? When we land a job providing health insurance, a plethora of forms and insurance booklets will be presented. We’ll make decisions with little time to overview the insurance plans. A sense of “Phew, I’m employed. I’m covered” may occur. But what are we covered for? Participating providers are organized based on disease states treated like cardiology, dermatology, and gynecology. There’s something called “internal medicine.” Whatever that means! Who do we — healthy people — consult if we want to stay well? You guess who and what is right for you. Sometimes you hit it. You are provided attention pretty much only if you’re sick, right? Gay men have to argue with insurances to get specific preventative coverage like hepatitis vaccinations and human papillomavirus screening. Newborns and students get hepatitis vaccinations paid for, but gay men, who get lots of hepatitis, cannot. Millions of Americans are uninsured. Striations of health care beliefs and patterns run through our culture when access is so varied.

I grew up in the 60’s and 70’s watching a minimum of two-to-three hours of television a day, like most everyone else. Food and beverage advertising came streaming at me. Most of the food was boxed, canned or frozen, usually sugary or fatty, and easy to prepare. Shows on health were tucked away in obscure hours. Cigarettes and alcohol were advertised. There weren’t many brown-skinned folks in television.
In school PE was about sports not fitness. Health education was nine weeks of one-hour lessons with nothing about sex, emotional wellness, or drugs. My mother had to sign permission to take the classes on Evolution and Reproduction in Advanced Biology. If one joined 4H or the Boy Scouts you’d get great health and safety teaching. If you are gay you cannot join the Scouts. I had a basic understanding of my body but sought out that information. I got a usual middle class education and was armed to leave my mother’s home with a fairly good idea of how to take care of myself. My male college peers, I observed, were not so prepared. They had limited ability to prepare food for themselves, manage their garments, or tend to themselves when ill. In my interactions with patients I find that most people have a pretty poor understanding of how their bodies work, and have a huge range of notions about ways to take care of themselves. I also experience that Americans have a lot more reserve and shame connected with showing me their bodies. Thus people enter into the current “health care system” with limited basic operating instructions about themselves or the systems of delivery and are probably self conscious and awkward.
The development of the Internet, in the age of AIDS, allowed queer people to get information lacking in our meager health education systems. I find patients coming to me much better informed, but with much more commercially biased information. Once again mass media and marketing have a dizzying effect.

In my female-dominated profession I embrace nursing, its history and culture. Part of that history is domination by modern medicine, a mostly male profession, over the existing health delivery and beliefs systems. The “wise women” in villages, witches, Native American healers, and midwives are some of the fore bearers of the knowledge I use as a nurse practitioner. Much of that oral tradition of healing was lost with the genocide of witches and local healers. Nursing theorists discuss this time as the political beginnings of the medical associations to suppress “the women who keep the people healthy and out of hospitals” and prevent the study of disease. My feminist leanings, as well as my first-hand personal, political, and professional experience of HIV, have made me distrustful of modern medicine, the public health system, and pharmaceutical industry.

The queer health movement shakes up the American health care system in radical ways. When the needs of people living and dying with HIV increased in the 80s, legions of gay men and lesbians set up networks of care and services. Not waiting for the existing health care system to respond, we set up our own systems of support, nutrition, counseling, and financial assistance. Queer clinicians provided health care to the masses, but weren’t reflected in health statistics, research or policy. Our exploration of our own health needs now pressures the medical and public health systems to evaluate and attend to our particular concerns. Queer health consumers have invigorated “alternative” health methods, often older than modern medicine, when Western modalities fail.

Our medically-oriented, disease treatment model of health is not sustainable. We’re witnessing this with inflation of costs, reducing of service and the demise of Medicare. We could say, then, that the existing dominant medical paradigm of health care is utterly flawed. The uninsured and many others must seek out methods for health that the existing structures just don’t provide or support.

Physicians study disease; Nurses, wellness. It is time for the over-arching paradigm to be informed by a philosophy more realistic to the multi-faceted human experience health. Nursing is one philosophy. There are others that view the human as an integrated whole such as Ayurveda, Acupuncture, or naturopathy. 
Let us envision a different health model. First, health teaching, not generated by the commercial industry, permeates our culture and schools. Health basics become as important as reading, writing and arithmetic. Health messages would address mind, body, and spirit. All citizens would be fed, dry and comfortable and national policy would reflect this reality. Periodic health assessment by a provider would include your image and knowledge of self, your ability to care for yourself, understanding of growth and development, aging, common afflictions and how to tend to them. The assessment is informed by cultural, spiritual, economic, and social knowledge. This patient-centered evaluation method assesses your level of health, the risks faced, and the ways to improve and prevent based on your historical, cultural, and genetic package. The assessment happens periodically when you’re well and able to comfortably interact. If you get sick, you engage this provider, informed of your being, to get advice and recommendations based on a much deeper understanding of you, not just the disease. You develop a relationship with the provider and trust them. Your health partner will not know everything, can admit that, and help you find answers when they don’t have them.

This ideal health care system isn’t close to reality today. Continue to learn about yourself, your body and each other through information and education. Be an on-going student of the human race. Take time to be conscious of yourself, those around you and your environment. Adapt and change based on the needs of you and your community. Find a healer with whom you feel comfortable. Interview and ask questions about provider and philosophy. Get referrals from friends. You want to feel welcomed, open, and prepared to share and receive. If there is no spark of connection find another. Not all healers assess mind/body/spirit. Look for someone who does. Ask questions. Manage personal risk. Be open to incorporating various modalities and professionals. Rigid belief or practice is probably as detrimental as no practice. Mostly, be sustainable. Make health a routine in your daily life through simple, ritualistic care and observation of yourself, others, and the environment around you.

I have been accused of being utopian more than once. To sustain, health requires a revolution of self and the world in which we live.
Humans, as organic beings, are capable of this change.
The story of evolution is proof…if you believe in that sort of thing.

This is just an excerpt from this issue of White Crane.   We are a reader-supported journal and need you to subscribe to keep this conversation going.  So to read more from this wonderful issue SUBSCRIBE to White Crane. Thanks!

Owner’s Manual is a new, regular health feature of White Crane. Jeff Huyett is a nurse practitioner living in NYC. His clinical work has primarily been in queer health with a focus on HIV, rectal and transgender care. He is the Radical Faerie Daisy Shaver and is involved with the development of Faerie Camp Destiny Radical Sanctuary in Vermont and can be reached at

WC72 – Our Bodies: HPV & Gay Men

Our Bodies
Yes, I’m Talking to You!
A Conspiracy of Silence about Gay Men’s Anal Health

By Jeff Huyett

If you have watched television over the last six months, you’ve seen public service announcements and advertisements about the advances in prevention of human papillomavirus (HPV)-related cancers.

Thankfully, a vaccine has been developed that will prevent nearly all cervical cancers and genital warts in women. Sadly, one will only see a female face in regards to the prevention of HPV-related cancers. Gay men, who face a much higher risk to develop HPV-related cancers, are non-existent in advertising and public health announcements about these medical breakthroughs.

72_ourbodiesCurrently, gay men develop anal cancers due to HPV at the alarming rate that women developed cervical cancer forty years ago when preventive screening began. That means that HIV-negative gay men develop anal cancers at a rate four-times higher than cervical cancer in women today. HIV-positive gay men develop anal cancers at nine times the rate of cervical cancer. Yet most gay men haven’t even heard about HPV. They do not know that methods exist to prevent the development of anal cancer due to HPV. HPV is the most common sexually transmitted infection with six million new infections each year.

Policy-makers and public health officials have known that gay men are getting anal cancer at increasing rates. Scientific papers in medical journals have reported the increase of anal cancer in men in cities like San Francisco for some time now. Why is it that gay men are not afforded the same kind of preventive screening as women if the risk is so much higher?

Just twenty-five years ago, I was part of a small number of gay men’s health advocates sounding the alarm about the impending HIV tsunami in large Midwestern cities. We were told not to worry, this “gay cancer” was only going to happen in New York, Los Angeles, and San Francisco. We knew different. We’d already buried gay men whose families has refused their bodies after they died. We also developed a healthy skepticism for public health officials who relied heavily on outmoded data collection systems and worked in a homophobic climate.

As a gay men’s health advocate during those twenty-five years, I find myself, once again, sounding an alarm about a health issue that impacts gay men more heavily than others and, yet, is being ignored by policy makers, insurers, and even gay men and their health care providers. The alarm isn’t as loud as twenty-five years ago when I watched friends, lovers, and patients dying rapidly from HIV. Nearly 2,000 men a year will be diagnosed with anal cancer. The cancer is treatable with chemotherapy and radiation treatments and it’s dangerous if it spreads throughout the body. The most alarming part, the part about which I speak most loudly, is the ignorance and inaction of gay men, health care providers and policy makers.

While anal cancer isn’t that common, it’s preventable. But you can only prevent anal cancer if you know you have HPV, are screened and have the precancerous areas treated. You can only do this if you live in an area where anal Pap smear testing is available and resources exist to provide preventive follow-up.
So why aren’t these methods employed? Clearly, one reason is homophobia — on the parts of public health officials and gay men themselves. You only have to read the Center for Disease Control’s (CDC) webpage on “HPV in Men” to see the blatant disregard for our health:

“The risk for anal cancer is seventeen times higher among gay and bisexual men than among heterosexual men.”

“There are currently no tests approved to detect early evidence of HPV-associated cancers in men.”
A lie.

The anal cytology test that screens for tissue changes can detect HPV-related cancers in the anal canal and is approved by the Food and Drug Administration. The test to screen for the HPV virus itself, while approved to screen a woman’s cervix is not approved to screen the anal canal for HPV.

The medical establishment — including gay health providers — is waiting for the study that proves that the prevention methods work. Specialists, like me, have been employing various methods to prevent the growth of HPV-related tissue mutations for nearly 10 years. We see it work to prevent cancer. We do not witness cancer develop in those who have preventive treatment. But clinicians demand that therapy be absolutely proven before employing screening. How do you research a currently employed method? You give half the subjects the treatment and you give have the subjects no treatment and see who gets cancer. This just isn’t ethical research when the prevention method is already employed and appears effective in those who use it.

Some officials say we shouldn’t recommend screening and treatment until we have more answers. This was not the approach taken to prevent cervical cancer. We didn’t even know HPV caused cervical cancer when clinicians began screening and offering preventive treatment. But it was considered poor practice not to enlist the methods available at that time to do everything possible to prevent cervical cancer. And it worked. Cervical cancer has been reduced by 500%.

During the HIV epidemic, clinicians like me became used to working in an information vacuum. We learned to keenly read scientific papers, experiment for non-existent treatments, and give full attention to layers of homophobia that existed in policy and procedure. In this information void, with no HIV treatment, we heartily encouraged gay men to run and get tested for HIV.

Anal cancer, and the tissue in the anus that it affects, has many similarities to cervical cancer. We do have an existing model of information to rely on — gynecology. Like other health issues, one employs existing knowledge about a disease state until more details of the disease emerge. I readily employ the methods of anal screening and prevention and see it work! My skill as a gynecological practitioner has informed me in the treatment of these HPV-related tissue mutations. Any gay-friendly health care provider interested in providing comprehensive health can do this.

A simple swab in the anus can detect the presence of abnormal cells. “Anal cytology” is an FDA-approved test and it has utility to inform the patient and the clinician about abnormal anal tissue. More precise examination and testing of anal tissue can isolate precancerous lesions and then one of many “ablative” techniques can be employed to remove this mutated tissue in-office. So why aren’t these methods demanded by gay men who are at risk?

I believe that gay men are plague weary from HIV. I believe that we are reluctant to address another health issue related to our sexual practices so just don’t advocate on our behalves. But, I find it astonishing, that in the midst of the HIV pandemic, we are unaware of another important health risk. Clearly, anal cancer prevention means we have to acknowledge we have butt sex. It dredges up the feelings of homophobia that we thought we had dealt with long ago. To screen properly, and to achieve optimal health, we must honestly admit to our sexual practices.

There is, still, a stigma to anal sex even in gay male communities. Bottoms are considered “less than” tops. For some, anal sex is considered “dirty” and therefore shameful. Even though research shows 40% of heterosexual women have engaged in butt sex, gay men are considered to have a corner on the market of this equal opportunity sex organ. Our sex is still considered unnatural. And we continue to own the shame that is contributed to that part of our body.

The anus is a nether region of the body not commonly inspected or felt by health care consumers or their providers. Standards of care for gay men do not always include inspection of the anal canal if one is having anal sex. It would be unconscionable to forego inspection of the vagina in a sexually active woman. Again, we do not apply the same standard of care for gay men’s sexual health that we provide to women. There should be no more shame in having testing for anal cancer than there is for women who have annual cervical Pap smears.

Like HIV, nothing related to anal cancer will likely change until gay men speak out. We learned this lesson with HIV. No one is looking out for gay men’s health so we must do it ourselves. It is time to demand changes in the health care system to bring our health screening and prevention methods into the modern age to reflect our risk. We must educate ourselves better about potential health risks, especially those that are ignored by governmental and officious bodies who are going to reflect the climate of the federal administration.

It is time that we become aware of anal health risks and prevention practices. We must do this for ourselves. No on else will.

In a recent letter I wrote to the CDC, I exclaimed my dismay that they were doing nothing helpful to prevent anal cancer in gay men. I explained that I would not be silent. I would continue to dog them as they clearly did not have my ass covered.

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This is just an excerpt from this issue of White Crane.   We are a reader-supported journal and need you to subscribe to keep this conversation going.  So to read more from this wonderful issue SUBSCRIBE to White Crane. Thanks!

Jeff Huyett is a nurse practitioner living in NYC. His clinical work has primarily been in queer health with a focus on HIV, rectal and transgender care. He is the Radical Faerie Daisy Shaver and is involved with the development of Faerie Camp Destiny Radical Sanctuary in Vermont and can be reached at 

Our Bodies is a regular feature of White Crane.