The NY Times discovers
anal cancer

Bill Weintraub

Bill Weintraub

The NY Times discovers anal cancer


New York Times, February 18, 2003

Some Urge Type of Pap Test to Find Cancer in Gay Men

By David Tuller

SAN FRANCISCO - Some doctors and researchers at major medical centers have started to recommend that gay men undergo regular anal Pap smears to screen for cell changes that could lead to anal cancer.

Although anal cancer is rare in the general population, the risk for men with a history of anal intercourse can be more than 30 times as great, published studies have shown.

Researchers from the University of California at San Francisco, Stanford, the Harvard School of Public Health and elsewhere have also reported that gay men with H.I.V. are at even more significant risk.

An anal Pap smear, which involves taking a swab of cell tissue from the rectum, is similar to the Pap tests that women receive to screen for precancerous cells in the cervix.

Cervical and anal cancers can be fatal if they are not caught early enough. The cancers - as well as cell abnormalities called dysplasia, which can progress to cancer - are linked to infection with the human papillomavirus, or HPV.

"This is something we really need to be paying attention to," said Dr. Joel Palefsky, a professor of medicine at the University of California at San Francisco.

"We've decided as a society that it's important to spend billions of dollars to test for and treat cervical dysplasia before it turns into cancer," Dr. Palefsky said. "And we should also be testing for and treating anal dysplasia in high-risk populations."

HPV is a widespread, though often asymptomatic, sexually transmitted disease. More than 20 million Americans are believed to be infected with it.

A number of studies have reported that sexually active gay men, especially those with H.I.V., are at high risk for anal infection with HPV.

A 1998 study, appearing in The Journal of Infectious Diseases with Dr. Palefsky as a co-author, showed that 61 percent of 262 H.I.V.-negative gay and bisexual men in San Francisco and 93 percent of 346 H.I.V.-positive gay and bisexual men were infected with anal HPV.

Dozens of HPV strains, including ones that cause common warts, have been identified, but only some infect the genital and anal areas. Even fewer are believed to cause dysplasia. And while treatment of dysplasia in the cervix has been proven to reduce the incidence of cancer, there is so far little hard evidence that the same is true for anal dysplasia, despite similarities in the disorders.

Many doctors who treat gay and H.I.V.-positive men still do not screen for anal dysplasia. They point to a shortage of evidence that treating the dysplasia, which can be painful, prevents cancer.

But Dr. Lisa Capaldini, a San Francisco primary care physician, says that anal Pap tests had nonetheless emerged in the past couple of years as a substantial topic of debate among her colleagues.

"This is an evolving field, and it's a very active issue among doctors who treat gay men," said Dr. Capaldini, who does not perform regular anal Pap smears.

Treatment of anal dysplasia involves either burning off the abnormal cells or surgically removing them.

Because the anal Pap smears and the treatment of anal dysplasia are still considered experimental, insurance companies generally decline to pay for them.

But they do pay for treating anal cancer, which usually responds well to a combination of chemotherapy and radiation.

The problem is growing because many men with H.I.V. are taking effective antiretroviral medications and are living long enough to develop anal cancer.

Dr. Palefsky recommends anal Pap smears every two to three years for H.I.V.-negative gay and bisexual men and annually for those who have H.I.V.

Gay men themselves often have not heard of anal cancer. David Maxim, 57, a San Francisco artist, knew nothing about it - until his was diagnosed two years ago.

"I didn't know about HPV, about anal Pap smears, and when I told gay male friends of mine, they didn't know about it either," he said.

A few comments from Bill Weintraub:

First of all, the emphases are mine.

Secondly, if all these gay men into anal are practicing safe-sex, how come 61% of HIV negative men and 93% of HIV + men have HPV?

Here's a hint -- a lot of those HIV neg guys are *barebacking* -- just as I said they are in my article on Bug-Chasers.

Why does that matter?

Because HIV is not the only virus to find a vector in anal penetration.

Indeed, it's difficult to imagine a more efficient means of disease transmission than anal injection of semen.

That's why neither HIV nor HPV will be the last pathogens to find an anal niche.

Of course, I wouldn't like anal penetration if it were safe.

But it's not safe -- it's very very dangerous.

And dirty.

And degrading.

And all those gay boyz out there are livin in denial land -- just as The Black Lotus said they are.

Finally, as it happens I know David Tuller, the author of this NY Times piece.

A couple years back, when he was health editor at, I asked him to do an article on the Frot Movement.

He refused -- three guesses why.

I'll ask again.

But you shouldn't look for succor from a guy like David -- because he's part of the culture and part of the problem.


Bill Weintraub

Re: The NY Times discovers anal cancer


This just in ...

But it's interesting, n'est-ce pas, that Rolling Stone was excoriated for publishing a piece on bug-chasing.

When so many gay men are ... bug-chasing!

AIDS, HIV Up in U.S. for First Time in Decade

Tue Feb 11, 2003 5:46 PM ET Add Top Stories - Reuters to My Yahoo!

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - Reports of new infections with the HIV virus (news - web sites), along with cases of AIDS (news - web sites), have risen in the United States for the first time in a decade, U.S. health officials said on Tuesday.

"AIDS complacency" means people are not getting tested for the virus and are passing it to others through unprotected sex and other practices, said Dr. Ron Valdiserri, a deputy director of the National Center for HIV (news - web sites), Sexually Transmitted Diseases and Tuberculosis Prevention at the U.S. Centers for Disease Control and Prevention (news - web sites).

In the 25 states that reported new diagnoses of HIV infection, there was an 8 percent increase in the number of cases between 1999 and 2001, Valdiserri told the 10th Annual Conference on Retroviruses and Opportunistic Infections, being held in Boston.

"We see a 14 percent increase in HIV diagnoses over this two-year period in men who have sex with men and a 10 percent increase in heterosexual transmissions," Valdiserri said in a telephone interview. About half the new cases of HIV are in women who are infected by men, the CDC says.

The 25 states represented about 25 percent of HIV cases in the country, Valdiserri said, but did not include New York and California -- the two states with the most cases.

"We are very concerned that it could represent a reversal in the trends that we believe have been relatively stable ... at about 40,000 new cases every year," Valdiserri added.

"We have seen a slight increase in reported AIDS cases for the first time since 1993. It is just a 1 percent increase, but it's the first time since 1993."

Infection with the human immunodeficiency virus used to progress quickly to AIDS -- the breakdown of the body's immune system that leaves a patient vulnerable to infections such as pneumonia and some cancers.

But in the United States and other rich countries, most patients have access to drugs that, while they do not cure HIV, can keep them healthy and symptom-free for years.


While welcoming the drugs, health officials have worried that people often forget how dangerous HIV is. "We are still talking about a deadly disease for which there is no cure," Valdiserri said.

"We are still dealing with this perception that HIV/AIDS is not a problem in America -- is it just a problem overseas," he added. "Some people call it AIDS complacency. I think it is an issue among all people, not just people of high risk. We are still very concerned about the estimated 280,000 people in America who are infected with HIV and don't know it."

An estimated 850,000 to 950,000 people in the United States are infected with HIV and 36 million worldwide.

Valdiserri urged doctors who treat HIV patients to remind them about ways to avoid transmitting it to others -- which include safer sex and letting sexual partners know they are infected.

He said the CDC had investigated a number of outbreaks of syphilis among gay and bisexual men that showed between 43 percent and 59 percent of those turning up with syphilis -- which, like HIV, is transmitted by oral, anal and vaginal sex -- knew they were HIV positive.

That suggests the men were having unprotected sex despite knowing they could pass on the virus.

"HIV-infected people need support so they don't transmit the infection to others," Valdiserri said. Busy doctors may have only a few minutes, but nurses and other staffers in clinics can help, he said.

"The patient can even be referred to community-based organizations," Valdiserri said.

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