April 15, 2013 - A new study indicates that young men who have sex with men (YMSM) around the world experience higher levels of homophobia, unstable housing, violence, and other factors that hinder access to HIV services, compared to older MSM. Conducted by the Global Forum on MSM & HIV (MSMGF), the analysis shows YMSM fare worse than older MSM in their attempts to access numerous HIV services, including HIV treatment. 

“Existing data indicates that rates of HIV are rapidly increasing among YMSM in low and high income countries alike,” said Dr. George Ayala, Executive Director of the MSMGF. “However, most research fails to disaggregate data focused on YMSM from broader samples of MSM and young people, making it impossible to understand the unique needs of this population. This is the first study to look at these issues among YMSM on a global scale, and the results are alarming.”

The analysis uses data from the 2012 Global Men’s Health and Rights study (2012 GMHR), a multilingual online survey of 5779 MSM from 165 countries, including 2491 YMSM (aged 30 and below). Data from YMSM participants was examined to assess levels of access to HIV services and factors that impact access to services for YMSM. Results are presented in a new policy brief entitled “Young Men Who Have Sex with Men: Health, Access, & HIV,” released today by the MSMGF.

The policy brief reveals that only 33% of YMSM surveyed reported that low-cost condoms were easily accessible, and even lower percentages of YMSM reported easy access to low-cost lubricants (18%), low-cost STI treatment (14%), HIV education materials for MSM (9%), and HIV risk reduction programs for MSM (7%). Of participants living with HIV, nearly half of YMSM with a CD4 count below 350 were not engaged in treatment (44%), compared with 17% of older MSM. Only 38% of YMSM living with HIV reported viral suppression, compared to 73% of older MSM.

Findings also indicate that 20% of YMSM surveyed had no income and 30% had no stable housing, which have both been linked to greater HIV vulnerability and reduced access to HIV services. Compared to older MSM in the 2012 GMHR sample, YMSM experienced significantly higher levels of homophobia and violence. Among all MSM surveyed, homophobia was significantly associated with reduced access to condoms, lubricants, HIV testing, and HIV treatment.

“While homophobia can be damaging to gay men of all ages, it can be particularly harmful to younger gay men,” said Daniel Townsend, MSMGF Steering Committee member. “Like many young people, they often have no income and depend on family for housing. If their family does not understand or accept their sexuality, they risk ending up on the street. Without stable housing or resources, many young gay men face extreme challenges in meeting their basic needs.”

YMSM not only reported greater barriers to HIV service access compared to older MSM, they also reported significantly lower levels of community engagement and comfort with service providers. These factors, along with family support and availability of safe spaces, were associated with increased access to HIV services among MSM of all ages in the 2012 GMHR.

“This data shines light on our collective failure to ensure that YMSM have the resources they need to keep themselves healthy,” said Dr. Ayala. “Moreover, it is a powerful reminder that HIV among MSM is an international development issue, inextricably linked with housing, health, education, and security. Donors and policy makers must treat HIV among MSM of all ages with the same level of urgency afforded to other international development priorities, and they must take concrete steps to ensure that the unique needs of YMSM are accounted for.”

Produced in collaboration with the MSMGF Youth Reference Group, composed of 18 YMSM advocates from 11 countries around the world, the policy brief concludes with a set of recommendations for addressing HIV and its social drivers among YMSM. Recommendations include addressing housing stability and economic dependence, providing comprehensive HIV prevention tailored to the needs of YMSM, improving treatment and care for YMSM living with HIV, taking action to reduce barriers and increase facilitators to HIV service access among YMSM, and supporting YMSM leadership and involvement in the HIV response.

The full policy brief can be found on the MSMGF’s website  here. http://tinyurl.com/br5qn6d.  

Vaccine Alert issued by Toronto Public Health.

Invasive Meningococcal C Outbreak among Men Who Have Sex with Men (MSM) in New York City: Recommendations for Travel

April 18, 2013: An ongoing outbreak of invasive meningococcal disease serogroup C has been occurring among men who have sex with men in New York City. Since 2010, there have been 22 cases reported: one in 2010, four in 2011, 13 in 2012 and four in 2013. Seven men have died, including three of the last five cases. The age range of cases is 21 to 59 years, and 50% have been Black, 27% White, and 18% Hispanic (any race). Twelve cases were HIV-infected, of which five have died. Cases of meningitis have also been reported in MSM in California.

The New York City Department of Health is recommending meningococcal vaccine to the following New York City residents:

• All HIV-infected MSM
• MSM, regardless of HIV status, who regularly have close or intimate contact with other men met either through an online website, digital application (“app”), or at a bar or party 

The Public Health Agency of Canada (PHAC) is not aware of any cases among Canadians related to this outbreak. Toronto Public Health has also not seen any cases related to this outbreak. Please call Toronto Public Health if you think you have a suspect or confirmed case of meningococcal disease to TPH's surveillance unit at 416-392-7411 during work hours (8:30am to 4:30pm, Monday to Friday) or at 3-1-1 after hours.

The National Advisory Committee on Immunization (NACI) recommends use of the quadrivalent meningococcal conjugate vaccine (Men ACYW-135 – Menactra or Menveo) to travelers where the risk of meningococcal transmission is high. NACI also says vaccination should be considered for individuals with HIV.

Toronto Public Health recommends physicians offer meningococcal conjugate ACYW-135 vaccine to MSM who are planning to travel to New York City and who are either HIV-infected or who may have close or intimate contact with other men met either through an online website, digital application (“app”), or at a bar or party in New York City. Note that this vaccine is not publicly funded for this group.

More information:

Toronto Public Health Immunization Information Centre:

416-392-1250 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

New York City Department of Health alerts. 

Canadian Immunization Guide on meningococcal vaccines.

Over and over, footage of Rock Hudson standing next to Doris Day was playing on television, and he looked ghastly. His skin was wrinkled and sunken as if by very old age. It was 1985, and it was one of the last close-up images most of us would ever see of the movie icon. And it was terrifying. 

My heart was pounding, and I tried to listen to the voice-over, which spoke of the sudden illness of Rock Hudson and speculation that he might have AIDS. Throughout the newscast, memories of a night in 1982, nearly three years earlier, sprang to life. The images taunted me and screamed at me and said gonna getcha gonna getcha gonna getcha …

Charley and I had recently moved to Los Angeles and the city still held such mystery and promise for us. We were excited about spending our anniversary at the gay restaurant New York Company, where you got a candle on your table and mushrooms on your prime rib and they would probably sing to us or bring a special piece of cake.

No sooner had we settled at our table and ordered drinks than Charley started nudging my arm and staring at something behind me. I glanced in that direction, and was stunned to find Rock Hudson seated there, talking with another man.

In our short time in Los Angeles, I had developed the attitude that famous people deserved their privacy and one shouldn’t ogle them. I thought it was cool not to care they were there, even though I was dying to look. In any case, Charley was staring across our table in a gay restaurant directly at Rock Hudson and I wanted him to stop right this minute.

I was definitely jealous, not only of being upstaged by a movie star at my anniversary dinner, but because I wanted to look at him so badly myself, and Charley had the perfect view. So I pestered poor Charley for the next ten minutes about how rude he was and how I couldn’t believe he found the man so fascinating and why couldn’t he pay attention to me on this special night and all sorts of other such lies.

“You men having any fun?”

There was no mistaking the voice, and I looked up from my pouting stance to Charley, who was grinning across our table at the man behind me. “Sure,” Charley managed to say. I turned around and Rock Hudson was smiling at me. I was a star struck boy and there was no hiding it now.

“Yeah, me too,” I said. How completely embarrassing.

“You sure?” he asked, “Because my friend and I were just discussing it, and I was saying that the two of you were having a fight.”

Rock Hudson was discussing me. Rock Hudson was discussing me.

“Uh no, not at all,” I lied, jumping in before Charley had a chance to say what a bitch I was and how I thought you shouldn’t ogle movie stars. “I think we’re just kinda tired. As a matter of fact, today is our anniversary and we’re celebrating.”

“Yeah,” said Charley, “we’re doing fine. How are you tonight?” He was playing along, had forgiven me, and was asking Rock Hudson a question. This was unbelievable.

“It’s really wonderful that you two are having an anniversary. How long have you been together?”

“Three years,” we said in unison.

“That’s just great. Congratulations.” At this point he introduced his friend, who went “way back” and who’s name I couldn’t tell you in a million years, and then he offered an invitation. “Come sit with us, boys. Have a drink. It’s a special occasion.”

I looked at Charley, holding on to my “protect their privacy” stance for a few more seconds, but he had already risen to join them. What the hell. Like I would have refused. I took my spot beside Rock Hudson because I would have broken Charley’s arm if he had tried that seat and he knew it. Another round of drinks appeared, and the star launched into clever stories that I don’t quite remember but were more than fascinating at the time.

The conversation wandered onto Trivial Pursuit, the game which was then new and all the rage.

“Yes, I’ve heard of that,” Rock said. “I haven’t played it yet.”

“We’ve got the game, Rock,” Charley said. “You should really come over some time and we’ll play it with you.” I couldn’t believe what he was saying. He actually called Mr. Rock Hudson “Rock.” Furthermore, my partner had just invited this man “over some time,” like that was really in the realm of possibility.

More drinks arrived. This man can drink like a cow, I thought, and not even show it. He was playful, though, and shot a few looks my way that I would have taken quite differently if it weren’t clear I was celebrating my anniversary with the man to my immediate left.

“It’s a great game,” I found myself saying. “You wanna come over and play it with us?” I was a teensy bit smashed, no doubt about it.

“Yes, I would.”

I’m sure there was more to it, more of a rationale as to why he felt comfortable crashing our anniversary evening, but I don’t remember. His friend kindly begged off of the event, and it was decided that Charley would take his friend home while I rode with Rock so he had no problem finding our apartment. I still will never believe he parked his classy import on Edgewood Avenue, because it made me nervous parking my car there. Once inside, I found a full bottle of Scotch, poured him a drink, and gave him a tour of our tiny apartment until Charley got back.

I was no fool. What we had here was a prescription for something… unseemly. But I was barreling through these bizarre circumstances and wasn’t weighing the specific possibilities. That’s a lie. I was pursuing it because I suspected what was to come.

We played the game for a couple of hours, Rock winning and drinking. Before it was over the Scotch would be history and I would offer to roll a joint. “Pot makes me horny,” he said, “so I don’t know if I should–” and of course I was passing him the joint faster than you could say Star Fucker.

He talked about movies. And sex. And people he loved and hated. The juiciest tales began with “I was really drunk one night when” and the meanest had to do with people he thought had treated him badly professionally (“You need Julie Andrews like you need a knife in your back,” said he).

Charley had taken it all in, but knew when enough was enough. He excused himself quite late to go to bed, Rock offered to go, I wouldn’t hear of it, and we continued sitting in the dining room passing the joint.

I knew what was being played out. Questions floated about in the back balcony of my head, just within earshot. What kind of guy was I? Was I going to have sex with this man right here in the living room? What about my anniversary? What about the man I loved asleep in the bedroom? Was Rock Hudson as well hung as everyone said? Some questions got my attention more than others.

Rock made motions for the umpteenth time that it was time to go home, so while he whispered another insincere goodnight, I drunkenly opened the pants of Mr. Rock Hudson. The fact that this was a famous escapade had overruled the anniversary etiquette issues.

Thirty minutes or so later, I stood in my robe outside the bathroom, wondering what Rock Hudson thought about the rust stained bathtub in which he was quickly showering. The sex had been in near dark, and without the pretext of romance — no tender caresses or meaningful glances.

I can remember only one direct look from the man. I stared down upon his face after the exhaustion of labored sex — too much bourbon, too much pot — and my eyes tried adjusting to his face in the dark. And then there it was, staring back at me, with a surprisingly impatient look. Stern and almost elderly.

“Are you done?” he asked blankly.

Well, life ain’t the damned movies, I suppose.

I would make small talk with him as he toweled dry and dressed, and then me, in a final act of staking my claim, asking for his autograph. Yes, so help me, I asked the damp, drunk and spent star to scribble “All my best, Rock Hudson” on a piece of notebook paper before his hasty exit down the duplex stairs and out to the dingy street below.

I watched the car pull away and walked slowly back to the bedroom, where Charley was sound asleep and snoring. I laid down in the dark and the night replayed in my mind. Was I triumphant? Excited, thrilled, guilty? I had just bedded the ultimate male screen icon of a generation, and I hadn’t the slightest idea how to feel about it.

Rock Hudson was now a ghastly figure on a television screen in my living room. My heart raced every time the evening news began and some new tidbit of information about his disease, his sex life, his kiss with Linda Evans on “Dynasty,” his lovers and his drug treatments were reported with morbid tones and oh-my-God urgency.

I had not yet been tested for HIV. In 1985, what was the point? There were no known effective treatments, the first drug treatment, AZT, was just being introduced and people with AIDS were dropping like flies. It was politically incorrect to get tested because it could lead to discrimination, brand you as terminal and assure you that every pathetic image of a dying AIDS patient applied directly to you.

And that is exactly what the Rock Hudson coverage was doing to me, test or no test. Magazines and Dan Rather news stories were talking to me specifically. ROCK HUDSON HAS AIDS, the headlines screamed, AND MARK KING WILL DIE AS WELL.

“Rock Hudson is now resting in his Los Angeles home beyond a doctors care,” reported Mary Hart on Entertainment Tonight, “and Mark, you’re an idiot if you think you can escape this now. You’re dead as a door nail, buddy. What were you thinking?”

I would stare at the coverage without a word, and nod my head at parties when someone said how tragic it was and excuse myself.

My parents had been told the censored version of the anniversary night story that very next day, and called me in Los Angeles shortly after Rock was reported ill. “Why not go down to the hospital?” my father asked. “You could try to cheer him up, maybe bring Trivial Pursuit!” I explained the man had a million fans and wouldn’t remember me, without mentioning how trivial the pursuit had been.

In October of 1985, Rock Hudson died in his home. News reports tortured me for months to come.

(Edited from A Place Like This, by Mark S. King. Copyright 2008.)

*******************

I love checking the analytical data produced by my blog software. It tells me what pages of my site you are visiting, what link sent you here, and even where you live (Hello, Cleveland! G’day, Sidney!). It also tells me what keyword searches bring people to my site, and once I sort through all the porn references (that piece on porn star Dawson still reels in the readers), the most popular Google search that brings people to my site, still, is the two words “Rock Hudson.”

Since interest in him remains so high, I don’t mind sharing this piece again (it appeared on my site in 2010). It allows me to provide a perspective on AIDS, celebrity, and our communal fear during the 1980′s that those Google visitors might never have expected.

Thanks for reading, and please be well.

Mark

This article originally appeared on Mark’s own blog My Fabulous Disease here. 

Normally, I eschew Facebook “Like” contests and changing profile pictures en masse to show solidarity under the misguided notion that the modern equivalent of jingoistic chanting does anything to influence policy. Surprisingly, then, yesterday I changed my Facebook profile picture to a simple red square with a white equality symbol, as did seemingly everyone in the LGBT community I’m friends with, to demonstrate my support for opponents of Proposition 8 in California, who just wrapped up oral arguments in favor of gay marriage before the United States Supreme Court.

Originally started by the Human Rights Campaign, an organization I typically criticize for its lack of effect when it comes to advocacy and seeming dearth of actual programs helping LGBT kids, youth, adults, and seniors, this Facebook movement has grown to reflect that there are, seemingly, more of “us,” supporters of gay marriage, than there are of “them,” the opponents of gay marriage.

“At first you resisted. Now you’re all red, red, red,” messaged a friend of mine the minute I changed my profile picture. I admitted to him that I got on the Orwellian bandwagon, but I began to think about why, in this instance, I had a visceral, immediate desire to participate.

Frankly, I have a reputation in Philadelphia as a bit of a curmudgeon, the type of writer and critic who could have witnessed Jesus Christ turn water into wine and write down later, “The red was dry, the conversation was ultra liberal, and the speaker needs a haircut.” Yet, when it came to gay marriage, I was on board without a second thought, enthusiastically taking the lead of thousands of people before me. Upon reflection, I realize it is because I, like many others, am fed up with this false equivocation in American media and politics that, somehow, idiotic arguments deserve a seat at the table alongside thoughtful commentary.

For years, American media has strenuously attempted to give proper voice to those opposed to gay rights. Much like how those opposed to civil rights for African Americans had their arguments rooted entirely in their own queasiness with blacks, foes of gay marriage and, by extension, LGBT rights, seemingly have no proper argument aside from a red-faced, flustered, “But it’s…it’s…wrong!” And, much like how factually-challenged climate change denialists are given a speaking platform with nauseating regularity on Fox News, gay rights opponents are somehow put forth as though they have any substantive grievance or sound opinion that is rooted in anything aside from their own inherent bigotry. They do not.

At issue is whether or not homosexuals like I am should be allowed to, privately but officially, wed. This issue is not about whether or not you support leather chaps and bathhouses; this issue is not about whether or not you are conflicted on allowing transgender women to attend all-girls’ colleges; this issue is not about whether or not you are queasy about the fact that 40,000 children in California are currently living in same-sex households, as Justice Anthony Kennedy rightly pointed out this week; and, certainly, this issue is not about gay sex. Rather, this issue is about whether or not I as a human being am deserving of the same rights and privileges you are as a human being.

The fact that a conservative evangelical might find the fact that I like to kiss other men gross is irrelevant to this debate; the fact that, gross or not, this goes on and I cannot change this component of my identity as a human being is the essence of whether or not I deserve to be able to have my love publicly affirmed through marriage.

Contrary to the reprehensible, and completely discredited, notions propagated by gay conversion “therapists,” I cannot change my sexuality. In fact, if I could have changed my sexuality as a 13 year old gay boy growing up in a town called Quakertown, PA, obviously not the most progressive and cosmopolitan of rural Pennsylvania areas, I would have. Making the decision to live as a heterosexual would have been much easier; I would not have had to come to grips with the fact that society was telling me I was a faggot, an effete leftover from human evolution. If I could change my sexuality and produce a child with a woman naturally, I would be able to continue to pass along my mother’s DNA and my father’s surname; and, I could touch the hand of my son or daughter and feel my own blood, developed from thousands of years of mating on part of my German ancestors, my naval officer great great grandfather, my beauty queen mother, my NY Times crossword-puzzle addicted grandfather.

As reality would have it, however, my innate sexuality prohibits me from honestly doing this. Instead, I have, for years, had to figure out how to wed my physical attraction to other men along with my principles and desires as a human being. That is, try as I might, I cannot get pregnant by a man; and, as such, I cannot physically, bring together my DNA with the DNA of the man I love to produce a new human being worthy of the same rights and dignitites as my brother’s son, my nephew. And, while I can certainly, at least in some states that don’t outright ban gay adoption, adopt a child, I cannot produce one with the person I love just as my mother or brother have done.

While this is, at best, annoying and, at worst, tragic, I, and millions of other homosexuals like I am, have figured out that family is what we make it, that friendship is key to a life of happiness and love as a gay man, and that so long as the government concedes that I am not biologically inferior but, instead, biologically different than my straight counterparts, we can peacefully coexist, society and LGBT folks.

Today, however, and for the past several decades, there are entire segments of the American population who, despite these facts, have caused me and continue to cause young LGBT folks great sadness, anguish, and pain about their innate identities. We are told routinely that we are separate, different, and, logically then, inferior to heterosexuals. We are made to feel badly about the fact that we like to kiss other men; we are made to feel dirty for wanting to express our sexual and romantic identities publicly.

Specifically, I remember being called a faggot on Walnut Street for holding the hand of the boy I was dating when I was 18. And, immediately, we stopped holding hands; after all, it was totally inappropriate of us in this straight world to try to publicly affirm our affections for one another. Similarly, I was called a faggot and then punched in the face because I, unlike the 18 year old version of myself years earlier, passionately protested this slur last year. The difference between these incidents, along with their separation in time, is the fact that no reasonable or legitimately thoughtful person thinks either incident is okay today. Ten years ago, however, a good number of folks would say things like, “Well, you should be careful, you never know who is around.”

Everyday, we hear news that more and more Americans are supporting gay marriage. And, everyday, we hear news that more and more gay Americans want to get married. And, everyday, we hear the truthful argument against gay marriage coming out more precisely; that is, they simply have an issue with us faggots and their issue has nothing to do with public affirmation or love or extending rights guaranteed by the US Constitution to American homosexuals. Rather, opponents of gay marriage rely exclusively on their own personal “ick” factor in relation to homosexuality and pretty much every sexual and gender difference that isn’t straight, missionary style, and monogamous.

This opinion does not deserve a voice in thoughtful media or commentary. It belongs in the dust heap of history along with Plessy v. Ferguson’s “separate but equal” distinction in relation to different facilities, including drinking fountains, pools, and public schools, for blacks and whites. And, just as the Supreme Court overturned Plessy v. Ferguson with Brown v. Board of Education, the Supreme Court is positioned to affirm what everyone knows but what American media still has difficulty conveying.

Gay people are equal and deserving of the same rights and dignities as straight people. So, I changed my Facebook profile picture. And, I suggest you do too.

This article first appeared on Josh’s own blog here.

This morning, I woke up like I usually do on a Saturday morning, earlier than I planned to get up, yet later than I ever sleep during the week.  Each Saturday morning, it is my routine to get up and flip the television over to Food Network, and I spend the morning soaking up culinary inspiration.

The highlight of my morning is watching The Pioneer Woman. For some reason, I connect to her show, her food, her way of life. She and her family live and work on a cattle ranch in Oklahoma. She is very vivacious and down to earth and her food vision is amazing. I have made more of her recipes in just the last month than I have ever made from any other recipe source.

But, I am sort of going off on a tangent. Gotta love age + HIV meds, they do screwy things to your head.

The me from a few years ago, or even a few months ago, would never have found joy in cooking.  I had always held a deep interest in cooking, though for some reason or another (usually just pure laziness) I rarely got on the kitchen and attempted to create.  But when you have HIV, or a terminal illness, I believe a light shines more brightly on your flaws, and one has more of an impetus to change.

All of a sudden your bucket list becomes real. Every day becomes another opportunity to do good, or to start over. Each day is a new recipe of trial and error, to see what fits and what doesn’t.

I know full well there are definite negative consequences to living life with HIV.I live those consequences daily and have written about them either on here of my Facebook. But HIV also has many positives (no pun intended) that I think can be easily overlooked, sort of like when the sun is covered over by clouds.

Walking hand in hand with my mortality enhances my senses, at least the physical senses. I taste things more intensely, I see things (literally see things) that I have not seen before, even on the same road I have been on a thousand times before.  I am always pointing things out to people that I notice and they tell me “Oh, that has been there for years.” (Of course, that could very well be because I am blind inside.)

I have a much greater appreciation for music of all types. I listen to and love things that are so far outside of myself that I would never have listened to or derived pleasure in before.  For example, jazz.  Or country.  Or classical.  All of these have become rich new means for me to feel.  And oftentimes, music has become one of the few ways that I can actually feel things.  I have struggled with depression off and on throughout my life, and to be able to feel again is a true gift.  Maybe one day I can feel outside of music, but for now I will take what I can get.

Having HIV also has taught me a lot about boundaries. To live life with HIV but without boundaries leads to a very exhausted person, or at least that has been my experience.  In the first few years after my diagnosis I was so very cautious and miserly with my energy and my time, to the point that I hid out at home and rarely went out.  Then I went through a period of becoming too social, too far outside of my energy zone.  Now, I am back to being a hermit again, but I really am starting to see the need for a middle road, of a balance between being a hermit and being exhausted.  I just have to figure out where that medium is and I have not done that yet.  I am very much like Goldilocks in that regard.

I guess my point is this: there can be a silver lining in situations, but they may not always be immediately evident. Sometimes you have to dig a bit before you come across any gold. Sometimes you have to bake a crappy batch of cupcakes before you figure out how to make good ones. 

This article originally appeared on Jason’s own blog, Embracing Pozitivity, here.

About the author: I am 38, gay male from Knoxville, TN who is not ashamed of my HIV+ status. I am optimism personified. I am strength realized. I am just me.

Website: embacingpozitivity.blogspot.com Twitter @jjemcdonald

The problem with scare-monger titles like this one is that you can be accused of over-reacting (especially if it turns out to be a false alarm) and therefore devaluing every warning in the future. That said, sometimes the message is more important than the delivery and a dramatic title may at least catch the eye.

Recent reports concerning the deaths of HIV positive men in New York who have suddenly contracted a new strain of meningitis may seem localised (especially when you look at the numbers involved) but they may well be the precursor to a very serious problem indeed. The ease in which meningitis can be spread, both sexually and via normal social contact, makes the New York situation a problem we ignore at our peril.

We can’t forget that HIV began as a localised problem with a few people coming down with strange symptoms. The good news is that there is a vaccine to prevent it; the bad news is that if you already have it, you need to get help before it’s too late.

“The Health Department issued new recommendations today for vaccinating against invasive meningococcal disease – commonly known as meningitis – after an increase in cases. Vaccinations are now advised for men, regardless of HIV status, who regularly have intimate contact with other men met through a website, digital application (“App”), or at a bar or party.”

(March 6, 2013, New York Department of Health and Mental Hygiene.) 

Many people won’t really understand what meningitis actually is, so first, a few facts.

The meninges are three protective membranes which cover both the brain (cranial meninges) and spinal cord (spinal meninges). You could describe them as layers of glue, following every contour of the brain and they prevent fluids from coming into contact with the brain and spinal cord. In this way, the nervous system is protected from blood and other fluids pressurizing those vital organs, although there is a layer of cerebro-spinal fluid between two of the membranes. They also serve as a framework for blood vessels. Isn’t nature wonderful!

Meningitis happens when these membranes become inflamed or damaged. There are two distinct types: viral meningitis and bacterial meningitis and generally, meningitis can be treated with antibiotics. The current problem in New York and amongst LGBT people is that this outbreak is a new form of bacterial meningitis (meningococcal) and it is very easily spread from person to person. It is unique and so new that it hasn’t yet been named but it is particularly deadly and kills one out of three people instead of the normal one out of five, as with other forms of meningitis. Most worrying of all, it seems to be targeting gay men.

Those are the basic biological facts; so what has actually happened in New York and should we be worried?

Since 2010, there have been 22 reported cases; 13 of them in 2012 and four so far this year. Seven of them have died and 12 were HIV positive. The cases are spread across various New York districts and the pattern and connection to HIV is just beginning to be fully realised; hence the warning from the authorities.

“It’s been sort of marching through the community in a way that makes us very scared,” Dr. Jay Varma, the deputy commissioner for disease control at the city’s health department, said last week.

Because meningitis very often attacks young men, the 12 cases of men in their early 30’s; eight of whom were HIV+, becomes an alarming factor. Four new cases in the last month and four deaths among the 12 younger men; plus the fact that the normal incidence of bacterial meningitis amongst gay men is about 20 times higher than in the rest of the population, all adds to the growing sense of alarm.

“Fortunately for meningococcus, we surely have the tools to prevent the next case. A vaccine is available to prevent almost all the cases seen in the U.S. It’s comprised of bits from four of the five strains that cause most human disease. In the usually drab world of hard-boiled science, these strains are organized by an eccentric lettering system: A, B, C, Y, and W135 (don’t ask). The current shot works against all but the B strain, which remains difficult to develop for reasons that only a vaccinologist could describe.”  (Kent Sepkowitz: Infectious disease specialist.)  

So what happens if you get meningitis and what should you look out for?

The symptoms of meningitis usually emerge pretty quickly (normally two to five days after contact) and because they progress very quickly, it can be a fatal disease if not treated as quickly as possible. It can go from a fever, to a headache; maybe a rash of red spots and a stiff neck and then death within a few hours. Without wishing to exaggerate in any way; people have reported sick and have died before the ambulance could arrive. This is a nasty disease. People need to see their doctor and receive at least preventative, prophylactic antibiotics as soon as humanly possible.

“This disease is spread by prolonged close contact with nose or throat discharges from an infected person. Examples of prolonged contact include living in the same household or intimate activities, including kissing and sexual contact.” (HIV and Hepatitis.com)

So yes, unfortunately sharing cups, tooth brushes and all the things that led to stigmas for HIV are pertinent in the case of meningitis.

What can you do about it if you display these symptoms?

First of all, we all know how common these symptoms are individually and how easily people may panic at the first sign of a headache, so it’s important to listen to your body and take action if you know that the symptoms you have just don’t feel normal. If you’re worried, contact your doctor immediately and report both your symptoms and the story behind them. In this way, the doctor will have a reference point from which to start and know what he or she should be looking for. This is a disease where quick action could save lives, so without being pushy, make sure you’re taken seriously. Unfortunately, the vaccine won’t cure those who are already infected but that equally doesn’t mean a death sentence. Quick and effective treatment is the key but delay can be dangerous.

What should you do if you have no symptoms but are now pretty worried that you’re at risk?

Again, try not to give in to rampant hypochondria (we’re all guilty of that from time to time!) but be aware of your local situation. If you live in New York, then you should heed the warnings and get vaccinated; if you live elsewhere, it will do no harm to ring your local LGBT/HIV/local health authority and ask if any cases have been reported near you and what their policy is. It may be that a vaccination is advisable for all gay men, especially younger gay men but then you may meet problems of availability, cost and general unwillingness plus the inevitable insurance coverage issues. Your local LGBT groups may be able to put pressure on health authorities to implement a vaccine programme or at least make the vaccine readily available.

As you may have gathered from reading so far, bacterial meningitis is no joke. Hopefully it will remain confined to small outbreaks but as this snippet from The Daily Beast shows; medical practitioners are holding their collective breath at the potential of this outbreak:

“So when the New York City Department of Health and Mental Hygiene yesterday sent around an alert about recent meningococcus cases in HIV-positive homosexual men, it caused a real gasp among practitioners everywhere—this one is scary. When you see a newspaper photo of people in a town lined up for shots and pills to prevent spread of the case of meningitis, it’s meningococcus causing the problem. Its name, which is already alarming enough, actually understates its potential devastation. The meningococcus bacteria can cause two different diseases—when it’s “just” meningitis, the death rate is about 10 percent, but the more lethal sepsis form (called meningococcemia) kills about half by overwhelming the body’s blood vessels while sparing the brain’s lining. We don’t know yet which manifestation is being seen among gay men in NYC—perhaps cases of both—but the high death rate suggests the more dangerous meningococcemia.” 

Finally…

It does seem cruel doesn’t it? We’re coming to terms with the consequences of HIV and both living longer and developing effective strategies to avoid its spread and along comes something else to scare the living daylights out of us. It may all turn out to be a storm in a teacup (with respect for those who have already died) but if HIV/AIDS taught us one thing, it’s that our own organisations are sometimes quicker to sound the alarm bell than the authorities.

That’s possibly not true in this case. When the New York medical authorities advise all gay men to get vaccinated that’s a pretty swift official response and one that shows how seriously they are taking the threat. They too may have learned their lessons from the past and want to prevent an epidemic before it takes hold. However, the problem is getting the message out.

What happens if you’re active sexually, or using intravenous drugs, or hiding behind marriage, or hiding from stigma, never read the gay press or websites and don’t take much notice of health warnings? These are the guys that may be at greatest risk and the ones who could spread bacterial meningitis out of control. The warnings need to be displayed as widely as possible; in doctors’ waiting rooms, hospitals, train stations, public libraries and of course, all gay establishments, wherever, in order to get the message across.

It’s not the only cloud on the horizon either: the spread of bacteria resistant gonorrhoea and the potential for resistant strains of syphilis and hepatitis may be occupying our thoughts in the years to come. It’s the way of all viruses and bacteria; those life forms have a survival instinct just as we do and are constantly seeking out ways to resist the things we develop to kill them. Plagues and viral epidemics are a part of human history; there’s no reason to suppose it will stop now. The key is remaining alert and just as in New York, reacting quickly when a threat comes along.

Bacterial meningitis is easier to catch than HIV and potentially much deadlier; the good news is that we can vaccinate against it at the moment; the bad news is that making people aware of this is not as easy as it sounds.

Further information:

http://en.wikipedia.org/wiki/Meningitis

http://www.dailykos.com/story/2013/03/24/1196531/-Health-Alert-Meningitis-Outbreak-in-NYC-Among-Gay-Men

http://www.huffingtonpost.com/michael-broder/gay-meningitis-outbreak-new-york-city_b_2932956.html

http://www.queerty.com/nyc-health-dept-issues-meningitis-warning-for-gay-men-20120928/