Blog Post

Understanding Human Papillomavirus (HPV) in Men Who Have Sex with Men (MSM) and Transgender Women

  • By Russell Rooms
  • 03 Apr, 2023

Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STIs) worldwide. While it affects both men and women, certain populations, such as men who have sex with men (MSM) and transgender women (TW), face unique challenges and risks related to HPV transmission and associated health issues. In this blog post, we will delve into the topic of HPV in MSM/TW, exploring its prevalence, transmission, potential health implications, prevention strategies, and the importance of regular screenings.

Understanding HPV: HPV is a group of viruses that can be transmitted through various forms of sexual contact, including penile, vaginal, anal, and oral sex. It is estimated that there are over 200 different types of HPV, out of which approximately 40 types can infect the genital area. These can be further classified as low-risk and high-risk types based on their association with various health conditions.

Prevalence in MSM/TW: Research indicates that MSM/TW are at a higher risk of acquiring HPV compared to heterosexual men. This is primarily due to factors such as the nature of sexual practices involved, including receptive anal sex, which can facilitate the transmission of HPV. Studies have shown that up to 70-90% of HIV-positive MSM are infected with at least one type of HPV. Additionally, the prevalence of anal HPV infection among HIV-negative MSM can range from 20% to 70%, depending on the specific population studied.

Health Implications: While most HPV infections resolve on their own without causing any significant health issues, persistent infection with certain high-risk types can lead to the development of various conditions. In MSM/TW, the most concerning outcome is the increased risk of anal cancer. Studies have shown that the incidence of anal cancer is significantly higher among MSM/TW compared to the general population. Other HPV-related conditions, such as genital warts, oral and throat cancers, can also affect MSM/TW.

Prevention and Screening: Preventing HPV transmission is crucial for MSM/TW to reduce the risk of associated health problems. Here are some key prevention strategies to consider:

1.    Vaccination: The HPV vaccine is available for both males and females, and it is recommended for MSM/TW up to age 45. Vaccination provides protection against the most common high-risk and low-risk types of HPV, reducing the risk of infection and related complications.

2.    Condom Use: Consistent and correct use of condoms during anal sex can help reduce the risk of HPV transmission. However, since HPV can also infect areas not covered by condoms, such as the scrotum or upper thighs, condoms do not provide complete protection.

3.    Regular Screenings: Routine screenings are essential for early detection and treatment of HPV-related conditions. For MSM/TW, this should include regular anal Pap smears and visual inspections conducted by healthcare professionals trained in anal health.

Conclusion: HPV is a prevalent STI among MSM/TW, with significant implications for their health. Understanding the risks, transmission methods, and potential health issues associated with HPV is crucial for MSM/TW to make informed decisions about their sexual health. By adopting preventive measures such as vaccination, using condoms, and regular screenings, MSM/TW can actively reduce their risk of acquiring and transmitting HPV, thereby safeguarding their overall well-being.

Remember, open and honest communication with healthcare providers and sexual partners is paramount to maintaining good sexual health. Stay informed, get vaccinated, and prioritize regular screenings for a healthier future. The providers at Diversity Family Health are skilled in the appropriate prevention and screening for HPV and HPV related anal cancers in MSM/TW. Make an appointment to discuss your sexual health needs at your convenience.
By Jewelle Scott February 10, 2025

When we think about being healthy, we often think about our bodies, like making sure we don’t get sick or going to the doctor. But did you know that our health is also affected by things in our daily lives, like where we live, if we have enough food, or if we feel safe? These are called *Social Determinants of Health*, and they can have a big effect on how healthy we are.

In this post, we'll talk about what these “social determinants” are, how they affect your health, and how you can talk to your doctor or nurse about these problems so they can help you find resources to make things a little easier.

 

What Are Social Determinants of Health?

Social determinants of health, or SDOH, are things in our lives that aren’t directly related to our bodies but still affect our health. They include:

1. **Money and Jobs** : If a family has a low income or if someone doesn’t have a job, it can be hard to afford things like healthy food, medicines, and trips to the doctor.

2. **Home and Neighborhood** : This includes things like housing (where you live) and the safety of your neighborhood. If a neighborhood doesn’t feel safe or clean, or if there isn’t reliable transportation, it can make it harder to stay healthy or go to the doctor.

3. **Education** : If someone hasn’t had access to much education, it might be harder to understand health information or find ways to stay healthy.

4. **Social Connections** : This means the people around you, like friends, family, and neighbors. If someone doesn’t have much support or if they face discrimination, they may feel more stressed or even sad.

5. **Access to Healthcare** : This means being able to see a doctor, get medicines, and find hospitals or clinics close by. If someone doesn’t have easy access to these things, they may struggle to stay healthy.

 

How Do Social Determinants Affect Your Health?

Social determinants of health can create *health disparities*, which are differences in health outcomes among different groups of people. Here are some examples:

 Low Income: If a family doesn’t have enough money, they might skip doctor’s visits or can’t buy medicines they need. This can lead to health problems getting worse over time.

  • Housing Problems: If someone doesn’t have a stable place to live, they might feel stressed and have trouble keeping up with their health.
  • Food Insecurity: Not having enough healthy food can lead to health problems like obesity, diabetes, and heart disease.

  When we’re dealing with things like housing problems, money worries, or lack of food, it can be hard to focus on staying healthy because the focus is on just surviving the day.


  How to Talk to Your Provider About These Problems

Your provider wants to help you with your overall health, which includes understanding the challenges you face outside of their office. Here are some tips for talking to them about these things:

  1. Think About What You Need Help With: Try to be clear about what problems you’re facing. Is it hard to afford food? Are you worried about paying for medicine? Making a list can help you share these things with your provider.
  2. Be Honest It’s okay to tell your provider what’s really going on. They aren’t there to judge you but to help you.
  3. Ask for Resources: Many clinics and hospitals have social workers or patient advocates who can help you find local resources. Some places offer things like food assistance, transportation help, and other services.
  4. Talk About How You’re Feeling: If these problems are making you feel stressed, anxious, or sad, let your doctor or nurse know. They may be able to connect you with mental health resources too.

Resources That Can Help

If you’re dealing with challenges related to social determinants, there are programs and places that might be able to help:

  1. Community Health Centers: These clinics often provide medical care at a lower cost or with a sliding fee scale.
  2. Food Banks and Pantries: Local organizations can help provide food if you’re struggling with food costs.
  3. Housing Assistance: Many states have programs to help people who are experiencing housing issues.
  4. Social Services: Your healthcare provider may refer you to people who specialize in helping you find local resources, such as financial counseling or job support.

 

Remember

Social determinants of health can make a big difference in how healthy we feel. But if you talk to your provider about the problems you’re facing, they can help you find support and resources. You don’t have to go through it alone—there are people and programs that want to help you succeed, not just in your health but in your life.

 Beginning in 2025, our clinicians will start asking about topics like your mental health and social factors that might impact your health during follow-up visits. This information will help us better understand any gaps in resources within our community and identify ways to improve support. Your comfort is our priority, so please know that it’s completely okay if you choose not to answer these questions. We want our clinic to be a safe, open place where you feel comfortable sharing and receiving care. Our goal is to keep providing you with the best possible support and healthcare.

By Ralph Cornelius, DNP, APRN January 10, 2025

January marks Cervical Cancer Awareness Month , a time to highlight the importance of screening and prevention. While cervical cancer awareness is often focused on individuals with a cervix, it's crucial to expand the conversation to include anal cancer, particularly in the LGBT+ community.

 

Cervical Cancer Screening for Trans Men and Nonbinary Individuals

For transgender men and nonbinary people with a cervix, cervical cancer screenings can be challenging due to discomfort, gender dysphoria, or previous negative experiences in healthcare settings. At Diversity Family Health, we prioritize trauma-informed and affirming care to ensure all our patients feel safe during these critical screenings.

 

The Link Between HPV and Anal Cancer

Human papillomavirus (HPV) is the leading cause of cervical and anal cancers. Individuals who are HIV-positive or engage in receptive anal sex may have an increased risk of anal cancer, making regular screening and prevention a priority.

 

How You Can Protect Yourself

  1. Get Vaccinated: The HPV vaccine is highly effective in preventing the strains of HPV most associated with cervical and anal cancers. It’s recommended up to age 45 for those who haven’t yet been vaccinated.
  2. Screen Regularly: Pap smears and anal cytology (where appropriate) are vital for early detection of precancerous changes.
  3. Practice Safe Sex: Using condoms and dental dams can reduce HPV transmission.

 

By taking these steps, you can reduce your risk of HPV-related cancers and live a healthier life. Contact us today to schedule your HPV vaccine or screening!

By Jewelle Scott APRN, FNP-C December 4, 2024

As the seasons change and days get darker earlier in the afternoon, many people begin to feel their mood shift. While it’s normal to feel down or anxious every now and then, it’s important to be able to recognize when these feelings are not normal. Knowing the signs and learning some easy ways to cope can help you or someone you care about manage these feelings better.

What is Anxiety?

Anxiety often shows up as intense worry that’s hard to control. It can make you feel nervous or even panicked, with signs like a fast heartbeat, trouble focusing, feeling restless, and sometimes a hard time falling asleep. Anxiety might also cause you to worry about things that aren’t likely to happen. Sometimes anxiety can also cause feelings of nausea, abdominal cramping, headache, and tense muscles.

What is Depression?

Depression, on the other hand, is more about feeling sad or hopeless for long stretches. It can make you lose interest in activities you usually enjoy, and you might feel overly tired, lack motivation to do activities, or have trouble sleeping or eating. Depression can also cause you to feel isolated from others or think negative thoughts often. With depression, this may cause you to be more irritable and easily overwhelmed.

 

Easy Coping Skills You Can Try

Dealing with anxiety and depression can take time, but here are some simple tips to help manage these feelings day by day:

  1. Breathing Exercises: Take deep breaths to help calm your body and mind. Try “square breathing” by inhaling for four seconds, holding for four, exhaling for four, and holding again.
  2. Challenge Negative Thoughts : When you start to think negatively, try asking yourself if there’s real evidence for these thoughts. This can help you see things more clearly and calm down a bit.
  3. Set Small Goals : Even if it’s something simple, like taking a short walk or finishing a small task, reaching a goal can boost your mood and give you a feeling of accomplishment.
  4. Stay Connected with Others : Spending time with friends or family, even for a little bit, can lift your spirits. Support groups can also help you meet others who understand what you’re going through.
  5. Create a Daily Routine : Having a regular routine can bring stability. Try to wake up, eat, and go to bed around the same times every day to help balance your energy.
  6. Practice Gratitude : Writing down things you’re thankful for—even small things—can help you focus on positive moments instead of stress or sadness.

  When to Get Help

Sometimes, anxiety and depression need more help than self-care can offer. Here are signs it may be time to talk to a counselor or therapist:

  • Feeling sad or anxious for more than a few weeks
  • Struggling with daily tasks, school, or relationships
  • Feeling hopeless or thinking about self-harm

Counselors and therapists can help you learn new ways to manage these feelings. You can start by talking to a parent, teacher, or your provider, who can help you find a professional.

 Getting Support

If you or someone you know needs immediate help, call the 988 Suicide & Crisis Lifeline, which is available 24/7. Remember, recognizing that you need support is a strong first step, and there are people ready to help you feel better.

Learning about anxiety and depression and using some of these tips can help make day-to-day life easier and brighter. You don’t have to go through it alone—support is always available when you need it. If you feel like you are struggling with your emotions and moods don’t hesitate to reach out to your provider at Diversity Family Health.
By Dr. Ralph Cornelius, APRN November 26, 2024

Cancer is often detected at a late stage, limiting treatment options and impacting outcomes. However, when discovered early, there may be more treatment possibilities and improved prognoses. We are proud to now offer the Galleri® multi-cancer early detection test* to our patients.

 Galleri is a groundbreaking test that screens for a shared signal across dozens of different cancers, including many that currently lack recommended screening methods. In clinical studies, Galleri detected cancer signals from over 50 types of cancer through a simple blood draw.

 KeyPoint's to remember:

  • Galleri is a screening tool, not a diagnostic test. A positive result requires follow-up diagnostic testing to confirm cancer.
  • The test identifies active cancer but does not assess genetic risk for future cancer development.
  • Not all cancers can be detected in the blood, and both false positive and false negative results can occur.

 To learn more about the Galleri test, visit galleri.com or watch this informational video.

 Empower your health decisions by contacting us for an appointment to see if Galleri is right for you.

 *The Galleri test is recommended for adults at increased risk of cancer, typically those aged 50 and older, and should be used alongside existing cancer screening methods, not as a replacement.

* The Galleri test is not commonly covered by insurance and current cost is $900 to perform.

By Dr. Ralph Cornelius November 8, 2024

The holiday season can be a time of joy, but it can also bring added stress, anxiety, and depression, especially for those in the LGBT+ community. These months can feel isolating for individuals who may not have supportive families or those struggling with mental health issues.

  How are You Feeling?

If you're feeling down, it's essential to reach out for help. Mental health screenings for depression and anxiety can be done quickly in your provider’s office. Symptoms such as persistent sadness, lack of interest in activities, fatigue, or anxiety may indicate that it’s time to talk to someone.

  Treatment Options:

There are various treatment options available:

  • Counseling/Therapy: Cognitive Behavioral Therapy (CBT), talk therapy, and other forms of counseling can help manage symptoms of depression and anxiety.
  • Medication: For some, medications such as antidepressants or anti-anxiety medications may be necessary. Work with your healthcare provider to find a treatment that’s right for you.

  Managing Seasonal Affective Disorder (SAD):

Seasonal Affective Disorder (SAD) is a form of depression that occurs during the winter months when there’s less sunlight. Symptoms include low energy, sleeping too much, and feeling hopeless. Treatment options include light therapy, vitamin D supplements, and regular physical activity.

 Remember, mental health is just as important as physical health. Reach out to your provider if you're struggling this holiday season.

By Ralph Cornelius October 15, 2024

October is Breast Cancer Awareness Month, a time to promote the importance of breast cancer screenings and early detection, especially within the LGBT+ community. While breast cancer predominantly affects cisgender women, it's essential for everyone, including transgender patients, to be vigilant about their breast health.

  Breast Cancer Screenings for Trans Patients:

  • For Trans Women: Trans women who have undergone hormone therapy with estrogen for at least five years may be at an increased risk for breast cancer. Regular mammograms may be recommended starting at age 50 or sooner, depending on your healthcare provider’s advice.
  • For Trans Men: Trans men who have not had top surgery, or who retain some breast tissue after surgery, should still consider regular breast cancer screenings. Mammograms may be necessary based on your remaining breast tissue and personal risk factors.

  Mammograms and Self-Exams:

  • Mammograms: These are one of the most effective early detection tools. It’s recommended that people between the ages of 50 and 74 undergo a mammogram every two years, but your provider may recommend starting earlier depending on your risk.
  • Self-Exams: Monthly self-exams are a great way to stay aware of any changes in breast tissue. Look for lumps, skin changes, or nipple discharge, and report any concerns to your healthcare provider right away.

  Support for Patients Undergoing Breast Cancer Treatment:

If you're diagnosed with breast cancer, remember that you're not alone. Support groups, counseling, and patient advocacy services are available to help you through treatment, whether it's surgery, chemotherapy, or radiation.

 Remember, early detection saves lives. Schedule your screening today!

By Ralph Cornelius, DNP, APRN-CNP October 3, 2024


Smoking disproportionately affects the LGBT+ community, and individuals living with HIV are at even higher risk for smoking-related illnesses. It’s time to take control of your health and quit smoking.

Smoking in the LGBT+ Community:

According to the CDC, approximately 20.6% of LGBT+ adults smoke , compared to 14.9% of heterosexual adults. This disparity may be due to stress, stigma, and targeted marketing by the tobacco industry toward the LGBT+ community.

  Take Control of Your Health:

During your next visit, talk to your healthcare provider about smoking cessation. Providers can screen for tobacco use and provide resources such as:

  • Behavioral Counseling: Therapy or support groups to help you stay on track.
  • Nicotine Replacement Therapy (NRT): Products like nicotine patches or gum.
  • Prescription Medications: Medications such as varenicline (Chantix) and bupropion (Zyban) can help reduce cravings and ease withdrawal symptoms.

  Resources for Support:

There are numerous resources available to help you quit:

  • Quitlines: Free phone-based services like 1-800-QUIT-NOW.
  • Online Support: Websites like smokefree.gov offer tailored support for the LGBT+ community.
  • Apps: There are many apps available to help track progress and provide motivation.

 

Quitting smoking is one of the best things you can do for your health, especially if you’re living with HIV. Reach out for support today—your future self will thank you!

By Dr. Ralph Cornelius September 20, 2024
As fall approaches, it's essential to stay updated on recommended vaccinations to protect yourself and your community. For those in the LGBT+ community and individuals living with HIV, certain immunizations are especially important.
By Katherine Kirk July 11, 2024

Herpes simplex virus (HSV) is a common viral infection that affects millions of people worldwide. Often misunderstood and stigmatized, HSV comes in two main forms: HSV-1 and HSV-2. In this blog, we'll explore the differences between the two types, how they are transmitted, their symptoms, treatment options, and debunk some common misconceptions.

What is Herpes Simplex Virus?

Herpes simplex virus is a contagious virus that can infect various parts of the body, typically causing cold sores (HSV-1) or genital herpes (HSV-2). Both types of HSV can also cause sores or blisters in other areas, such as the mouth, lips, or genitals.

HSV-1: Oral Herpes

HSV-1 is primarily associated with oral herpes, characterized by cold sores or fever blisters around the mouth and lips. However, HSV-1 can also cause genital herpes through oral-genital contact. Transmission can occur through kissing, sharing utensils, or coming into contact with saliva of an infected person.

HSV-2: Genital Herpes

HSV-2 is primarily responsible for genital herpes, characterized by sores or blisters in the genital or anal area. Transmission usually occurs through sexual contact with an infected individual, including vaginal, anal, or oral sex. However, it's important to note that HSV-2 can also cause oral herpes through oral-genital contact.

Symptoms

Both HSV-1 and HSV-2 infections can be asymptomatic, meaning individuals may not experience any symptoms. However, when symptoms do occur, they typically include:

  • Pain, itching, or tingling around the affected area
  • Small red bumps or blisters that may break open and form painful sores
  • Flu-like symptoms such as fever, headache, and swollen lymph nodes

Treatment and Management

While there is no cure for herpes, antiviral medications can help reduce the severity and frequency of outbreaks, as well as alleviate symptoms. These medications, such as acyclovir, famciclovir, and valacyclovir, are most effective when taken at the first sign of an outbreak or as suppressive therapy for individuals with recurrent infections.

In addition to medication, practicing safe sex, using condoms or dental dams during sexual activity, and avoiding sexual contact during outbreaks can help reduce the risk of transmitting HSV to sexual partners.

Debunking Myths

Despite its prevalence, herpes simplex virus is often shrouded in misconceptions and stigma. Here are some common myths debunked:

  • Myth: Only promiscuous individuals get herpes. Fact: HSV can affect anyone who comes into contact with the virus, regardless of their sexual behavior.
  • Myth: You can only get herpes from sexual contact. Fact: HSV can be transmitted through skin-to-skin contact, including kissing or sharing personal items.
  • Myth: Herpes is always symptomatic. Fact: Many people with HSV may not experience any symptoms or have mild symptoms that go unnoticed.

Conclusion

Herpes simplex virus is a common viral infection that affects millions of people worldwide. While it can cause discomfort and inconvenience, it's essential to understand that herpes is manageable with proper treatment and precautions. By dispelling myths, promoting education, and fostering open conversations, we can reduce stigma and support individuals affected by HSV in leading healthy and fulfilling lives.

By Katherine Kirk June 17, 2024

In recent years, the conversation around sexual health and the prevention of sexually transmitted infections (STIs) has gained significant attention. Among the various strategies available, Post-Exposure Prophylaxis (PEP) has emerged as a crucial tool in reducing the risk of STI transmission. In this blog, we'll delve into the use of Doxycycline PEP (Doxy PEP), exploring what it is, how it works, and its implications for sexual health.

What is Doxy PEP?
Doxycycline PEP, often referred to as "Doxy PEP," is a form of prophylactic treatment used to reduce the risk of acquiring certain STIs after potential exposure. Potential exposures would include condomless sex: meaning oral, anal or vaginal/front hole sex.
It is sort of like the “morning after pill” for STIs. It involves taking a course of antibiotics, specifically doxycycline, within 24 to 72 hours following unprotected sexual contact or other high-risk sexual activities. Taken as directed Doxy PEP can reduce the risk of getting syphilis and chlamydia by approximately two-thirds. Doxy PEP may not be effective against gonorrhea, as about 25% of gonorrhea in the United States has significant resistance to doxycycline. Safer sex practices remain the best way to reduce risk against STIs.

How Does Doxy PEP Work?
Doxycycline is a broad-spectrum antibiotic. When taken as PEP, doxycycline works by targeting and inhibiting the growth of bacteria that may have been transmitted during sexual contact, thereby reducing the likelihood of infection.

How is Doxy PEP Administered?
Doxy PEP is typically administered as a short-term course of oral antibiotics (200 mg), taken once within 24 to no later than 72 hours after a risky sexual contact. You can take another 200 mg dose if you have unprotected sex again within the next 24 hours. It's essential to follow the prescribed dosage and duration of treatment as instructed by a healthcare provider to maximize effectiveness and minimize the risk of antibiotic resistance.

Considerations and Side Effects
While Doxy PEP can be an effective tool in preventing STI transmission, it's not without its considerations and potential side effects. Some important points to keep in mind include:

Effectiveness: While Doxy PEP can reduce the risk of certain STIs, it may not provide complete protection and should not be viewed as a substitute for other preventive measures, such as condom use and regular STI testing. It does not protect against MPOX (monkey pox), HIV or other viral infections, such as genital herpes.

Side Effects: Common side effects of doxycycline may include gastrointestinal upset, nausea, and sensitivity to sunlight. Make sure to take doxycycline with plenty of water to reduce the risk of it getting stuck when you swallow and severely irritating the esophagus. Avoid taking doxycycline within 2 hours of foods or medications containing calcium (milk, calcium supplements, antacids or multivitamins). Avoid over-exposure of sun or wear sunscreen with use.

Antibiotic Resistance: Overuse or misuse of antibiotics, including Doxy PEP, can contribute to the development of antibiotic resistance, making it harder to treat bacterial infections in the future. It's crucial to use antibiotics judiciously and only when necessary. Doxy PEP may not be effective against gonorrhea, as about 25% of gonorrhea in the United States has significant resistance to doxycycline. Safer sex practices remain the best way to reduce risk against STIs.

Conclusion
Doxycycline PEP (Doxy PEP) is an important component of comprehensive STI prevention strategies, particularly in situations where there has been a high-risk exposure to certain bacterial STIs. By understanding how Doxy PEP works, its recommended use, and potential considerations, individuals can make informed decisions about their sexual health and well-being. As always, open communication with healthcare providers and adherence to recommended guidelines are key to maximizing the effectiveness of Doxy PEP and promoting overall sexual health.
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