Leading voice on Cancer in the same gender loving community passes

Sadly on May 13 sister Rowena who spoke openly of her struggles with breast cancer passed in a medical institution after a brief struggle with treatment via chemotherapy, you may remember or have seen the post on this blog on her courses and the photos she provided while raising the awareness of breast cancer in the lesbian community.

In June 2011 she had granted permission for the photos and her story to be carried exclusive on GLBTQ Jamaica, here is an excerpt:

(WARNING – some photos contained may be unsettling)

On the evening of October 19, 2011 at the Couture Oasis’s Open Mic Open Soul Wednesday night discussions series we were asked to invoke the presence of a Jamaican same gender loving breast cancer survivor who from the moment she opened her presentation had all wondering if she was really going through this struggle and complications with this awful disease. The picture of doom and gloom mixed with uncertainty and doubt as often marketed with cancer victims of all sorts was clearly missing from this vibrant soul. Her resilience had audience members in awe and deep appreciation and other stories from the transfixed persons came flying out as well at some points leaving many in the small air conditioned room teary eyed.

Breast after the surgery

“Judy” as I shall call her for purposes of this post is in her late twenties or early thirties from as early as 2010 said she started to notice strange things happening with her right breast and especially at or around the nipple. There were leakages at some points with what appeared to be water and blood as the residue from it and this she thought was maybe she had scratched her nipple area. After seeing this for some time she decided to have a check up done but doing the tests including a mammogram nothing was found , she had repeated tests over time but still there was neither any lumps or any blots on her X-Ray results to indicate there was trouble or via self examination the few times she attempted them. It was not until a new doctor she consulted went further than just the breast itself and focused also by her underarm to her lymph-nodes and realised that her nodes had overgrown onto her breast tissue, it was then she was finally diagnosed on November 26, 2010 after repeated calls from the doctor’s office up to her due checkup date that she had Breast carcinoma, For solid tumors, stages I-IV are actually defined in terms of a more detailed staging system called the “TNM” system.

N classifies the amount of regional lymph node involvement. It is important to understand that only the lymph nodes draining the area of the primary tumor are considered in this classification. Involvement of distant lymph nodes is considered to be metastatic disease. The definition of just which lymph nodes are regional depends on the type of cancer. N0 means no lymph node involvement while N4 means extensive involvement. In general more extensive involvement means some combination of more nodes involved, greater enlargement of the involved nodes, and more distant (But still regional) node involvement. M: Metastasis M is either M0 if there are no metastases or M1 if there are metastases.

As with the other system, the exact definitions for T and N are different for each different kind of cancer. As you can see, the TNM system is more precise than the I through IV system and certainly has a lot more categories. The two systems are actually related. The I through IV groupings are actually defined using the TNM system. For example, stage II non-small cell lung cancer means a T1 or T2 primary tumor with N1 lymph node involvement, and no metastases (M0).  She was kind to provide me with some photos of the courses of treatment she underwent. (photos published with permission)

One other issue she faced was her own constant movements during some of her sessions as this can auger negatively for any patient and can lead to punctured or damaged skin that may itch or get infected if not properly monitored. She now does her Herceptin treatment every three weeks and has subsidized the costs through insurance and other state healthcare benefits under the National Health Fund and some help from Jamaica Reach to Recovery. Treatment can run in the millions literally locally as her initial run was budgeted for over $2M. Her type of cancer as you may have gleaned is rare as her family history does not have many persons who have or had the disease, she was alone on this front. Four other members of the audience expressed their own stories of losing loved ones and are presently under pain from some sort of cancer, but mostly that of the breast, clearly there are issues of closure for some persons with cancer of any sort. Judy’s case however is a testament to survival and proof that strong will and determination can help to overcome the odds, her sister who was present in the discussion paid testament to that as she said she sometimes draws strength from Judy even though it is Judy who is ailing and she still wonders how does she do it?. Applause rang from the audience and commendations as to how she dealt with the whole ordeal and for openly sharing the information the audience ended the session which was followed by the floor opened to poetry.

See the previous post HERE

Rest in Peace Rowena, her service is slated for June 7th.

Peace and tolerance

H

Young MSM/Transgender want to be treated as citizens not potential HIV/AIDS victims

More and more I seem to be coming across young gay, transgender and bisexual youth who feel weary it seems from the over supply of pinch leave an inch condoms, pamphlets and paraphernalia on safer sex and AIDS and other related materials as multiple agencies jostle to reach what has basically become the same cohort on the face of it of males for the most part in the quest for HIV prevention but where are the more meaningful outreach and interventions for holistic development and nurture?

Some in the know may say that funding is hardly available for those kinds of developmental work (which maybe true in a sense but still sounds more like an apology for slackness and maintaining the old status quo) and indeed the more cynical would go as far as to say it is not the agencies involved best interest to do or offer such meaningful interventions as that will diminish their cohort of potential service users and thus nothing to report hence no need to prepare programs only to seek future funds, after all agencies exist to supposedly help but how many persons are actually being helped or impressive success stories to prove same while old narratives are still being used to suggest that gay/bi men do not have access to safer sex implements which is a lie.

CVM Newscast of the Cargill Avenue eviction where the truckmen/movers found and commented on the condoms they found

also see: Homeless MSM/Trans youth draw attention in New Kingston

Homeless MSM having their version of fun recently by the infamous Gully nearing the Island Car Rentals office

From the Millsborough Avenue embarrassing eviction of some of the homeless MSM/Trans persons last year, condom wrapper is clearly visible

More condom wrappers indicating that the men are only seen as HIV Prevention targets, what about other developmental work?

The complaints and reports still come almost on a monthly basis these days of some homo-negative outcome somewhere on the island and the phone calls of requests for money or some form of assistance are growing in frequency too as economic issues abound. There agencies that run and managed by powerful gay persons who have the clout to solves this long standing matter of displacements seeing we have both hard and anecdotal evidence that tells us in no uncertain terms that those are visible consequences of stigma, homophobia and homo-negativity.

Take for example this flashback: UNIMPRESSED WITH THE CVM TV SHOW ON MSM HOMELESSNESS

The September 6th 2012 appearance of representatives from The National Council of Drug Abuse and AIDSFREEWORLD’s Maurice Tomlinson to address the recent public eviction of homeless MSM from Cargill Avenue was at best damage control to another embarrassment regarding the poor response from the relevant LGBT agencies. JFLAG WAS NOT PRESENT AT THIS CVM TV LIVE @ SEVEN Program The attempt to use old programmatic language by Maurice Tomlinson to suggest MSM have no access to condoms while the CVM newscast itself showed the movers holding the condoms in their hands they found on the site and saying the men were practising safer sex should be instructive to ALL in view.

Young gay men as indicated above are also becoming weary of the way they are viewed despite the aforementioned concerns in a group session over the past week some young men some of whom were teetering on homelessness were invited to a meeting called by a community influential who is concerned about the numbers of them on the streets mostly from Kingston, Portmore and Spanish Town (excluding the five who are helped by a church/LGBTQ group in an ongoing weed whacking project) where they aired some issues they had it was instructive that some of them had a barrage of condoms on their person and laughed at the exposure of them as they accidentally fell from a bag of one of the attendees. He joked “All dem do a full mi up wid boots” (all they do is full me up with condoms) “boots” is the colloquial expression for condoms but something happened after the initial laughter died down as it seems the realization that they were having trouble finding permanent shelter or other crisis issues ongoing were real and that “boots” cannot be a solution whenever they are met by the various outreach teams as part of the HIV prevention strategy. The homeless men for example who have been making the news in New Kingston have been receiving food items once a week but is that enough? They too have had loads of condoms thrown at them as we have seen repeatedly on the television newscasts and other videos covering them. What about the deeper issues and personal concerns they have. The men in the meeting of which I was present were asked to fill out a random list of what they require and their lists read as a call for items and things you and I may have probably not considered important as we enjoy those amenities or interactions on a daily basis and indeed take them for granted. The simple lament by the boots carrying man screams far more than just the obvious since they fell in such a great numbers, one could easily count thirty or so. The conversation continued after the list creation exercise and what came out was a stunner to me despite my knowledge of how some persons feel about the whole scenario as older displaced men in time have echoed a similar sentiment with some level of frustration.

The ideal scenario would be a meeting place for group session and support meetings

Steady supply of food cooked or uncooked

Shelter and some sort of transitional living program towards independence

Educational or skills building opportunities

Guidance on developing and executing life plans through self efficacious activity not just limited to HIV prevention

Exploring the arts and possible skills linked to cross dressing aesthetics and affinity to cosmetics (drag culture, forced feminization and female cisgenderistic presentations for male to female transgender persons in the group)

But by the sound of the lament and the subsequent tete a tete the men are not satisfied; theirs is a perception that more privileged homosexuals control tons of money in funding and that the money is being spent on non essential things such as court cases, fat cat salaries and perks while persons who are on the lower socio totem pole are just relegated to being “victims” or service users and nothing more, doomed to get HIV (if they do not have it already) or waiting to die. Such were the tones in the ensuing discourse. Recent history has unfortunately given some credence to these perceptions as feelings of abandonment of the aforementioned homeless men in New Kingston still linger from the repeated news headlines, shenanigans and police interventions of that population and believe me word travels whenever there is any such occurrences. The men in the long and short of it want to be seen as human beings that deserve respect as one older person claims that there is favouritism as well in how interventions are carried out by some agencies and their representatives. Why are some powerful advocates and personalities in HIV/MSM prevention in particular refusing to go this route of real life changing intervention rollouts is still not clear to some, the departure of a Board Chair of Jamaica AIDS Support for Life also has not gone down so comfortably with myself and others as her stance on homelessness was supportive for the most part despite the run-ins with the men and the stoning incidents on their former offices at Upper Musgrave Avenue yet by the soundings out there one particular former chair but who still sits on the bench has been haggling against any such proactive moves to address homelessness which does not surprise me as he was the chair when the Safe House Pilot was closed with no psycho-social interventions allowed to stop the “bad behaviour” that was used a justification to take such final actions on a needed project.

My part in the whole affair however was to offer some encouragement to the lads in the scheme of things especially owing to the fact that one of the men’s friends was hospitalised recently for a brief illness but how can words heal when the real life toughness abounds and affect their present reality? Then we turn around and wonder why the anti social behaviours are happening when it is obviously clear to those looking that such are only means to an end to forget if only for a fleeting moment the worries of the hour. It is also interesting that as a group the men are indeed “rowdy” (word used by voices in the gay lobby to describe them also “maladjusted miscreants” showing the elitist side to this) but as individuals is it amazing what comes flying out of them in a one on one session discussing real life matters yet they are for all intents and purposes made to become martyrs in a sense for a cause that they might not have subscribed to in ordinary circumstances when asked to do so. Leaving them out in the cold for so long seems unethical on the face of it then allowing the numbers to reach levels where they can be used and paraded as “concerned” advocates make themselves look good in coming to their rescue. We are not fooled by the deception but let us see how long the using will take place and if really any proper productive end will come of the recently announced shelter idea, yet another one.

Some indigenous groups such as the aforementioned St Catherine weed whacking project group, Colour Pink (aligned to the aforementioned JASL) and Aphrodite’s PRIDE Jamaica of which I am performing Outreach and Facilitation duties for their Enterprise Training Project for more stable formerly displaced MSM/Trans and Lesbian individuals are addressing in their own way psycho-social issues and other concerns such as jobs and education development but we know where some of the blame of all this lies at the feet of these same agencies who only do enough to look as if they are addressing some issues but not with a view to adequately address what they take on only for the interventions to last out for experts have jobs it seems. Others seem more interested in media whoring possibly to satisfy a narcissistic complex at the expense of the least amongst us and then we wonder why we are here with an exploding displaced and homeless grouping and advocacy in limbo in the face of steady HIV/AIDS infection rates in the MSM cohort.

The APJ training for example we stay far away as a possible from an over preponderance of HIV messaging and instead go for positive reinforcement in terms of identity, coming out and so on.

Some things to think about but who is brave enough to say it openly when their snouts are in the troughs?

Integrity in advocacy anyone?

Peace and tolerance

H

The Gay Gene: New Evidence Supports an Old Hypothesis

Daniel Honan

What’s the Big Idea?

If a so-called “gay gene” exists, what is the evolutionary logic for it?

After all, you would expect that homosexuals would have fewer children than heterosexuals, so that any genetic cause of homosexuality would have been selected out of the gene pool a long time ago.

The answer, as you might expect, is a bit complicated (if it’s even the right answer).

A new study published in the Journal of Sexual Medicine has found a link between homosexuality and female fertility. The mothers and maternal aunts of gay men have “increased fecundity compared with corresponding maternal female relatives of heterosexual men,” the authors of the study write.

This study, which the authors note was based on a small sample and “would benefit from a larger replication,” supports the so-called “balancing selection hypothesis.” The gay gene — or genes — are thought to exist on the X chromosome, and “increase the reproductive value” of the female relatives. In other words, it makes the women more attractive to men, allowing them to produce more offspring. So while the ‘gay gene’ may not be passed down directly, it will survive over the course of many generations.

Not only are the maternal relatives of gay men more attractive, more fertile and subject to fewer complications during pregnancy, the study also found these women are extroverts and generally happier. In other words, if you’re the mother of a gay man, you’re pretty awesome.

Can this idea survive scrutiny?

Bryan Sykes, the author of the new book, DNA USA, tackled this subject in a previous work, Adam’s Curse, and more recently in an interview with Big Think.

According to Sykes, “there is some evidence that there is a genetic predisposition to male homosexuality.” And yet, in Sykes’s view, it is highly unlikely there exists “a simple gay gene” that you either have or don’t have. To put it another way, the idea that a simple gay gene exists “as a kind of mutation” is downright ludicrous, according to Sykes.

However, Sykes also points out that there is some evidence that suggests the possibility of a genetic association with homosexuality without the existence of a mutated gene. He tells us:

I think you could explain it by the way that mitochondria–that piece of DNA which I’m full of admiration for because they aren’t interested in men at all–are inherited down the female line. And they have ways, I think, of getting rid of male embryos and making sure that they’re propagated at the expense of males.

One way that mitochondria might do this, Sykes says, is to influence some male fetuses during early development so these fetuses “do not turn into heterosexual males.” This controversial idea, according to Sykes, “would explain how you can have a genetic association without there being a mutant gene.” But why would mitochondria act this way? While it may sound weird, Sykes says this type of activity has been observed in many other animal species. He tells us:

It’s the basis of how beehives work. There are bees working away for the queen bee with no hope of having their own DNA propagated in the next generation. I think there’s a possibility, at least it’s something to argue about, that a similar thing is operating in humans as regards male homosexuality.

What’s the Significance?

If the existence of the ‘gay gene’ is ever proven conclusively, it is unlikely to have much of an impact on the beliefs of some people who reject homosexuality as a “lifestyle.” After all, some of those people simply reject science. Indeed, there are some people who want to bury their heads in the sand, and that is an issue that impacts the field of genetics in general, gay gene or no gay gene.

So what does genetics have to teach the rest of us about who we are? Quite a lot, says Sykes, if we’re in fact willing to find out. The other significant question, of course, is how much is our behavior pre-programmed in our genes and to what extent can we change ourselves and grow after we are born? Sykes has a good answer.

While it’s “perhaps too deterministic” to say that your genes determine everything you do, Sykes says your genes are like a deck of cards. You’re dealt these cards, you’re influenced by these cards, but the rest depends on what you do with them.

Watch the video here:

bigthink on gay gene

What needs to be done to help Transsexuals In Jamaica

Coming on the heels of the Miss Jamaica Universe’s group basically disagreeing with the inclusion of a previously booted transgender entrant in Canada albeit she allegedly was not clear on filling out the entry form to say she was born female, a local transgender voice has prepared a post to add her voice to the furore to look at related issues as this time.

I also feel is an opportune moment to help sensitize the public including L, B and G populations about transgenderism and transsexuals as several misconceptions abound and frankly there maybe many persons who identify as GLB but who maybe in fact transgender but do not know it or have sought the necessary consultations to find out.

see a previous post on the Jenna matter from Canada on my sister blog GLBTQ Jamaica on Blogger:

Transphobia: Miss Jamaica Universe Pageant rep says no to transgender entrant in Canada beauty contest

Miss Laura wrote:

Take the buggery law off the books; the buggery law hampers education about this topic. Jamaican’s on a whole consider transgender and transsexuals to be homosexuals. They are not aware that being transgender or transsexual is about a person’s gender Identity their sense of self and not sexual preference. Here in Jamaica people tend to group anything that is not considered normal (gay’s, Lesbians, transvestites, transgender, transsexuals, cross-dressers and the list goes on to be all homosexuals or as it is called (batty man, and sodomites).
Removal of the buggery law would open a door not for just gay men and women but it would also allow transgender people to feel a certain level of security knowing that the law is now on their side and can enjoy equal rights and protection.
I have heard people say that there are no transgender people in Jamaica. That’s just ridiculous and ignorant why would they state this as a fact? Well it is simple most transgender people don’t even know they are transgender or transsexual. They automatically are grouped with the gay community. Many transgender and transsexuals adopt the “GAY Life Style” hoping they would fit into the social landscape where there is friendship and protection and the possibility of feeling less of a freak and more of a normal human being.

Once the buggery law is repealed we can begin to make change in the way how people treat and associate the transgender community with homosexuals and lesbians.

What changes need to be made?
1. The health care system where transgender people can access to counselling, hormone treatments, and Sex Reassignment Surgery. At this time there are no health organisations offering transgender Services Island wide. Many transgender people access hormones mainly on the black market and or through if they are lucky a doctor who is willing to treat them on the QT. Some if they happen to have the financial resources access hormones by purchasing them online.

Many transgender people are often too poor because they cannot get jobs because of their transgender status. Many resort to prostitution due to being ejected from their families and have nowhere to go but the streets. Transgender and transsexuals seek refuge within gay communities as a means to survive.
Those lucky enough to leave the country and make their way to the US or the UK where they can access treatment and live in relative peace. Unlike here in Jamaica where you will most likely be beaten or killed because Jamaican s confuse gender with sexuality.

2. Educating the public about transgender and transsexuals will bring greater enlightenment to the masses, and change the lives of many who are wrestling with a gender identity conflict. Many transgender or transsexuals know they are different from an early age. Little boys seen playing with dolls many not be gay but might be or most likely are transgender or transsexual. Educating people of this will greatly improve the lives of these young children and lead them to a better quality of life and most likely a productive one and far from the thought of suicide.

3. Amendments to Labor laws preventing the discrimination against transgender and transsexual people in the workplace or from being denied job placements in both public and private sector organisations due to their lifestyle or mode of dress e.g. a transsexual living as a woman, dressing as a woman, but may not look feminine . Such a person would be seen as a freak and be automatically turn down for a job placement. Most transsexual’s transition late in life and this tends to be the norm in some cases some transition early in life if they have the support of family.

image from: transgenderzone.com

Late transitioning

A late transition equals less chance of passing unless that person had many expensive surgeries to undo the many years of testosterone exposure. Where early transition starting in the teenage years can have a favourable outcome where the masculine features can be reversed and made feminine under the effects of oestrogen will most of the time produce a passable young woman.

4. Amendments allowing transgender or transsexual men and women to have the same equal right like every other non transgender or transsexual man or woman.This means individuals should have the right to marry like non transgender /transsexual people. Have the right to have their identity papers altered to fit their chosen gender Identity without being judged and told that what you’re doing in the eyes of God is wrong.
Transgender/transsexual people should have the right to equal opportunities like all other peoples that make up our diverse culture.

ENDS

Over the many years of LGBT advocacy in Jamaica transgenderism has been given a back seat for too long and while a few voices speak intermittently on the issues surrounding same it is not enough to properly help the public to understand that there are many identities that abound in the human species and deciphering them is a must for us to co-exist. Major advocates seem not to have time to deal with this matter as decriminalizing buggery is far more important than the other inter and intra community matters that are parallel to men who have sex with men issues. Miss Laura is one of the few voices who have been consistent on the matter from the ground up.

Let us continue to listen to that voice and learn as only she can tell it from her own realities as a transwoman in Jamaica.

Miss Laura can be reached through this email lgbtevent@gmail.com

Peace and tolerance

H

Rectal Formulation of Tenofovir Gel Found Safe and Acceptable in Early Phase Clinical Study

Follow-up study planned to further assess gel’s potential as a rectal microbicide to prevent HIV

March 5, 2012 – A gel formulation of the antiretroviral drug tenofovir designed specifically for rectal use was found safe and acceptable, according to a Phase I clinical study led by the U.S. National Institutes of Health (NIH)-funded Microbicide Trials Network (MTN), and presented today at the 19th Conference on Retroviruses and Opportunistic Infections (CROI). The results of the study, which included HIV-negative men and women who used the gel rectally once a day for one week, serve as an important step toward the development and testing of arectal microbicide to prevent HIV from anal sex. 

Microbicides, products applied on the inside of the rectum or vagina, are being studied as an approach for preventing or reducing the sexual transmission of HIV. The majority of microbicide research has focused on products to prevent HIV through vaginal sex, yet the risk of becoming infected with HIV from unprotected anal sex may be 20 times greater than unprotected vaginal sex. Developed as a vaginal microbicide, tenofovir gel was reformulated with less glycerin, a common additive found in many gel-like products, in the hopes of making it more appropriate for rectal use. 

The study, known as MTN-007, began in October 2010 and enrolled 65 men and women at three sites – the University of Pittsburgh, University of Alabama at Birmingham and Fenway Health in Boston. It is a follow-up trial to an earlier study, RMP-02/MTN-006, which assessed the rectal use of the vaginal formulation of tenofovir gel. That study found the gel produced a significant antiviral effect when used in the rectum, but gastrointestinal side effects were problematic.

In MTN-007, study participants were randomly assigned to one of four study groups. Three of these groups were assigned to use one of the following products for a one-week period: a rectal formulation of tenofovir gel; a placebo gel containing no active ingredient; or a gel containing the spermicide nonoxynol-9. A fourth group did not use any gel but took part in all of the study-related procedures and tests, including physical and rectal exams.

Study results indicated no significant differences in side effects among the three gel groups. Eighty percent of participants reported only minor side effects related to the use of study products, while 18 percent reported moderate side effects. (Two study participants reported severe adverse events, but they were not deemed to be related to use of the study products.) Participants’ adherence to the use of their assigned study products was high, with 94 percent using the products daily as directed. When asked about the likelihood that they would use the gel in the future, 87 percent of the participants who used the rectal formulation of tenofovir gel indicated they would likely use the gel again, compared to 93 percent of the placebo gel group, and 63 percent of the nonoxynol-9 gel group. In addition to assessing safety and acceptability, researchers also conducted preliminary gene expression testing, and noted changes in the activation of some genes in the tenofovir gel group, which they are continuing to evaluate to understand more fully.

“These findings tell us that the ‘rectal-friendly’ version of tenofovir gel was much better tolerated than the vaginal formulation of the gel when used in the rectum,” said Ian McGowan, M.D., Ph.D., co-principal investigator of the MTN and professor of medicine, Division of Gastroenterology, Hepatology and Nutrition and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine. “We are very encouraged that the rectal gel was quite safe, and that most people who used it said they would be willing to use it in the future.”

As follow-up to MTN-007, researchers are now planning a Phase II, multi-site trial called MTN-017that will involve186 men who have sex with men and transgender women at clinical sites in Peru, South Africa, Thailand, and the U.S. Participants will cycle through three study regimens: rectal tenofovir gel used daily, rectal tenofovir gel used before and after anal sex, and daily use of the antiretroviral tablet Truvada^®. MTN-017 will allow researchers to collect additional information about the gel’s safety and acceptability in the rectum, and compare it to the use of Truvada.                                         

In addition to Dr. McGowan, other authors of MTN-007 are Craig Hoesley, M.D., University of Alabama; Ross Cranston, M.D., University of Pittsburgh; Philip Andrew, FHI 360; Laura Janocko, Ph.D., MTN and Magee-Womens Research Institute; James Dai, Fred Hutchinson Cancer Research Center; Alex Carballo-Dieguez, Ph.D., Columbia University; Ratiya Kunjara Na Ayudhya, BSMT, MTN; Jeanna Piper, M.D., Division of AIDS, National Institute of Allergy and Infectious Diseases; and Ken Mayer, M.D., Fenway Health.

MTN-007 is funded by the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) and the National Institute of Mental Health, both components of the NIH. Tenofovir gel was developed by Gilead Sciences, Inc., of Foster City, Calif., which assigned the rights for tenofovir gel to CONRAD, of Arlington, Va ., and the International Partnership for Microbicides of Silver Spring, Md., in December 2006. 

The reduced glycerin formulation of tenofovir gel that was evaluated in MTN-007 is not the same formulation developed for vaginal use. The vaginal formulation of tenofovir gel was found safe and effective in reducing the risk of HIV in women who used it before and after vaginal sex in a study called CAPRISA 004. More recently, however, MTN researchers conducting the VOICE Studyclosed the tenofovir gel arm of the trial after a routine review of study data determined that the gel, while safe, was not effective in preventing HIV among the women in that study group, who were asked to apply it vaginally every day. In the meantime, a Phase III trial called FACTS 001 is currently evaluating the vaginal formulation of tenofovir gel using the same regimen as CAPRISA 004, with results expected in 2014. 

The Caribbean Men’s Internet Survey is underway

PRESS RELEASE

The Caribbean Men’s Internet Survey is underway

16 January, 2012 – A groundbreaking anonymous online study of the lives of men who have sex with men (MSM) in the English, French, Spanish and Dutch-speaking Caribbean is underway now. CARIMIS, the Caribbean Men’s Internet Survey (available at http://www.carimis.org) aims to learn more about this group while for the first time testing the potential of the internet to conduct research with key populations in the region. The initiative is led by the Joint United Nations Programme on HIV/AIDS (UNAIDS) Caribbean Regional Support Team (RST) and involves several individuals, non-governmental organisations and partner agencies throughout the region.

UNAIDS Caribbean RST Director, Dr. Ernest Massiah, explained that the approach presents exciting possibilities for responding more meaningfully to the realities of MSM.

“Almost everybody’s online,” he said. “That’s where people are and that’s where the survey needs to be. It’s the most modern, effective way to connect with communities to find out more about their experiences and their needs. Good data provides the evidence that allows countries to make good decisions about their HIV response.”

Article 29 of the 2011 Political Declaration on HIV/AIDS notes that many national HIV prevention strategies inadequately focus on populations that evidence shows are at higher risk. In June governments committed to identifying the specific populations that are key to their epidemic and response, “based on the epidemiological and national context”. CARIMIS will contribute to this goal by offering new insight into the realities of Caribbean MSM communities at country-level, including respondents’ behavioural risks and their access to HIV prevention, testing, treatment and care.

Participants in pilot tests done in the Dominican Republic, Haiti, Jamaica and Trinidad and Tobago revealed that they responded to questions about their sexual behaviour during the survey that they would not answer in face to face interviews.  Importantly, the approach will reach across boundaries of class, race, socio-economic status and professed sexual identity as anyone with 15 minutes of internet access can participate anonymously.

“Studies among MSM have been conducted in the larger Caribbean countries using traditional sampling methods. While these methods have been useful they have always excluded sub-groups within the MSM community who cannot be reached through public venues or network systems. The internet holds the potential to reach a wider spectrum of MSM and could in the future be used to connect with other hard-to-reach groups,” explained Research Associate, Sylette Henry-Buckmire.

In the Caribbean HIV prevalence among MSM is estimated to range from 0.71 percent in Cuba to 32 percent in Jamaica. The average adult HIV prevalence for the region as a whole is one percent.

The survey is available on www.carimis.org It is targeted toward people who are 18 years or older, were born male and either are attracted to men, have sex with men or think they might do so in the future. Eligible participants must provide informed consent online before completing the survey. No information will be collected that would identify respondents. The website includes links to local referral services for those who require emotional or medical support. CARIMIS has been approved by the Ethics Committee of the London School of Hygiene and Tropical Medicine (LSHTM). The website and its supporting technology underwent a rigorous certification and accreditation process to assure security.

Contact

UNAIDS Caribbean| Cedriann Martin | tel. +868 623-7056 ext. 283 | martinc@unaids.org

UNAIDS

UNAIDS, the Joint United Nations Programme on HIV/AIDS, is an innovative United Nations partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. Learn more at unaids.org.

 

 

 

FDA ASKED TO APPROVE NEW HIV PREVENTION METHOD, PRE-EXPOSURE PROPHYLAXIS (PrEP)

 

For Immediate Release                          Contact

December 15, 2011                                  Mark Aurigemma; 646-270-9451; mark@aucomm.net

                        Pedro Goicochea; 415-490-8350; pgoicochea@gladstone.ucsf.edu                                                                                                      

 

FDA ASKED TO APPROVE NEW HIV PREVENTION METHOD, PRE-EXPOSURE PROPHYLAXIS (PrEP)

 

An application from Gilead Sciences, Inc. has been filed with the U.S. Food and Drug Administration toapprove an HIV antiretroviral therapy to reduce the risk of HIV infection among uninfected men who have sex with men (MSM) and heterosexual women and men. The application to approve the new HIV prevention method called pre-exposure prophylaxis, or PrEP, is based partly on data from the Global iPrEx study, the first human efficacy study to prove that PrEP reduces HIV infection risk inpeople (http://www.iprexnews.com).

 

The PrEP drug is a single-tablet once-daily combination of emtricitabine (FTC 200 mg) and tenofovir (TDF 300 mg), marketed under the brand name Truvada®. The iPrEx study found that MSM who were prescribed a single daily FTC/TDF tablet experienced an average of44% fewer HIV infections than those who received a placebo pill. Among a study sub-set those who took the tablet frequently enough for drug to be detected in their bodies, the rate of protection against HIVinfection was more than 90%. All participants in the iPrEx study received condoms and comprehensive HIV prevention support. The HIV prevention benefits of PrEP were in addition to the benefits obtained from other prevention methods.

 

iPrEx study results were first reported in the New England Journal of Medicine in November, 2010 (http://www.nejm.org/doi/pdf/10.1056/NEJMoa1011205).

 

Data supporting the use of PrEP to reduce HIV infection risk in heterosexual men and women were provided by the Partners PrEP study, which involved 4758 HIV serodiscordant couples (couples in which one partner is HIV-infected and the other is not) at nine trial sites in Kenya and Uganda. Both the iPrEx and Partners PrEP studies found that PrEP is safe, with very low levels of sideeffects and limited risk of HIV drug resistance.

 

“With 2.6 million new HIV infections occurring each year, and fewer than half of people with HIV receiving treatment, the world needs new and effective HIV prevention strategies,” said iPrEx Protocol Chair Robert Grant, MD, MPH of the Gladstone Institutes and the University of California at San Francisco. “Men who have sex with men have borne an enormous burden in this epidemic, and have also beenconsistently at the head of efforts to help reverse it. The 2,499 men and transgender women who participated in the iPrEx study Brazil, Ecuador, Peru, South Africa, Thailand and the United States have made an historic contribution to the effort to help end this epidemic.”

 

“The data are clearly strong enough to warrant FDA approval of Truvada for HIV prevention,” said Dana Van Gorder, Executive Director of the AIDS advocacy group Project Inform. “The decision about whether to approve Truvada for prevention should be made with compassion, based on science rather than ideology, and without judgment regarding the behaviors of people at risk for HIV. We firmly believe in the right of people at risk of becoming infected with HIV to choose PrEP, which has been shown to be effective when used with condoms, as an additional method of HIV prevention.”

An Open Label Extension of the iPrEx study (iPrEx OLE; http://www.iprexole.com/index.html) is currently underway at 11 clinical trials sites in the United States, Peru, Ecuador, Brazil, South Africa and Thailand. iPrEx OLE is designed to provide additional information about the safety of PrEP and the behavior of people taking PrEP over a longer term.

 

The iPrEx study was sponsored by the U.S. National Institutes of Health (NIH) through a grant to the Gladstone Institutes, a non-profit independent research organization affiliated with the University of California at San Francisco. Additional support for iPrEx was provided by the Bill & Melinda Gates Foundation.

# # #

 

Mark Aurigemma

mark@aucomm.net

212.600.1960 (office)

646.270.9451 (mobile)

Breast Cancer Month: A Jamaican Lesbian’s survival story …………….

(WARNING – some photos contained may be unsettling)

On the evening of October 19, 2011 at the Couture Oasis’s Open Mic Open Soul Wednesday night discussions series we were asked to invoke the presence of a Jamaican same gender loving breast cancer survivor who from the moment she opened her presentation had all wondering if she was really going through this struggle and complications with this awful disease. The picture of doom and gloom mixed with uncertainty and doubt as often marketed with cancer victims of all sorts was clearly missing from this vibrant soul. Her resilience had audience members in awe and deep appreciation and other stories from the transfixed persons came flying out as well at some points leaving many in the small air conditioned room teary eyed.

“Judy” as I shall call her for purposes of this post is in her late twenties or early thirties from as early as 2010 said she started to notice strange things happening with her right breast and especially at or around the nipple. There were leakages at some points with what appeared to be water and blood as the residue from it and this she thought was maybe she had scratched her nipple area. After seeing this for some time she decided to have a check up done but doing the tests including a mammogram nothing was found , she had repeated tests over time but still there was neither any lumps or any blots on her X-Ray results to indicate there was trouble or via self examination the few times she attempted them. It was not until a new doctor she consulted went further than just the breast itself and focused also by her underarm to her lymph-nodes and realised that her nodes had overgrown onto her breast tissue, it was then she was finally diagnosed on November 26, 2010 after repeated calls from the doctor’s office up to her due checkup date that she had Breast carcinoma, For solid tumors, stages I-IV are actually defined in terms of a more detailed staging system called the “TNM” system.

N classifies the amount of regional lymph node involvement. It is important to understand that only the lymph nodes draining the area of the primary tumor are considered in this classification. Involvement of distant lymph nodes is considered to be metastatic disease. The definition of just which lymph nodes are regional depends on the type of cancer. N0 means no lymph node involvement while N4 means extensive involvement. In general more extensive involvement means some combination of more nodes involved, greater enlargement of the involved nodes, and more distant (But still regional) node involvement. M: Metastasis M is either M0 if there are no metastases or M1 if there are metastases.

As with the other system, the exact definitions for T and N are different for each different kind of cancer. As you can see, the TNM system is more precise than the I through IV system and certainly has a lot more categories. The two systems are actually related. The I through IV groupings are actually defined using the TNM system. For example, stage II non-small cell lung cancer means a T1 or T2 primary tumor with N1 lymph node involvement, and no metastases (M0).  She was kind to provide me with some photos of the courses of treatment she underwent. (photos published with permission)

short time after surgery and stitching

 Herceptin treatment course

day 1 of draining

 day 2 of draining to remove excess liquid around the area

She took it in strides much to the surprise of her family, close friends and then partner while they in turn had great difficulty emotionally in dealing with the news, many were surprised how she was calm and in control which in the long run made the road to recovery easier for all in knowledge of her illness and drew on her strength. Her mother and father in particular were deeply affected by the news according to her. Surgery was the next move and in preparation for that she dove into attending as much entertainment gigs as possible just weeks before going under the knife then came the faithful day of December 9, 2010 where she underwent her single mastectomy and a new set of problems presented themselves almost from the get go post the breast removal, the LMA – Laryngeal mask airway was apparently absent during the session so she was not fully drained the remaining tissue area where the breast was before leaving the hospital, as in most surgeries of this nature there is the issue of liquid gathering around the area where the tissues were and she had to make repetitive visits to do the drainage procedures with some side effects such as numbness, pain from where the needles were implanted and some lethargy but the nurses and medical team again expressed surprise and some elation at how she took it, she was even considered as a model patient to others who were also doing their own courses of treatment. In April 1, 2011 she commenced chemotherapy as of course one of the first things to go was her hair but one wouldn’t recognize that it was the fault of cancer or chemo but more just her natural style. Her personality superceeds all other underlined issues  thus helping her to cope. At this point economic factors to navigate the sessions presented themselves as she required 17 injected doses of a particular treatment known as Herceptin HER2 test to determine if your cancer is HER2-positive before taking Herceptin, as benefit has only been shown in patients whose tumors are HER2-positive and there was some concern about other side effects such as the hardening of her veins and repetitive phlebotomy exercises leaving her skin marked and difficult to find new areas to puncture. Worsening of low white blood cell counts to serious and life-threatening levels and associated fever were higher in patients taking Herceptin in combination with chemotherapy when compared with those who received chemotherapy alone. The likelihood that a patient will die from infection was similar among patients who received Herceptin and those who did not.  Herceptin treatment can also result in heart problems, including those without symptoms (such as reduced heart function) and those with symptoms (such as congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Because she was diagnosed with a form of Metastatic Breast Cancer here are some quick facts about the drug/treatment/side effects.

Metastatic Breast Cancer

Herceptin has 2 approved uses in metastatic breast cancer:

• Herceptin in combination with the chemotherapy drug Taxol^® (paclitaxel) is approved for the first line treatment of Human Epidermal growth factor Receptor 2-positive (HER2+) metastatic breast cancer
• Herceptin alone is approved for the treatment of HER2+ breast cancer in patients who have received one or more chemotherapy courses for metastatic disease

Taxol is a registered trademark of Bristol-Myers Squibb Company.

Some Infusion Reactions include

• Some patients have had serious infusion reactions and lung problems; infusion reactions leading to death have been reported
• Symptoms usually happen during or within 24 hours of taking Herceptin
• Your infusion should be temporarily stopped if you experience shortness of breath or very low blood pressure
• Your doctor should monitor you until these symptoms completely go away
• Your doctor may have you completely stop Herceptin treatment if you have:
  • A severe allergic reaction
  • Swelling
  • Lung problems
  • Swelling of the lungs
  • Severe shortness of breath
• Infusion reaction symptoms consist of:

• Fever and chills
• Nausea
• Vomiting
• Pain (in some cases at tumor sites)
• Headache

• Dizziness
• Shortness of breath
• Very low blood pressure
• Rash
• Lack of energy and strength

One other issue she faced was her own constant movements during some of her sessions as this can auger negatively for any patient and can lead to punctured or damaged skin that may itch or get infected if not properly monitored. She now does her Herceptin treatment every three weeks and has subsidized the costs through insurance and other state healthcare benefits under the National Health Fund and some help from Jamaica Reach to Recovery. Treatment can run in the millions literally locally as her initial run was budgeted for over $2M. Her type of cancer as you may have gleaned is rare as her family history does not have many persons who have or had the disease, she was alone on this front. Four other members of the audience expressed their own stories of losing loved ones and are presently under pain from some sort of cancer, but mostly that of the breast, clearly there are issues of closure for some persons with cancer of any sort. Judy’s case however is a testament to survival and proof that strong will and determination can help to overcome the odds, her sister who was present in the discussion paid testament to that as she said she sometimes draws strength from Judy even though it is Judy who is ailing and she still wonders how does she do it?. Applause rang from the audience and commendations as to how she dealt with the whole ordeal and for openly sharing the information the audience ended the session which was followed by the floor opened to poetry.

God Bless Judy.

Peace and tolerance

H

Prostate Cancer Awareness Month: Prostate Cancer Risks, Anal Sex Separate Yet Intertwined Issues For MSMs

This article is written and put together in the attempt to dispel the popular myth that anal sex can be a cause of prostate cancer. 

Anal sex does not cause prostate cancer, nor will it cause it to come back.

September is Prostate Cancer Awareness month locally and there has been some talk that anal sex especially as practised by same gender loving men who play the passive role in their sexual encounters or relationships are likely to suffer from prostate cancer. This is a myth, Prostate cancer is usually one of the slower growing cancers. In the past, it was most frequently encountered in men over 70, and many of those men died of other causes before their prostate cancer could kill them. This led to the old saying &ldquomost men die with, not of, prostate cancer&rdquo. However, that is certainly is not true today. Three developments have changed things considerably:

• Men are living longer, giving the cancer more time to spread beyond the prostate, with potentially fatal consequences.
• More men in their early sixties, fifties and even forties are being detected with prostate cancer. Earlier on-set, combined with the greater male life expectancy, means those cancers have more time to spread and become life-threatening unless diagnosed and treated.
• Prostate cancer in younger men often tends to be more aggressive and hence more life-threatening within a shorter time.

Provided appropriate treatment commences while the cancer is still confined to the prostate gland, it is possible to “cure” it. The possibility of cure is the main reason why early diagnosis is critical

What is it?

The walnut-sized prostate gland is located in front of the rectum and below the bladder. Its main job is to produce the fluid that nourishes and protects sperm cells.

(scroll over image to veiw the prostate. Image taken from http://www.prostate.org.au/what-is-the-prostate.php)

The most common form of prostate cancer develops in the glandular cells. While most prostate cancers grow very slowly, if it’s an aggressive form, it can quickly spread to the area surrounding the prostate, and eventually metastasize to the lymph nodes, lungs, liver, and other parts of the body.

What is it about the prostate that causes so much pleasure with anal sex?

The prostate is a very sensitive gland or organ that resides between the rectum and the bladder. There are nerve endings in the prostate which connect to the base of the spinal cord and directly to the brain. Stimulation of the prostate with a finger, dildo, penis or other sex toy can be very pleasurable. The use of adequate water-based lubrication and a condom on an erect penis can increase the pleasure to the receptive partner.

Who is at risk?

Your chances of developing prostate cancer have a lot to do with factors you can’t control, like age and family history. Some doctors believe that having a vasectomy can also increase the risk, but the medical community is divided on the issue.

Some of the known risk factors include:

• Age: The risk of prostate cancer increases as you get older. All men should be aware of their risk of the disease and consider being tested for it regularly from age 50 onwards, or from 40 onwards if there is a family history of prostate cancer.
• Race: The reason is a mystery, but prostate cancer is more likely to occur in Afro-American and Hispanic men, who are more than twice as likely to die of the disease than their Anglo-Saxon counterparts. The occurrence of the cancer is lower in Asian men.
• Family history: Having an immediate family member who has suffered from prostate cancer more than doubles your risk of eventually contracting it.
• Diet: Eating an abundance of red meat and high-fat dairy products may increase your risk of prostate cancer.

Some doctors think that a condition known as prostatic intraepithelial neoplasia, or PIN, can be an important indicator of whether or not you will develop prostate cancer. PIN refers to tiny changes in the size and shape of prostate gland cells, and can appear in men as young as 20. A high-grade PIN on a prostate biopsy may or may not indicate the presence of cancer, but your doctor will definitely want to keep regular tabs on your prostate if a high number is discovered.

What are the common reasons to get tested?

Most men will seek testing for prostate cancer for the following reasons:

• As part of a general check up – usually after 50 years of age
• Due to a recent experience with a relative or friend who has suffered from prostate cancer
• A family history of prostate cancer
• A recent onset of urinary symptoms

Speak with your doctor and make up your own mind in regards to testing.

Some men, when enquiring about prostate cancer, may be confused by conflicting views expressed about methods of diagnosing and treating the disease. Perhaps the most controversial is the view – which PCFA disputes absolutely – that it would be better for men not to know whether they have the disease and therefore they should not be tested be treated.

The thinking behind this is:

• because the disease can be relatively slow to develop, most men would die with, rather than of, the disease.
• because treatment has potentially serious side effects such as impotence and incontinence, treatment may be worse than the disease

All men have the right to make decisions for themselves about whether to be tested. It is your choice.

What are the symptoms?

Many cases of prostate cancer are slow-growing and symptom-free. That said, some men do experience symptoms like difficulty urinating, a weaker urine stream, pain or burning while urinating or ejaculating, dribbling after urination, and stubborn hip or back pain. If you experience any of these symptoms, it’s important to see your doctor immediately.

How is it detected?

If you’re in a high-risk category, regular screening can help spot the cancer early on. Prostate cancer can be found in two ways: A doctor can test the amount of prostate-specific antigen (PSA) in your blood or conduct a digital rectal exam.

A digital rectal exam is pretty much what it sounds like. The doctor inserts a finger into your rectum to manually check for any irregularities on your prostate. If the thought makes you squirm, you may want to realign your priorities: Regular tests can help catch prostate cancer at an earlier, less hazardous stage and increase the odds of eliminating the disease.

If prostate cancer is suspected, your doctor will likely want to schedule a blood test to determine the amount of PSA in your blood, as well as conduct a biopsy.  A prostate biopsy is usually performed by a urologist, who removes samples of tissue from your prostate with a needle and the visual help of a transrectal ultrasound.

If cancer is detected, it must then be graded. Grades are assigned to the two areas of the prostate that contain most of the cancerous cells and are added together to obtain a Gleason score. The higher the score, the more aggressive the cancer could be.

How is it treated?

There are several treatment options with which to combat prostate cancer, but some men with the slow-growing variety choose no treatment at all. The term &ldquowatchful waiting&rdquo describes the decision to forgo treatment, but still keep tabs on the cancer.

This route is sometimes chosen by older men for whom the treatment&rsquos side effects represent more of a health risk than the cancer itself or by men who don&rsquot want to deal with the possible side effects of treatment. Often, men with slow-growing prostate cancer have about the same life expectancy as those without cancer.

If you decide to pursue treatment, you have several options:

• Radical prostatectomy: Removal of the prostate gland can be a very effective treatment option, but having to recuperate for weeks and endure possible side effects like incontinence and impotence causes many men to shy away from it.
• Radiation: It can be just as effective as RP and the recovery time is shorter, but radiation treatment is also linked to impotence.
• Hormone therapy: Lowering testosterone levels can slow the progression of some forms of prostate cancer and help manage aggressive forms of the disease.
• Chemotherapy: Chemotherapy drugs are often used to treat men with advanced prostate cancer.
• Cryotherapy: It’s a relatively new treatment with a space-age name, but cryotherapy actually consists in freezing — and hopefully destroying — cancerous cells.
•  High Intensity Focused Ultrasound (HIFU): The opposite of cryotherapy, HIFU uses a high-intensity ultrasound beam to heat the cancerous prostate cells until they die.
  

Prevention is key

Prevention

Current information on prostate cancer risk factors suggests that some cases might be prevented. One possible risk factor that can be changed is diet. You may be able to reduce your risk of prostate cancer by eating a diet low in fat and high in vegetables, fruits, and grains. The American Cancer Society recommends limiting your intake of high-fat foods from animal sources and choosing most of the foods you eat from plant sources. Eat five or more servings of fruits and vegetables each day. Bread, cereals, grain products, rice, pasta, and beans are also recommended. These guidelines on nutrition may also lower the risk for some other types of cancer.

Tomatoes (raw, cooked, or in tomato products such as sauces or ketchup), grapefruit, and watermelon are rich in lycopenes. These vitamin-like substances are antioxidants that help prevent damage to DNA and may help lower prostate cancer risk.

Taking vitamin supplements may affect your prostate cancer risk. Some studies suggest that taking 50 milligrams of vitamin E daily can lower risk. Although other studies found vitamin E to be of no benefit, reasonable doses of this vitamin have no significant side effects and are not expensive. On the other hand, vitamin A supplements may actually increase prostate cancer risk. As always, you should use vitamin supplements with caution.

Because the exact cause of prostate cancer is not known, we do not know if it is possible to prevent most cases of the disease. Many risk factors such as a man’s age, race, and family history are beyond his control.
The Prostate Cancer Prevention Trial is a study that has enrolled more than 18,000 men to determine whether a drug called finasteride, which prevents the prostate from using male hormones, can reduce prostate cancer risk. Androgens are male hormones that are known to be important in promoting the growth of normal and cancerous prostate cells and may be important in the development of prostate cancers. Because prostate cancers form slowly, it will take several years before we know.

The same mantra you hear about many cancers also applies to prostate cancer: Early detection can play a key role in its control and elimination. That’s why it’s important not to let your squeamishness get the best of you; relax and get the test over with. Regular prostate exams, along with knowing the steps you can take to prevent this disease, will go a long way in keeping your prostate health on the right track.

Is there sex after prostate cancer?

Although the diagnosis of prostate cancer is devastating, the disease is highly treatable. Treatment, however, does have side effects that can drastically affect sexual function both from a physiologic and psychological standpoint.
Younger men, men with less extensive prostate cancer and those who have had an active sex life before developing prostate cancer are less likely to experience difficulties with sexual function after cancer treatment. Communication between sexual partners and physicians is also crucial for dealing with alterations of sexual function. Sex with another man did not cause the prostate cancer and it will not cause it to return.

Will I have sex again? is not an easy question for a doctor to answer because it depends on a multitude of factors. Hopefully one&rsquos doctor will have raised the issue before treatment&mdasheven if the patient did not. But still, discussing sex with one&rsquos doctor early on may not offer much solace when trying to &lsquoget it up&rdquo that first time after treatment for prostate cancer has occurred.

Treatment for prostate cancer affects sexual function for two important reasons: The prostate contributes the bulk of the fluid that makes up semen; so depending on which of the two major treatments for prostate cancer a man chooses, he may discovered that he has little to no ejaculate at all after treatment. Second, the nerves that stimulate the penis to become erect run close-by the prostate gland. They too can be affected by cancer treatment. In addition, anal sex, which may be an integral part of a gay man&rsquos sex life, may also be affected by certain treatments for prostate cancer. Sexual function can depend greatly whether or not the treatment was surgery or radiation therapy. It is best to discuss the various issues specific to each treatment.

Radical Prostatectomy

Surgical treatment for prostate cancer is called a &lsquoradical prostatectomy.&rdquo The surgery removes the entire prostate gland and some surrounding tissue. The doctor tries to spare the nerves that stimulate an erection, but sometimes nerve injury cannot be avoided as the surgeon tries primarily to cure the cancer (Jelsing, 1999). Most men notice significant change in erections even after what is called &ldquonerve sparring&rdquo surgery. It can take as long as two years for erections to stabilize.

Inability to ejaculate

The other universal complication after radical prostatectomy is failure to ejaculate. When the surgeon removes a man&rsquos prostate, the muscle that closes his bladder allowing his ejaculate to move out of the penis rather than back into his bladder is destroyed. Instead of shooting out, his ejaculation becomes &ldquoretrograde&rdquo and shoots into his bladder. While still perfectly capable of having an orgasm, no ejaculate comes out. This can be a very troubling complication of surgery for some men and their sexual partners. Some men feel that they are not really sexually satisfied if nothing comes out. They may also feel less manly. Semen itself is erotic for many gay men. They like to see it, feel it and taste it. Retrograde ejaculation can rob them of this very important stimulant. Fortunately, radical prostate surgery does not affect the anus or rectum. Once the patient gets over the pain from surgery and the incision fully heals, he will be able to have anal sex again without restriction. Anal sex did not cause the prostate cancer not will it cause it to come back.

If you have any queries, please consult your local GP.

Combined sources

Jamaica Cancer Society

Malecare Fighting Cancer Together

http://www.amazon.co.uk/gp/reader/1560235535/ref=sib_dp_pt#reader-link

How a gay man coped with Prostate Cancer 

Radio program “Love & Sex” on Sexual Identities & Transgenderism (Were you born in the wrong body?)

December 1st, World AIDS Day the Jamaican transgender community got a chance to voice their concerns through representative “Jane” on a radio program aired on Newstalk 93FM

named :Love and Sex” hosted by Jamaican Clinical Sexologist of The Caribbean Sexuality Research Group (CSRG) Dr. Karen Carpenter and co-host Gavin Walters. Sexual identities were the broader subject of the discussion as other variants and orientations were also examined. It is not very often the local transgender community gets an opportunity on the airwaves to share real information on their lives and to dispel the misconceptions about their community and the mix up with the Lesbian, Bisexual and Gay lifestyles.

Host Dr. Karen Carpenter made mention of Cuba’s lead in public education on sexual identities and their interventions with the various groups. She highlighted the outreach there as providing jobs and overlooking the packaging of persons but more so seeing people as people.

Dr. Marilyn Volker famed international Sex Therapist who has worked with transsexuals in the United Stated as well was also a guest on the one hour and forty two minute discussion touched on the possible causes of transgenderism to sexual orientations and identities.

(photo from GIRES) Gender Identity Research and Education Society UK

The opening dialogue before the interview also dealt with the differences between Transgender, Transvestite and or Cross dressers. Being the qualified person that Dr. Carpenter is she simply defined the differences.

• Transgender – seems themselves as a different gender than the one they were born as physically also known as body dysmorphia or born in the wrong body. The person is unable to conceptualize themselves as the sex they are physical in. Sexual re-assignment surgery is used to make the changes for the individual.
• Transvestite – Persons who like to dress in clothing of the opposite sex mostly for entertainment.
• Inter sexual – persons born with undefined genitalia or sexual organs.
• Drag Queens – Dr. Carpenter referred to famed diva Rupaul or males who wear female clothing either for entertainment or just comfort.

Dr. Marilyn Volker Adjunct Professor with the University of Miami Florida, Florida International University and Diplomat of the American Board of Sexology, Associate Fellow of the American Academy of Clinical Sexologists and teacher to Dr. Karen Carpenter was introduced. She also hosted a program Sex with Marilyn. She contributed much to the discussion.
She contributed among other things:

Sexual Identity: consists of four parts, Biology consisting of chromosomes and hormones persons need to look at the brain structure and not the sexual organs to determine the finality. Gender identity is the second part; it’s the brain that determines sexual identity not the genitals. i.e. male, female or in between no matter what sexual organ the person has. The there is gender role that means how persons appear or dress, if we went by what the sexual organs are and not what exist between the ears we may be dressing a child or person of a different gender. We must see children and people with the heart and not by outward appearance. Gender role is on the external, Gender identity is on the internal Sexual orientation is the last no matter what is between the legs of the person, or the brain orientation is who one is attracted to.

So a transgendered person could be right handed or ambidextrous, heterosexual, homosexual or bisexual. It is very complicated at times but bear in mind what’s between the legs and ears doesn’t necessarily match how a person dresses.

Dr. Volker referred to twin studies where pairs of twins have different orientations that suggest there is more than just parenting, social and chromosomal and hormonal structure of each person. A child in as far as identity is concerned that may be born with a vagina may get more male hormones when in the uterus it could develop a masculine brain with feminine private parts.
The term for matches in sync with brain identity versus physical genitalia is CISGENDER transgender is the opposite and doesn’t match. In one in every two to five thousand births there is some difference in chromosomes and hormones. There maybe ambiguous development during birth. When there is a combination of chromosomal hormones in the middle that leads to ambiguous genitalia it is called inter sexuality also called androgyny (outside of entertainment use for rock music). Androgyny comes from the Greek word “Andro” Male and “Gyny” Female suggesting behaviour roles as well identifying with a wide range of activities and feelings excluding biological concepts.

“Jane” the leading local transgendered voice was introduced to the program where she explained she discovered she was trans when she was six years old but never started the process of living as trans female until her late twenties. She explained she was born male growing up she acted effeminate and liked doing girl’s things. “Living in Jamaica one knows that kind of thing is not normal” so she hid it depicting a male persona even becoming a bully at school using it as a shield. She adopted a very macho personality using it as a shield and became in Jamaican terms “a girl’s man” i.e having many girls and hyper masculine or the stereotypical yard man. In doing so she tried to purge the feelings within and the guilt of growing in a Christian home with heathen thoughts. She adopted a destructive cycle while cross dressing in private with suicidal thoughts which temporarily relived the tension. She would often destroy and burn feminine personal possessions only to recycle the same actions all over again. She struggled with the fact that she was still a man; the early morning boner was like “alien appendage” to her. She also had a fiancée while as a man but eventually broke off the engagement; persons were shocked upon discovering her “change” as family shunned her save and except for her father surprisingly as mothers are expected to cope with this better, she has since become accommodating.

Dr. Volker responded by emphasizing doctors are now realising through brain scans, hormonal tests and chromosomal tests to say to parents with children who are possibly transgendered that one may have a child who has a particular genitalia but is the opposite sex in the brain. If many parents and troubled transgendered persons were told as early as birth what the proper diagnosis is then a lot of the problems similar to the ones described by Jane would have been avoided. She also touched on chromosomal issues as in X and Y versus hormonal levels in determination of the baby’s sex, usually in a female it’s XX and a male XY, there are children born XXY born with a penis but an extra female chromosome meaning they could look more feminine or look masculine on the outside with a penis with a feminised brain, things can occur during birth. Usually girls get XX patterns with more estrogen and progesterone while most boys gets XY patterns with testosterone and androgen sometimes there is a mix in the uterus where a mix of chromosomes like XXY leading to less masculine development somewhere. There may even be more testicular tissue in girls where this mix up occurs. The available tests now can see into the hormonal and chromosomal structures. The pediatrician can now ask a parent does the they like to or want to know the chromosomal structure of their child.

Jane continued that she harnessed the power of the Internet as there were few doctors in Jamaica who knew about transgenderism. She sourced her own hormones from the Internet, she looked at the Harry Benjamin principles of care and read where possible medical journals. Dr. Volker noted that several Trans persons have to teach their doctors about the issues. Jane noted her website was down at this time. She is aware of ten individuals in Jamaica living as women some of whom are lost in the gay community due to the lack of education for them. Dr. Volker said the important thing is what the brain is attracted to and not the physical. There maybe a heterosexual female born in a girl who has a penis her brain maybe attracted to a male who maybe mistaken as gay. There maybe need for a serious re-socialization process globally to deal with these new phenomenons. One would have to also go to gender specialists, endocrinologist to get more professional and detailed information.

Jane highlighted she is pre-operative transgender meaning she has not done the full sexual re-assignment procedure so she can father a child now but after surgery cannot have children naturally or get pregnant. She plans to have the surgery as soon as she can find the money.
In answering Dr. Volker’s questions on her orientation Jane responded bisexual. Dr. Volker continued to explain that gender identity and orientation differ in the trans world. She has worked with transgendered who have moved from having a penis while trying to be heterosexual male but their brain was heterosexual female but couldn’t express it as they would look as if they were gay on the outside,” it is confusing to persons going through the issues.” She emphasized the need for support. Jane continued on the lack of support systems in Jamaica except the Internet or possibly contacting JFLAG who may put one on to other transgendered persons.

Dr. Carpenter noted that the Caribbean Sexuality Research Group (CSRG) offers some support to transgender persons and runs a free clinic at the UHWI Psychiatry Unit which has been running for the last month by calling 977-0316 with a small registration fee of $500.00, leave a message for appointments as all calls are answered.

She also remarked on the misconception of homosexuality and paedophilia and the tabloid papers sensationalism creating the homo-negative perceptions over time. “The minute we find out someone’s sexual orientation is different from others we begin to monitor, oh they must be about to hit on somebody which is inappropriate.”
She highlighted that paedophilia happens when there is an economy is depressed and the power differential between the adult versus the young person despite sexual orientation is wide.On the matter of gender variant children from a caller to the program Dr. Volker suggested that the child be monitored by a pediatric endocrinologist or a child psychiatrist who understands gender. Children who present with the mis-match usually the assessment is done in early puberty where hormones may be administered dependent on the case to stop the actions opposite to the physical presentation but the sexual re-assignment surgery is left to later in life in most cases unless they were born with both genitals or intersex. (A practice which is opposed by some intersex activists)Program continues to the end.

Peace and tolerance.

H