Might sound crazy, but it ain't no lie, baby bye bye BYE!!!

Yay! It's almost time to end this semester, and for me, end my schooling!!! (At least until I decide if I want a masters...gulp). For the rest of the ladies that still have a few more semesters ahead of you, good luck! But for those of us about to graduate, woo hoooooo!
Ok, I'm trying to contain my excitement here. I'm going camping in two days, and I'm pretty excited about that as well! This has been a very productive semester for me and I'm ready to relax. So we are finally in the home stretch and I'm trying to keep it together at least through finals.

This week's QOTW was intriguing as the situation had happened to me many moons ago. I worked at a DME/homecare company and I had to pick up patients' sharps containers. One of the patients had thrown his needles in a red bag instead of the sharps container and it jabbed me in the leg. Very low risk of exposure, but the physician who gave us recommendations for our company suggested I go on PEP. I ended up taking AZT for a little over two months, not one month like the CDC recommends today. Luckily I wasn't infected, but the AZT didn't sit well with me either. I no longer work in high-risk situations, but I think about this if I ever get back into the clinical side of a physician's office.

Did You Know?

The ACLU AIDS Project issued an interesting report back in 2003 about HIV/AIDS discrimination, and how this affected the gay population. While 2003 seems like forever ago, and in many ways it is, it really is just a blip in our HIV history. After extensive research and interviews with ASO's and communities as a whole, it was determined that HIV discrimination was still alive and well, especially in the rural areas.

It was reported that in rural areas many people still thought you could get infected with HIV by casual contact. There was also a church in the Florida Panhandle that the congregation would ask HIV positive parishoners to leave the church. It was also still considered a "gay disease" in many of the rural areas. It got to the point that many didn't want to come out for fear of being banished from their own communities.

This was 2003, not the 80's!! It's hard to swallow that this kind of thinking was happening in America. Unfortunately, it still does. While each year the acceptance grows, there are still little nooks and crannies of unforgiveable discrimination within our own country. Now that we've taken this class, hopefully those that weren't aware about how HIV was transmitted can educate those that aren't aware. I have a special place in my heart for the gay community and I will use my knowledge about HIV disease to stand up for them and correct anyone that stands in the way of the truth. It is my hope that in my lifetime these nooks and crannies will all disappear...

www.aclu.org/FilesPDFs/HIVCivilrights.pdf

Medication Management

Graduation is almost here! Well, at least for some of us! I don't think I'm going to walk...it's on a Friday, and I'd much rather use a day off for the beach or camping than hanging out in a crowded arena for a few hours. I'm actually scheduled to work that day, but I think my boss will let me off early to blow off some steam...he's the one that paid for my education, after all!

With the M & M simulation come and gone, I must say I was surprised to see how many times I missed a dose and/or forgot a particular pill altogether. With working with HIV patients in the past, I never really felt their frustrations with keeping a strict medication schedule. I used to think it was easy. And this was before the invention of cellphones, which we could program to remind us! I would think, "just write it down!" I now see that it isn't that easy. Not to mention the dietary restrictions that go along with it. I am happy that I don't have to deal with something like that on a day to day basis, but it makes me feel bad for our patients and my friends that do.

Did You Know?

I really wanted to change my "Did You Know" title to "What the..." after reading this story. A basketball day camp in Rockland county was found guilty of discriminating against an HIV positive boy who wanted to attend their camp in 2004. The director of the camp denied the boy's admission due to his HIV status. According to the article, his status was disclosed by his mother during the admission process. The camp nurse had raised the question to the camp pediatrician on what the transmission risk would be. The Director in turn denied the boy admission.

There's a couple of statements here that make me want to smack my head against the desk a few times. The NURSE, whom I assume is a degreed nurse, asked the PEDIATRICIAN, whom I can only assume is a degreed and licensed physician, what the trasmission risk was, and between these two brainiacs they determined that the risk was sufficient enough to deny this boy admission. What nursing school/medical school did they attend? Are these medical professionals for real?

I often wonder what the medical community thinks when reading things like this. If a medical professional is stating there is a major risk, they could be spreading this kind of misinformation to the masses through the patients they treat. It's no wonder people are still roaming the United States thinking we can get AIDS from the toilet or a drinking fountain!

Would this boy be playing basketball with youths and have to have sex with them? No. Would this boy be playing basketball with youths and share dirty needles with them? Doubtful. It's justice that the camp was found guilty in violating state and federal discrimination laws, but what about the health practitioners in this case? Business as usual? It just makes me cringe.

www.thebody.com/content/legal/art55363.html

Who would you tell if you had HIV?

This week's QOTW focused on who would we tell if we were HIV positive. Being diagnosed with HIV would be devastating enough, but I can't imagine if I were shunned by family and/or friends after disclosing my status. In reading my fellow classmates' posts, I wonder if their families would be as supportive as they think. And I'm not talking about the posts for this QOTW.

Some of the answers I've been reading in response to these situations that have been given to us have been a little close minded. I don't disrespect anyone's family situation or opinion, because it is just that. But if we are close minded to the idea of being around or helping someone who is HIV positive, how do you think our friends, family, and children are going to react? I would imagine much in the same way.

I treat everyone in the same manner that I expect to be treated. That is with love, respect, and an open mind. And that's why even when it comes to close minded people, I have to be open minded. You never know when there is another learning opportunity, and every person, place, and thing I come into contact with in this life is a mini lesson to be learned.

Did You Know?

Scientists have developed an HIV Stigma Scale to determine top reason why one would not disclose their status to others. In 2006 researchers embarked on a study to determine reasons for disclosure and more importantly, reasons for non-disclosure in HIV positive women. The study was specifically targeting women and their disclosure/non-disclosure habits with their children.

Reasons for non-disclosure included allowing the child to have a "carefree childhood," afraid of the stress it would put on oneself and the child, and fear of the child telling others and being exposed to HIV stigma. Not surprisingly, those mothers that had already reported facing HIV stigma were less likely to tell their children about their HIV status. While this study didn't prove conclusively that stigma plays a huge role in our disclosure habits, it showed that it does have an impact. It also referenced a study that stated the contrary, in that stigma does have a major impact and how we steer our disclosure decisions.

What kind of world do we live in when we can't even share what would most likely be the most devastating news to our children? And the reason why we can't disclose this information is fear of how people on the outside would think of us? We should learn to love and honor our family and those closest to us, and live and let live with the rest. I know it's easier said than done, but focusing on other's reactions will not help one's cause. We can only positively use what is at our disposal: our friends and family that will support us. The rest is just a negative mark on our emotional support system.

www.ncbi.nlm.nih.gov/pmc/articles/PMC1381980/

Holy Moses, Missing Doses!

I'm in the middle of my M & M Simulation and I have to say...it's hard to keep up! I hope that we are graded on the content of our paper and not the accuracy in how we take the "pills" because I've already missed a couple of doses. It's hard to keep up with the regimen. Granted, it's only a week, and my "first week" at that, but it just goes to show how difficult just the dosing regimen is. I can't even imagine factoring in actual side effects of the meds and dealing with HIV itself.

These exercises do much to let us have a minor glimse into what it's like in the day to day routine of someone battling this disease. Hopefully we as students will take this exercise to heart and try to stop the spread of HIV. It starts with us.

Did You Know?

The National AIDS Trust reported earlier this year that legislation is moving forward for the elimination of pre-employment health questionnaires in the United Kingdom. This could do wonders at eliminating workplace HIV discrimination at the onset. Previously employers were allowed to ask health related questions, even if it didn't have anything to do with the job.

Apparently this addition to the Equality Bill has support from all parties. I imagine that many HIV positive individuals can breathe a sigh of relief at the momentum this addition to the bill has. I'm going to keep my fingers crossed and watch this piece of legislation.

www.nat.org.uk/News-and-Media/Press-Releases/2010/January/Pre-employment-health-questionnaires.aspx

Back in the swing of things...

Well, spring break has come and gone. It was a nice break from my studies, but of course my boss was lost on the meaning of spring break and I had to work every day last week. Hmmph! I am excited that spring training has begun for my beloved Yankees and that the weather is *somewhat* getting warmer...even if it isn't consistent.

I had another "class crossover" moment this week. In my Community Healthcare text it stated that "...it is estimated that up to half of all new HIV infections occurring in the United States are found in people under the age of 25." It goes on to declare how alcohol and drug abuse are contributing factors in health problems of younger persons, as well. I know that these two may very well go hand in hand. We all know that we can lose our inhibitions when under the influence of alcohol and drugs, which can then lead us to not protect ourselves.

At football games I have attended in the past (at UCF and other college campuses) I have seen young adults consuming large quantities of alcohol in a short amount of time. It happens, it's college. Can we all just stop and think about the amount of alcohol that is going into our bodies and how we can safely end up home in our beds instead of next to some icky dragon breath guy (or girl!) in the morning? This specific example has never happened to me, but I've been in certain situations in my young adult years that I look back and cringe about. If you're going to drink that much, make sure you are with a sober friend who will help you get back home and not go off into the night making idiotic decisions.

An Introduction to Community Health, 6th edition

Did you Know?

If you didn't go to the Womens Infected Panel you may have missed the POZ magazine handout we received. The cover story of the December issue of POZ magazine detailed HIV discrimination and stigma. The article posted the results of a survey that asked what people thought about HIV/AIDS.

Sprinkled throughout the article were personal stories about stigma people had faced, including a person whose doctor came out in a hazmat suit for his/her office visit! Stigma and discrimination with the general public due to ignorance and lack of education is one thing; to have this done to you by your own physician is another. I can't imagine how this person must have felt... in a medical office with a supposedly educated person nonetheless. It never ceases to amaze me how fear can really drive a person to stupidity, in my opinion.

One of the pictures in the magazine showed a young black man with the t-shirt "Got AIDS?" printed on it. Someone from this class (and possibly from my blogging group) had mentioned this t-shirt campaign previously. I think it is very "in your face" and sends a strong message to others reading it. As a side note, this person's name is Anthony Bolden and we have now become Facebook friends. He does HIV education and awareness through his Facebook to help others become more aware and less fearful about HIV disease. Ah, social networking at its finest!

www. POZ.com

Eazy-E and Freddie Mercury

Eazy-E, born Eric Wright, was an American rap star and formerly a member of NWA. He was known for his truthful lyrics and blatant honesty about the neighborhood and city he grew up in, Compton. Despite his name, life for him wasn't easy. He sold drugs when he was younger and engaged in the fast lifestyle of a gangbanger. He dropped out of high school but later earned his GED. He was an associate of the Crips gang. In later life he became a member of the highly influential group NWA. I won't say what NWA stands for, but if you grew up in the 80's, I'm sure you already know. NWA disbanded around the time (1991) that he was accused of stealing money from the group.

Life after NWA showed mild success. He had some solo contributions between 1991 and 1994. In March of 1995 he was admitted to the hospital with flu like symptoms. He was immediately diagnosed with AIDS. He came out publicly with his diagnosis while in the hospital. About his diagnosis, he said "I'm not looking to blame anyone but myself." He died on March 26, 1995, ten days after his diagnosis. Eazy-E was one of the first straight rap singers that publicly acknowledged the AIDS crisis and is instrumental in helping kids in the 'hood realize that not everyone who is infected with HIV/AIDS is a gay white man.

Freddie Mercury was the lead singer of the rock opera group Queen. Queen can be heard at any football game today with hits such as "We Will Rock You" and "We Are The Champions". Freddie was private about his homosexuality to his fans and the public, but it was widely known amongst his circle of friends that he was gay. His performances were always very dramatic and flamboyant, to say the least. There is a statue of him in Switzerland standing in a rock star pose. I hope to visit it one day.

Freddie was diagnosed with HIV in the spring of 1987. This information was withheld from the public. One can only assume that he didn't disclose his status for fear of discrimination. He died on November 24, 1991, from complications of pneumonia resulting from AIDS. He had only made a public statement about his status to his fans one day prior. The remaining members of Queen have established the Mercury Phoenix Trust, which has raised millions of dollars for the fight against HIV/AIDS.

http://www.eazy-e.com/

http://www.fyne.co.uk/

Did you know?

Is there a fine line between HIV discrimination and a dangerous position? In 2009 an HIV positive Green beret that was to work protecting diplomats in Haiti sued the State Department because he was removed from training. His job would consist of throwing himself in the front of bullets and protecting high end foreign diplomats. The security firm that he worked for stated in the contract that workers are not to have any communicable diseases.

Federal law states that we must "promote employment for those with disabilities, but it is not intended to do so at the risk of their own health or the safety of others" (Davidson, 2009). I like to think that I am firmly against HIV discrimination in the workplace, but this case has me thinking. There could be a lot of bloodshed when the bullets are flying. The risk of the worker and the person he is protecting of both having open wounds is quite high. This case is different than other work scenarios that I have presented, where the risk is minimal.

What do you think? I thought I was on the fence with this one, but I think common sense states that job requirements for a position that could have a high risk of transmission, such as this one, should be carefully considered when determining if discrimination exists or not.

www.washingtonpost.com/wp-dyn/content/article/2009/01/27/AR2009012703503.html

Class crossover

I'm currently taking Community Health with Teach along with this course. I read a very disturbing statistic in my text that I wanted to share. It stated, "...31% of teenage girls get pregnant at least once before they reach age 20" (McKenzie, Pinger, & Kotecki). The inital thought of this statistic shocked me, and then it got me thinking: If almost one in three girls become pregnant before the age of 20, can I make the assumption that one in three girls are probably not using protection? Sure, some of those pregnancies can be attributed to a torn condom or a pregnancy on the pill. But I suspect that the majority of those pregnancies resulted from not using protection. And if this many teens (and yes, I consider a 20 year old a teen) are not using protection, where is the sex ed in our high schools?

This week's QOTW was about helping an injured person who had HIV. I look forward to reading the answers from my fellow classmates. I wouldn't have a problem helping an HIV positive individual, even if they were profusely bleeding. I hope many of my classmates feel the same way.

Now if any teens end up on this blog for some reason, could you please read that statistic again? And run to Walgreen's and get some protection? The youth out there is scaring me.

"An Introduction to Community Health" by McKenzie, J., Pinger, R., and Kotecki J.

Did you know?

Africa is no doubt the place most in peril when it comes to HIV. Global efforts always seem to focus on Africa, and with good reason. The numbers of those suffering with HIV in Africa are staggering and there is still antiquated thinking that poses an obstacle to becoming fully educated about the disease. Despite the best efforts, however, part of that antiquated thinking comes up in the form of gay discrmination.

In 2007, Reuters reported that many gay Africans are faced with teasing and are ridiculed when they try to seek treatment for HIV. HIV is still considered pretty taboo in Africa, even with the prevalent numbers. Being openly gay is also criminalized in Africa. Combine that with gay discrimination and you now have a formula for disaster. This creates a population that is probably not going to seek treatment out of fear, embarrassment, or possible estrangement from their family and/or loved ones.

"Homophobic stigma, the denial of homosexuality, and legislation that criminalizes same-sex behavior, all serve to push the issue of same sex HIV transmission further underground, and drastically limit HIV services" (reuters.com).

Of all the places I can think of that doesn't need discrimination based on HIV, it is Africa. While I doubt it will happen anytime soon, Africa would be better off looking at the health of their people and not worrying about their private sexual practices. Once again, only through accurate and consistent education can we beat this disease.

www.reuters.com/article/idUSL0159088020070301

We shouldn't be afraid of HIV...

This week's question of the week topic was to ask other people in our circle of friends questions regarding HIV. I saw a recurring theme: People's somewhat negative reactions to HIV and how many people are not only scared to talk about it, but are also scared of the disease itself. What promotes this fear?

I think a major factor in why people may be afraid of the disease is lack of education. Education takes many forms. Of course early HIV education plays a pivotal role in how youth perceives those who have HIV. But education can continue well after high school and college. Sometimes just talking around the family dinner table (if you have one....a family or a dinner table would certainly help!) or starting a dialogue with a mere stranger can foster an exchange. These exchanges may lead to someone who once didn't know anything about HIV to venture out into the world of the internet and library and possibly learn a thing or two. You can teach an old dog new tricks!

Did you know?

Many people still have the thought that gay = AIDS, or AIDS = gay. I don't even like the term "AIDS"...it is antiquated at best. But this thought process still blankets America today, especially throughout our conservative states, in my opinion. This quote from the National AIDS Trust says it best: "The link in people's minds between homosexuality and AIDS is so firmly established that discrimination against people with HIV/AIDS is inseparable from discrimination on the basis of sexual orientation." (National AIDS Trust, 2003)

Why is this? Another recurring theme, in my opinion: a lack of education. When some hard right conservatives push their agenda onto our HIV education platform, we foster a relationship of mistrust between teacher and student. Teachers can't say all they want in regards to HIV education, and teachers may not be able to point out misconceptions to their students, as well. HIV is not a prostitute's disease. It is not a drug abuser's disease. It is not a black man's disease, or a gay man's disease. HIV is a PEOPLE'S disease, and we better learn this fact pretty quick if we want to help others and survive.

Calling HIV "the gay plague" or "the gay cancer" in the media certainly didn't help things along in the beginning. There was a case a few years back about a movie projectionist who had been charged with gross indecency in a restroom. He was openly gay in the workplace. Fellow employees put two and two together and determined, a-ha! He must have HIV, too! This led to workplace discrimination as others refused to work with or near him for fear of his "gay disease." By the way, he wasn't HIV positive.

Until we teach our children, our family, our friends, our neighbors, and anyone and everyone else who will listen, that HIV is not a gay disease, we will continue to see HIV discrimination in the workplace and beyond. It is up to us as responsible citizens to share our knowledge and pass this message on.

www.hawaii.edu/hivaids/HIVAIDS%20stigma%20and%20Discrimination%20%20%20Gay%20Men.pdf

Keep on trucking...

This week we were asked a troublesome scenario: While on African safari, we injured ourselves to the tune of a compound fracture of the leg. Given the choice of a possibly infected blood transfusion or waiting 20 hours for U.S. blood, what would one do? For me, it was an easy choice. I don't like blood, and I certainly don't like the idea of bleeding out. I'm also not too fond of bones sticking out of my body, so I'd take my chances with the blood transfusion.

Module 1 was an explosion of data and educational material that should be required material shown to all students in high school. It was very in-depth and well written. There were so many concepts that I wasn't aware of in my 15 years of working for a couple of ID docs. Some of the statistics were sad to know, but I'm better off for it. I'm relieved that a class with this magnitude of material on HIV is available to UCF students. Those outside of health majors should consider taking it. It certainly is an eye opener.

Did You Know?

Up until 2008, the Peace Corps had a policy stating that if you tested positive for HIV, you had to hit the road. The Peace Corps is responsible for missions that reach far and wide to many countries. Peace Corps volunteers provide education in underdeveloped countries by teaching and living in those countries.

When one goes on the Peace Corps' website, under "What is the Peace Corps?" tab, the second paragraph states that "nearly 200,000 Peace Corps volunteers have served in 139 host countries to work on issues ranging from AIDS education to information technology and environmental preservation..." (peacecorps.gov)

I wonder what kind of AIDS education the Peace Corps was teaching up until 2008? Did they believe that an HIV positive teacher would pose a threat to the students? Apparently so. Jeremiah Johnson was a Peace Corps volunteer in early 2008. He was an English teacher in the Ukraine, and the only volunteer in Rozdilna.

An HIV test is required as part of the medical examination for the Peace Corps. His initial test was negative. His mid-service exam, however, yielded a positive HIV result. He was told by the Peace Corps that his service could not be continued in the Ukraine due to a law barring HIV positive individuals from working in the country (aclu.org). He was then informed that his services wouldn't be needed anywhere else, either. In the summer of 2008, after Johnson filed a complaint with the ACLU, the Peace Corps have reversed their decision and now will not fire anyone solely for being HIV positive.

While this is a great stride in HIV discrimination, how many people were turned down or terminated prior to Johnson? And leaving country's HIV laws off the table, why would the Peace Corps think that an HIV positive individual would pose a danger to those that they are serving? The last time I checked, volunteers taught students. They didn't share needles or have sex with them. It makes me wonder what their "AIDS education" curriculum was all about in the first place.

http://www.peacecorps.gov/

www.aclu.org/lgbt-rights_hiv-aids/hiv-advocacy-behalf-peace-corps-volunteer

Getting settled in...

This class is off to a good start. I am happy that I am learning more and more about HIV disease with every passing conversation, discussion board, and article. So much information is available on the topic, and having the opportunity to discuss openly with those that are afflicted with the disease puts a real world aspect on this class that cannot be done with others. I am looking forward to attending the panels that are being offered and putting the names to some faces that I've been communicating with.

The blogging topic for this week is ASO's in other parts of the country. I really wanted to learn more about China's ASO's, and found a few that looked promising (HomeAIDS, AIDS Concern, and TeenAIDS) but unfortunately Google wouldn't translate any of the pages for me. Cest la vie. I decided to take a closer look to see what our upstairs neighbor, Canada, had to offer.

The ASO I came across is called ACT, which stands for AIDS Committee of Toronto. ACT provides services to those who are infected and affected, as well as provide education to those that want to learn more. Specifically for the HIV population, some of the services provided include free counseling, transportation services, and employment help for those re-entering the workforce.

One service that ACT offers that I found to be of interest is a consultation with a naturopathic physician and graduating students of naturopathy schools. These consultations are to help evaluate the client to determine if there are alternative medicines to help ease the side-effects of anti-retroviral therapy. I had never heard of the term "naturopathic" prior to this, and had to ask the physician I worked for what it meant. It roughly translates to natural medicine. Natural medicine I have heard of, but I had no idea that one could receive a degree in naturopathy.

ACT also provides forums and educational seminars led by medical experts. These forums are open to the public. It looks as though ACT is doing a lot of good up in Canada. Their services reach far and wide, and many are very specific to those infected with HIV.

www.actoronto.org/home.nsf/pages/livingwithHIV

Did you Know?

Cirque du Soleil: A dancer and gymnast's dream. Those who have been around the gay community may think that "The Arts" have a long and deep relationship within the community. This is especially true in matters concerning HIV discrimination. While history has proved this to be true for the most part, there are still instances of HIV discrimination in every facet of life, including the arts.

According to Lamda Legal, Matthew Cusick was an aspiring dancer and trapeze artist who passed the tryouts at the Orlando Cirque du Soleil. While he disclosed his HIV status to those closest to him, he kept it from his employers at Cirque du Soleil. Upon finding out about his HIV status, the company terminated his employment due to the risk of injuring other performers or audience members.

Was this a case of intolerance or a true risk assessment? The courts found it to be the former. There wasn't any scientific evidence available to determine that there was a substantial risk, and the courts found in Cusick's favor. At what cost did this come? How about disclosure of his HIV status to whoever picked up a newspaper at the time. While it was a hefty price to pay for Cusick, his openess paved the way for other companies to take note that discrimination, in any form, cannot be justified. According to Lamda Legal, Cirque du Soleil paid a record $600,000 for the wrongful termination. An expensive lesson, indeed.


www.lambdalegal.org/in-court/cases/matter-of-matthew-cusick-and-cirque-du-soleil.html

www.abanet.org/irr/hr/fall04/casestudy.htm

Thrush Simulation

I work for two infectious disease physicians and have been involved in the HIV community in the past. Our first assignment for our HIV web class was an assignment on thrush. We've had many patients complain of this infection, and every tale is different. Thrush is an oral yeast infection that some HIV positive individuals experience.

The simulation exercise was unpleasant to say the least! Nausea was the least of my worries, and forget about swallowing. It made me realize what people who are infected with HIV have to deal with. It made me feel blessed that I don't have to go through that, but it also made me sad to know others that do. The exercise was a good reminder for me.

Did you know?

This semester I'd like to blog about behaviors within the HIV positive gay community and discrimination following the HIV positive gay community. While strides have been made in regards to the stigma of HIV, many people, particularly those in the gay community, still face discrimination on a daily basis due to their disease. Some may fear the disease, some may fear the gay community, and some may fear what they do not understand. Ignorance is the basis of this discrimination. The more we know about HIV and how it affects the gay community, the less we have to fear.

A good example of this discrimination is shown in the movie Philadelphia, starring Tom Hanks. The court case surrounding this drama showed employers that were not only discriminatory towards Hanks' character due to his disease, but also because of his sexual orientation. The gay community in Orlando is a tight knit one, but not every part of the United States shares in this cohesiveness. There are many places tucked away neatly in parts of our country that think nothing of discriminating based on disease or sexual preference alone.

Back in the 80's when HIV was the "gay cancer" and first became news, the gay community mobilized into action. They created groups, gatherings, marches, and peer counseling at the onset of the disease. In California several gay men advocated to their peers to help them understand what was going on in their communities. Sex education was revamped and awareness was taught so that other gay men and women had an ear to bend and a shoulder to lean on.

Through their grass roots efforts spawned numerous organizations to help those infected and affected with HIV today. We can learn from their efforts by educating ourselves about the disease and what it means to be gay and HIV positive today.

www.avert.org/young-gay-men.htm