Fridae

In 1992, when Quinn visited the student health center of the University of Michigan where he was a sophomore, he didn't know that his life was about to change forever. As he puts it candidly, he had noticed "something going on" in his rectum. When the health center couldn't make a diagnosis, his anxiety and fear peaked. They called in a specialist who was able to identify the growths as anal warts caused by the human papillomavirus (HPV). "I was trying to be tough and sophisticated at the young age of 20. Yet, I was so scared."

Some 12 years later, Quinn is still in touch with the anger elicited by the treatment when his doctor asked him to be a specimen case for his students. Quinn vividly remembers that being examined by a group of people made him feel like an alien. "It was like a freak show and I was the freak," he says. He felt ashamed because he was a gay man having anal sex. "What's worse than having anal sex is being the bottom."

Recovery wasn't smooth either. While the warts were quickly removed via laser surgery, he was given no care directives by the medical staff. "I worked at a restaurant the next day and I was sore all over. I had no idea that I'd feel so bad -- I had never even had surgery. I couldn't tell my parents. I didn't know to ask friends for help."

Quinn believes that had he not been gay, he would have had emotional support. He felt powerless. Even worse, he felt like he deserved it. "Shame fuels hatred toward ourselves, just as it fuels hatred toward others," write Gershen Kaufman, Ph.D., and Lev Raphael Ph.D., in their book, Coming Out of Shame.

In fact, shame powerfully dominates the experience of many gays and lesbians, often crippling the healthy development of self-esteem, identity and intimacy. Shame can make you feel painfully diminished. And contracting an STD can magnify these wounds and feelings of inadequacy. Getting an STD and experiencing shame is an all too common, though little discussed, aspect of gay health.

"The two people who have broken down in my office saying, 'this is God's punishment!' had rectal warts," shares Dr. Gal Mayer of Callen Lourde Community Health Center. In fact, the numbers of infection are astounding: two-thirds of HIV negative gay men and nearly all HIV positive gay men are infected with HPV. The virus comes in various strains -- some cause warts, some do nothing and some cause your cells to undergo a transformation into malignant cancer cells.

Syphilis is on the rise too. The fact that many gay men are embarrassed and ashamed with such diagnoses is not surprising. Having an STD can challenge even the most "out" and self-confident gay man's internalized homophobia and fears. "There is undeniably shame around even less invasive things like crabs and herpes," adds Mayer.

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Of course, anyone can feel shame about contracting an STD. But Bradley Thomassen, Ph.D., believes that shame is often compounded with gay men and lesbians because discussing STDs means potentially disclosing one's sexuality too. "It's often described as 'coming out twice,' which can be debilitating to your health -- both physically and emotionally," says Thomassen. " He goes on to cite Geoffrey Reed, Ph.D., a former research and clinical psychologist at UCLA School of Medicine, who studied the impact psychological factors have on immunological changes in HIV positive men. Reed's research showed that closeted men who are also closeted about their HIV status, have a higher incidence of health problems than non-closeted men who are out about their HIV status. In general, "the message is that keeping secrets is unhealthy, " says Thomassen.

Gay-Friendly Docs are Crucial
Quinn stresses that he finally became more at ease talking about his experience with HPV only following his visit to Callen Lourde. After two unsuccessful surgeries, the warts had returned. He grew frustrated with HMOs and randomly-chosen doctors who made him feel uncomfortable. A year into therapy, his self-esteem had grown enough to ask his therapist for a referral to a gay-friendly facility. It was the first place to treat him with respect. "At Callen Lourde, it was a given that I was gay and having sex," he says. "In the past, there was so much work to explain who I was and what I was."

Dr. Susan Blank, director of the New York City Department of Health's Bureau of STDs, offers another reason why shame is prevalent. "HIV is highly politicized and has advocacy groups, but you don't see HPV advocates or syphilis groups because in this regard they're more stigmatized." Ironically, she adds, healthcare providers may themselves be the culprits of reinforcing silence about STDs due to lack of obtaining thorough sexual histories. Kaufman and Raphael believe that it is this endless cycle of mutually reactivating silence and shame that can keep gays and lesbians bound and feeling like, "�prisoners within their own society." If there's no dialogue, "The individual who may not be 'out' to his/her healthcare provider, may be engaging in high risk behavior," says Dr. Blank. Having an understanding relationship with your doctor is an important part of having a healthy relationship with your body.

For Quinn, who is in a vaccine trial to treat his anal warts, that means feeling more comfortable with his rectum. He says Eve Ensler's Vagina Monologues, a play in which women discuss their feelings about their vaginas, had a strong impact on Quinn feeling good about himself. "I'm not talking just about having an STD, but shame about having certain body parts -- about having a rectum with shit. I've always just dealt with it." If he can "re-own" this disregarded part of himself, then he can perhaps more easily work on intimacy within his relationships and continue to reclaim his self-esteem.

"Since I was born with and will die with a rectum," he says, "it will be good to appreciate, understand and have feelings about it."