十項男同志應注意的健康議題

十項男同志應注意的健康議題

10 Things Gay Men Should Discuss With Their Healthcare Provider

為確保醫療品質，最好讓醫生知道你是男同志，以便他提供適當的問診與檢測，若你的醫生因你的性向讓你感到不舒服，請換一個醫生。

In order to provide you with the best care possible, your clinician should know you are gay. It should prompt him/her to ask specific questions about you and offer appropriate testing. If your provider does not seem comfortable with you as a gay man, find another provider.

2. 愛滋病、安全性行為 HIV/AIDS, Safe Sex

男男性行為會提高愛滋感染的風險，同志社群所倡導的安全性行為可大為降低感染風險。如果你是愛滋病毒帶原者，請尋求良好的醫護照護。若參加愛滋感染風險較高的活動時，也需立刻與醫生討論暴露於風險後所能採取的保護措施。如果你處於一段交往關係，而其中有陽性反應者，你也應向醫生討論預防措施之選項。

Many men who have sex with men are at an increased risk of HIV infection, but the effectiveness of safe sex in reducing the rate of HIV infection is one of the gay community’s great success stories. If you are HIV positive, you need to be in care with a good HIV provider. Safe sex is proven to reduce the risk of receiving or transmitting HIV. You should also discuss and be aware of what to do in the event that you are exposed to HIV (Post-Exposure- Prophylaxis)—contacting your provider IMMEDIATELY following an exposure to explore your options. If you are in a relationship where one of you is positive, you should discuss options for prevention with your provider as well.

男男性行為有較高風險感染性病且進一步造成肝臟危害，如肝炎。這樣的感染可能是致命的，導致長期的肝臟傷害甚至肝癌。免疫接種可預防三分之二的高危險病毒，建議有發生男男性行為者接種A肝疫苗與B肝疫苗。安全性行為可有效降低病毒性肝炎的發生，也是目前唯一可預防嚴重C型肝炎病毒的手段。如果你患有C肝，現在已有更有效的治療方式。

Men who have sex with men are at an increased risk of sexually transmitted infection with the viruses that cause the serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious long-term issues such as liver failure and liver cancer. Immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all men who have sex with men. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C Virus. If you have Hepatitis C there are new, more effective treatments for that infection.

4. 身體意象（飲食與運動）Fitness (Diet and Exercise)

男同志較常有身體意象的焦慮問題，容易造成飲食失調，如貪食症或神經性厭食症。適當且規律的運動對健康是有幫助的，一旦過量便是一種傷害。而對物質的依賴，如合成代謝類固醇和某些補充劑可能是危險的。肥胖也影響許多男同志，並可能導致一些健康問題，包括糖尿病、高血壓和心臟疾病。

Problems with body image are more common among gay men, and gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for your health too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can be dangerous. Obesity also affects many gay men and can lead a number of health problems, including diabetes, high blood pressure, and heart disease.

5. 物質濫用、酒精 Substance Use/Alcohol

相較於一般大眾，男同志有較高比例的物質濫用情況，這情況不限於大城市。包括亞硝酸烷酯（也稱Poppers或Rush，為一種引致肛門肌肉鬆弛的興奮劑）、大麻、搖頭丸和安非他命。這些物質濫用對長期的健康影響是未知的，然而，目前的觀點認為潛在的嚴重後果會隨年齡增長而出現。如果你的用藥已干擾到工作、學校或關係，請與你的醫療保健人員尋求協助。

Gay men use substances at a higher rate than the general population, and not just in larger cities. These include a number of substances ranging from amyl nitrate (“poppers”), to marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however current wisdom suggests potentially serious consequences as we age. If your drug use is interfering with work, school or relationships, your healthcare provider can connect you to help.

6. 抑鬱、焦慮 Depression/Anxiety

抑鬱與焦慮影響男同志甚於一般大眾，對於未出櫃或缺乏足夠社會支持的男同志有更嚴重的影響，也導致青少年與年輕成人有較高自殺風險。針對男同志族群、具文化敏感度的心理健康服務才能較有效的預防、及早發現與治療。

Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions.

7. 性傳染病 STDs

性傳染病在性活躍的男同志有相當高的發生率。這些性傳染病包括可以治癒的梅毒、淋病、衣原體、陰蝨​​等 ，以及無法治癒的愛滋病、肝炎、人類乳突病毒、皰疹等。安全性行為是絕對可以降低性病風險並預防傳染的。有愈多的性伴侶就應該愈常接受篩檢。你可能得到性傳染病卻沒有症狀顯現，但仍有傳染給他人的可能。

Sexually transmitted diseases (STDs) occur in sexually active gay men at a high rate. These include STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is available (HIV, Hepatitis, Human Papilloma Virus, herpes, etc). There is absolutely no doubt that safe sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key. The more partners you have in a year, the more often you should be screened. You can have an STD without symptoms, but are still able to give it to others.

8. 前列腺、睪丸、直腸癌 Prostate, Testicular, and Colon Cancer

男同志可能的死亡風險包含前列腺癌、睪丸癌、直腸癌。但在生命週期的不同時期中，男同志在篩檢出這些癌症的發生或是獲得篩檢服務的可能性都是困難的，因為醫療院所缺乏文化敏感度。建議所有男同志甚至一般大眾都應定期接受這些篩檢。

Gay men may be at risk for death by prostate, testicular, or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be harder for gay men because of not getting culturally sensitive care. All gay men should undergo these screenings routinely as recommended for the general population.

9. 菸草 Tobacco

男同志抽菸比例高於異性戀男性，在好幾個研究中都顯示有將近50%的男同志吸菸。與菸草相關的健康問題包含肺部疾病、肺癌、心臟疾病、高血壓，以及其它一堆嚴重的問題。應該要提供男同志具文化敏感度的篩檢項目、預防措施與戒菸計劃。

Gay men use tobacco at much higher rates than straight men, reaching nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and offered culturally sensitive prevention and cessation programs for tobacco use.

10. 人類乳突病毒（疣、肛門癌）HPV (virus that causes warts and can lead to anal cancer)

男同志暴露於所有的性傳染病風險之下。人類乳突病毒造成的肛門、生殖器疣，往往僅被視為難看與不便而已。然而，這些感染可能是導致男同志肛門癌增加的因素。一些健康專家建議，類似於女性的子宮頸抹片檢查的肛門抹片常規篩檢是必要的，也應重視安全性行為。雖然HPV是可治療的，但疣的復發是很常見的，且在性伴侶間的傳染率是相當高的。

Of all the sexually transmitted infections gay men are at risk for, human papilloma virus (HVP) — which cause anal and genital warts — is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in gay men. Some health professionals now recommend routine screening with anal Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high.