Gay Viagra

Are Gay Men Who Use Viagra at Higher Risk?

Viagra abuse may increase the risk of contracting HIV or STD's during sex or cause other health problems.
Viagra, manufactured by pharmaceutical company Pfizer, increases blood flow to the penis. This prolonged rise in blood circulation can increase the risk of transmitting or contracting HIV or blood borne STD's, especially during oral sex if either partner has a cut or scrape in the gums or during anal if there are abrasions.

Experts Fear a Risky Recipe: Viagra, Drugs and H.I.V.

Viagra has become popular with gay men here and in other cities, reflecting a trend that has begun to worry health care experts, who fear that it may foster the spread of H.I.V.
Many gay men, like many straight men, are using Viagra solely for its approved purpose -- as a remedy for persistent erectile dysfunction. Some H.I.V. positive gay men take it because the infection itself or the antiviral drugs may have reduced their abilities to perform sexually.
But many gay Viagra users are treating it as a recreational drug and taking it along with Ecstasy and other illegal substances, according to surveys. And some H.I.V. educators now fear that this more casual use of Viagra could lead to an unfortunate side effect: an increase in unprotected anal intercourse.
''For a subset of gay men, it's definitely found its way into the mix of party drugs,'' said Dr. Ken Mayer, a professor of medicine at Brown University, a board member of the Gay and Lesbian Medical Association and medical director of research at the Fenway Community Health Center in Boston. ''And in a bathhouse or other setting where there's an opportunity to have sex with multiple partners, to have a longer-lasting erection can be a prescription for H.I.V. transmission.''
In addition to concern about H.I.V., health professionals warn that Viagra can be harmful if used together with ''poppers,'' a nitrate-based liquid drug that many gay men inhale during sex to relax their bodies and heighten the sensation.
Both Viagra and nitrates, a category that includes prescription drugs for cardiovascular conditions as well as recreational varieties like poppers, cause blood vessels to dilate, and combining them can cause dizziness, stroke or heart attacks. Deaths have been reported among Viagra users who were also taking nitrate-based medicines for heart conditions.
A recent survey by the San Francisco health department of more than 800 men visiting a clinic specializing in sexually transmitted diseases has highlighted the issue. Of the gay respondents, 32 percent said they had used Viagra in the past year, compared with just 7 percent of the heterosexuals, and many of the gay men indicated they had combined it with Ecstasy, methamphetamines, poppers and other recreational drugs.
Moreover, the gay men who reported using Viagra also reported having had more recent sexual partners than gay men who did not use it, and they were more likely to have a current sexually transmitted disease. More than half the men had gotten Viagra from a friend rather than a doctor, and 30 percent of gay H.I.V.-negative Viagra users reported having had unprotected anal sex with H.I.V.-positive partners or men of unknown H.I.V. status, compared with just 15 percent of gay H.I.V.-negative men who had not used Viagra.
A handful of other studies, including a British survey of 677 gay men in London, have identified similar trends. Dr. Jeffrey Klausner, director of sexually transmitted disease prevention at the San Francisco health department, said he was particularly concerned about those who combined Viagra with methamphetamine, or speed, which can amplify and prolong sexual desire but make erections difficult to have and maintain.
''Viagra can turn people with chemically induced erectile dysfunction into more effective transmitters of H.I.V. and other S.T.D.'s,'' Dr. Klausner said.
He and others cautioned, however, that it was difficult to generalize about Viagra use among large groups of gay men from statistics garnered among specific populations, like men visiting an S.T.D. clinic.
It is also unclear whether Viagra use itself can lead to an increase in risky behavior, or whether those who tend to engage in risky behavior are simply more likely to take Viagra.
Some Viagra advocates say the drug may actually reduce H.I.V. transmission by making it easier for men to maintain erections while using condoms. And others say that focusing on recreational Viagra use among gay men smacks of prejudice.
''Straight men are using Viagra recreationally all the time,'' said a 39-year-old San Francisco gay man who has taken the drug to counteract the effects of speed. ''So in some ways the concern about gay men using it is implying that using Viagra to enhance gay sex is not as legitimate as using it to enhance straight sex.''
Apart from H.I.V. transmission, experts on gay men's health are most concerned about the potential dangers of the combined use of Viagra and poppers. Like speed, poppers can make sustaining an erection difficult for some men.
Dr. Ron Falcon, a gay physician in St. Paul, said that one of his patients had obtained a Viagra prescription from another doctor, inhaled poppers and suffered a stroke. The man experienced partial facial paralysis and has not recovered completely, Dr. Falcon said.
''He said he didn't even remember that he wasn't supposed to use poppers at the same time, and the next thing you know he was unconscious on the floor,'' Dr. Falcon said.
He estimated that a quarter of his gay male patients have asked for Viagra. He turns down most, except for the few who have serious erectile dysfunction.
Yet many gay men, like many straight men, can obtain Viagra relatively easily through the Internet. Others receive it from friends. And some doctors are simply much less selective than Dr. Falcon in prescribing it.
Jim Hopkins, a 44-year-old journalist in San Francisco, said that two years ago he called his doctor to make an appointment to discuss Viagra. Mr. Hopkins, who lived in Kentucky at the time, hoped the medication would help him sustain an erection during condom use.
The doctor prescribed it without seeing him or even talking to him. ''I was surprised at how easy it was,'' Mr. Hopkins said. ''There was no counseling, no warnings about poppers, nothing,'' he said.
Dr. Klausner of the San Francisco health department said he hoped his survey results would help persuade Pfizer, which makes Viagra, of the importance of creating educational campaigns for gay men and their doctors about the uses and abuses of the medication. He has suggested that the company buy ads in gay magazines and produce informational materials specifically for doctors with a high proportion of gay men in their practices.
A Pfizer spokesman, Geoff Cook, said he did not know whether the company would pursue a gay-oriented educational campaign. He stressed, however, that Pfizer had long warned against the use of Viagra for nonapproved purposes, and that doctors had been informed about the dangers of combining it with both legal and illegal nitrates.
''Our position to not use Viagra for recreational purposes is well-known, but any pharmaceutical product can be abused,'' Mr. Cook said. He added that Pfizer also advised caution when the drug was used with protease inhibitors, an important class of H.I.V. medications.
Protease inhibitors can sometimes amplify both Viagra's potency and its potentially troublesome side effects, which can include priapism, a condition of prolonged erection that can cause permanent damage, as well as headaches and heart-related complications.
Michelangelo Signorile, whose book ''Life Outside'' explored gay club life and sexual culture, said: ''I don't think it's problematic for people to enhance their sex life any way they can. But people already have a lot of difficulty adhering to safer sex, even without Viagra in the picture.''

Viagra May Raise STD Risks in Gay Men

Researchers have called on the federal government to impose new restrictions on Viagra because studies suggest it makes gay men more likely to use illegal drugs, have unprotected sex and become infected with sexually transmitted diseases.
But a prominent physician said the findings of the researchers, based on a new analysis of 14 studies, don't prove that Viagra is responsible for changing anyone's behavior.
"To blame the drug is foolish," said Dr. Abraham Morgentaler, associate clinical professor of urology at Harvard Medical School. "Just because two things happen to go together -- in this case, risky behavior and Viagra -- doesn't mean Viagra caused the risky behavior."
Since the introduction of Viagra in 1998, health advocates have worried about its impact on the gay community. Viagra and its newer rivals -- Cialis and Levitra -- are designed to treat men who can't sustain erections, but they've also gained a reputation as basic sexual enhancers.
Researchers at the San Francisco Department of Health examined 14 studies that looked at Viagra use among gay men. Their findings appear in the June 2005 issue of the American Journal of Medicine.
Most of the studies surveyed gay men in San Francisco; many of the studies polled men at sexually transmitted disease clinics. All the studies were published between 1999 and 2004.
Eleven of the studies looked specifically at gay and bisexual men; seven of them reported that 10 percent or more of gay men said they used Viagra.
Five studies reported that gay men who used Viagra were 2 to 5.7 times more likely to have put themselves or their partners at risk by having unprotected sex with a person whose HIV status they either didn't know or was the opposite of their own.
Studies in San Francisco suggested that Viagra users were 2.5 times more likely to test positive for HIV than other gay men, two times more likely to get diagnosed with a sexually transmitted disease other than HIV, and 3.5 times more likely to have used methamphetamines within the past four weeks.
Viagra "is the only sexual health product that's associated with increased risk for STDs," said study co-author Dr. Jeffrey Klausner, director of STD prevention and control services at the San Francisco Department of Health. "Condoms, birth control, emergency contraception -- they've all been shown not to be associated with increased risk of STDs."
It's possible that Viagra increases the risk of STDs by prolonging sexual contact during intercourse, Klausner said. However, Morgentaler, the Harvard urologist, pointed out that Viagra "doesn't affect how you think or how you reason and make judgments."
Klausner acknowledged that it's possible that Viagra users are just risk-takers in general. "But even if it were true that more risky people were more likely to use Viagra, shouldn't those people be protected as well, and offered education and opportunities to reduce their risk?"
On that front, the study authors are calling on the government to mandate more extensive warning labels to alert consumers that their risk of STD infection may go up if they use Viagra. The authors also want the government to consider making Viagra a controlled substance.
According to Klausner, the latter move would eliminate free samples and make it harder for drug traffickers to sell Viagra.
While the study didn't look at use of Cialis and Levitra, the government should examine those drugs too, the investigators wrote.
Pfizer Inc., the maker of Viagra, did not respond to a request for comment.
Morgentaler, author of The Viagra Myth: The Surprising Impact on Love and Relationships, opposes further restrictions based on "poor scientific conclusions."
"Viagra has been a tremendous boon for millions of men," he said. "The fact that there's a small population that abuses it should by no means penalize the rest of the population."
Gay Viagra