PMS Matters

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New PMS Medical Director Creates Anal Dysplasia Clinic

Dr. Ross Cranston was recruited to Pittsburgh in 2007 to create an Anal Dysplasia Clinic at the Pittsburgh AIDS Center for Treatment (PACT). The focus of the clinic, which is also open to non-PACT patients, is to address the high incidence of human papillomavirus (HPV or wart virus).  HPV has been associated with anal cancer in gay men - particularly those living with HIV. 

 “As gay men, we run the risk of serious health issues because we don’t pay enough attention to our butts.”  Dr. Cranston states. “So, one of my goals is to promote an ‘anal agenda’ that increases awareness of the medical conditions gay men are more likely to experience.” Putting the issue into perspective, he adds: “Anal health has yet to emerge as an area to which it is deemed appropriate to direct our attention. As a result, gay men in particular are unaware of their increased risk of many anal diagnoses including those related to sex or sexually transmitted infections, such as the development of anal cancer.”   

Patients with an abnormal anal cytology (a test of anal cells that is used to detect abnormalities) are referred to Dr. Cranston for high-resolution anoscopy (HRA). This office procedure involves examining the anal canal using magnification.  If there is evidence of high-grade dysplasia – the precursor to anal cancer – a biopsy may be performed. If high-grade dysplasia is confirmed, Dr. Cranston can then remove the lesion in order to prevent its potential progression to cancer.

“We are currently diagnosing about one case of anal cancer every 2 weeks,” says Dr. Cranston, “which is why I suggest that gay men who are HIV-positive talk to their clinician about anal dysplasia screening and have an annual anal Pap smear.” Although there are no national screening guidelines, Dr. Cranston notes, it is also suggested that HIV-negative men over 40 get tested every two to three years.

Dr. Cranston is an Assistant Professor in the Division of Infectious Disease and the Medical Director of the Pitt Men’s Study.  He began his studies at the University of Edinburgh before moving to London, where he completed a fellowship in HIV and Sexually Transmitted Infection. He moved to the U.S. to conduct doctoral research at the University of California—San Francisco and then spent five years working at the UCLA Center for AIDS Research and Education in Los Angeles, where he established and ran the UCLA Anal Dysplasia Clinic. 

For many years, Dr. Cranston has used his knowledge of anal dysplasia, HPV, and HIV to help countless HIV-positive men. He moved to Pittsburgh in September 2007 with his partner of 11 years, Ian McGowan, who is also employed by the University as a Professor in the School of Medicine, and is Co-Principal Investigator of the Pittsburgh-based Microbicide Trials Network. 

For more information about the anal dysplasia clinic, you can call 412-647-0996. 

In Remembrance of Long-Time Civil Rights Activist

and Friend to the PMS

Randal G. Forrester

Dec. 13, 1947 - April 23, 2008

Most of us in the community knew him simply as Randy. His name carried a fair amount of notoriety.  The local media turned to him for an interview whenever LGBT civil rights were an issue. He co-founded Persad Center in the early 1970’s with his long time partner, Jim Huggins—one of only a few counseling centers for sexual minorities. He founded the Lambda Foundation in the early 1980’s, which has been responsible for funding endless LGBT organizations, HIV/AIDS services, and individuals in and around Pittsburgh. 

The Pitt Men’s Study turned to Randy in 1984, when it came time to organize the gay community around recruitment for the study.  After getting the ball rolling, Randy then recommended Dr. Silvestre for the position—Randy had too much on his own plate to take up the task full-time.  Randy recounted the early days of the PMS as part of an oral history project (click here to read the oral history article that includes Randy’s interview). In those early days of the epidemic, it was Randy who insisted participants in the study remain anonymous, and that the person who would eventually handle the recruiting should also be gay. 

Randy’s obituary in the April 25th edition of the local Post Gazette sums up his long list of  accomplishments, and gives credit to his dedication to community activism and civil rights (click here for the full article). But on a more personal note, Dr. Mark Friedman, a researcher at the University of Pittsburgh, studying LGBT youth, had this to say: “I remember when a representative of Bishop Donald Wuerl requested a meeting with Randy. I was there, as Persad’s Director of Development. The representative wanted to build a relationship with Persad. Randy told him, politely but firmly, that the Bishop’s and the Church’s positions on condoms lead to the transmission of HIV and to death, that their position on homosexuals lead to personal anguish among so many; that these positions were incompatible with the mission of Persad Center and, as a result, a relationship between the two would not be possible. Randy was that direct,” Friedman concluded, “And of course, so on-target.” 

When asked about their personal relationship, Friedman went on to say: “Randy was a mentor to me, in addition to being a good friend.  He helped teach me the importance of community activism.  He was a tireless advocate for gay civil rights when the general population considered homosexuality on par with criminal behavior.  Randy helped change that. We may have a long way to go in terms of civil rights, but it was Randy who laid the ground work in southwestern Pennsylvania.”     

Envelope of LIFE

City of Pittsburgh residents are being urged to take advantage of the Envelope of LIFE program offered by the city’s Emergency Medical Services. The Envelope of LIFE is a standardized form that provides vital health-related information to emergency personnel in the event that you are incapacitated or unconscious during a medical emergency. 

The Pittsburgh Emergency Medical Services websites notes: “By taking just a few minutes to fill out an Envelope of LIFE form, you will be giving yourself the advantage in an emergency and will also help in making a difficult time much easier for your family.” 

Marcy Holloway, a Physician Assistant here at the Pitt Men’s Study, brought the city’s Envelope of LIFE program to the attention of the PMS staff and volunteers.  “The study values the health and wellness of our participants,” she said, “and this program is an excellent mechanism that can essentially save lives.”      

Click on the picture above, or follow this link to the Envelope of LIFE document:

http://www.city.pittsburgh.pa.us/ems/assets/07_envelope_life.pdf

For more detailed information, you can go to the Pittsburgh Emergency Medical Services website at: http://www.city.pittsburgh.pa.us/ems/html/envelope_of_life.html#overview

Adult Male Circumcision and HIV

The NIH recently announced an early end to two clinical trials of adult male circumcision because an interim review of trial data revealed that medically performed circumcision significantly reduces a man’s risk of acquiring HIV through heterosexual intercourse. The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.  While this has limited impact in the United States, this is big news in the international battle against AIDS.  For the complete story go to Adult Male Circumcision.