For over a decade, Daniel Garza has been an advocate for health awareness.
In 2000, the California native was diagnosed with human immunodeficiency virus (HIV), a virus that compromises the immune system, making it hard for the body to fend off infections.
Following his diagnosis, Garza devoted his time to promoting HIV prevention, encouraging at-risk groups like drug users and gay men to get tested and adhere to treatment plans.
What he didn’t realize was that HIV significantly increased his risk of developing anal cancer, a condition that famously took the life of Charlie’s Angels star Farrah Fawcett in 2009 and is often linked to sexually transmitted infections.
For many of the 11,000 Americans diagnosed annually with this disease, symptoms often begin subtly, including minor blood on toilet paper and persistent abdominal pain.
This was true for Garza, who began noticing blood and severe pressure during bowel movements in the spring of 2014. In the following weeks, he, then 45, experienced bloating and so much abdominal pain that he could only manage a nearly liquid diet.
Despite this, he surprisingly gained weight, going from about 150 to 170 pounds in just months while maintaining his exercise routine but eating very little.
About a year later, he had surgery for a hernia. During a follow-up, doctors discovered a mass in his anal sphincter, which plays a role in the release of stool.
On May 5, 2015, a colonoscopy and biopsy confirmed stage two anal squamous cell carcinoma, which constitutes about 90% of anal cancer cases.
When caught early and not yet spread, the five-year survival rate for this type of anal cancer is about 85%. If it spreads, however, that rate plummets to 36%.
Garza was taken aback; despite his years of advocating for HIV awareness, he had never considered the link between HIV and cancer.
Research indicates that HIV can heighten the risk of various cancers, including anal cancer, due largely to its effect on the immune system.
Moreover, HIV raises the likelihood of contracting human papillomavirus (HPV), which is responsible for over 90% of anal cancer cases. Garza suspects he contracted HPV in the early 2000s.
Studies also show that men who have sex with men, like Garza, could face up to a 20-fold increased risk of anal cancer, as HPV can be transmitted through anal intercourse.
“After all my years of education and prevention work, I had never heard of the cancers related to HIV,” said Garza, now 55. “I had no idea. We never talked about these issues. As gay and Latino men, discussions around cancers down there just don’t happen.”
Each year, about 11,000 Americans are diagnosed with anal cancer, and approximately 70% of these cases are women due to a higher likelihood of HPV infection. Just under 2,200 people die from this cancer annually, with men and women affected about equally.
The overall chance of being diagnosed with anal cancer is roughly one in 500, according to the American Cancer Society, contributing to just 0.5% of all new cancer cases.
Data from the National Cancer Institute estimates that 30% of anal cancer patients are between 55 and 64 years old, with an average diagnosis age of 64. However, HIV diagnoses often occur among those aged 25 to 34, which may be linked to rising anal cancer cases in those under 50.
From 2001 to 2015, anal cancer in the U.S. saw an average annual increase of 3%. Federal data indicates a 46% rise from 2005 to 2018, particularly among older individuals who missed HPV vaccinations in youth.
The HPV vaccine was introduced in 2006 but primarily recommended for girls and young women until 2009, when it was also approved for boys. This meant that many older individuals in a vulnerable demographic missed their chance for vaccination.
Interestingly, HPV can remain dormant for decades, possibly fueling the uptick in anal cancer among individuals in their 50s and 60s.
After his diagnosis, Garza quickly transitioned into advocacy mode, documenting his cancer journey through a series of YouTube videos for the first month post-diagnosis, including the day he shaved his head before chemotherapy.
“That part of me was like, ‘Yes, let’s talk about this,’” he mentioned. “If I didn’t know how to begin the conversation, countless others wouldn’t either. We need to learn together.”
Yet, as a Latino gay man, he also felt a sense of shame.
When Farrah Fawcett died from anal cancer at 62, it sparked intense speculation regarding her sexual history. Anal cancer has long been seen as a taboo topic, often linked to sexual practices.
Garza expressed concern that the damage from cancer and its treatments could impact his intimacy with his long-term partner. “It’s a lot of trauma,” he said, “and it’s part of who we are, so I felt some shame and stigma. There were times I wondered, ‘Is this my fault? Is this a punishment for my sexuality?’”
Starting in late May 2015, Garza underwent treatment, including 38 rounds of radiation, weekly chemotherapy, and 40 sessions of hyperbaric oxygen therapy (HBOT).
This therapy involves lying in a chamber with increased air pressure to help oxygen reach damaged tissues and promote healing.
While lifesaving, the radiation treatment resulted in the loss of half of Garza’s anal sphincter, which may lead to future pain and issues controlling bowel movements. To address this, he received an ostomy bag in April 2016 to redirect waste from the digestive tract.
Garza continued maintenance treatments until 2017, when he was declared cancer-free. Although doctors believe the chances of recurrence are low, he still undergoes regular blood tests to monitor tumor markers like carcinoembryonic antigen (CEA) and keep an eye on his HIV.
His experience with anal cancer has altered his relationship with his partner, who served as his primary caregiver throughout treatments.
“When a partner assumes the caregiver role, it changes the dynamic,” Garza shared. “We both experienced this journey together, and it shifted how we see each other.”
Intimacy has become challenging due to the physical changes from treatment, but he says they have adapted.
Garza has broadened his advocacy efforts beyond HIV to include anal cancer and other related cancers that more commonly affect those living with HIV.
“I attend HIV and cancer conferences,” he noted. “I have conducted research and added topics like HPV, mental health, and body image into my narrative.”
He urges anyone facing symptoms such as anal bleeding, abdominal pain, or bloating to seek a second opinion if they feel overlooked by healthcare providers. “Don’t ignore the signs,” he emphasized. “If you suspect something is wrong and it persists after following your doctor’s advice, don’t hesitate to get a second opinion. Offending your doctor a little is fine as long as it’s about your health.”
