Every 27th of June, HIV organizations across the United States of America promote their HIV testing campaign everywhere they can afford. In theory, this day is to ease people’s fears and concerns about taking ‘THE TEST” while providing lists of places where it can be done quickly and free. Celebrities love taking part by getting stuck on camera, and then telling you, the viewer how easy it is.
The day was created in 1995 by the National Association of People With AIDS to increase the number of people being tested for HIV, and got off to a successful start. But, although the percentage of people living in the U.S. with undiagnosed HIV has been decreasing, the Centers for Disease Control and Prevention (CDC) estimates that 1 in 7 people who are HIV positive still don’t know it.
Ok, let’s cut the bullshit. Gay males have a very complex and complicated history with HIV. It is the ignorance of this fact that makes convincing guys like you, to get tested harder. From the beginning of the AIDS crisis to yesterday, getting tested evokes fears of not only infection but rejection, isolation, loneliness, stigma, sickness and a long painful death. If you are a straight, cis gendered female celebrity, your chances of contracting this virus is almost zero. They don’t know the internal pain and conflict that comes from being part of the community that was left to rot and die in the streets by its own government. The anger that is borne from having to fight for the very right to life saving medications. The sorrow that stays in your heart after you have seen loved ones infected and die in hospice. Testing for HIV will never be an easy affair for us.
Quick history lesson:
While the first AIDS cases were reported in 1981, HIV wasn’t discovered until 1984 and ELISA, the first test for HIV, did not become available until 1985. This was a blood test that looked for HIV antibodies, which meant that a person had to have been already infected with HIV for three to twelve weeks — the time it takes to develop HIV antibodies — to test positive. That test was also not as accurate as those that would follow — offering a significant number of false positive results. At the time, it was generally used to test the blood supply, not individuals.
In 1987, a much more accurate (but more difficult to perform) test — known as the Western Blot — became available. Though the test would seem as simple as blood being drawn from a patient’s perspective, that blood would still first be sent for an ELISA test, and if it came back positive, the Western Blot test would be used to confirm that result. This meant that the wait time for results was a nerve-wracking two weeks. Like ELISA, the Western Blot also depended on antibodies, rendering tests within months of infection potentially inaccurate.
In the late 1980s came second and third generation HIV tests. These tests also looked for antibodies but were more reliable and tested not only for HIV-1 (more common worldwide) but also for HIV-2 (more common in West Africa). These tests could also register antibodies sooner — within approximately four to six weeks of infection.
In the 1990s and 2000s, fourth generation HIV tests arrived, which tested for not only HIV antibodies but also for HIV antigens — a part of the virus itself. This allowed the tests to indicate a positive result in as little as two weeks after infection. Today’s fifth generation tests can distinguish between HIV-1 and HIV-2 and also differentiate between antibodies and antigens, which provides valuable information about the progress of the infection.
What’s significant here is the continuing reduction of the “window period” — the time between when a person becomes infected with HIV and when that person can test positive for the virus. In the early days of testing, that window was up to three months. With current testing methods, that is down to about two weeks. This is important because a person could be infected with HIV on Saturday and get a negative HIV test on Wednesday. Though he will test positive at some point in the future, he will be highly infectious in the meantime and making decisions under the assumption that he is negative. This is one reason why it is important for sexually active people to be tested on a regular basis and to always use safer sex practices. This is also why it’s important that we continue to seek improved testing methods which close that window further.
Your fears are valid:
As gay males, we understand why you fear having this test. It is scary. From the first moment you decide to make the appointment to the second the results are read to you; time seems to stand still. Relief only comes after hearing that you are HIV negative. But then the cycle begins again in three (3) months. It’s hard. We get it.
Our collective cultural memory about the AGE of AIDS remains strong. Long -Term Survivors of the illness are all around us. Some of them carrying the scars and bodily changes that came with the illness, the medication and/or both. But, just as much as the physical signs are there, so are the deep rooted emotional ones. They lay thick in the air like humidity on a hot summer’s day, making it harder to breath.
And then there is the stigma. We can’t forget about HIV stigma. Somehow, when treatment and prevention reached a high-point, stigma seemed to grow even more within our community. The internet made everything so much worse as hook-up sites became a place to causally run across profiles stating “drug and disease free, UB2“. This one small sentence could send shockwaves through those living with HIV as well as those too nervous to find out. It’s hard. We get it.
Finally, there are the legal ramifications and responsibilities that come with infection. We have a detailed article about HIV criminalization laws and how they deter guys from getting tested, more than encourage them. Knowing that your sex must be regulated and your status disclosed, even if undetectable, is heart wrenching. Especially in a world where once you tell one guy, he can run to his internet followers and spill your tea all over the web.
With all of this being said, and us wholly validating your fears and concerns, you still need to bite the bullet and get it done. Not for others. Not for your community or future sex partners, but for yourself. This is a chance for you to take control of your body and health, no matter the outcome of the test.
Gay, bisexual, and other men who have sex with men bear the greatest burden by risk group for infection, representing an estimated 26,000 of new HIV infections per year within the United States. It is estimated that at least 1 in 7 don’t know they are infected. These are the ones that are keeping HIV going within our community, not those who know they have the virus and are on treatment.
- Since the beginning, HIV has been our illness to carry. Yes, members of other communities have and will continue to contract this virus, but gay males and especially those of colour are on the front lines of infection everyday.
- Gay and bisexual men accounted for 66% (25,748) of all HIV diagnoses and 82% of HIV diagnoses among males (2017, most recent numbers)
- Black/African American gay and bisexual men accounted for the largest number of HIV diagnoses (9,807), followed by Hispanic/Latinos (7,436) and whites (6,982).
- Young people were the most likely to be unaware of their infection. In 2015, among people aged 13-24 who were living with HIV, an estimated 51% didn’t know.
- In 2017, 17,803 people in the U.S. and 6 dependent areas received a stage 3 (AIDS) diagnosis.
- Treatment as Prevention is amazing news, and so is Uequalsu, but it will take time before the level of stigma in our community decreases. And, for some, they will always fear those living with HIV.
- Testing positive will change your life forever. There is no going back.
- Testing negative is not the end of the cycle. You will need to keep getting tested as long as you live and are sexually active.
- PrEP works, but most guys still don’t have access to the medication due to cost, insurance, and even a lack of knowledge of its existence or proof that it works.
- Testing positive any time after common knowledge of condoms effectiveness in slowing the risk of infection and PrEPs 99% showing will lead others to have some very negative opinions about you. Either you are a meth users, “whore” or plain stupid. Compassion will not always be freely given.
It is hard being a gay man and HIV doesn’t make it any easier. Hell, other gay men don’t make it easier. But we would like for you to ignore the words and slogans of other HIV/GLBT orgs. Getting tested cannot be done as a measure of community service and a good natured heart: it needs to be done out a pure level of selfishness and desire to live and survive. Embrace the suck and get it done.
Some good things:
- HIV testing has gotten easier and much faster, with results coming in minutes and not weeks.
- A blood draw is the most common method of testing but many places offer mouth swabs for those that are needle shy.
- Over the counter home testing kits are becoming more accurate and less expensive.
- We advise seeing your own medical provider for testing but there are numerous HIV orgs that make themselves available year round for testing. Some even have mobile van units.
- If you do test positive for HIV, treatment options are made available very quickly and many guys are able to get to undetectable in less than three (3) months.
Making testing easier:
We have an informative article about How to Find a Doctor, which discusses issues around HIV and STI testing. If you have a provider that you trust, that you can be open with about your sexual activities, it will make getting tested much easier.
Make testing a regular habit, but one that you don’t need to think about. Just like you have a yearly physical, make sure that STI testing is part of it.
Get in touch with your provider and let them know that you would like a standing appointment, every three (3) months, where you are tested for every STI, including HIV. This should take a small amount of the load off your emotional plate.
There is no shame in asking a friend or close family member to accompany you to get tested. A nice warm hand to hold or shoulder to cry on, can make the experience much better and comforting. No rule says you have to go it alone.
Understand your real sexual life. You know how risky your activities are and who you are having sex with. The greater the risks you take, the more you need to keep yourself safe and protected. This includes using condoms and PrEP but increasing your knowledge about your sexual partners status.
Don’t shy away from guys who notify you that they are HIV positive but undetectable. Uequalsu is real and these guys are not likely to lie about their status and are more likely to be tested regularly for other STIs.
The more guys that get tested for HIV, and if positive, get proper treatment and become undetectable, creates a level of herd protection. This is increased when added to those guys on PrEP. What this means is that all around you, the virus is being fought back, making you less at risk for infection. But you should want to be one of the guys in the herd, not just benefiting from its effects.
Guys who take PrEP are required to get tested for all STIs every three months if they want to have their prescriptions refilled. They are much safer to have sex with than those guys cheering about being negative without any level of proof. Remember the window period from above?
There is a significant amount of guys that are living with HIV but don’t know it. Either they have never been tested, haven’t been tested recently or have converted during a window period between testings. Don’t believe those pictures on profiles stating their negative status. You don’t know what he did right after getting that result.
Use your better judgement. The head on your shoulders should make the best decisions for the head below your waist.
After the test:
There can only be one of two possible outcomes. Either you are still HIV negative or you are HIV positive.
If you are negative, your work doesn’t end there. You still need to think about your sexual life and history, your activities and even drug and alcohol usage. Was this negative result a stroke of good luck, or was it by action and design? Only you know the truth and if changes need to be made.
If you test positive we have an amazing guide to help you through the first few years. They can be a bit tough but we will help you get through it. HIV treatment has come a long way, and those diagnosed now are expected to live a nice long life.
The Wrap up:
There are numerous methods to keep yourself protected from HIV infection. We won’t insult your intelligence by listing them again, but we also understand that shit happens in the heat of the moment. You cannot live your sexual life in fear but all of our actions have outcomes and consequences that we must be willing to pay.
Don’t let getting tested for any STI freak you out, because by the time you decide to actually take the test, you either are or are not infected. The actions have been done and the outcome of the test is all that awaits you. So, be strong and make decisions that are best for your short and long-term health, before and after each testing cycle.
Yes, your fears are valid, but you can control the outcome of each test before stepping inside of a providers office.