HIV 101

First, we want to be honest about a few things regarding HIV.

After almost four (4) decades, there is very little new information, if any, about how this illness is transmitted. Also, by now, you should know the basics about safe/safer sex and how to protect yourself and your partners from this disease. Next, the research regarding gay males and anal sex is very light, even though we are the major demographic infected and affected by this illness. Finally, even with this being said…something is not working. HIV is still a major health concern for the gay male population and even as numbers slowly drop regarding the rate of infection and death from AIDS, the overall effects on our community don’t look good. Obviously something must change.

We at the Gay Male Journal (GMJ) decided to have a conversation with you, instead of a lecture, while answering some of the questions we have received most over the course of our careers. This is not a perfect account of HIV, nor is it a history of the virus as it devastated a generation of our community, because you know all of that. It is also not a shame-blame hit list to make you feel bad about yourself or sexual life. We’re just a bunch of guys, sitting around, talking.

Here is our promise to you: Throughout this Primer, we will not lie to you. We will not fill your head with topics of false hopes or fears. We will not give you antidotal experiences as evidence or spend any time reinforcing stereotypes with homophobia, racism or POZ-phobia. What we will do is tell you what we know, what we and other researchers have been able to prove and let you make the choices for yourself about your body, your life and your integrity as a man. As always, links are provide for you to further research this topic for yourself.

• AIDS: Acquired Immune Deficiency Syndrome is when the body can no longer protect itself from opportunistic infections. Someone with HIV alone does not have AIDS.
• You must make your own decisions about your sexual practices and their outcomes. This is not a group project. Keep your eyes on your own paper.

The above flow chart shows the most common ways HIV is transmitted for gay males. If HIV lives within his body, it is transmitted through bodily fluids such as blood and semen and is passed on during anal sex and/or IV drug use. It is very, very rare for HIV to be contracted through oral sex alone! Receptive anal sex partners (bottoms) are at much greater risk for contraction of HIV than active partners (tops).

The boxes get smaller because, as far as sexually transmitted diseases are concerned, HIV is difficult to contract. It is not the like the common cold virus or even Herpes, which have longer life cycles and can live outside of the body for long periods of time. HIV dies almost immediately on contact with air, and there are enzymes within saliva which are known to kill it. Check out the section on oral sex down below.

Currently, there are three (3) best practices to decrease your chances of contracting HIV.

1. Condoms

The gold standard in HIV/STD prevention. They are easy to find, free in many locations, and most guys are generally familiar with how they work. But, the cold hard truth of the matter is that no one truly knows how effective or not condoms are in slowing down or stopping the transmission of HIV during gay male anal sex. The reason is because the research simply does not exist. What scientists and researchers are known to do is take the samples from heterosexual couples and vaginal sex and claim the figures are true for us. Check this out!

Individual gay males are known to repeat the “99% effective” statement written on the back of condom boxes about birth control. And some people believe that any study about HIV/AIDS and condoms must automatically be inclusive of gay dudes. NOPE. Read the fine print. And don’t forget, condoms are created for vaginal intercourse and birth control. One has not been invented to stand up to the, let’s just say, more vigorous act of gay male anal sex.

This does not mean that we are advocating for anyone to not use condoms during anal sex. That is your choice and responsibility alone. Man. Up.

What we are saying is that when you do your further research…which you should be doing anyway, remember that gay males are not usually in the study sample. We are not being counted. Also, remember that “STD” does not always equal “HIV”.

The United States Center for Disease Control and Prevention (CDC) researchers go even further, stating “while MSM represent approximately 2% of the U.S. adult population, researchers explained they accounted for 62% of all newly diagnosed HIV infections. Yet few studies have looked at the effectiveness of condom use among this population. The most widely used estimate of condom effectiveness (80%) was based on studies among heterosexual people with HIV-positive partners.” Read it for yourself, since you won’t believe us.

As for HIV infection, to err on the side of caution is always a good idea. Just because we don’t know how well condoms protect against the HIV virus does not mean that they do not protect at all. And, even if they provide, for example, 10%…that is better than nothing.

There are a few things that you can do regarding condoms that may ease your sense of mind.

1. Vote! Elect politicians that have your healthcare issues at heart and act on them.
2. Take part in studies about gay male sex and practices.
3. Do your own, extra research. If it does not specifically say “GAY MALE ANAL”, it means we were not in the study. Pregnancy rates and HIV/STDs are not the same.
4. If you use condoms, they are best when used every time and correctly. This provides the best over all coverage and security. Randomly using condoms have been shown to be less effective and almost like never using them at all.
5. Stop being cheap. Yes, use the free ones if that’s your only choice, but think ahead and purchase your favourite brand that fits you and your sexual lifestyle. Also, we all know the free ones break and are known to have tears, so inspect them out before using. With condoms, you do get what you pay for.
6. Finally, gay male anal sex requires lube. LOTS OF LUBE. Condoms work best when liberally lubricated to prevent breakage and provide extra comfort.

EXTRA CREDIT: How to Build a better Condom…and why they suck!

2. Do not do IV drugs (if you do, use clean needles and do not share!)

We at the Gay Male Journal take a harm reduction approach to drug usage. There are many reasons why guys do drugs and “just say no” is great on a bumper sticker but obviously does not work in real life. But here is a statistic that got our attention and may assist you as well.

The Prevalence of HIV in those that inject drugs is 28 times higher than the rest of the general population. Yea, that happened.

Many cities around the United States now have needle exchange programs and some hospitals are known to provide assistance as well. Blood transferred illnesses, like HIV and HEP love dirty needles. So do yourself a favour if you are going to continue to shoot up; do it smarter.

3. PrEP and PEP

GMJ has an entire section on PrEP and PEP, which you can check out. Two quick points on the controversy about this medication:

2. The cost. Depending on your insurance coverage and income, the monthly cost could be free or up to the full $1,200 a month price tag. Now, we don’t know which insurance you have, if any, or how much money is in your wallet, so we cannot make this decision for you either. But, you have this information and should use it when making your considerations. Don’t let how others see the cost of this medication dictate what you want to do. This is your decision to make.

But the most important information we wish to share is that these medications work. Really. Studies on this medication, with gay males practicing condomless anal sex, show 99 percent effectiveness in preventing HIV transmission. But, we are sure you really want to talk about those 3 people, out of tens of thousands, that failed on PrEP and contracted HIV. Remember, there are only three (3) known individuals in the entire world known to have failed on this regime, and they’re all being treated effectively for their HIV infection, but also being studied to find the cause(s). If someone, probably on the Internet, tries to convince you that he or someone he knows contracted HIV while on PrEP, he is lying. He/they would have been reported, further studied and added to the list for the HIV medical community to look into, but also the media. If this really happened to them, there should be no problem releasing their substantiated medical records to the public and the media. We need to know as much about each unique case as possible. The first two individuals failed due to drug resistance, and the 3rd is still being studied. Many doctors now test for drug resistance before prescribing PrEP. You can ask for this, if you are concerned.

And here are five (5) controversial practices:

1. Sero-sorting: This is the practice of only having sex with guys that share your HIV status. It is on the list because it is also a way for (some) guys to ditch condoms all together, forgetting about other STDs.
2. Positions: This could include only oral, topping, or pulling out before ejaculation. This made it to the list because it gives a false sense of security about HIV transmission while decreasing the guys overall knowledge about modern HIV prevention options.
3. Only having sex with guys that claim to be HIV negative/on PrEP. This one is pretty obvious. You don’t know if he is telling the truth, or if he has other STDs. Untreated HIV is our enemy, not HIV positive guys.
4. Only having sex with guys that are HIV positive/Undetectable. This one is a bit tricky because there is some logic to it. If he knows that he is HIV poz and takes his meds, he is also regularly tested for other STDs every three (3) months. The issue is that some believe that this still is not a reason to keep the condoms in the box. This is less about HIV than about other STDs
5. Limiting your sexual partners. Some guys have really bad luck. One act can lead to a life-time of HIV, while other guys have loads of partners, without condoms, and are still HIV free. Instead, we suggest increasing your education, communication skills and what’s in your HIV prevention tool kit.

HIV has always been controversial because it involves sex, gay males and honesty, three scary topics rolled into one. In the early days, we saw lots of our friends/lovers die very publicly, as a community and we are still in shock. This has impacted how we make our decisions and who will be allowed to give us the information about our healthcare. This includes what we see and read on the Internet. This powerful tool can educate or slow progress. We can use it to communicate facts or spread fear, stigma and lies. Which brings us to the major topic about HIV/AIDS: FEAR.