HIV: A Conversation

Hopefully, you have read our Piece called HIV 101 for the basics about this illness. We at GMJ buck the system and lay claim to it as a gay male disease. We do this because, yes, anyone CAN contract HIV, but overall in the Western world, gay men do at disproportionate rates. These are facts. Control your feelings.

These rates are high enough that we need to keep the bell ringing that education and services need to be targeted toward our community first and foremost, and not equally among the general population. By making these requests, we are also asking you, our brothers, to do the work to educate yourselves and practice forms of sex that reduce your risk for contracting this disease, and if you are HIV positive work to control the virus and become undetectable so that you’re unable to infect others.

But, just as much as we have “enemies without” we have them within. Willful ignorance and fear have created a culture of stigma and shame that is crippling our community. Laws are created that punish knowing your status and privacy has gone out the window in the internet, free form of communication era. We can do better. And it starts with a conversation.

Introduction:

Fear has always been known as a positive motivator. It activates our primal “fight or flight mode”. The notion has been that if we, the public, are made not just aware of an issue, but also afraid, that it will garner a certain action or reaction. Fear sells even more than sex.

But, fear is more well known to paralyze and cripple an individual and sometimes a community, as it forces them into submission or to act on the goals of another party (like a deer in headlights). We don’t support fear in any shape or form because, not only is it not a pleasant feeling but it doesn’t produce the desired effect of behavioral change for the long term. That is the role of education.

Yes, fear of contracting HIV or some other sexually transmitted disease may get you to use condoms or PrEP for the short term, even for years and decades, but it will not last. You’ll start to feel forced and manipulated. We prefer education over fear. We prefer to provide evidence as a method of choice, and risk factors which allow you to make the best decisions for yourself and your partners. If we’ve learned anything about HIV over the last generation, it should be that fear doesn’t work.

As an example, we could do what the government and other non-profits do and add a laundry list of data and statistics to this article. Allowing you to see just how close you are to a quick death every time you have sex. We could show you graphs of how many gay males in your state contract HIV and how many of them are living with the virus, but don’t know it. We could scare the holy hell out of you, but that wouldn’t be healthy for you physically, mentally or emotionally. This is a bad way of teaching you or any member of our community because there is only one number that you truly care about, and that is yours.

You’re here, reading this because you don’t want to live in fear any more. You want someone to finally give you a true and honest answer to your questions and not just a list or bullet points that don’t take in the complexities of your real life. Fear only breeds more fear and then, we as individuals do our best to make ourselves feel safe by harming others…before they can harm us. This is how we went from assisting our brothers with HIV to hating them.

In the beginning, fear was stoked by the government and individuals alike. The fear came from straights, as GRID was a new cancer killing off gays. The fear came from within because not only did we not know what HIV was or how it was contracted, we didn’t even have a test to see who was infected. It could’ve been anyone, including you. Fear will forever be associated with this illness. That fear persists even now in the face of new medications and treatments because fear is where many found their comfort. And what we fear, we hate and try to destroy.

So let’s first talk about how you cannot contract HIV; no matter what you heard or need to believe.

Sharing eating utensils/drinking glasses
Toilet seats
Swimming pools/Saunas/Whirlpools
Clothing
Kissing/Saliva
Coughs/Sneezes
Tears
Sweat
Urine
Human/bug Bites
Shaking hands/hugging
Living/visiting a home/office of someone with HIV
Blood found outside of the body
Sexual fluid on your skin
Masturbation
Sex toys
Rimming

Bonus Round: Oral Sex

Oral sex is not considered to be a major activity for infection in gay males. The tiny amount of research done regarding this act is polluted by the fact that oral sex is a very common mode of foreplay, which leads to other sexual contacts such as anal sex. Also,…guys lie. So researches can never truly know if “he only sucked, never swallowed, and really has never done anal.”

There are some guys determined to believe that oral sex is a major way to contract HIV. They won’t go anywhere near a dick without a condom or dental dam. No matter what they’re told, they must believe that sucking dick is going to kill them.

We joke, but this is important because guys that are still convinced of this method of HIV transmission, also harbor some very outdated information about gay sex education in general and they usually are not seeing a doctor regularly (every 3 months) for proper STD screening or education themselves. Fear is keeping them from taking charge of their lives, but we are sure they all have Internet access and are decrying every new advance as soon as the study hits their feed.

We thought a great way to approach this subject was to begin with logic. Think about this for a moment. If HIV was transmitted highly and only through oral sex, wouldn’t the number of guys with HIV be, like really, really high? Even though you won’t believe us, here is some of the research we found:

CDC: There is little to no risk of getting or transmitting HIV from oral sex.

Thebody.com: The chance an HIV-negative person will get HIV from oral sex with an HIV-positive partner is extremely low.

HIV I-base: Oral sex is generally a low risk activity. It is likely to be zero or close to zero in most circumstances.

GMFA.org: A very adult way of talking about oral sex, but it get’s the point across.

You should never have oral sex if:

A. You have sores /cuts on your penis

B. You have sores/cuts in your mouth

C. You brushed your teeth within the last hour

So, why all of the confusion and no one just coming out and saying “zero” risk? Yea, we wish they would just say it too, but because of fear and a huge dose of homophobia it ain’t gonna happen. (To be fair, scientist really don’t like to say “zero chance” of anything.)

Very few governments on earth have ever had a truly healthy medical relationship with its gay male population. Gay male sex education isn’t taught in American schools, and in 11 states it’s against the law!

By the way, The CDC only recently updated its website regarding oral sex, condomless sex, and the definition for UNDETECTABLE VIRAL LOAD, which we will discuss later. But first… Check this Out

I am a top, am I at risk for HIV?

The short answer is… maybe. It all depends on your sexual habits.

• Do you use condoms, all the time?
• Do you know how to properly put on a condom?( Let our UK friends give you a lesson)
• Do you have any open sores or cuts on or around your penis?
• Are you on PrEP?
• And the most important question: Does the person you are having sex with have HIV with a detectable viral load?

Researchers agree that tops have a significantly lower risk of contracting HIV from his receptive partner and if condoms are used, the risk is zero. The reason there is so much confusion about this issue is that many gay men are both tops and bottoms or have switched sexual positions over time or with a particular partner. It’s almost impossible to gather information when your demographic is inconsistent or does not tell the truth. This also goes for oral sex.

I am a bottom, am I at risk for HIV?

Once again, the answer is maybe. It will depend on your sexual habits as well.

• Do you make sure your partner has on a condom each and every time?
• Does the condom fit, without being loose and does not break during intercourse?
• Are you on PrEP?
• Do you have any open sores inside of your rectum?
• Do you have any sexually transmitted diseases?
• Do you douche before anal sex?
• Does your partner have HIV with a detectable viral load?

For both the “top and bottom”, we listed the risk factors. No, we cannot tell you exactly how much you are or would be at risk, but we can say that there is some risk involved in all sex but there are ways to minimize them.

Extra Credit: Check this Out!

He said he was HIV Negative, what does that really mean?

We live in the digital age. As gay men, we can order sex as fast as our hetero friends get pizza. Hook-up apps make it easy and all you have to do is read a few (hundred) profiles. Once again fear shows up in our lives without us even knowing it. Fear of HIV, stigma, rejection and of knowing the truth makes the above question a difficult one to answer. But, it could mean…

1. He is tested every 3 months, regularly and is definitely HIV free.
2. He hasn’t been tested recently, but the last time he was tested, he was HIV negative.
3. He doesn’t know the last time he was tested, but he remembers being HIV negative.
4. He’s never been tested for HIV and is afraid to find out.
5. He is HIV positive but doesn’t want to say so because of fear, rejection or stigma.

You will only know if someone is truly HIV negative if you are with them as they receive negative test results twice over a six month period. There is a “look-back” period of around three months, as the body develops anti-bodies to the HIV virus. An HIV test doesn’t check for the actual virus, rather anti-bodies which are produced to fight off the infection. This will take time to occur, in the mean time, the newly infected and those not being properly treated will have a very high viral load. Thus making them highly infectious. Guys are infected by people that don’t know that they are HIV positive, not on medication or do not have an undetectable viral load. (No, we aren’t going to give you the statistics on those that don’t know. It will not help you sleep any better.)

But, he said he was on PrEP:

We discuss this medication as an option for your personal use. But, as more guys are going on PrEP, you will encounter more who say they are taking it too. This is a judgment call only you can make. If he says he is on PrEP:

1. He is on this medication, which requires three (3) check-ups yearly, which will also include tests for other sexually transmitted diseases.
2. Because he’s on PrEP, he doesn’t have HIV. This is sometimes said as a backhand against guys who are HIV positive and may, or may not be true about himself.
3. He wants to have condomless sex.

Now, depending on your sexual role of choice, condom and/or PrEP usage you have a choice to make. This information, if true, may decrease your risk factor to zero or may not change it at all. But at some point, you’ll need to start trusting yourself, gut instincts and other men. We’re not all lying.

He says he is HIV positive but undetectable. What does that mean?

Undetectable is the new black. In the “bad ole days” the only way we could track the health of someone with HIV was with a T-cell test. This fluctuating measure would give medical professionals and those infected an idea of how much damage the virus was doing to their overall health. But, now a so-called Viral Load Test is the gold standard as it literally tests for the amount of virus located within the blood. This is a much more sensitive and sophisticated test than the standard HIV test because it checks for the actual virus, not the anti-bodies.

But, of course there are issues.

• Not everyone is going to reach this goal, even if they take their meds regularly.
• Not everyone is compliant and takes their meds regularly.
• Drug and alcohol usage is a major factor in guys not being compliant.
• Mental health issues are a hurdle as well.
• Though rare, medication resistance may have developed and impaired his ability to become fully undetectable.

If he is truly undetectable, this means, even without a condom during anal sex, he cannot infect you with the HIV virus.

Does Undetectable mean Non-infectious?

This is the topic that many are not going to want to believe, but here is the science.

To be very clear: Undetectable does not mean HIV negative. It means that the treatment for HIV disease is working enough to drastically reduce the amount within the blood stream and body as to slow down, if not halt, the progression of the virus. If treatment is stopped, the virus will rebound!

It has taken almost two decades for the government and many medical professionals to come to the agreement that undetectable does equal non-infectious (#uequalsu). This means that a guy who is truly undetectable cannot transmit the HIV virus, no matter what, because he does not possess an amount great enough in his body/fluids to do so. But, I know you won’t believe us, so here are some smarter people who said it first. Click on the links below to read the full reports and studies.

AIDSMAP:

NAM aidsmap, one of the foremost sources of HIV information in the world, strongly endorses the ‘Undetectable Equals Untransmittable’ (U=U) Consensus Statement issued by the Prevention Access Campaign.

NAM’s Executive Director, Matthew Hodson, says, “The scientific evidence is clear. Someone who has undetectable levels of virus in their blood does not pose an infection risk to their sexual partners”.

In terms of HIV prevention, if condom use is safer sex, then sex with someone who has maintained an undetectable viral load is even safer sex”.

This understanding transforms the way that HIV is considered with enormous implications for what it now means to live with HIV and the best ways to prevent it. The preventative impact of effective HIV treatment underlines the importance of expanding access to treatment and of improving treatment uptake and adherence for all people living with HIV worldwide.”

I-base

The PARTNER study provides good evidence that undetectable viral load might be a threshold below which sexual HIV transmission does not occur. The PARTNER study is important in that it included both gay and straight couples, that it measured risk in people who were not using condoms and that it estimated absolute risks.”

Thebody.com

“We are not dirty, we are not a threat, and we are not disease vectors. In fact, we are the solution. People living with HIV who achieve viral suppression, who become undetectable, are the solution to the end of new HIV infections in the United States. … When we look back 20 years from now we’re going to judge ourselves in terms of how well we responded to this opportunity.”

Dr. Rich Wolitski, person living with HIV and acting director for the Office for HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services

{When Dr. Wolitski delivered his speech at the closing plenary of the 2016 United States Conference on AIDS (USCA), he received a standing ovation. He was referring to this year’s newest findings of HPTN 052 and the PARTNER study, which showed that people living with HIV who are undetectable are not transmitting the virus to their negative partners.}

This news is amazing for us. But it’s only as good as those who believe the science, get tested, and if POZ…get treated and get to undetectable.