Short Form

Writing these few posts has helped me to think through some things about poz/neg sex and UB2 attitudes.   

The short form is this:  HIV is with us, and infection rates are climbing in the gay community.  Any realistic effort to stay negative is a very good thing.

If you're negative, having multiple partners, meeting men on line, and less than 100% safe, you are already taking bigger risks than safer sex with a known positive guy who's on medications.  Keep that in perspective.  After all, when we talk about relative risks of a sex act, 1:200, 1:20,000, or whatever, it isn't just the act, but the frequency of the action that are in play.  

If you're meeting lots of men on the net  (And "lots" does not mean "a couple of times a week, but less than my REALLY pig friend does."), you are at risk.  In short, if the  main focus of your self-protection plan is "UB2," you'll be changing teams, in the near future.  In the October issue of Journal of AIDS, there is a new article clearly showing this.  Men who stick with UB2s, but who have unprotected sex, are serocoverting rapidly.

I understand anxieties about sex with poz guys, and I respect it.  I'd be less than honest if I didn't say I was more comfortable with pozzers than negs.     Just be clear, and respectful, and please stay safe.

Read the rest of my posts, if you like, and leave me a note-

Oh, and please, don't refer to your negative status as "clean."  I may have some antibodies, but I bathe, regularly.  Kind of disgusting to refer to us as somehow, "dirty."

JB

Logic and Fear

If you've ever watched a cat try to cross a street, you're seeing a monumental failure of evolutionary adaptation and real world risks.  Cats come to the edge of the street, crouch low, and scurry across, avoiding large pouncing predators and diving hawks.   Of course, in a world where slow moving Toyotas is the biggest "predator" to avoid, looking both ways and carefully crossing would be more adaptive.   Maybe in a few million years.

On the same theme, every Spring and Fall, the Discovery Channel regales us with "Shark Week."  People all over the world are terrified of sharks, and watch in awe of monsters, including people living in Kansas, Manitoba, Paraguay, and probably Mongolia, where shark attack is about as realistic a fear as being burned by a fire-breathing dragon.

Still, like our feline friends, we are programmed to be afraid of predators, snakes, and disease.  It is adaptive behavior to be afraid of illness, some types are contagious, and best avoided.

So, when someone is afraid of the spectre of HIV, it is instinctive, and can be part of an effective program of avoiding infection.   Avoiding infection is a very good thing, and I'm all in favor.

Now, that question of relative risk.   While you may slightly reduce risk by avoiding even safer sex with an HIV infected partner who is undetectable with HAART, you may be taking far bigger risks, if you are having unsafe sex with men who claim to be negative.    Unsafe sex between "negatives" is a very dangerous act, as the recently infected are the most dangerous, and the least likely to be aware.   If meth is involved, well, no need to say more.

I'm not urging anyone to have sex in any situation that makes them uncomfortable.  I am suggesting that you do really effective things to reduce the risk of infection.  Reduce your number of sexual partners, avoid intoxication with sex, and use a condom, every time.

Otherwise, your UB2 thing is not effective protection.  And it will come back to bite you.

An important article about HIV tranmission

Hey guys,

Please take a moment to read, "Driving Forces of Increasing HIV Transmission in German MSN" on the NATAP web site, by Marcus, U, Schmidt AJ, Hamouda O.  

It clearly states how "serosorting," the practice of UB2 negs only seeking each other, is contributing to the rise of new HIV infections.

If you're negative, safer sex, every time, no matter what you think the other guy's status is!

More on bareback risks

Today, there was a new study looking at the question of bareback sex and HIV transmission risks.  I think everyone should have a look at this.

The study, published in "The Lancet," July 26th suggests that the risk of infection rises by a factor of four in discordant couples, even if the infected partner is on effective anti-retroviral therapy.

http://www.aidsmap.com/en/newsC144FC4F-2707-4D1F-87

You may think you've been going a long time, playing "mostly safe," and you'll stay safe, but statistics eventually win.

I just spent the afternoon with a 50 year old friend, who after a long career of "mostly" safer sex, exclusively as a top, just found out that he is positive.

It's hardly the first time this year I've dealt with this, and I hate it.

Please, go back and study "safer sex 101."  There's no reason to get infected these days!

UB2 and you

If declining to have sex with men who are HIV positive reduces your risk by a small percentage, feel free.  I'm not sure what I would do in your position, so I make no judgements. 

When drugs, especially methamphetamine are involved, I don't know what all is going on, but I have heard some HIV doctors speculate that 80% of the new infections they see in gay men are related to meth use. If you're using meth, the risk is so high for getting HIV that worrying about a partner's status is almost silly.

About a third of men with HIV are totally unaware of their status, and some of these are recent infections.  These men who may honestly believe that they are negative, are the biggest danger, as they have the highest viral levels in the blood, and possibly they semen.  These contacts will not identify themselves as "positive" and they are the highest risk.    Tracking the contacts of the acutely infected proves this.  The acutely infected are the most likely to transmit HIV to the HIV negative.

In both settings, new infection and meth use (and these groups travel together, frequently) asking men if they are positive or negative, is a pretty useless strategy, especially if you also assume that everyone not only knows the score, but tells the truth, too.

Another third of HIV positive men is aware of status, but not on treatment.  It's probably a safe bet that many of these men have been infected for months to years.  They are controlling HIV with their immune systems alone, and while they have detectable viral loads, the levels of virus in the blood  and semen are not terribly high, and they are not a terribly high risk for transmission (though certainly not zero risk), as long as "safer sex" rules are followed.

The remaining third of men who are aware of their HIV status, and who are on treatment, have low levels of HIV in the blood, and probably, but not definitely, pretty low levels of HIV in the semen, as well.   This makes theme even lower risk of spreading HIV, but the risk is not zero.  The  presence of other sexually transmitted diseases, and whether that person is a top or bottom certainly do affect the risk of infection, too.   Practicing "safer" sex remains an important part of a harm reduction strategy, too.

Make your choices, and do what you will.......

but please take care of yourself.

and please, try to be respectful of others.

Who is really poz or negative on line?

A new study from the "Journal of Urban Health" looks at men on line at the various sex sites.

17% of HIV positive men have "negative" in their profiles.

Almost 75% of men who have never been tested have "negative" in their profiles.

Probably 25% of the "never tested group" is positive.....and these untreated men are the most infectious contacts you can have......

Buyer beware.

Disclosure kharma

So, some really hot guy sends you a note, they want to meet.  Now, I think from my profile and from my pics, it's at least obvious that I might be HIV positive.  Even if obvious, if it's an issue to you, shouldn't you be the one to ask?  It's your health, not mine that's at risk.

Still 95% of the time, it's my job to bring up the subject.  It gets old, but goes with the territory.

What I never get is this:   Some guy is hot to trot, and you say, "OK, but are you clear that I am HIV positive?"    

They don't even respond.  Not even a "Sorry, no thanks."

Disclosure is not always easy.   Like a bruise, it doesn't get less sensitive with time, but it's something you do out of a sense of responsibility, and frankly, self-protection, too.    

You make it easier to disclose if you have the minimal courtesy to acknowledge that someone has taken a moment to respect your life and health.

and, if that person started the conversation, he has more respect for your negative status that you do, it would seem.

Follow up BB safety

Have had a couple of comments about the BB post.

Are there BB acts that are lower risk than others?  Yes.

  

The most dangerous thing would be to bottom for a BB top who was infected recently.  That person is a viral spreader, with sky high viral load.  Your risk of infection from that kind of encounter may be 1:20 or higher, especially if other STDs are present.

A BB top with a poz bottom, who has been infected for years, and who is on HAART, with an undetectable viral load might be a low risk.  I know that many men chose to accept this risk, and that is a personal decision.   I would not want anyone to think that the risk is zero, however.

Whatever you do, you should have this discussion every time, and if someone says they are negative......... well, who knows when the last test was?

BB: It's not safe

I see this profile on Dudesnude, one of those guys who's so hot you think he's pro, and with a career in "adult movies," he may or may not be.

He seems intelligent, and thoughtful, and in his profile, there's a long discussion of how bareback sex is safe, now, in this age of good anti-viral medications.   There is even a reference to a website promoting "safe" barebacking.

It's a very dangerous idea.

In the spring of 2008, there was an article about +/- heterosexual couples in Switzerland who practiced unsafe sex, and who had negligible rates of seroconversion.   Truth be told, I have a female positive friend who has conceived two children by her negative husband, they were obviously at least sloppy, and he remains negative.

But what happens in a straight couple, married for years is not the same thing as what happens in random encounters between gay men.   

It is relatively difficult for straight women to infect men, even compared to the risk of a "bottom" infecting a "top."

The lining of the vagina is much, much tougher and resistant to friction and tearing than the lining of the rectum.   Small blood vessels are more protected, and there are fewer lymphoid cells, which is what HIV is looking for.  

Different encounters pose different risks.  Someone who thinks he's negative, but who was infected last month is a viral bomb, with levels of virus in the stratosphere.  Someone infected for years, even not on therapy, poses a risk, but it is less.......and the risk is lower for those on therapy, especially with "undetectable" viral loads, but it is not zero.

I see too many "tops" who have become infected with unprotected sex to be casual about it.  

I suspect that many of these cases involve recent seroconversions, but  you can't tell who those guys are, until they take a test.  

And by then, it's too late.