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?