Media campaigns regarding HIV tend to be of two minds. They mean to warn people that the virus is still a life-threatening disease, to help convince people to use condoms. But at the same time, the message is that people can live a fairly normal life despite having HIV. Both of these messages are valid and important. Try your best to avoid getting HIV, but should you end up getting it, don’t see it as the end of your world. It can be lived with reasonably well. Though the amount of virus can be wrestled down to undetectable levels with medication, it still can’t be cured.
What is HIV?
HIV (Human Immunodeficiency Virus) is a virus which hijacks your immune system. It enters defensive cells (called CD4 cells) to replicate itself inside them, after which the new virus spreads to other cells and the process repeats itself. Because this severely undermines the immune system, people with untreated HIV are likely to be more susceptible to secondary infections from other viruses or bacteria. But even when using medication, the immune system can remain somewhat impaired. In a lot of the people with HIV, the immune system never fully recovers.
Having HIV can be indicated as being ‘seropositive’, ‘positive’, ‘poz’ or ‘HIV+’. Not having HIV is called being ‘seronegative’, ‘negative’, ‘neg’ or ‘HIV-’. HIV can lead to AIDS (Acquired Immune Deficiency Syndrome) in someone who is HIV positive but not getting treated or when treatment isn’t successful over a long period of time. The diagnosis ‘AIDS’ is made when someone’s immune system has deteriorated to the point where he or she gets sick because of something a healthy immune system could easily have handled.
“Some men who occasionally sleep with men but don’t consider themselves ‘gay’, think they can’t get HIV. They see it as a disease that only affects gay people. Like the virus cares about the image you have of yourself.”
More about safer sex and avoiding STDs can be found in chapter 20, but here are the main points regarding HIV. Strangely, considering the amount of people it has killed, HIV is a rather ‘weak’ virus, meaning it initially won’t manage to worm past your immune system all that easily. The fatalistic attitude some gay men have (“Why try to avoid it? I’ll get it sooner or later anyway.”) is definitely not warranted.
Kissing someone who has HIV is not a risk factor, unless that someone has such a large wound in his mouth that you can taste blood, in which case kissing probably isn’t all that pleasant anyway. As a man who sleeps with men, the most important tool to prevent getting HIV is simply using condoms correctly, consistently and in combination with a whole lot of lube when you’re having anal sex. The lube should be water-based or silicone-based.
Anal sex without protection is probably the riskiest thing you can do sexually, both as a top and as a bottom. If you are a bottom, part-time or full-time, you should really train yourself at slipping a condom over your partner’s dick and take charge in that area if he doesn’t beat you to it. But as a top you should also not have performance anxiety about slipping on a condom. If you feel self-conscious or insecure about it, practice it by yourself while jerking off.
The HIV risks of oral sex are hard to quantify, but are very low compared to fucking. Erring on the side of caution — not getting come in your mouth — is a good idea. Pre-come has less of the virus in it than come does and the antiviral elements in your spit should be able to handle that amount normally, so pre-come shouldn’t be much of a worry. If there is a lot of it, wipe it away before going down if you like. Don’t suck without a condom if you have a sore throat, bleeding gums or little wounds in your mouth, like canker sores. Don’t brush your teeth too hard just before a suck to avoid making new little wounds, and rinse your mouth after giving a blowjob.
“I hit puberty around the time that AIDS was responsible for a lot of deaths and constant emphasis was put on safer sex. It’s all I know. I even had to unlearn some paranoia: just kissing a guy could make me worry about HIV.”
When your immune system is running low, due to sickness, drugs or exhaustion, you will be more at risk for initial infection, and HIV will have an easier time getting its foot in the door. It bears repeating, having an STD, especially syphilis, brings with it an increased risk of catching HIV. And many STDs don’t always have clear symptoms. Because of that, it is very important to get checked for syphilis and other STDs every six months or so, whether something seems to be wrong or not.
Keep in mind, you will not be able to get HIV from someone who simply doesn’t have it. The problem is that you can almost never be completely sure of someone’s status. Partners may cheat, even yours, and an HIV test doesn’t cover the last three months of someone’s sexual history. The tests look for cells in your blood that your body makes to defend against HIV, and it takes a couple of months until those can be found. Most transmissions happen through people who do not (yet) know their own status. People who are getting treated and are taking medication for HIV, probably have a low viral count (if the treatment is working) and are less likely to pass the virus on, though it will still be possible. The most practical thing is to assume anybody may have HIV unless proven otherwise, and just do your best to be safe at all times. So fuck with a condom and ample amounts of water- or silicone-based lube, and don’t get come in your mouth.
Feel free to ask people diplomatically about their status if you’re headed for sex, regardless of your own status, to make it clear that safer sex is an issue for you. But don’t expect the answer to necessarily be the truth. No matter what the answer is, safer sex is a necessity and that makes your partner’s actual status less important. Always stick to the boundaries you have set for yourself regarding safer sex.
“I think that the two main evildoers are willful ignorance and fatalism. The first kind of people don’t want to think about HIV. They pretend it doesn’t exist and hope this will make HIV pass them by, like a kid during hide-and-seek who closes his eyes and is convinced no one can see him. The second group is of the opinion that they will inevitably get it sooner or later, so they don’t even really try to avoid it, even though it can be avoided quite easily.”
If a condom ripped during a fuck with someone who has HIV (or whom you suspect has it) there is an emergency treatment called PEP (Post-Exposure HIV Chemoprophylaxis), which greatly reduces the chance that you will get HIV if you were exposed. Treatment should start as soon as possible, preferably within two hours, but at the latest within 72 hours of the possible exposure. You can get it through your general practitioner, or ask about it at your local health centre. But it’s no walk in the park. The preventive treatment consists of taking a heavy mix of HIV medication for a month, leaving you to deal with all the unpleasant side-effects these bring. It is, however, a fairly effective last resort when you have run a big risk. Your physician or local health centre will probably be able to prescribe it for you.
Assuming you are having sex outside of a monogamous relationship with an already tested partner, get tested at least yearly for HIV, even if there are no symptoms. Some people may have a serious reaction during initial infection, but for others it slips by unnoticed, mistaken for the flu. You generally no longer have to wait for days for the results of the HIV test. Depending on where and how you get tested, results may be available within an hour. There are also less reliable tests for HIV that you can do yourself at home, but testing through a doctor or health centre is recommended. You don’t want to make a mistake, get an inaccurate result and scare yourself unnecessarily. And should you test positive, you will want someone around straight away to advise you on how to proceed.
Living with HIV
If your test comes back positive, meaning you have HIV, don’t blame yourself and don’t let others blame you either. It can take just a moment of bad luck, misplaced trust or a lapse in self-control. Consider the many straight men regularly having sex without a condom; they are only less likely to get HIV because of the lower rates of infection among straight people in the Western world and because of biological construction, not because they are being more careful than gay men. Pretty much everyone has had a lapse of judgement related to safer sex at some point, but the consequences are more serious for some. Given the relatively high number of gay men with HIV, the chances of catching it are unfortunately also higher than average.
First, get some professional advice on your options for treatment. When should you start treatment and which approach will work best for you? Don’t be a passive patient, do some research and keep up to date about different or new medications. Get informed about your body and the virus. You should be receiving regular check-ups, charting your immune system and your viral load (the concentration of the virus in your blood). Not all people respond in the same way to the treatments available. If your body does not deal well with the medication you are taking, you need to know as soon as possible and switch to something different. A treatment that works could bring your viral load down dramatically. This means that you will be less likely to pass on the virus. But since the amount of virus can sometimes spike back up unpredictably for a while, you still need to be careful with others and always use a condom.
Taking medication to control your HIV is necessary, but it is not always pleasant because of the possible side-effects, which include fatigue, nausea, skin problems and issues with the liver. Older medication often had an effect on the users appearance, such as an unusual distribution of fatty tissue. This meant that you could sometimes tell if someone was taking these meds. Current medication however has resolved many of these issues. Keep in touch with your physician, and let him know about any side-effects you are experiencing. This might mean a switch to a different treatment plan, but you shouldn’t stop taking medication entirely once you have started taking it, to avoid the virus becoming resistant.
Having HIV doesn’t mean you can stop using condoms, it’s actually even more important to use them. In addition to protecting your partners, it’s important that you protect yourself from other STDs. HIV permanently weakens your immune system, making it easier to get a second STD. And if you get one, the symptoms can be more severe and can even become chronic. Syphilis, hepatitis C and scabies will be easier to catch if you have HIV and harder to get rid of. HPV can also be a problem. Most sexually active people carry one or more strains of this virus, some mostly harmless and some potentially dangerous. HPV can lead to an increased chance of anal cancer in people who have HIV, so you will have to get yourself checked for that.
There is still a stigma attached to having HIV. Some people feel dirty and withdraw from the world for a while when they find out they are positive. Others go on a bender with drugs and unprotected sex, figuring that ‘the worst has already happened anyway’. But you can also take it as an opportunity to become more aware of what is good for you and invest time in making your body and mind as fit and healthy as they can be. Staying upbeat and doing constructive things will be better for you and your immune system.
“I’m an HIV-positive man who has done the unthinkable. I’m living my life. I’m having a ball.”
– Cole Tucker, pornstar
Coming out positive
There is no ideal moment to tell someone that you are positive. Do it too soon and people may discard you in their minds as a potential lover or fuckbuddy. Do it too late and people might get angry at you for withholding the information. Someone’s response will mostly be out of your control. Someone who is very scared of HIV may have a bad reaction no matter when you tell him. Someone who is relaxed about it and maybe has friends or ex-partners who have HIV, will probably take it in stride, even if you tell him after you have had safer sex a couple of times. There is also the possibility, of course, that your new partner also has HIV, like you, but hasn’t felt comfortable telling you yet.
If the date is a romantic one, it is probably best to disclose your status sometime before you end up in bed together, to avoid his resenting you for having sex with him without telling him. Around the second or third date might work best in most cases, assuming you actually took the time to get to know each other and didn’t slide between the sheets right away. If someone is not willing to deal with your status, then the romance wouldn’t have gone anywhere anyway, so you might as well get it over with. Some men may be able to understand your fear of rejection and not fault you for only telling them after several months, but delaying can also lead to a more painful and bitter rejection.
For casual sex dates, a lot of people with HIV do not disclose their status, assuming that the other person will ask about it if it is an issue. Both parties should take responsibility for themselves, of course, though ideally someone who is positive would take extra care not to pass on HIV even if his partner doesn’t seem averse to taking risks. Don’t just assume your partner is also positive because he is being reckless; it’s worth asking him explicitly. On the other hand: never assume the other party is negative even if he claims to be and protect yourself.
You are, of course, under no obligation to tell family and friends that you have HIV. If you think that certain people will start treating you differently or will distance themselves from you, your options are to keep quiet, drop these people from your life or try to help them understand. Try to control who will have the information; it shouldn’t turn into gossip. It can be a relief to share with others and not carry your status around like a big secret. It will be easier for those around you to help you get through an emotionally tough time if they know what’s going on.
With close friends and relatives, the question is if you would even be able to keep your status a secret in the long run. Dropping these people will probably not be something you want to do. To make sure they don’t start worrying about you unnecessarily when they find out that you have HIV, it’s advisable to inform them about what having HIV actually means. Point them towards sites with up-to-date information on the treatment of HIV, allowing them to school themselves, should they want to. See the links list at the back of the book for some informative sites.
With regards to your work environment, legally speaking, you are not generally obliged to tell your employer that you have HIV, though the exact legal situation may differ depending on the job you have and the country you live in. During job interviews, irrelevant questions about your health are not allowed in most countries. Should you be asked anyway, you are free to decline to answer. Firing someone because of their HIV status is illegal in a lot of Western countries. In these countries, if your employer tries to fire you under false pretences, while it is actually about your status, you can sue him.
“The advent of AIDS made absolutely imperative an inflated level of sexual honesty.”
– Samuel Delany, writer
The term ‘sero-sorting’ indicates a controversial phenomenon: picking potential partners on the basis of a matching HIV status. Some men with HIV only date other positive men, to avoid getting stigmatized and rejected. On the other hand, there are also negative men who only want to date other negative men, to reduce their risk of getting HIV. However, that is an inherently flawed strategy, as a lot of people are not sure about their status but will claim to be negative regardless. And the people that are unaware that they are positive and are not getting treatment are the most likely to actually pass on HIV.
Sero-sorting is a touchy strategy from either side. People are being reduced to a medical condition, without regard for the person who comes attached. With new and better medication available, it also seems less necessary. Some people in sero-discordant relationships (where one partner is positive and the other negative) have been together for years without the negative partner becoming positive.
A common side-effect of sero-sorting is positive men having bareback sex together. In doing so, they take the risk of a possible re-infection with a different strain of HIV, called super-infection, and the accompanying complications in treatment. Not enough research has been done to determine how big a health risk this is. It’s a fact that super-infections have occurred, but how often they happen is unknown. However, since fucking without a condom also increases the risk of other STDs and since positive men in particular pick them up easier and have a tougher time shaking them, barebacking between men with HIV can be seen as a bad idea, particularly outside of a monogamous relationship.
“AIDS doesn’t go away when you turn off the television or close the newspaper.”
– Michael Thomas Ford, writer
The future of HIV
Every now and then there are rumblings in the scientific world about a vaccine against HIV or even a cure for people who already have it. But until one has actually been proven to work and is widely available, don’t get too optimistic. So far, none of those ‘cures’ has worked out on a broad scale, even if small steps are being made in the right direction. Recent genetic research, for instance, seems to indicate that some people are biologically more inclined to get HIV than others, but this suspicion doesn’t have a practical application yet. A newborn baby was apparently cured of HIV by wiping out the virus with medication before it could find a place to hide. Gene therapy may be used at some point in the future as one man appears to have been cured of HIV after a bone-marrow transplant, but this treatment is still being studied.
There are also scientists looking for safer sex alternatives, to be used in combination with condoms or instead of them; like lube that kills HIV. At the end of 2010 a surprising application of the HIV medication Truvada was made public. If taken daily, the pill apparently decreases the odds of getting HIV. However, this was tested in combination with condom-use and further research is still being done. It seems unlikely that the pill will be able to replace condoms, however. Opinions are divided on the idea of giving people medication they don’t currently need, to keep them from possibly having to take it in the future. For the time being, the most sure-fire way to avoid getting HIV is still to use condoms consistently and correctly when fucking. This is highly advisable for everyone who isn’t in a truly monogamous relationship where both partners have been tested after a period of six months or more, and are negative. And ask yourself this: when an irresistible ass that does not meet those criteria presents itself, is slipping a condom on really that much of a sacrifice? Check the back of the book for sites with further information about HIV.
“I have a beautiful address book a friend gave me in 1966. I literally cannot open it again. Ever. It sits on the shelf with over a hundred names crossed out. What is there to say? There are no words. I’ll never understand why it happened to us.”
– Jerry Herman, composer