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22 Dealing with HIV
Media campaigns regarding HIV are a bit schizophrenic; they mean to warn people that the virus is still a life-threatening disease to 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 anyway, don't see it as the end of your world. With some concessions, it can be lived with reasonably well. Though the amount of virus can be wrestled down to almost undetectable levels with medication, it still can't be cured.
What is HIV?
HIV (Human Immunodeficiancy 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 undercuts the immune system, people with untreated HIV are likely to be more susceptible to secondary infections by other viruses or bacteria. But even when using medication, the immune system can remain somewhat impaired, as it doesn't fully recover in a lot of the patients.
Having HIV can be indicated as being '(sero)positive', 'poz' or 'HIV+'. Not having HIV is called being '(sero)negative', 'neg' or 'HIV-'. In someone who is HIV positive but not getting treated - or when treatment isn't successful over a long period of time - HIV can lead to AIDS (Acquired Immune Deficiency Syndrome). 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 have easily handled.
Avoiding HIV
More about safer sex and avoiding std's can be found in the previous chapter, 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 for butt-fucking correctly, consistently and in combination with a whole lot of lube. The lube should be water-based or silicone-based. Just using spit, will give too much friction and increase the chances of a condom ripping during sex. Butt-fucking 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 seems lax. 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 at home while having a nice wank.
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 cum in your mouth is a good idea. Pre-cum has less of the virus in it than cum does and the antiviral elements in your spit should be able to handle that amount normally, so pre-cum shouldn't be much of a worry. You can wipe any excess of 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 chancre 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.
When your immune system is running low, due to sickness, drugs or exhaustion, you will be more at risk for initial infection; HIV will have an easier time getting its foot in the door. When it comes to std's: especially having syphilis brings with it an increased risk of getting HIV and that std doesn't always have clear symptoms. Because of that, it is very important to get checked for this and other std's 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 that: partners may cheat - yes, 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 taking medication for HIV and are getting treated, likely have a low virus 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 everybody could have HIV unless proven otherwise and just do your best to be safe at all times, so: fuck with a condom and water- or silicone-based lube and don't get cum 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.
PEP Talk
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 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 heady mix of HIV medication for a month, leaving you to deal with the unpleasant side-effects. It is, however, a fairly effective last resort when you have run a big risk.