I’ve watched very closely the responses that came from my last posting regarding when to tell someone their HIV-positive status. For the most part, it seems that the topic is one that still remains relevant and controversial. The majority of the responses, as I suspected they would be, fell firmly on the side of complete disclosure from the start. And as I also knew would happen, a couple people either misread or ignored the point of the posting and came back with reactions that were judgmental or accusatory and with no added value to the discussion. It’s obvious that our society, or community, or whatever demographic label we choose to describe ourselves as, we men who are sexually attracted to men need to be continuously discussing and sharing valuable and pertinent information regarding not only HIV but all sorts of issues that affect us as a group. I believe we still need to rely on ourselves for information, protection, and in many parts of the world, our survival. For now, however, I’m going to remain on the topic of HIV. I am also going to keep it simple. The main reason for simplicity is because so many men are not talking about it. I don’t know exactly why this is, perhaps the subject seems passé, but I have a hunch that the real reason is because people just don’t know basic facts regarding HIV, transmission, and safety. For this I blame the governments, I blame schools, I blame morally conservative politicians and religious leaders that refuse to believe anything other than what has been handed down from 1000+ year old books. But mostly I blame us, the people that have been affected a great deal for not keeping HIV in the forefront of accurate discussion and awareness. It can get boring, I know, but the discussion must continue.
Let me start by talking about what being HIV-positive and undetectable means. Essentially, undetectable simply means that the virus itself is in such low quantities in the blood that the current technology at a laboratory is unable to get an accurate count from the small sample of blood analyzed. It does not mean that a person who is undetectable is HIV-free; it just means that the virus is not replicating and is being suppressed. Such a situation really only occurs when an HIV infected person is taking medication faithfully. Undetectable status has become the norm for men who are infected and on medication. Studies have been coming out recently that also indicate that someone who is undetectable is also less likely to pass the virus onto someone who is not infected. But less likely is not 100% guaranteed to mean it can’t happen. It still can. Doctors or lab technicians may not be able to count all of the virus levels (well they can, but it costs more than insurance companies want to pay), but the little buggers are still there somewhere, just in a very small quantity. They still exist. They can still infect. Protection still needs to be used.
That’s a very simple explanation I know, but it basically covers the gist of it. My apologies to those of you that are much more aware and educated on the subject, and I trust you will continue to add to the discussion supportively. Unfortunately it seems many men are not as experienced or knowledgeable and the discussion needs to be understandable to everyone.
Up until the last year, the only absolutely certain protection we had against contracting HIV was to abstain from sex entirely. Well, that’s still the only 100% safe option, but for the vast majority of us, it just won’t do. The second option was using really safe (and really boring) sexual play such as mutual masturbation. Finally, using a condom during intercourse gave the highest percentage of safety we could get…maybe in the 80-something percent ranges, but that tracking is difficult to verify. People may not always use condoms or don’t always report not using them. Plus, sometimes there is condom breakage or other defects. So our best options to remain sexually active and healthy were not having sex, using condoms, or taking medication if we were HIV-positive (and using a condom). Again, up until last year…
Last year, the U.S. Food and Drug Administration approved the use of an already existing HIV medication on the market called Truvada for use by HIV-negative people to help keep from becoming infected. It is being re-packaged and renamed PrEP for Pre-Exposure Prophylaxis. Studies have shown that the medication can stop the virus from getting a foothold in the body’s system and therefore not infecting the user. The studies are showing that infection blockage was being increased up to the high 90 percent ranges. Now here comes the catch: it was studied in conjunction with use with a condom. Ethically, the people doing the studies could not just hand out pills and tell people to go fuck and let’s see if you become positive or not. The control groups were condom-only users and compared with the people using the Truvada/PrEP in addition to the condom.
Unfortunately, I’m concerned that the studies with a condom are being lost in the hype of the additional protection the medication provides. I’m reading accounts from one blogger in particular on another sex site write about how he’s using himself as a guinea pig by only taking the medication and not using anything else just so he can get fucked bareback the way he prefers. Needless to say, I’m skeptical. I’m skeptical about precautions not being fully explained to or understood by people wanting more protection from HIV. I’m skeptical that people can afford this very expensive medication (in the $2000 range for one month’s supply). I’m skeptical that people will forget to take the medication daily. It MUST be taken every day in order to be effective. Finally, I’m skeptical that it will add a false sense of security from other god-only-knows-what infections such as hepatitis, syphilis, or other STIs like gonorrhea or chlamydia; diseases the drug has no effect against. Remember herpes? It’s still out there.
Please don’t get me wrong. I think this newest tool to combat HIV is worthwhile. I want HIV dead, crushed, completely obliterated from the human population. But use PrEP correctly with the full facts. For a quick rundown, check out: http://www.cdc.gov/hiv/prep/pdf/PrEPfactsheet.pdf. And always, always remain vigilant. We really can get rid of HIV in our lifetime if we stay informed.