SL Letter of the Day: A Timely Inquiry

Comments

1
What does undetectable viral load mean? I wonder (scientific curiosity) if its possible that there are people out there who at one time contracted HIV* and then their body fought it off and they are now 100% clean but they don't know it and are continuing to take meds?

I should point out that I"m just asking, so no one should take this as a reason to stop taking their meds. But I'm genuinely curious. Does this guy for sure have HIV if he's had no symptoms and no positive tests in 10 years?

I thought I read about a case where someone did spontaneously stop having HIV, and its not unbelievable that there would be some rare people immune to it, just as there were people who never caught the black plague when exposed to it.

*Or had a false-positive test.
2
Dan, what do you mean you don't have to disclose to " casual/anon partners as long as you are strict about protection"? Whoops the condom broke, so sorry about that.
3
people like this piss me off. imagine how you felt when you got tested and found out that you were HIV positive. now imagine giving that terrible feeling to someone else out of your own neglect.

simply put: fuck you.
4
what the fuck is wrong with this guy? if someone did this to me and then told me "oh yeah, i'm HIV positive and didn't tell you but i really like you so let's date!" i think i would go postal. i hope the guy he had sex with is still negative and is able to put this dude in his place.
5
I work in the HIV field and this conversation comes up often. Undetectable viral loads have become a big deal. There is a lot of research being done on the matter. It basically means that when someone is taking meds with perfect adherence their viral load decreases. We have combination therapy that both prevents HIV from replicating and also prevents HIV from finding open receptors in the body. This along with your anti-body response keep HIV in check. HIV NEVER goes away, but exists in such a small about that the chances of passing that infection on are minimal. In fact there are studies from Europe ( of HETEROSEXUALS) with couples that had a different HIV status. The poz partner was taking meds with perfect adherence and there was very few if any transmission of HIV. Now that presents the idea of medications replacing condoms and equating to safer sex. But there is SO many other factors that come into play. For example.. If some one skips a dose of medications, especially on a regular basis they could easily have spikes in their viral load!! During those times the would be more infectious. We also know what the level of viral load in the blood is undetectable but we are not sure if that would be the same for the viral load in the cum. Poz guys who get their viral load counts only check up 3-4 times a year and a lot can happen in those few months to the viral load. There is also a risk of passing on other STI's including gonorrhea and syphilis! So the idea of safer sex is not always perfect. Condoms are the safest way. If you hate them, chances are you havent found one that you like or one that fits you well. Keep trying different styles. At least ASK about your lovers status and the last time they were tested! If you feel uncomfortable asking these questions then do you really feel comfortable enough to let them fuck you up the ass?? And if you are still unsure then make your session hot and kinky without fucking. There are LOTs of ways to play safe.
6
I have heard before that there are different HIV strains... What karmic justice if his one-nighter had a different strain and gave it to him when they went unprotected. If one can lie - then so can another...
7
Ugh. I agree with most people here. This is so beyond not cool. The pos guy mentioned he was hesitating to let his friend skip the condom- which says to me he obviously had some notion of what was going on. There are situations when you just need to grow a pair and speak immediately, because you care for yourself and your partner enough. You might derail things for a little while but waiting until after the fact seems almost sure to ruin any future prospect. Disclosing beforehand, even in a moment of passion about to be made sour, is always better than waiting until the deed is done.

Facts about viral load aside, when someone tells you they're positive and neglected to let you know, I imagine all that other stuff goes out the window for everyone but the most rational, patience-of-a-saint having people, who are very few. Yes, from a rational perspective, having zero viral load and being the bottom is fairly safe, but when the sentence begins with the other part of this fact, nothing afterward is going to sound very reassuring. I would lose my mind if someone did this to me and have trust issues for centuries. What a shitty situation for everyone involved.
8
This does remind me of an ad campaign in San Fran, two guys about to get it on.

The thought bubble of one says "he's fucking me raw because he's negative too" and the other is "he's letting me fuck him raw because he's positive too."
9
The LW didn't say the other guy asked him if LW is poz or not. If that guy didn't ask then is LW still obligated to tell ?
10
A great varsity-level exchange with this question. I just adore how your focus was how he can quit being a dildo and do better from here on, whether this works out or not with the fella at hand. Aces aces aces.
11
Yeah, living with the consequences of bad behavior often sucks.
12
Does anyone know what the result is of having TWO different strains of HIV? P.A. is taking a risk of getting HIV on top of HIV everytime he catches from a guy with no protection. And as a guy who lived through the 80's I am just ... just.... just... yowl!!!!!!!
13
Does anyone know what the result is of having TWO different strains of HIV? P.A. is taking a risk of getting HIV on top of HIV everytime he catches from a guy with no protection. And as a guy who lived through the 80's I am just ... just.... just... yowl!!!!!!!
14
My approach to safe sex is to presume everyone is positive and go from there. It has kept me free of HIV for the past 25 years of my sexually active life. Obviously Dan is right, PA has to come clean. I hope his friend is mature and intelligent enough to accept it. It must be a terribly difficult thing to disclose in the heat of the moment. Open and honest communication is the key to any successful relationship.
15
I hope he lets you know how it goes and I hope the other guy can hear the news and come out the other side of this healthy and happy, both of them.
16
"Clean enough"? Jeez, Dan, why not just call all of us HIV+ people lepers. There are plenty of diseases transmitted through sex - safe and unsafe.
17
People seem to forget that HIV isn't the only incurable sexually transmitted infection out there. Both of these men are idiots.
18
Everyone here is beating down on the positive guy, and yes, he made an incredibly stupid decision and definitely deserves some repercussions. But this other guy - in this day and age - actually tried to CONVINCE someone he had JUST MET to have unprotected anal sex. WITHOUT asking his status. I'll say it loud and clear:

THAT. GUY. IS. AN. IDIOT.

Both people are to blame here. If that guy has asked, and PA had lied - or if PA had attempted to convince his partner to have unprotected sex - then he would be 100% responsible and should be in prison. But he didn't, he's not, and he shouldn't.
19
what a selfish fucking asshole.
20
WOW, did I miss something here? From the letters it sounds like this guy had one little incident of unprotected sex ("we both had a couple of drinks in us and I let him fuck me without a condom.") during a 16 HOUR SEX MARATHON!

"We had a brief hook up the day before where I blew him in his car and then the next day we had marathon sex for 16 hours off and on (taking breaks to eat and drink and shower and nap). I have never had that much sex in one day in my entire life. We havent hooked up again because I have been making excuses..."

Was this 16 hour marathon of sex unprotected? Cause even if his partner is topping, 16 FUCKING HOURS OF UNPROTECTED SEX is a damn good way to up your chances of contracting HIV from "slim" to "moderate."

Secondly, this guy needs to disclose (truthfully) if asked, period. That goes for Neg and Poz alike. As @2 points out, condoms break, and it's not unreasonable for someone to make a personal risk assessment that they don't want to risk HIV-exposure as the result of a broken condom. Of course someone who takes that risk when a partner says he/she is negative is deluding themselves, you can't trust what people say (or in the case of the letter writer, what they don't).

Thirdly, if someone exposes a partner to HIV and feels bad about it, the BEST SINGLE THING thing they can do to make things right is TO TELL THEIR PARTNER ASAP so their partner can protect themselves by going on P.E.P.

P.E.P. (Post-exposure prophylaxis) is the administration of HIV medications to sero-negative persons potentially exposed to HIV. The idea behind this is that the HIV medications will suppress the replication of the virus in someone who is negative so that an initial infection can't take place and they'll remain negative.

The letter writer is justly commended for trying to make this situation right and taking some considerable emotional and possible legal risks in the process. It should be noted though that studies of PEP have shown impressive results but these sames studies indicate the efficacy of PEP is time-dependent. Like the morning-after pill every hour counts.

Finally, we need to stop acting like bareback topping is a no-risk activity. It's not even an virtually no-risk activity like oral sex. This April an article in the International Journal of Epidemiology found that the exposure risk "per-partner" for "unprotected insertive anal intercourse" (i.e. topping) was 21.7%

When looking at per-contact rates of transmisibility another study found lower numbers: "The estimated transmission rate for insertive UAI in participants who were circumcised was 0.11% (95% CI 0.02-0.24), and it was 0.62% (95% CI 0.07-1.68) in uncircumcised men."

That more conservative estimate translates to about a 1 in 1000 chance of contracting HIV through unprotected insertive anal sex, odds that many of us are and still very uneasy with.

Disclosure is important, and better late than never. But the sooner one discloses one's status the greater chances there are to reduce transmission before, during, AND after the act. Or in the case of the letter writer, 16 marathon hours of acts.
21
What is so fucking hard about using a condom? Who has sex with someone for the first time, someone with whom they have not yet discussed STDs, without a condom? Gay or straight, this is fucking stupid. Both these guys are idiots, and if the LW gets dumped for this, he deserves it.
22
The "negative" top in this story sounds full of shit. I mean, seriously, this guy talks a stranger into letting him into his ass sans condom with a mere "I'm clean?" How the fuck does he know he's clean if he's in the habit of fucking random guys bareback?

IMHO, there's a good chance the top was already positive, and if stupid bottom admits to his non-disclosure now, he may get the blame for something already well underway.
23
“You don't have to disclose to casual/anonymous sex partners, so long as you're strict(er) about using protection.”

Sorry, but that is BULLSHIT. The last thing I want to do, Dan, is demonize people with HIV, but how dare you be so cavalier with the lives of others. This is bizarrely extreme individualism. Yes, one night stands are intrinsically risky; yes, you should always use a condom; yes, you should ask about HIV status; yes, low viral loads decrease the odds of infecting others (theoretically, if you haven't forgotten our pills etc). But regardless of these factors, if you are HIV positive and are planning to have sex with someone, YOU HAD BETTER TELL THEM. I think you know quite well that whether they ask or not, 99.9% of the time, the person about to sleep with you is doing so on the premise that you do not have HIV. Given that knowledge, withholding that information is immoral. I realize that this will inconvenience your sex life, but no matter how supposedly low the risks are, YOU DO NOT HAVE THE RIGHT TO MAKE DECISIONS LIKE THIS ON THE BEHALF OF OTHERS.

In giving advice Dan almost always emphasizes that harming or putting others at risk, whether emotionally or physically, is wrong. This time he’s fallen off.

24
@22, if the guy is tested immediately, he won't have seroconverted UNLESS he was already positive. Switching AFTER a 2-4 week period is typical. The delay in converting is dropping with better assays but antibodies take time no matter what. If this became a big issue, one could also look at resistance patterns or even genotyping to determine the source of the infection.
25
srsly? We don't have to disclose our status now if we're 'clean enough' or playing safe? srsly?

I mean, I'd fuck/get fucked by a poz dude with protection, but I think I still deserve to know the risks I'm taking.

Huh. And I pick NOW to open up my gay marriage. Well fuck. Time to rethink that shit.
26
Whoa, apparently this guy NEVER LEARNS HIS LESSON. He already has HIV but he lets strangers fuck him in the ass bareback, like there's nothing else he could catch? So much for "twice shy."
27
I also think the "You don't have to disclose to casual/anonymous sex partners, so long as you're strict(er) about using protection" conversation needs to change. I recently read an academic study of barebackers in which the author found that barebackers are using the rubric of "personal responsibility" to actually avoid responsibility: they choose to assume that those who don't ask about their HIV status are themselves HIV+, and that everyone is well educated about HIV and STDs. The same study found that the opposite is actually true: that HIV- barebackers assume that people who are willing to have sex with them bareback are also HIV-, and that ignorance of safer sex is widespread. In other words, everybody expects everyone else to disclose, even when they themselves don't, and people are using the notion that everyone must take responsibility for themselves to absolve themselves of responsibility to their sex partners.

Both guys in the above scenario did incredibly stupid things. It's dumb to let anyone you barely know fuck you without a condom based on their claim of being "clean," and it's dumb to fuck anyone you barely know without a condom. True, these things sometimes happen in the heat of the moment. But there's no excuse for engaging in condomless sex with someone who apparently assumes you're HIV- when you know you're positive, even if you are undetectable.

And the more I think about it the more this guy sounds like an asshole. He claims he "always plays safe," but in the very next paragraph he admits to having been fucked without condoms before "andd no one sero-converted because of it." He's also "not worried" about this latest guy being infected because he assumes that the chances are so small that it's not a cause for concern. And his big worry--the reason he wrote to Dan--is that "things are getting serious" and he's afraid of the consequences of admitting to the guy that he's HIV+.

He obviously must tell the guy so that he can be tested, but personally I could never be in a relationship with someone who had done something like this to me.
28
I agree with #22. With the way the top behaved, it's highly likely he might have already contracted something. The top might even have been HIV+ and known it.
29
I am sorry. The letter writer is a total asshole. He doesn't get to make the other guy's decision about whether the other guy wants to take the risk (no matter how small) and fuck him.

He has a legal and moral duty to disclose, regardless of the other guy's actions or omissions. Dan, I don't know whether he should drive to another city to meet and tell this guy in person, because this guy might lose it and become physically violent in response to this kind of news.

But listen, asshole letter-writer, you don't get to make the decision for other people about whether they want to fuck a poz guy, you pathetic, self-centered, rationalizing piece of shit. Always disclose after this.
30
Both the letter writer and his partner were unwise and irresponsible. PA for not disclosing his status as he let himself be fucked bareback is ethically irresponsible. I can understand in the heat of the moment BUT you are HIV+ and you need to manage this issue with partners (tell them upfront BEFORE you get hot and heavy). His parter is stupid for barebacking as he is not taking repsonsibility for himself - what an idiot. I agree with others replying that it is probably likely that PA's shag partner could be positive already.
31
Dan,
1. you mention that "But you ALWAYS have to disclose before you let someone—anyone—have unprotected anal sex with you." What about oral sex? What about the even minimal risk that oral sex presents? These men were blowing each other to kingdom come.
2.This man needs to disclose his status, regardless of his viral load-- and be proactive about it-- not just wait until he's asked, especially if he is worried about the legal ramifications. He knows he is positive. He is not disclosing because he wants to get laid and he knows that many prospective partners would not engage if they knew. This is why people are suing and winning their cases in court. Juries and judges don't know "viral load" or "maintenance plans." They know "HIV" and "willful deception."
3. He seems to not have learned anything about the dangers of practicing unsafe sex-- even after contracting and living with HIV for several years. He continues to put himself at risk, but now, he's including others in this risk. His behavior is irresponsible. And I wonder if you didn't address this because you were suffering from a bad case of flattery?
33
wow, WHAT A BUNCH OF FINGER POINTING HYPOCRITES you all are. While I agree that PA and his partner were equally (IR)RESPONSIBLE, I am thinking how many times most of the readers here (this one included), straight and gay, have engaged in unprotected sex with thier partners. I know most, if not all of us, have done it especially after having FALLEN in love with and gotten to know our partners better. How else are children still being born everyday? Any type of sex is risky, period. You could wait six months after you have been dating your partner, or wait till marriage, and then get tested, but the cold hard fact is: Men and Women both CHEAT. No one is ever truly safe, EVER! I don't care what race, religion, gender or sexual indentity you are, WE ARE ALL THE SAME! What if you and your partner are together a year and you go and get tested and you both test negative for sexually transmitted diseases, but one of you just cheated the week before and the disease has not yet built up in your system to levels of detection yet? Or you are just a carrier and whatever you are carrying is not detectable because of some genetic or biological anomally? You will at some point have unprotected sex with your partner. Men have been conning women into unprotected sex since the invention of the condom and women have been letting them because they like it, are trying to get pregnant to trap him, or are afraid they will lose the guy if they dont consent. I think Dans response was right on the money. As for all on the readers who responded, Let he/she who is without fault cast the first stone. Me thinks that if this was the case PA and his partner would be walking away with no rock dents in their faces. Shame on all of you/us.
32
Dan, I'm amazed you didn't grill him more. You're coming down way too softly on him. And I don't mean he should feel ostracized or anything like that, but he fucked up - and every single person he has sex with and doesn't disclose his HIV status with is another mistake.
34
I'm going to come out in defense of the letter writer. Regardless of how stupid (very) he was, and regardless of how much of a dumbfuck-who-probably-already-has-something (very) his partner was... at least the letter writer has remorse and regret over not being up-front with his disclosure.

I live in NYC, where HIV is once again running rampant among the young gay community (I'm actually starting a new prevention project aimed at the under-30 gay crowd, because the groups that SHOULD be doing that are asleep at the switch), and I've had the misfortune of meeting, and hearing about, guys who don't honestly disclose their status EVER and feel FINE about it. There are far, far worse people out there than this poor sap. At least he's willing to listen to reason and try to do the right thing after the fact.

As for "undetectable" -- well, I already know one guy who got HIV at 20, took meds, was undetectable, kept fucking around bareback, got another few strains, and had a huge spike and got sick. New drug regimine, kept fucking around, spreading HIV and contracting other STDs, and the new regime didn't work. Another new drug, this time had painful side effects. Another drug regimine, and back to undetectable. And then dead. At 27. Drugs are not, and never will be, a substitute for playing safe.
35
I'm with 31, dan, you disappoint me so fricken much right now. I just can't believe how cavalier you are, dan. God I'm so disappointed in you, you're like my idol- I tell everyone to read your columns and Slog and I feel ashamed for doing so right now.

there is NO excuse, EVER for not disclosing ANY contagious disease to a partner. Be it as minor as chicken pox or as life-altering as HIV [and do not even think of telling yourself it's not life altering or how small the chances are. One in a million chances DO NOT MATTER if you're that one in a million.]

for shame, Dan. I don't even want to read your column anymore you've disappointed me so much.

disgusting.
36
I may to late in posting this. Where no one will still be reading this far back. But.... I am a little sad with all the comments over all. I am going to keep this short and quick. HIV is not end all of the world. I am negative and partner is Positive and it is not the end all of the world. BUT EVERYONE SHOULD ALWAYS PRACTICE SAFE SEX.
37
Is it all about AIDS? This kind of young gay grew up in an era of anti-HIV drugs and doesn't care about hep, herpes, syphilis, genital warts etc?
38
Oh my god! Dan? Seriously? I can't believe how easily you let this guy off! This isn't just an issue between two people but about an entire community. More HIV is more HIV for all of us. It puts all of us at more risk. Sure the fault doesn't lie with the letter writer alone but that gentle understanding attitude toward people with HIV who knowingly expose others?? That doesn't sound like you.