Anyone who's familiar with the concept of "Induced Demand" will understand one outcome of PrEP: Increased risk taking.

Thankfully, and somewhat surprising, is that thanks to PreEP, this increased risk taking hasn't led to an increase in new infecti….

I don't know if straight people are using PrEP or if there are versions of more common STD's, but it seems like a start.

Can we stop with the trying to make people feel guilty for not wanting to have sex with people they don't want to have sex with? Point out errors of fact or logic if you like, but drop it after that (like Mr. Grindr had the sense to do). Even if their reasons are irrational, it's their choice not yours, and pressuring them on it is creepy.

Chase @ 2 - The point here is that this guy wrote in precisely because he already feels guilty, and he wanted some advice on that. Now that he's received it, he can do whatever he pleases with it; as Dan regularly reminds us, advice it's not binding arbitration.

advice is not...

There are at least two documented cases of people on PrEP getting HIV- rare strains that came after having lots of unprotected sex. So, even being on PrEP, he should not have unprotected sex until he has an exclusive relationship with someone and knows that person's Status. It is great that his chances are very reduced, but they are not effectively zero, and we dont know what strain Mr. G has.

Okay, so I wanna preface this by saying 1.) that I think everyone (including poz people) have the right to love and (safe) sex, and 2.) I understand that with PrEP and modern antivirals leading to "undetectable" HIV it's fairly safe to have sex while poz (if done right), and 3.) people should be able to have as much sex as they like (within the bounds of consent, practicality, permission from significant others, chafing, etc.) but.... does anyone else just not feel too sorry for people who score less on Grindr because they're poz?

It's like, "oh, woe is me, I now score slightly less on the revolving dick buffet that is Grindr. It's terrible, I have to swipe right twice as much to arrange my rando bang-fests - I now spend about as much effort setting up a single one-night-stand as I do researching a good pizza delivery place on Yelp and choosing the toppings for my after-sex pizza! The unfairness!"

I mean... it's NSA sex practically at the click of a button! Are you really that oppressed that fewer people are lining up to bang you after 15 min of texting?

I've lived with HIV for a good fifteen years now so it's sometimes kind of hard for me to remember just how frightening it can be, even though I was around and sexually active back before there were no effective treatments and really did feel like one slip-up could be a death sentence.

Having lived through both of those experiences, sometimes it's hard for me to understand why people like LW are so worked up about the risks. Doesn't he know HIV+ people can have a normal lifespan now? Isn't he aware that, other than popping a pill every day, our lives are otherwise usually quite normal?

It's easy to forget that fear of HIV is still reasonable. Treatment requires continuing vigilence. You can't miss a day of treatment. And the medications do have side effects (my kidney functions have to be watched fairly carefully). And there are still little reminders I carry with me...a touch of neuropathy in my feet for instance. And that's not even getting into the expense of treatment.

So LW's fears aren't completely unreasonable. Even with treatment, this is still a serious disease, with serious consequences. Yes, I am alive and healthy fifteen years after my diagnosis, which is a miracle that I am enormously grateful for, to all the researchers who have worked on finding cures, vaccines and treatments, to all the health professionals who have helped take care of me, to all the legislators and taxpayers and insurance company employees who have helped come up with the means of keeping me alive when I would otherwise have died years ago.

It is a serious disease. And I would rather see LW err on the side of caution and protect himself, even if it means a little irrationality creeps into the choices he makes. We're all irrational on some level; LW's unwillingness to jump into bed with me seems like a pretty harmless kind of irrationality compared with a lot of the stuff people out there in this country seem to believe these days.

As an alternative to random Grindr sex with undetectable HIV+ men, can I instead suggest that LW make an effort to welcome poz guys into his social circle in other ways? Personally, I can attest to the fact that, among out gay men at least, there's no longer much social stigma attached to HIV. But everyone can always use good, supportive friends and sometimes poz guys can feel doubly rejected, on account of both orientation and status.

It's also possible that simple association with guys who are openly HIV+ may help LW to see past a status box in an online database which is such a stumbling block now.

@6, perhaps it's because I'm a bit older, so most of my peers have had plenty of time to grapple with this issue (if they aren't already HIV+ themselves), but I've found that my status doesn't really have too much of an effect on my sex life. Sure there are cases here and there of guys like the LW here who will shoot me down over my status, but so what?

I get shot down over my age, my race, my appearance, all kinds of reasons. Happens all the time, to everyone.

It's really not a big deal. If you can't handle rejection (on any grounds!), you probably need to stay out of the dating and/or casual sex pool.

I have herpes. I take medication that suppresses outbreaks and helps to keep me from shedding the virus. I insist on condom use at least until such time as a partner and I, getting tested and knowing each other's full history, decide to fluid bond. If I feel like an outbreak may be coming on I don't have any genital contact with any part of anyone else's body for 2 weeks, even if it turns out not to have been a visible outbreak. As a straight woman, if I were to pass the virus to a partner, the worst that would happen is that he'd be subject to some discomfort and inconvenience occasionally, because the biggest threat with herpes is to newborn's eyes as they're coming through the birth canal if the mother has an outbreak at birth. That isn't going to happen.

I cannot begin to tell you how badly people react. I have a lot of anxiety about disclosing because of the response and the stigma. I've had men act like I've got full-blown AIDS or the Bubonic Plague. I've heard so many herpes "jokes" from people who don't know I have it. I've heard it talked about like the worst thing ever. If I try to say it's at worst an inconvenience, not a life-threatening illness or one that ravages your reproductive system, people contradict me or accuse me of trying to take a cavalier attitude so I can infect people at will. Heck, I'm a more active sufferer than many people, and it really isn't the end of my life.

I've tried not disclosing, telling myself that the odds are high that the guy already has it or has been exposed, and that between the condoms, my lack of symptoms, and the medication, I'm not contagious, but I felt bad and then read another essay about disclosing, so I do, emphasizing that they may already have it or have been exposed and all the precautions I'm taking if the man doesn't reciprocally disclose. Lately, the men I've dated either have HSV-2, too, or are aware of the risks and decide that they're okay with it. I haven't had to educate anyone lately. But it's nerve-wracking every time I have to disclose and I hate hearing how people who don't are pieces of shit--I know exactly why someone today wouldn't disclose and it's not for the same reason as the guy who gave it to me didn't.

I've heard Dan say that when you disclose something like your HSV-2 or HIV status you're telling someone one thing about you and their response tells you everything about them; Dan's had guest doctors on his podcast who, after talking about what a non-issue herpes is, still tell people they should always disclose. Why is a guy who's HIV positive any different?

I'm sorry it's going to reduce his chances to get laid. But as I said a while ago in reaction to a married man who had permission from his wife to get laid but who didn't feel it necessary to disclose his marital status when he picked a woman up to have sex with her, if you feel as if you have to lie about some aspect of yourself to get laid, that seems to me to be precisely the thing you should disclose. People should be allowed to make informed decisions.

This is not to say that people shouldn't be tactful and cool-headed in their rejection. And it was very nice of the man to help the lw decide to get on PrEP.

@8 I suspect your good health is related to having quality health insurance. I imagine the regimen isn't especially affordable out-of-pocket.

@10 My understanding is that, essentially, everyone already has herpes, and that most people are asymptomatic? I did learn recently that when you go in for STD screening, they don't even bother checking for herpes.

@2 No one is making him feel guilty. And it's not just about preference; the LW is concerned about HIV risk and was having sex with partners that were riskier than the ones he was turning down. Wanting to correct an irrational belief that drives someone to engage in riskier behavior at the expense of safer options (all else equal) is perfectly understandable and very healthy.

@10: "I've heard Dan say that when you disclose something like your HSV-2 or HIV status you're telling someone one thing about you and their response tells you everything about them." YES. I've encountered so much fear and ignorance and irrationality around STIs in the dating world. I suspect it's a result of our sex negative culture: we put a tremendous emphasis on sex as a signifier of desirability and success, but deep down, we think it's a dirty deed, so contracting an infection like herpes or gonorrhea from sexual contact is TOTALLY DIFFERENT AND OBVIOUSLY FAR FAR MORE DISGUSTING than contracting a cold from someone sitting next to you on the bus.

@12 Since being diagnosed, I've had:

- Student health insurance (pre-ACA) that didn't cover prescriptions (they did help me by referring me to a study that got me treatment for the duration of the study, with the downside being that I had to use the study's medications, which had some pretty gnarly side effects for me)
- Coverage through VA (which, whatever their problems may be, has always been stellar for me, and for which I am immensely grateful)
- Coverage from an employer (varying degrees of quality, but generally decent).

I haven't used Medicaid, because I've had the VA open to me, but I know people who have used it and been covered.

You should know that local organizations which receive Ryan White funding generally have the means to help cover the cost of coverage, depending on your income. Essentially, Ryan White really helps take care of people who don't qualify for Medicaid but whose other insurance options are generally too expensive for them based on income. I had a partner in this situation and the local HIV organization helped him cover his costs immensely.

Happily, Ryan White funding was one of the few areas that Trump left alone in his otherwise brutal budget, so it's likely safe for the immediate future, though we'll see what Congress does.

Basically, if you're not getting treatment, especially in an urban environment with a good HIV organization, you're probably not looking for it.

STI fear is also used as a mechanism of sexual shame enforcement by the religious right.

Corydon @9 - this has been my observation as well - the main result of being an openly poz gay man is a 10%-30% decrease in the people willing to NSA sex him after 5 minutes of texting. For everything else, there's hardly a difference in their social or romantic success. On a numbers level it's like the equivalent of not having abs - you can still expect to pull pretty regularly in a big city, but all in all you'll pull less than you would if you had washboard abs. And when those are the stakes I can't say I'm too sympathetic to people who choose not to disclose It's not like you turn into a social leper or anything. A mild to noticeable reduction in bang-buddies doesn't justify lying to people about your status.

Sportlandia @12: My understanding is that STI tests don't include herpes because the only way to detect herpes is by the presence of a visible sore. If you have a sore, the doctor (and you) can see it. If you don't have a sore, there is no way of knowing whether you carry the virus.
I could be wrong, though; happy to be updated if this information is incorrect.
It's HPV that nearly everyone has, and they therefore don't bother to test for. HPV can either be completely benign or cause genital warts or cervical cancer.

Corydon: Thank you for your perspective.

@18 @BiDanFan Here's the deal with HSV testing. There is a blood test (IgG) that accurately identifies 95% of HSV2 cases and 70% of HSV1 cases (with the remaining 5% of HSV2 cases and 30% of HSV1 representing false negatives.) However, blood tests can't identify the location of the infection. Because HSV2 is much more likely to be a genital infection, positive HSV2 results are generally assumed to be genital in the absence of symptoms, but positive HSV1 results are more difficult to interpret in terms of location. In children, HSV1 infections are almost always oral, but in sexually active adults, HSV1 infections can easily be oral or genital. So this is a limitation of blood testing in the absence of symptoms. Location specific swabbing is better in that regard but can result in false negatives if a lesion has already begun to heal. And of course those who do not have lesions to swab don't have this option.

False positives can occur with IgG tests, though almost always within a very narrow value range. Results between .9 and 3.5 can be false positive with the lowest numbers in that range being more likely to represent false positives. OTOH, results of 3.5 and higher are very, very rarely inaccurate.

BiDanFan @18: Men don't get tested for HPV, but women generally get the HPV test along with their Pap test. Checking for HPV helps with diagnosing cervical cancer at a point when it is still easily treatable, which is why cervical cancer isn't generally fatal for women who get routine medical care.

"A Pap test is used to find cell changes or abnormal cells in the cervix. (These abnormal cells may be pre-cancer or cancer, but they may also be other things, too.) Human papilloma virus (HPV) is a virus that can cause cervix cell changes. The HPV test checks for the virus, not cell changes. The test can be done at the same time as the Pap test, with the same swab or a second swab. You won’t notice a difference in your exam if you have both tests. A Pap test plus an HPV test (called co-testing) is the preferred way to find early cervical cancers or pre-cancers in women 30 and older."

From https://www.cancer.org/cancer/cancer-cau…

@21 Cocky, It probably depends a lot on where you live. My friends appear to have no problem getting laid on Grindr. It's possible that they are exaggerating, or maybe they aren't getting laid half as much as they'd like to be, but it seems that it would be pretty elaborate to carry out that lie for so long and between so many different people who don't even know each other. They are pretty regularly hooking up with someone on weekends, and even the only two stable gay male couples in my friend group met through Grindr though one made up another story for how they met at first until the other said they met through Grindr and the first laughed and said yea they did too. But yes I live in the countryside near a city with a huge gay scene so this might make a difference- it's very easy to meet people in general, gay or straight- maybe it is harder elsewhere. Also, I'm calling all those apps Grindr- I know there are others and I don't know which they are actually using. My straight guy friends have far less luck with Tinder, even for dates. In fact I don't know know anyone who has had more than a very small handful of dates from Tinder. The single women I know (gay and straight) tend to not use the apps. As for myself, I'm just nosey and married so I'm watching all these dating/hook up apps from afar, and I have no idea if this is indicative of national norms. Also it seems that the few people I know under 35 have more trouble hooking up than those that are older which might be more of a perception bias since younger people who get a lot of action are probably less likely to be hanging out with folks over 40, etc. I'd love to read a nerd report on Grindr/Tinder success rates spread out over different cities and towns and broken down by demographics. I wonder where I can apply for a grant to do that? :)