In my town statistics reveal that 1 out of every 5 gay men is unknowingly HIV-positive. This means that on average, 20% of the gay population in my city is not being treated for HIV, has viral loads that are high enough for transmission, and is potentially at risk in passing on this virus to others.
Since the AIDS epidemic in the 1980s, an HIV-positive diagnosis has experienced a major shift both in the way it is treated, and what the long-term health implications are. Having HIV is no longer a death sentence, and most individuals who undergo treatment and routine check-ups lead healthy, long lives, no different from those who are HIV-negative. However to many, an HIV-positive diagnosis is synonymous with social death in the gay world (or their current version of it), and this negative stigma attributed to HIV in general prevents people from getting tested, perpetuating the cycle of transmission (most cases of HIV occur when one sexual partner unknowingly has, and transmits, HIV).
HIV-Ignorant: A preventable diagnosis
Just as we have control over deciding who we have sex with, what we eat for lunch, and which pants we decide to wear to work on any given day, we also have the ability to control knowing our status. In most cities there are numerous state-funded free sites (planned parenthood, LGBT center, mobile testing trucks) that offer rapid viral testing. Many of these stay open past normal work hours to accommodate individuals who have a 9-5 work schedule. There is no excuse to not know your own status – it is your responsibility to your own health, and the health of others around you.
Knowing your status is only the first step in avoiding being HIV-Ignorant. As men who have sex with men, it is also our responsibility to educate ourselves on the facts in order to make well-informed decisions. Much of the fear and avoidance people have toward HIV and HIV-positive individuals stems from ignorance; they simply do not know these facts. Any fear that represses knowledge and education is dangerous, and we must do our best to combat it in all of its forms.
Here are 6 steps you can take to NOT be HIV-Ignorant
- Learn the facts about transmission
It pains me to hear accounts of people worried about catching HIV because they made out with several guys one night and just found out that one of them is positive. Plain and simple: HIV is transmitted by blood, semen (including pre-cum), rectal fluids, vaginal fluids, and breast milk. You WILL NOT transmit or receive HIV by kissing (unless both individuals have intense open wounds inside their mouths). You are also highly unlikely to develop HIV from oral sex (although if you have open sores in your mouth there is always a small chance).
The reason anal sex is considered the highest-risk sexual behavior for HIV is due to the somewhat delicate nature of the rectum. During anal intercourse, many individuals who are on the receiving side are not even aware of the tiny tears that are happening while bottoming, and these tears make the rectum extremely susceptible to infection. Other high-risk activities include sharing needles, vaginal sex, and sharing douches. Find out more transmission facts at the CDC linked here.
- HIV-Positive and Negative people who know their status are less likely to transmit HIV
Think about it – if you are routinely getting tested (every 3 weeks) or are on a regimen to treat HIV, you are more likely to be accurate when you talk about your own status. Having sex with someone who knows that they are HIV-positive and are undetectable as a result of daily adherence to a treatment regimen is safer to have sex with than someone who regularly has sex and has not been tested for half a year.
Also, do not be afraid to ask your sexual partners for evidence! Make them send you a screenshot of their most recent STI panel test, evidence that they really are taking PrEP, or evidence that they are receiving treatment for HIV.
- Know what “undetectable” means
In a major study examining 1,763 mixed status couples (meaning one partner is HIV-Positive and one is HIV-Negative), the results yielded that not a single individual contracted HIV from their undetectable partner. None.
Being undetectable means that an individual who once tested positive for HIV is experiencing such success with their drug treatment regimen, that their viral load is so minute (fewer than 50 copies of HIV per milliliter of blood), that tests are unable to detect enough antibodies to register the individual as positive. In other words, the individual still has the virus, but with the help of drug treatment they have suppressed it such that it is literally undetectable when tested. Unfortunately, an undetectable viral load can only be attained by an individual who knows their status and is receiving treatment.
- Learn the facts about prevention
Condoms and PrEP are no longer the only topics of conversation when it comes to preventing transmission. PEP (post-exposure prophylaxis) and TASP (treatment as prevention) are also considered legitimate means of stopping the virus from spreading.
TASP: Generally refers to individuals who are diagnosed with HIV, but are undetectable due to adhering to a drug regimen to treat their diagnosis. They are preventing the spread of HIV by treating themselves.
PEP: Post-exposure prophylaxis is a drug regimen an individual can opt for when they think they have been exposed to HIV and are not on PrEP. If taken within 72 hours, this option can be up to 99% effective in preventing the contraction of HIV.
PrEP: Pre-exposure prophylaxis. Commonly referred to as Truvada, this is a pill taken daily by individuals who work in high-risk environments (medical field) or are sexually exposed to HIV on a regular basis. When taken regularly, this can prevent HIV contraction up to 99%.
Condoms: Most commonly used option. When used correctly, these also prove to be very effective in preventing HIV (read more about the effectiveness of condoms here). Most effective when used in combination with other prevention methods, such as PrEP.
…the list doesn’t end here. Refer to the CDC’s HIV prevention page for more results.
- Ask the right questions
Prevention starts with open dialogue. Open dialogue requires the knowledge to know what to ask. Questions like “when were you tested last” or “what is your status” are excellent starting points. Once those are out in the open, talk about prevention habits (whether or not you use condoms, PrEP, etc). Knowledge is as powerful as it is sexy. Use it to your advantage.
- Get tested regularly
Seems intuitive enough given the other points I have delivered in this article. However, for some this is the hardest part.
Try getting tested with a friend or boyfriend. Make it a habit you do every three weeks. Make it fun – get ice cream after, or even go out for a drink!