There’s a dilemma here in perspectives when looking at HIV prevention and HIV risk. I’ve worked in all angles of HIV/AIDS work for many years; testing and counseling, answering the hotline, direct patient care, community prevention education, research (seroprevalence and behavioral studies) and now HIV epidemiology for the last 8 years. I’ve worked in different parts of the world, too. And I’ve lost numerous friends and colleagues to this disease.
Let me see if I can describe this dilemma without people misinterpreting what I’m saying.
One of the early slogans in HIV education was: “It’s not who you are but what you do that puts you at risk for HIV infection”. The point here was to reduce stigma and discrimination by pointing out that AIDS doesn’t care if you’re gay or not. BUT this message is not completely accurate, either. It’s not Who You Are and it’s not even just What You Do, but also Who You Do It With that puts one at risk. You can have any kind of sex you want with a person who is uninfected and you will not get the virus. And depending on the saturation in the population from which you draw your sexual partners, your risk - statistically - varies. When a guy would call the hotline all panicky and say, “I did such and such (blow job/anal sex/whatever)… What are the chances I became infected with HIV?” My question back to him would be, “What are the chances your partner is infected?” If it was with a prostitute drug user, then the “chances” (though I don’t like putting odds on this kind of Russian roulette) are probably higher than if it was your live in partner (depending, of course, but you get what I’m saying?).
We did seroprevalence studies in some gay bars (granted, not an unbiased sample of gay men, as many gay men don’t hang out in bars). We found 20% - 40% HIV infection rates in this population in our area. Similar studies done in straight bars in similar communities found less than 1% HIV infection in patrons. At least in THIS community, if one were to pick somebody up in a gay bar and have unprotected sex with them, they would be far more at risk for becoming infected than if they picked somebody up in a straight bar. This is not true everywhere, of course. In Botswana, 30% of heterosexual adults are infected, so you’d be at equal risk in the straight bars there.
That said, a couple of gay men who are monogamous with each other, neither of whom is infected, can have any kind of sex they want with each other and not be at risk for contracting HIV. It’s not what they do, it’s who they do it with. IF however, like Scott, you have an infected partner, it IS what you do that puts you at risk. They can have lots of kinds of sex and intimacy together without much risk, but other practices would put the seronegative partner at risk. And it is absolutely true that HIV doesn’t care if somebody is straight or gay. Insertive sexual intercourse with somebody who is infected - male or female - puts you at risk for contracting the virus.
Stigma and discrimination are a problem in the gay community, partly because of HIV impacting them so heavily. Gay men, in many places, are still way disproportionately becoming infected with HIV and it would be irresponsible and dishonest and unethical not to tell young gay men the truth about this. They CAN protect themselves and still have sex and have lovers. But they should be educated about the impact that HIV has had and continues to have on their population. It’s a dilemma, because these messages can be misused to cause discrimination. But let’s be careful about the spin we put on everything.
On another, but related note: Is it a good idea or such a badge of civic duty for everyone to be frequently tested for HIV? If you don’t continually put yourself at risk for HIV, then no - it’s a waste of health resources to keep testing. If you do have continual risky activity, then you should regularly test (or, say, in Scott’s situation with an HIV+ partner, it is understandable). If you do test every few months, then it makes sense that the person testing you is going to assume that you continually put yourself at risk. They are still an ignorant, ineffective counselor if they sound judgmental or punitive.
If you’ve never been tested before for HIV and you’ve been sexually active, then by all means test. If you have had no real risky behavior, then you don’t need to keep testing for HIV any more than you need to keep testing for any of the muriad of other health conditions you possibly could have. I mean, be real.
Oh, and wear your seatbelt, don’t ride with drunk drivers, quit smoking and get regular exercise.
Jill
