Wednesday 25 March 2015

Multiple sex partners with or without protection against HIV? Read this exciting article

Promiscuous Gay Nerd: Choosing to Love Poz Guys

I met James1 on Grindr. Well, not exactly – he was a friend of a friend, who also happened to be a fan of my writing. We had connected years ago and intended to meet up, but we never found the time. So when James pinged me on Grindr, my interest was piqued. He was gorgeous, successful, and hung like a fucking horse. I thought to myself, “okay, what’s the catch?” We made plans to spend a weekend in his hometown, a two hour drive from me.
But before I got in my car and made the schlep over to see him, he texted me to say that he had something to tell me. Something I should know before we met. At this point, most gay men I know would be preparing to run for the hills. Having a Grindr trick tell you before you ever meet that there’s something you ought to know, without just spitting it out, is usually a code red situation. But I wasn’t most gay men. Quite the contrary: Rather than feeling anxious or ominously worried, I put my hands together like a skinny girl at McDonald’s and prayed, “Please let him say that he’s positive.”
To say that this is a new perspective for me is an understatement. Nearly two years ago, just a few weeks after I started taking Truvada daily for PrEP, I penned an article on “Learning to Fuck With Poz Guys.” In that piece, I talked openly about the challenges I experienced incorporating HIV-positive guys into my (mostly condomless) sex life. The writing on the wall was pretty clear then that sexual transmission is nearly impossible with guys who are on treatment, have undetectable viral loads, and do not have an STI co-infection. Despite that growing scientific consensus, I still struggled with my own irrational fears and deeply-ingrained stigmatizing views of HIV-positive men. Like most gay men, I had been trained to avoid HIV-positive guys at all cost. Sure, you could use condoms. But why risk it?
We know even more today than we did in 2012. The preliminary results from the PARTNER study released in March this year firmly planted the jaws of many in the field squarely on the floor. If you’re not familiar with the ongoing clinical trial tracking serodiscordant couples that don’t use condoms consistently, let me briefly rehash its findings thus far.  In two years, not one person with an undetectable viral load –gay or straight – had transmitted HIV to their primary partner, during an estimated 16,400 occasions of sex among gay men and 28,000 among straight couples.
The kicker for HIV-negative folks like me on PrEP: none of the HIV-negative partners in the PARTNER trial are on PrEP (or PEP, for that matter).
But all this science aside, why in the world would I pray for my new beau to be HIV-positive? Knowing that there’s no risk of infection is one thing. But to actually seek out and desire HIV-positive partners is quite another.
The answer, I think, lies in the spectacular failure of my last relationship.
Like so many gay couples, Tim and I fought tirelessly over monogamy. We were both sluts who clearly loved to spread our seed. I didn’t mind the idea of him having sex with other guys, but he was controlling and jealous. He ominously threatened one day that if I ever cheated on him, he would beat the shit out of me. I nervously laughed it off. He couldn’t be serious? Right?
When we finally did open the relationship, he insisted on all sorts of restrictions. It turns out those restrictions were only for me. No sex in our house, he said. I’d come home from work and find evidence to the contrary. I didn’t really care. But the real stickler was his insistence that we use condoms whenever we fucked outside the relationship. As the bottom in the relationship, my getting fucked condomless would threaten both his dominance over me and his HIV-negative status.
So when I found out he bred a friend of a friend in the woods outside a party while I was inside with friends, I was done. A few weeks later, when he went out to the bar with friends, I enacted my own form of resistance: I went out and got my ass creamed. It felt exhilarating – liberating, even.
When I came home, he was drunk and furious. Somehow, he seemed to know what I had done. I denied it. But as I walked up the steps to our apartment, he took his first swing – the beginning of a long night that ended with his arrest.
Throughout the entire relationship, HIV provided the rationale for Tim’s controlling jealousy in our open relationship. I’m under no illusion that this explanation is entirely legitimate; clearly, Tim had his own demons and insecurities that he desperately needed to deal with. Nonetheless, it was always lurking in the shadows of our relationship, providing a kind of scientific legitimacy to his control.
Tim’s behavior is an extreme example of what is a pretty common phenomenon for gay men I know. The fear of HIV leads gay men to all sorts of irrationalities. This is especially true for HIV-negative gay men, whose knowledge of the disease is largely fed by stigma and misinformation. When I came out to my parents at the age of 14, my parent’s first response was that I would probably die of AIDS. The LGBT youth group I attended regularly for the next two years didn’t teach me gay history; it taught me how to use a condom. Irregularities in the blood tests I needed to start Accutane in high school compelled my doctor to warn me that I might be HIV-positive. If a condom broke with a partner, I would get tested every month for the next six months – each time reading into some minute detail (the counselor’s tone of voice; his delay in returning to the testing room; an ominous voicemail)convinced that I was positive.
For most of my life, HIV was a specter haunting me and my sex life. Over time, I found ways to cope and manage the stress and risk that comes with being a promiscuous HIV-negative gay man. Perhaps the most significant step in that journey was educating myself about the actual risk of transmission, something that most gay men still don’t know enough about. If you asked a 21-year old Jake Sobo what the chances are of getting HIV after being fucked by a poz guy without a condom, I probably would have said 50%. It’s actually less than 2%, on average. And as we know now, treatment and/or PrEP virtually eliminates that risk altogether.
Getting older as a gay man almost always means that some of your friends will test positive at some point. While as many as one in four gay men overall are HIV-positive in some urban areas, that percentage jumps to over 40 percent for guys in their 40s. It sounds trite, but being friends with HIV-positive guys and realizing that their lives were basically no different from my own played a significant role in helping me reshape my understanding of the disease.
What PrEP has done for me cannot be understated. I no longer live in a world where contracting HIV seems a possible outcome that warrants my anxiety or stress. With PrEP, I can have the sex that I want, with whomever I want, without HIV looming over my decisions.
As I picked up the pieces after my last breakup, I resolved to never be in a relationship again in which I didn’t see eye-to-eye with my partner about non-monogamy and HIV risk. I’m just not built for sex with one person, and I don’t ever want to be in a situation where HIV provides the grounds for controlling my behavior. But finding another gay man as liberated from the fear of HIV seems daunting – especially living in a non-urban area. I used to think that I might never date seriously again.
But, as luck would have it, it turns out guys on PrEP aren’t the only ones who don’t fret about contracting HIV anymore.
iphone3Three dots moved silently on my iPhone screen, indicating an impending message. Finally, after what seemed like an eternity, James’ message came through. My prayer was answered.
Of course, James is a lot of things other than being HIV-positive. His serostatus turns out to be only one of so many things that I love about him. He’s goofy and ambitious. And, like me, he is a whore. We practice compersion, not jealousy; when I get my ass creamed by another guy, he doesn’t get angry. He gets turned on.
But I don’t love him despite his status, as many guys might imagine. It is not a glitch or problem or downside.  I love him, in part, because of it.
To guys out there who still don’t understand how this is possible, I invite you to look around you. The serodivide is crumbling. Hookup sites that used to allow only two options for HIVstatus now offer endless choices, from undetectable to on PrEP. Recent life expectancy projections suggest that gay men who test HIV-positive today and start treatment quickly will live longer than those who do not. Statistically speaking, my positive boyfriend is likely to outlive me.
While some friends of mine give guys who blithely refuse to fuck poz guys a pass, I don’t. You cannot hide your prejudice under the veil of risk anymore. That ship has sailed.
I know it’s not easy. Unlearning decades of stigma and fear will not happen overnight. It will take time and learning. That’s okay. But the cost of staying in place is too great, both for poz guys who face that stigma and fear on a daily basis, and to our communities which remain divided.
Tomorrow, September 27, is National Gay Men’s HIV/AIDS Awareness Day. If you’re an HIV-negative gay man and you serosort but want to do something to help end HIV stigma, take a first step. Stop serosorting. Fuck a poz guy.
Who knows, he just might be the man of your life.

1 Names have been changed.
Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade. He previously published a 19-part series documenting his experiences on pre-exposure prophylaxis (PrEP), “My Life on PrEP,” for Positive Frontiers magazine, which was picked up by Manhunt, translated into French, and widely read in the HIV prevention world. He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV.

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