Ask the poz guy: comprehensive HIV information

July 11, 2005

 
2 New Condom Trends

Using 'Female' Condoms

Dislike wearing condoms? Have the bottom guy wear one instead. A female/vaginal condom is basically a donkey-sized condom that fits inside his ass. Pull out the rubber ring inside, you won't need it when using it for anal sex. The top guy wears nothing. Made of HIV-safe thinner and stronger polyurethane and can last for up to 8 hours of continuous use ...

Custom-sized condoms

Many guys don't use condoms because they go limp wearing the wrong size. Too small cuts off blood flow, too large and you lose the contact friction which keeps you hard and they can also slip off during sex. A take-home size chart helps find the exact size you need. Available at specialty shops like Condomania on Bleecker St.

Have questions? You can email "askthepozguy" at yahoo.com

This post covers:

HIV info for
Tops and Bottoms
Oral Sex The Game of Bluff Free HIV Testing Safer Sex Guidelines Addiction Resources Questions?


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Information for the top and bottom

What a top needs to know about HIV
Your risk is much lower than a bottom, but not zero. The San Francisco City Clinic estimates that unsafe anal sex with an HIV poz bottom is a risk of about 1 in 1,600 for the top. And if you think you know the HIV status of the strangers you meet, that you only play with "neg" guys, think again. Statistics from the American Foundation for AIDS Research (AMFAR) reveal that approximately 50% of people nationwide infected with HIV do not know their true status. They feel no symptoms, avoid testing, and so could easily be carrying the virus. You cannot tell by looking at someone (or frankly even asking) if they are HIV positive. Meeting strangers for sex you have to assume everyone might be HIV positive and not know it.

How can a top be infected during unsafe sex?

1) The urethral tube, aka 'pee slit'

You can be infected if your urethral tube is soaked in infectious fluids. What fluids, you ask? Many guys do not know that rectal secretions (aka 'ass juice') has 25 times more HIV in it than cum, even if someone is on effective HIV meds - no difference. It's very dangerous stuff. Thankfully there's usually not enough of it in someone's ass to soak your urethral tube. You can understand though why heterosexual men are more easily infected as the vagina is more "juicy" with the highly infectious vaginal/cervical fluids.

2) An untreated sexually-transmitted infection (STI)

Researchers discovered that an untreated urinary tract infection or other STI (an active Herpes outbreak, or Chlamydia, for example) can dramatically increase your risk of absorbing HIV - up to 5 times. An untreated STI brings huge numbers of white blood cells to the surface of the skin and membranes, and it is these white blood cells that HIV seeks out to start the infection process. Unsafe sex is not such a good idea at this point.

Often those who end up with HIV start out by getting Gonorrhea, Chlamydia and/or Herpes.

3) Uncut Foreskin

Certain cells found in uncut foreskin are more easily attacked by HIV. HIV passes through the cells in the foreskin 2-3 times more easily and the risk of infection is thus higher. This is particularly true if the infectious fluid ('ass juice'?) is trapped underneath the foreskin for extended periods of time during unsafe sex.

In a recent study* of gay and bisexual men in NYC, 45% of them admitted to having unsafe receptive anal sex (a 'bottom') in the past 3 months. The biggest reasons they reported for having unsafe sex were 1) easily available sexually oriented internet sites, 2) the perception of HIV treatment advances, 3) emotional fatigue regarding HIV, and 4) the increased popularity of "club" drugs.

* Arch Sex Behav. 2003 Aug;32(4):351-7

Why a bottom is so easily infected
The inside of your ass (the rectum) is like a sponge.

You don't have to have a cut or tear in your arse to get HIV. Some researchers estimate the risk at about 1 in 10 for a load-taking bottom from an infected top.If you get some infected pre-cum or cum inside your ass, some of it will soak directly into your bloodstream. Enemas work on this same principle. This absorption issue is exactly why bottom guys so easily get HIV from unprotected anal sex.

Almost everybody says they're 'clean/neg' (or even 'tested recently') when they sometimes haven't been tested in years. Be aware of the horn-dog hype. The point is, as a bottom you are much more vulnerable to infections. You're taking in all his fluids.

If you insist on unsafe sex, at least have him pull out before shooting.

Talk about your limits before you have sex as nobody wants to listen to an HIV lecture in the middle of fucking. If you can't stop yourself from always having unsafe sex with strangers, talk to someone about it - admit this to a close friend, a 12-step, a priest/rabbi, therapist, ANYONE. If you only talk about this fact with total strangers, you're likely in trouble.

Rimming?

There have been no reported cases of anyone getting HIV from rimming, either the rimmer or the recipient. Saliva is not an infectious fluid. Fecal material (aka 'shit') is not infectious. Ass juice is HIGHLY infectious but appears to be difficult to transfer during rimming.

Intestinal parasites and bacterial infections are quite commonly passed though during rimming, and sometimes Hep A. Think about using a dental dam, or at least wash them up with soap. Be aware of any unusual symptoms and get them checked.



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Oral Sex

If you like to get head
It's nearly impossible to get HIV from getting head since the saliva touching your dick is not by itself an infectious fluid. The rule is to keep your dick away from blood, cum, vaginal fluids, or the highly infectious rectal secretions (ass juice). Throat fucking or going deep poses no extra risk as long as you're not breaking skin and getting infectious fluids rubbed in.

Fairly warned: in getting head there is still a moderate risk of a urinary tract infection, Herpes, or some other bacterial hit - check with your doctor if you feel any symptoms. This is not a small thing, as an untreated infection such as this makes HIV much more risky for you (read the 'for tops' section).


If you like to suck cock
Oral sex is all about risk reduction. HIV is looking for a way to get into your bloodstream, and with oral sex it has very few chances to do this, but there are some rare exceptions.

The health of your mouth/gums is important

If you brushed your teeth too hard and your gums are still bleeding when you suck dick you are at higher risk of absorbing infectious fluids if you have them in your mouth. Yes, pre-cum has HIV in it and your gums are vulnerable if not taken care of. Go see your dentist. Even so, HIV infection from oral sex is very rare - partly because the gums heal quickly from any abrasions. The tongue can be vulnerable if chewing on hard candy or biting on it of course.

Swallowing? Deep-throating?

Swallowing cum does not add much risk over and above the damaged gums issue. The throat is fairly well protected against bacteria and viruses - your gums are the potential danger zone. If the face-fucking is so rough that you are bruising/damaging the back of your throat or tonsils you might want to reconsider or at least reposition. You can have him blow on your chest instead.

Is HIV killed on contact with air?

This is a popular myth and the answer is NO.

HIV can last several hours in a pool of cum, or other infectious fluid. Licking cum off someone's chest is not any "safer" - there's no difference. Fingering someone with a cum-drenched hand or sharing anal sex toys is not safe at all.



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Sex with strangers & the game of bluff

If you read the ads online
If you read anything, read this: "it is estimated that half of all people with HIV in the U.S. have not been tested and do not know they are carrying the virus." (See AMFAR.org.) Locally in NYC, that's at least 25,000 people, a clueless army of highly infectious untreated guys still claiming they are 'negative'. These guys will tell people that they are "clean", "negative"... even saying they're "tested recently" because they actually don't know any better and just want to avoid the issue. If they haven't been tested, it becomes easier to bluff than to find out the truth.

If you are writing ads
Fear and prejudice starts and continues the surge of new infections.

It is okay to prefer sex with HIV negative guys. But you have to understand the impact of your words on others. Because of the obvious stigma and rejection attached to being HIV positive ("D/D FREE UB2", "NO POZ GUYS"), people avoid testing for years at a time, bluff (or even lie about) their status - and in turn infect countless others. Perhaps someday you'll "play well with others" regardless, but that's beside the point. Understand your part in the game.

Put "safe only" in your ad instead.

You can't persuade someone you are HIV negative in your ad (if smart, they won't believe you anyhow), and you can't possibly screen out HIV positive guys since many of them don't know their true status and will just bluff it. But you CAN control what kind of sex you have, and tell them that unsafe sex is not in your ballpark regardless. Many people read "clean", "neg", "dd free" etc. as code words that it is cool have unsafe sex with you. That might be great for you, but you have no idea what they are carrying.

Try for openness, dialogue, and self-protection.

To play the game you need good buddies and a good supply of your favorite condoms. Reduce the number of strangers you meet and increase the awareness level from those you do. Monogamy doesn't have to be your goal but knowing your partners should be. Ask questions. Be realistic and open-minded if you can but always focus on safety regardless. Strangers increase your risks.

Disclosure
If you're neg

If you haven't had ANY unsafe sex, promoting "safe sex only" will keep you HIV negative.

If you don't know your true HIV status, just admit it.

Honesty is very sexy. Try it out some time.

Q: Are you clean?
A: To be totally honest, I haven't tested in awhile. What about you?
If you're poz

Be honest at the appropriate time. Some pioneers can disclose up front or even OUT LOUD. Bravo. For others, a quieter & delayed approach is much better. After you meet, but before the sheets. Waiting can be worthwhile because many people are still loaded with myths, misinformation and fears about HIV. Letting them get to know and like you a bit before you disclose and have sex is one way to remind them of any knee-jerk preferences (or even prejudice) they may have. This is your chance to educate. Try not to get frustrated. Most of us have fears of some kind and make decisions based on them.

It depends on the type of encounter you're having. Don't expect emotional depth & acceptance when it's just a stranger who wants to get off and find someone new for the next time. Disclosure isn't easy. HIV isn't easy. Your courage and honesty will attract the ones right for you. Tip: before you fully disclose on a date, try slipping in the conversation that you made some mistakes in the past and had some unsafe sex. See how he reacts. Get people talking openly about their issues/fears rather than reacting with them.



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HIV Testing

Why you should get tested
There are few if any signs of early HIV infection. Many people never had (or never noticed) the famous 'flu-like' symptoms that can occur a day or two after an initial infection. Severe anxiety and stress creates its own 'flu-like' condition very often. You cannot diagnose yourself but you can worry yourself sick trying. HIV is a very stealthy, slow-working virus ... part of the reason it is a huge global epidemic right now.
The "I know my own body" effect. Getting tested for HIV can be frightening, and many people avoid it for years. Often people say they "know their own body" - and feel that they would know if they are infected. Unfortunately you can't tell - HIV is a stealthy virus and the only way to know is to go in and get tested. It usually takes years before any obvious symptoms appear. If you are anxious about testing, get a testing buddy and go get tested together regularly.

How and when to get tested

Rapid Tests

Nobody should have to wait weeks for a test result. With rapid tests, it takes only 20-40 minutes and a tiny pin drop of blood. Offered free (or low cost) at your doctor's office or most public health centers. However, because these tests only check for immune-system antibodies (not the actual HIV virus!), it can sometimes take up to 3 months for an infection to be detectable. The time between infection and detection is called the "window period". With rapid tests, about 95% of people will be detectable (if indeed HIV positive) within 4-6 weeks of the infection. The remaining 5%, because of their individual immune response, can take up to the full 3 months advised by the CDC (the feds).

Oral-Fluid Tests

Takes about a week to get the results back, no blood drop necessary. Has the same "window period" uncertainty issue as with rapid tests.

Viral Load Testing

This is the gold standard of HIV testing, used to confirm an HIV diagnosis and detect the level of virus in the blood. This test has no window period as it is testing for the actual virus itself, not the presence of immune-system antibodies. It is expensive though, around $150-250. It is not available at public testing centers, but your doctor can order it for you.

Emergency?
If you shared a needle or injection equipment with someone, or you took a stranger's load in your ass - you have a valid HIV emergency. Call your doctor or clinic and discuss the details. If it's the evening or weekend and you can't reach anyone, head to the ER immediately and ask for PEP, post-exposure prophylaxis. It's generally a month's supply of an HIV drug cocktail designed to interrupt a possible infection process. Most effective if started within 36 (up to 72?) hours after exposure.


Where to get tested in New York City

Advice on choosing testing centers:
• Call before you show up, not all are open late or on weekends.
• Ask for "rapid testing", you want your results back in minutes, not days or weeks.
• Ask if they test for other things besides HIV. (Herpes/Syphilis/Hepatitis/etc.)
Ryan Center
Confidential free rapid HIV testing, and comprehensive health services.
3 Manhattan locations (Midtown, UWS, LES).
(212) 316_7911
Callen Lorde Community Health Center
Comprehensive confidential testing and treatment, regardless of ability to pay.
Call for appointment.
356 W. 18th Street.
(212) 271_ 7200
GMHC
Free confidential HIV rapid tests plus Syphilis and Hepatitis C testing.
Appointments only Mon/Tu/Th. Walk-ins Wed/Fri/Sat.
119 W. 24th St, 6th floor
(212) 367_1100
APICHA (Asian Pacific-Islander Coalition on HIV/AIDS)
Free testing and services available in Chinatown.
150 Lafayette, at Howard St.
(212) 334_7940
Toll-Free Nationwide
The CDC's National AIDS Hotline. Answers questions about HIV testing
and locates testing sites for you. Operators are available toll-free 24/7:

English: (800) 342_2437
Español: (800) 344_7432
TTY/deaf access: (800) 243_7889



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Safer Sex Guidelines

A safer sex recipe for any situation:

Sex has unlimited variety. Just keep the infectious fluids list (yellow) from the entry sites list (red), or separate them with a condom or latex barrier.

Safe fluids
These fluids do not have infectious HIV levels, unless they have blood in them.
Saliva / 'Spit'. Saliva is not an infectious fluid. Kissing is safe from HIV. Saliva does carry Hep B, a risk only if you bite hard or if open cuts/sores are in or near your mouth.
Feces / 'Shit'. Rimming & Scat play are considered safe from HIV, but a moderate risk for Hep A and other bacterial infections.
Urine / 'Piss'. Watersports or Piss Drinking has no HIV risk, but urine does carry the CMV virus, a risk for those with weakened immune systems.
Sweat
Tears
Fluids with infectious HIV levels
Keep these fluids away from the 'entry sites' below.
Rectal secretions
Aka 'ass juice'. 25 times more HIV virus than semen, even if on HIV meds.
Blood
Semen / 'Cum'
Pre-cum (less than other fluids, but still infectious)
Vaginal & cervical fluids
Breast milk
Entry sites
Where HIV can get into your body
• Injection sites (needle pricks, shared injection equipment, tattoo needles, etc.)
• The rectum (unsafe anal sex)
• The vagina (easily gives and absorbs HIV)
• Uncut foreskin.
• The urethral tube of the penis ('pee slit')
• Herpes outbreak, or other open sores
• Open and bleeding cuts/wounds in the gums, mouth, tongue, skin.
• Mucous linings of the eyes (rare)
• Mother-to-child transmission (during birth or breast-feeding)



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Addiction Resources

There are many kinds of addiction. Since these two are linked to the many new HIV infections, they get the attention. If you need a referral or additional help, just ask.

Crystal-Meth

Crystal-Meth is a relatively cheap and powerful drug designed to give you an incredible high. It's also designed to give you an incredible crash and severe withdrawal, making it very addictive and a cash cow for the drug makers. Many experienced users will tell you it's harder to break a Crystal addiction than either cocaine or heroine. Crystal-Meth lowers inhibitions and makes you horny - thinking you're lucky and unable to catch HIV, you'll have a lot of unsafe sex with strangers. Unable to sleep properly for days/weeks at time, your body will slowly fall apart and crave more drug to make you feel better.

Before you head to a "PnP" event, for "favors" or "snow" for "skiing", meet someone who wants to "party" - make sure you are able to try something and maintain control of yourself. Some can - others can't and get hooked.

If you want to quit, reduce, or just find out more, ask for help.

Crystal-Meth Anonymous (CMA)
A 12-step group focused on Crystal Meth.
The Center on 13th street
Beginners every Tues and Sun at 7:30 pm.
Intergroup: (212) 642_5029
The Center 'CARE' program
The Center on 13th Street.
Referrals, counseling.
(212) 620_7310
GMHC Substance Use Counseling
Drop-in counseling, groups, step programs,
acupuncture and forums. Open to HIV neg or positive both.
(212) 367_1354.

Sex Addiction
This is no joke. Few people understand the reality of sexual compulsion but many people have seen its effects.

If you spend hours every day or weekend haunting internet sex sites, on phone lines, in public restrooms, hunting for sex with strangers and ruining your friendships, relationships, finances, your career, and most likely even your health - then sex addiction is something you have to look at seriously. Just as with AA, there are 12-step groups set up to help you find out about yourself, and attempt to bring your life back. Pick any meeting - there are no rules, just suggestions. Come and go as you please and according to your needs. Speak or say nothing. Showing up and just listening to others share their experiences is a big step in itself. There are no dues or fees, the meetings are self-supporting by donations only (generally a buck or two).

Sexual Compulsives Anonymous (SCA)

For more information: sca-recovery.org/cities/newyork

Newcomers are welcome at all meetings, but to save space I have listed only the beginner's meetings here. You can get a full list by attending a meeting or visiting the SCA New York web-site

Monday, 8:15pm - Beginners Step
St Ignatius Episcopal (West End Ave, near 87th)
Monday, 9:15pm - Sharing Towards Recovery
The Center (208 W. 13th)
Tuesday, 6:15pm - Beginners Tools
St. Veronica's (155 Christopher street)
Wednesday, 7:00pm - Beginners
GMHC (119 West 24 Street, Rm. 410)
Friday, 5:45pm - Beginners/Interim Sponsor (Open)
The Center (208 W. 13th) LARGE GROUP
Saturday, 6:00pm - First Step/Interim Sponsor
The Center (208 W. 13th) LARGE GROUP


____ If you have any questions...

I am trained in HIV outreach [2004 Cicatelli/NYC Dept. of Health] but don't know everything.

Send an e-mail to "askthepozguy" at yahoo.com if you'd like to chat.

Thanks,

Poz Guy


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