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HIV STI info

Risks and HIV Transmission for Gay Men

Author: March 7, 2012 0 Comments

 

 

This one tends to continuation on from my last article in Xtra on 15 Dec 2011, but from a new angle.

 

I recently talked to an MD who works for the government in the field of HIV and s/he said that we need a nuanced message to deal with the new information out there about undetectable viral load reduces the risk of transmitting HIV.  S/he feels we need new messaging because s/he see people every day coping with viral load questions.  My response was that the CDC does not know the meaning of nuance they only know short messages with an all or nothing message, Later I talked with one of those bureaucrats that is part of developing those all or nothing messages. (S/he does not see patients in real life, and I wonder if s/he only knows about sex from journals and books.)  S/he confirmed s/he likes the all or nothing short simple messages.  Short and simple seems to be more important than how accurate the message is.

 

 

 

What if you wanted to go skiing and wanted to make sure you would not get injured in an accident on the dangerous highway 99.  You could decide to drive only between 2AM and 3AM, when there are fewer cars, you can get the best snow/ice tired there are, you can get the safest car with the most air bags, you could decide to only drive on days when there is no snow or rain.  But likely this would not be practical or fun – but safer.  Likely you will just drive to the ski hill when you want to ski and tell yourself to be careful.  After all you did it for two years and had no problems so just tell yourself to be careful.  Well it is a lot like fucking.  There are things you can do to make it safer but they may not all be fun or practical.

 

The Journal Science has declared that the scientific breakthrough of 2011 was a study (HPTN 052), this study found that a person with an undetectable viral load reduces transmission of HIV by 96%.  One article said “Having an undetectable viral was as effective as condoms.

 

That is like going to buy a pair of jeans for $100.00 but finding out they are reduced by 96% so they now cost $4.00.  That is a huge difference.

 

So lets look and what this means for fucking without condoms.  If you are getting fucked raw by a HIV poz guy with and undetectable viral load the chance of getting infected goes from 1 in 200 (no HIV treatment) to 1 in 5,000.  If you are fucking a poz guy raw with undetectable viral load the chances of getting HIV goes from 1 in 1,538 (no treatment) to 1 in 38,461.

 

So if you have sex with a poz guy with an undetectable viral load and if you use a condom that reduces it a further 96%.  So it is like those $100 pair of jeans go to $4.00, and then are deduced again by 96% and now they cost 16 cents.

 

We are told that BC government is spending $50,000,000 to get as many positive persons as possible to have an undetectable viral load.  They call it “Treatment as Prevention”, but that is just the marketing to the government.  It is not preventing HIV transmission but it is reducing the risk of getting HIV by 96%.

 

The risk of fucking without condoms changes dramatically – yea it is reduced by 96%!.  What do us as gay guys do?  Do we take more risks?  Do we decide that maybe we play more in the sandbox with the poz guys with undetectable viral load because they are not so scary now?

 

Do negative guys become scarier to play with because 2.5% of them may be poz and not know it and therefore may be 20 -25 time more likely to pass on HIV. For the guys who think they are negative but are newly positive then getting fucked by them changes the risk from 1 in 200 for a (poz guy with detectable viral load) to 1 in 10 for newly poz guy.

 

You may ask a negative partner if he get tested on a regular basis.  If he does it likely is because he is concerned he is maybe positive.  So why would you think he is negative if he thinks he may be poz and gets tested regularly to find out.

 

So if you decide to have sex only with guys who believe they are negative what is the chance of getting HIV?  We know 2.5% of those guys who think they are negative are really positive.  If we assume that those 2.5% are newly infected and that is why they do not know they are poz then the chance of becoming poz is about 1 in 200 if you choose only guys who think they are negative.   An interesting number – it is the same number as getting fucked by a poz guy with detectable viral load.

 

Where do all these numbers leave us.   Well poz guys with undetectable viral load are a lot less likely to infect someone then if they did not have an undetectable viral load.   Negative guys who will take risks with you will take risks with others also, – did you think you were special – so he may be poz.

 

A number of negative guys have told me that often poz guys are just more fun to have sex with than negative guys.

 

So where does the leave us?  Are poz guys (with undetectable viral load) sought after now, and are the “negative” guys shunned as having the potential for infecting others?  The science may say there is a good case for this.  But after all it is fear and prejudges that made many negative guys shun poz guys in the first place, – it was not science!  Our prejudges against poz guys as sex partners will not change easily.

 

What we do not need is the institutional marginalization of poz guys.  Many organizations will tell us we are at higher risk if we have sex with a poz guy.  Surveys ask “do you have sex with poz guys?”, they then tell you are at more risk if you do have sex with poz guys, this is not true if the viral load is undetectable. The institutional response should be: “ know your partners viral load” not his HIV status!

 

Well this is my last regular column in Xtra,   I plan on doing a retrospective piece next month outlining what I have learned while writing these pieces and bring up a few points to consider.  I may be back with the occasional writing on gay men’s health.

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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PEP can stop HIV infection

Author: November 15, 2011 0 Comments

Are we being punished for irresponsible sex?

OPEN WIDE / Why we need access to PEP

Bill Coleman / Vancouver / Thursday, November 18, 2010

 

If 28 days of pills could prevent you from getting HIV after possible exposure, would you take the meds?

The meds exist. They’re called post-exposure prophylaxis (PEP) and they could significantly reduce your risk of contracting HIV. So why isn’t everyone demanding access to this treatment?

The Health Initiative for Men (HIM) has written a position paper on PEP. In it, three cases are briefly described:

Case 1
A gay guy says he went to emergency at St Paul’s Hospital and told them he had relapsed on cocaine after four years of abstinence. He had been in a monogamous relationship with an HIV-negative partner for 18 months — until he went to a bathhouse and had unprotected receptive anal sex with multiple anonymous partners.

Twenty-four hours later he went to the hospital. He was advised not to take PEP, as the risks of taking them outweighed the risk of getting HIV. He was told his chances of getting HIV were less than one in 5,000.

Two months later, he tested positive.

Case 2
A gay guy went to a clinic for HIV testing. He had tested negative six months earlier. He said he was having consensual anal sex with a partner of unknown status when that partner, despite being asked to use a condom for penetrative anal sex, removed the condom during sex and ejaculated.

The guy went to St Paul’s emergency 36 hours later. He was refused a prescription for PEP and told the risk of seroconversion was not high enough.

The guy’s HIV test came back positive three months later.

Case 3
After having unprotected receptive anal sex with a partner he had met online, a guy found HIV meds in the man’s bathroom. He went to emergency at St Paul’s 12 hours later and asked for PEP.

He was told he didn’t meet the criteria.

Like the others, he was not given the option to pay for the meds himself, even though he wanted PEP and could afford to buy it.

He later tested positive for HIV.

The paper’s conclusion: PEP should be available to gay men.

It’s great that HIM has started a push for PEP. Let’s hope they push hard enough to make BC a safer place for gay men.

So why isn’t PEP available?

Simple. I’d say the medical profession is reluctant to give people, and especially gay guys, too many opportunities to behave recklessly. And our community’s silence is letting them get away with it.

I don’t expect a change in policy until someone stands up to demand it. So far, no community group or agency has directly taken on the BC government for its shameful policy on PEP.

How PEP works

If you are exposed to HIV and are concerned about getting infected, you need to start on medication as soon as possible. The treatment has to begin within 72 hours to be effective; some local doctors suggest within 24 hours is best.

How effective is PEP? One study showed that persons who did not take PEP were seven times more likely to get HIV (Roeding et al, 2008).

But accessing PEP is not easy. You need a doctor to prescribe it, which can be tricky at the best of times, and even harder at 6am on a Saturday morning.

One more hurdle: in BC you have to cover the $1,500 price tag yourself, unlike in Quebec and  Australia where the medication is free.

If the BC government can prevent infection in even one person in 20 by providing access to effective medication, the investment is worth it. From a purely financial point of view, paying $1,500 for PEP is much cheaper than providing a lifetime of HIV treatment.

But maybe it’s not simply about saving money; maybe gay guys are not important enough for the government to prioritize. Or maybe this policy is punishment for irresponsible sexual behaviour. Or maybe it reflects an ongoing squeamishness around gay sex.

Bottom line: our government won’t care about us unless we make them care.

So talk to your community organizations and ask them to take action to make PEP available to everyone in need. Write to the health minister. And find yourself a doctor who knows about HIV and PEP, and talk to them about how you might access it quickly if you need it.

 

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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Gay guys and warts and vaccines

Author: November 15, 2011 0 Comments

Gay men and warts

OPEN WIDE / Why aren’t gay and bisexual men getting free HPV vaccines?

Bill Coleman / Vancouver / Thursday, December 16, 2010

 

Warts.  Warts.  Warts.  Almost all of us have had them (or have them now).

Warts make wonderful dinner conversation, which  can lead to all sorts of interesting discussions about homophobia, anti-gay government policy, fucking, penises, asses, hope, and even cancer and death. Who knew those little pesky spots can have so much effect on gay men?

When I was young, in the middle of the last century, my parents were not so educated and did not know anything about warts. In those days we were told to rub a penny on the wart, bury the penny for six weeks, dig it up, then rub the wart again and it would magically disappear. Now we know that a wart comes from a virus.

Yes, another virus for gay guys to worry about. But this virus has an effective vaccine.

The wart virus is called human papillomavirus, or HPV for short. Gay guys can and do get anal cancer from the HPV (wart) virus, but the BC government will not pay for gay guys to get the vaccine, even though they pay for every school-age female to get it.  (Anti-gay government policy? Homophobia?)

Warts are the most common sexually transmitted disease. So if you’ve got warts, you’ve probably been sharing them with your boyfriend. But if almost all of us gay guys have this wart virus, does it really matter?

HPV is the most common cause of cervical cancer. Granted, most gay guys do not have cervixes, but they do have asses. A penis may enter an ass and bring the HPV virus along with it. (See: now we’re on to fucking. And no, you do not have to have a wart on your dick to have the virus.)

If your dick does transmit the wart virus, in five to 10 years there can be big problems. The HPV virus can cause anal cancer.

Dr Joel Palefsky, an infectious disease expert from the University of San Francisco, says, “almost all HIV-positive gay men have HPV in their anus.”

The Vancouver sample of the ManCount survey of gay men shows 79 percent of HIV-positive guys and 62 percent of HIV-negative guys have anal wart virus.

The survey also found that 64 percent of HIV-positive guys and 34 percent of HIV-negative guys have abnormal cells in their anuses, which can lead to anal cancer.

HIV-positive gay men are 10 times more likely to get anal cancer than women are to get cervical cancer.

In a paper published in 2006 by a Vancouver group, gay men were found to be 35 to 70 times more likely to get anal cancer than the general population (Lampinen 2006).

HIV-negative gay men have a rate of anal cancer at 35 per 100,000. Women get cervical cancer from the wart virus at a rate of 8 per 100,000. Is the health of gay men not important to this government? Or are we expendable?

So here it is: there is a vaccine for warts. It is effective. Why not just take the vaccine?

Well, there are two complications. The vaccine works best if you get it before you have the virus in your ass. The BC government will pay for any female under age 26 to be vaccinated against HPV, but they will not do the same for gay guys — even though the vaccine is approved for use in males aged 9 to 26 in Canada. Gay men in the UK have been receiving the HPV vaccine for some time now.

All young gay and bisexual guys in BC should be getting this vaccine, too.  But our not-so-gay-friendly healthcare system won’t pay for it.

How many young gay and bisexual guys even think about warts, let alone have $450 lying around to pay for their own vaccines?

I wonder if our health minister thinks you deserve to get cancer and die if you let some guy put his dick in your ass.

Why is no one standing up and demanding proper healthcare for gay men?  It is time to speak out to demand proper treatment from our medical health system. We will not be heard by being quiet, by being nice. It is time to act!

Lobby the health minister, talk to your doctor, and ask your doctor if you need to be examined for HPV virus in your anus

 

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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How often should you get tested

Author: November 15, 2011 0 Comments

How often should you get tested?
HIV / The higher the risk, the more frequent the test
Bill Coleman / Vancouver / Thursday, January 13, 2011

Most of us hate tests.Some of us thought the end of school meant the end of tests. But gay guys know better.

Gay guys face the prospect of additional tests for life — or at least until a positive one shows up. Either way, they’re not much fun.

Still, most of us should get tested regularly.

How regularly? Have a look at the matrix I created. It’s not intended to address all aspects of a gay man’s complex sexual life. It is only my suggestion for developing a testing strategy based on individual risk activities, rather than poorly defined window periods.

For more than a decade, there was some unhelpful advice that we should wait six months after a risk to get tested. The theory was it took six months for evidence of the virus to show up, and therefore six months to be sure a negative test was truly negative.

Now we know that testing three months after a risk, using the conventional antibodies test, yields a result that’s more than 99 percent accurate.

And now there’s an even quicker test available in some locations in BC.

No more waiting even three months for an accurate HIV result. The new early-detection test (called the NAAT test) can identify the presence of HIV in the body less than two weeks after possible exposure. The Health Initiative for Men is one of several clinics in Vancouver running a trial on this test.

We, as gay guys, have been the largest group of people testing positive for the last few years, so we need better information and guidelines on when to get tested. The BC Centre for Disease Control and other public health agencies should work harder to inform gay guys about testing.

In the meantime, I have made this general guide for gay guys. My theory: the greater the likelihood of testing positive, the more frequently we should get tested.

Open Wide appears in every other issue of  Xtra.

 


HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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Show us the real HIV transmission risks

Author: November 15, 2011 0 Comments

Show us the real transmission risks

OPEN WIDE / Stop dumbing down HIV for gay men

Bill Coleman / Vancouver / Thursday, February 10, 2011

 

Gay men need to know the truth about HIV transmission.

I asked staff at a local AIDS agency why they don’t tell people the whole story about the risks of HIV transmission. The reply was something like, “Well, we thought about it but decided not to.”

I tried to get another local organization to provide this information on its website, but they declined.

What is going on here? Do people think we can’t handle the truth? How can we make informed decisions when we aren’t given the information we need to calculate the level of risk we’re each comfortable taking?

Can you answer this question accurately: how likely is it that an HIV-negative guy will get HIV if he is fucked in the ass by an HIV-positive guy not wearing a condom? Most people do not know the answer and will guess wrong. The risk is not as high as you might think.

When I used to lecture groups about HIV, I would ask this question. Many people thought there was a 100 or 90 percent chance that the negative guy would get infected. Some ventured to suggest a 50-50 chance of infection.

The truth is the risk is far lower! If you’re getting fucked in the ass by a positive guy, the chance of transmission is one time in 200, according to the US Centers for Disease Control.

The only local place I know of that will tell us these facts is on the Spectrum Health website. It is not easy to find but it is there (www.spectrum-health.net/index.php?option=com&mdashcontent&view=category&layout=blog&id=83&Itemid=200).

Here is the breakdown of sexual transmission risks for gay men, according to the US Centers for Disease Control:

•    being fucked by an HIV-positive     guy who cums inside you:     1 in 200

•    fucking an HIV-positive guy:     1 in 1,500

•    sucking an HIV-positive guy:     1 in 10,000

•    getting sucked by an HIV-positive         guy: 1 in 20,000

I’m not suggesting we all go out and take risks. I’m just saying we’re all entitled to make our own decisions about how many risks, if any, we want to take.

If you like to fuck and get fucked but do not like condoms much, then you can see it is seven times more risky to get fucked than to fuck without condoms.  Make your own choice about how much risk you are comfortable taking and how important the sex is for you.

I also think there would be less stigma for poz guys if we all knew the real risks of HIV transmission. Maybe then negative guys would find poz guys less scary. Living with constant fear of getting HIV can become a huge burden. Knowing the facts can help all of us to feel more in control and can help in making informed decisions around our sexual activities.

Other factors can affect the odds of getting HIV. High viral loads and sexually transmitted infections make transmission more likely, for example. Whereas an undetectable viral load makes it less likely. (Needless to say, avoiding getting cum in your ass makes transmission even less likely.)

Newly infected guys can have a high viral load for two months or more and be up to 20 times more likely to infect someone. I have concluded that it may be safer to have sex with a poz guy with an undetectable viral load than with someone who mistakenly thinks they are negative but really has a high viral load, which is what happens three to six months after infection.

A final rule of thumb to prevent HIV transmission: don’t get cum in your eyes. Getting blood in your eyes in a hospital setting is considered high risk.

Open Wide appears in every other issue of  Xtra

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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HIV Immunity – Interesting stuff

Author: October 21, 2011 0 Comments

What if you’re immune to HIV?
OPEN WIDE
What would you do with that knowledge?
Bill Coleman     Vancouver      Thursday, September 22, 2011
In the last decade, studies have shown that a very small percentage of people seem to be almost totally immune to HIV.In 2005, American journalist Randy Dotinga summarized the early findings like this: “An estimated one percent of people descended from Northern Europeans are virtually immune to AIDS infection… All those with the highest level of HIV immunity share a pair of mutated genes — one in each chromosome — that prevent their immune cells from developing a ‘receptor’ tht lets the AIDS virus break in. If the so-called CCR5 receptor — which scientists say is akin to a lock — isn’t there, the virus can’t break into the cell and take it over.”“To be protected,” Dotinga continues, “people must inherit the genes from both parents; those who inherit a mutated gene from just one parent will end up with greater resistance to HIV than other people, but they won’t be immune.”One study from 2001 in Science Daily reported that persons with the CCR5 gene from only one parent “had a 70 percent reduced risk of HIV infection.”Reports that I have read suggest that between one and three percent of Northern Europeans are “immune” overall, and about 10 to 15 percent have greater resistance to HIV. So it seems as if a few people are genetically predisposed to block the virus from their bodies almost, but not quite, 100 percent of the time. We just don’t hear about them very often.Thousands of organizations around the world broadcast HIV messages on a regular basis, but very few of them talk about immunity, probably because they’re concerned that some people might take the possibility of immunity as a licence to practise unsafe sex.Two organizations were so alarmed they reportedly pressured a genetic testing company to stop offering a CCR5 test to gay men. A 2007 brief from the Australian Federation of AIDS Organisations describes an Australian company, delta32.com.au, that advertised CCR5 testing on gaydar.com.au but closed its website after receiving complaints about the test being offered to gay guys.

I found links to other websites that test for the CCR5 gene, but they too have closed down or did not reply to my emails. Still, the test is available to the public.

But before we discuss where to find it, there are a few important questions to consider: Would you want to know if you are immune to HIV? What would you do with that knowledge?

Would you stop using condoms?

Would you believe someone who tells you they’re immune to HIV so they don’t have to use a condom to fuck you? (What about other STIs?)

If you are an HIV-positive guy, would you want to know if you had one of the genes that make it less likely to have complications from HIV?

How much would it be worth to you to find out if you are immune to HIV?

These are all interesting and difficult questions. But I think the real question is: should you have the right to know that you might be immune to HIV?

Is it better that we not know that HIV immunity exists? Does this make a better and safer society?

I have no clear answers. But I tend to believe that honesty and transparency make for a better society. I do not think there are many times that hiding information from the public is a good idea.

So I did a great deal of searching online to find someplace where you might find out if you have the CCR5 gene and, if you do, whether you have it from one parent (partial immunity) or both (almost complete immunity).

There is a company in the US called 23andme that does a broad range of genetic tests, including testing for the CCR5 gene. To order the kit and for instructions on how to send them a saliva sample, go to  23andme.com/store. The test costs $209 (US). To see an example of the report you will receive, look at: https://www.23andme.com/health/resistance-to-hiv-aids/.

I assume there are other places that test for HIV immunity, too, but I could not find them. I hope that readers will post addresses of other places, if they find them, on xtra.ca as a comment to this column.

Do I think that, armed with the knowledge of immunity, people might practise more unsafe sex? Probably.  Is it their right to make that decision for themselves? Yes, that’s always been our right.

HIV STI info, Interesting stuff for gay guys, Xtra newspaper columns

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