The BEST of Lifelube - "When Barebacking is Noble: The Ongoing Controversy around Serosorting" From Friday, April 6, 2007

Before you get to the article, a note on language. At the LGBTI Health Summit in Philly last month, I learned a great new term called "sero-adaptation" which was coined by this very cool, edgy Parisian HIV prevention group called The Warning"

Sero-adaptation includes, but is not limited to, the idea of "sero-sorting." It refers to a selection of harm reduction strategies that do not involve the use of condoms. These strategies may reduce the risk of HIV transmission, but are not a guarantee and require a clear-headed risk analysis, weighing the good, the bad and the ugly and making a decision around the amount of risk you and your partners are comfortable with.

So, what are some examples of sero-adaptation?

Sero-sorting - having condom-free sex with guys who share the same HIV status

Strategic positioning - determining who does what based on HIV status. For instance, the neg guys fucks the poz guy, which is less risky than the other way around.

Dipping - just sticking the dick inside a little bit and for a brief amount of time

Pulling out - kinda like the "rhythm method" of the 50"s, meaning withdrawal before cumming. Lot's of people become parents like this, and this is exactly how I myself tested poz, but it is less risky than actually allowing cum inside.

Lube - using a generous amount of the slippery stuff reduces friciton in one's tender, delicate anus/rectum and therby reduces the risk of HIV being offered a pathway in.

And of course, there are other sexual activities that can be done by people with same or different HIV statuses that do not involve fucking - sucking, rimming, water sports, JO, fisting, massage...

By the way, just for a moment of clarity, none of the above can be taken to offer complete or partial protection from other types of sexual transmitted infections...

--Jim

So here is that article already..

"When Barebacking is Noble..."

By Christopher Murray

[From the current issue of Circuit Noize, with thanks to the Gay Men's Health Listserv for posting...]

Last month, a virtual Vesuvius erupted when the popular New York gossip blog,Gawker , posted a link and then the next day an interview with a twenty-something gay guy in Manhattan who gets off on fucking guys without condoms.Confessions of a Bareback Top, his site, details his unapologetic adventures and is whack off material for some guys and proof of the end of civilization for others. The kink with the blogger, and those who identify with him, is the thrill we get when we break the taboo of safer sex.

The undeniable point of Mr. Bareback Top, is that while many gay men mouth lip service to safer sex practices, when push comes to shoving it in, so to speak, it's a different story. The bareback top loudly proclaims both his negative status and his assertion that it takes two to tango and that even if discussions before and during sex with his partners revolved around intentions to practice safe sex, once they acquiesce during the act, then they are just as responsible for what happens as he is, no matter how much they or others cry victim.

A storm of disapprobation not surprisingly followed the boost in the bareback blogger's profile. Gawker's comments file was crammed with postings suggesting he be put on the next train to Dachau, other gay men's health listserves picked up the drumbeat of dismay and disgust. But this controversy is only the latest concerning the practice of serosorting.

Defined as guys choosing only to have unsafe sex with others of the same HIV-status, serosorting has been ade facto reality in gay men's lives since the AIDS epidemic started, and before, if you count guys choosing not have sex with others they knew to have an STD or saying fuck it , if they knew they both had herpes, or whatever.

Serosorting, however, is a concept that is exclusive to considerations of HIV prevention. It's based on the premise that men need to know their status and that if they do, and then limit their unsafe behavior to only others of the same status, that HIV infections will fall. This assumes of course that people take steps to learn their status, that their status stays the same, that they are honest about their status, and that others are too. It is true, by the way, that people are more likely to have safer sex if they know they are positive. This is part of the innate civic-mindedness and altruism of gay men, we'll come back to that later.

Serosorting has recently been picked up by some advocates and taken out of the realm of decisions that gay men make on their own and promoted as a serious prevention strategy to be encouraged. Last fall, the San Francisco Department of Public Health launched their "disclosure" campaign that links knowing your status and talking about it with potential sexual partners to intentionally choosing partners of the same status. And Robert Brandon Sandor, the organizer ofBrandon's Poz Parties, a longstanding occasional sex club event for poz guys in New York, took up the charge, hosting a forum at the gay center in Manhattan on serosorting a month later. Brandon has run afoul of some local public health advocates for his championing of serosorting, as they claim his promotion of the concept is overly simplistic.

For Brandon, serosorting means, if you are poz, and only fuck without condoms with other poz guys, HIV won't be transmitted and will eventually burn itself out. Critics note that the world is more complicated then this with people not sticking to the system, assuming things about other people's status, and remaining vulnerable to other STDS.

This also lays the burden on poz guys to have unsafe sex – or maybe by extention of the argument sex, period – only with other positive guys, but also for negative guys or guys of unknown status to continue to have sex only with condoms.

It's easy to fall into a moralistic discussion about sexual ethics when considering serosorting. But in fact the issue is really one that has been around forever and complicated forever: assessing risk. A noted HIV researcher once told me about a guy in Los Angeles he spoke to who would have unprotected sex if his partner had clean matching socks on. The reasoning went that if he was a nice, clean enough guy to have nice, clean enough socks, they it's likely he wasn't a skank and therefore HIV-negative. Sounds pretty silly, but it's a risk assessment strategy, albeit a poor one.

We are all responsible for making decisions about how much risk we can tolerate. Just about any sex can lead to the transmission of an STD; bottoming for anyone carries some risk of exposure to HIV, no matter how minimal if we choose to engage in sex, a major part of being alive, then we are taking risk. If we have sex with people we don't know, or with people we do know, but whose status we can't be 100 percent sure of, we are taking a risk.

While serosorting is a strategy that attempts to lower that risk, as Bareback Top makes clear, sometimes, for whatever reason, we are likely to be taking risk with less than complete information. Like we do when we are drunk, or high, or deeply in love, or deeply in lust, or inexperienced, or desperate, or stupid or lonely. How much risk we are willing to take is a combination of our mind's intelligent assessment and our hearts over-riding blindness to circumstance based on our desire in the moment. That leads back to the altruism issue. What alternately upsets and turns people on about Bareback Top is that he puts his needs for sexual satisfaction and thrill above others. He turns other people into objects, his playthings, and gets a kick out of when their intentions to protect themselves and others are undermined by their desire for hot sex and closeness with another human being. 

In his most recent posting, Bareback Top describes fucking a young guy without a condom and his assumption that it's the first time the kid has been fucked, He says that the kid was clearly in pain. But he did what he wanted and took care of his own needs, popping a nut up the guy's tender ass. Did he give the young man HIV? Probably not, presuming he's still correct that he doesn't have HIV. Did he give the kid any other STD, who knows? Did he use another human being for his own pleasure at the cost of his own and the other person's humanity? Sounds like. That occurs with a cost that Bareback Top has yet to become aware of. You pay for such cavalier games with a little piece of your soul.

Most of us have probably used other people at some time or another for our own gratification. That's called exploitation. The lucky among us learn to regret it.

Testing and Hearing HIV Test Results Together

via The Associated Press, by Carla K. Johnson

CHICAGO — Newly dating and slightly anxious, two men bared their arms for blood tests and pondered the possibility that one of them, or both, could be infected with HIV.

An innovative program — called Testing Together — would allow them to hear their test results minutes later, while sitting side by side.

In this Jan. 5, 2012 photo, Dominic Poteste, left, and Eric Zemanovic pose before taking HIV tests together at the Howard Brown Health Center in Chicago.

Testing Together, now under way in Chicago and Atlanta, takes an unusual approach: It encourages gay male couples to get tested together and hear their results together.

In this Jan. 5, 2012 photo, Dominic Poteste, left, and Eric Zemanovic pose before taking HIV tests together at the Howard Brown Health Center in Chicago.

Testing Together, now under way in Chicago and Atlanta, takes an unusual approach: It encourages gay male couples to get tested together and hear their results together. 

.Eric Zemanovic, a dental hygienist, and Dominic Poteste, a restaurant server, had been dating two months after a yearlong friendship. In the past, they'd both practiced safe sex and got regular HIV tests.

Both are in their early 30s. They'd grown up when AIDS meant an early, horrible death. So, whenever they heard about friends testing positive, they felt pangs of fear.

Poteste explained: "There's always an anxiety that comes with getting tested, even though 99 percent of the time I've been safe and been careful, there still is always ..."

His voice trailed off.

"A slight possibility," Zemanovic completed the sentence.

"A slight possibility," Poteste agreed.

Testing Together, now under way in Chicago and Atlanta, takes an unusual approach: It encourages gay male couples to get tested together and hear their results together.

After delivering the results, a counselor talks with the couple about what to do next, including agreements they may want to make with each other about sex and health.

Are we agreeing to be monogamous? Is any sexual activity outside the relationship OK? How are we going to protect each other from infection? Couples address these questions and more.

The idea is to bring honesty to sexual relationships, said one of the researchers behind the program, Rob Stephenson of the Rollins School of Public Health at Emory University in Atlanta.

Relationships offer only "mythical protection" from HIV, Stephenson said. Some couples may have avoided talking about each other's HIV status, thinking, "If he were HIV positive he would have told me," or "If he wanted to know, he would have asked."

Poteste and Zemanovic, the newly dating Chicago couple, differed in their past approaches. Zemanovic was in the habit of asking his sex partners about their HIV status; he was "neurotic" about it, he said.

Poteste hadn't been as sexually active as his new boyfriend, but he hadn't always asked the questions: Have you been tested? What's your status?

"You have an assumption that if there's something this person could do to potentially hurt me, they would tell me," he said.

Zemanovic hoped getting tested together and discussing results with a counselor would build trust between them.

Poteste hoped the counselor could help them start a conversation so they could ask and answer difficult questions.

It started in Africa more than 20 years ago. Researchers believe couples testing has successfully reduced the spread of AIDS among married, heterosexual couples in some African regions.

One study that looked at couples where one spouse is HIV positive and the other is HIV negative estimated that couples testing was cutting the rate of transmission by more than half.

In Washington, D.C., where the rate of HIV infection rivals some African nations, some community agencies allow couples to test together. Family and Medical Counseling Service Inc. has been testing about 145 couples together annually since 2008. Most are heterosexual couples.

In Chicago and Atlanta, Testing Together, funded by the MAC AIDS Fund, hopes to test 400 couples by the end of the year.
___
Each participant in Testing Together signs a consent form that addresses receiving counseling, testing and results with a partner in the same room at the same time with a trained counselor: "I hereby consent to allow my partner to know the results of my HIV test," it begins.

The program challenges conventional practices in the United States, where HIV testing is usually private and for individuals only. At most other clinics, a man who asks if his partner can be there when he hears his test result is denied because of patient confidentiality concerns.

There are two trends fueling Testing Together. One, the number of gay Americans telling the U.S. Census they're living with same-sex partners nearly doubled in the past decade, to about 650,000 couples. About half those same-sex partnerships are gay men.

What's more, a new line of research suggests that up to 68 percent of new HIV infections in gay men come from a main sex partner, not from casual sex, in part because main sex partners are more likely to forgo condoms.

Counselors are trained on how to deliver test results, with particular emphasis on how to tell partners the most difficult news: one partner has the virus and the other doesn't.

With these so-called "HIV discordant" couples, counselors have a great opportunity to reduce the spread of the virus by helping the couple learn ways to protect the uninfected partner, primarily through correct and consistent condom use.

Counselors are trained to dispel myths. If the couple thinks the test result means one partner has been unfaithful, the counselor might point out that the infected partner could have acquired HIV before the partner became a couple.

If the couple believes the virus is "sleeping" and can't be transmitted, the counselor might explain that HIV can be transmitted even if there are no signs or symptoms.

If the couple believes their status is proof that precautions aren't needed, the counselor might explain that HIV could be transmitted in the future as the infected partner's virus levels rise.

Sam Hoehnle is a counselor in the Chicago program. "It never becomes easier emotionally" to deliver the news to an HIV discordant couple, Hoehnle said. He tells the HIV negative partner his results first, then spends more time and attention on the HIV positive partner.

He's seen partners support each other, but he acknowledges he can't read minds. A show of compassion could mask anger or fear.

"You don't know what's happening internally, in their heads, about how they're feeling about each other," he said.


Read the rest

The Safety Spectrum: Negotiating Strategies and HIV Risk

via aidsmap, by Gus Cairns

The vast majority of gay men, HIV-positive and negative, make some effort to moderate their risk of transmitting or acquiring HIV, Dr Limin Mao of the University of New South Wales in Australia told the Tenth AIDS Impact conference.

The results of three annual surveys show that the decisions faced by gay men are much more complex than the decision whether or not to use a condom.

Choices range in terms of the likely degree of protection from HIV they offer: from avoiding sex or anal sex altogether to at least avoiding unprotected anal sex with someone known to have the opposite HIV status.

Using condoms 100% of the time for anal sex is still the most popular single strategy, the study found, but only a third of HIV-negative men and a quarter of HIV-positive men now do this.

Taken as a whole, strategies involving basing whether to have unprotected anal sex on a partner's HIV status (serosorting) are now at least as popular as consistent condom use.

The study found a clear difference between serosorting practices according to participants' HIV status. The second most popular safer-sex strategy for HIV-negative men was to restrict unprotected sex to an HIV-negative regular partner – a strategy that has been called 'negotiated safety'.

HIV-positive men were less likely to restrict unprotected sex solely to their primary partner; instead the most popular strategies were to limit unprotected anal sex, both with regular and casual partners, to other HIV-positive partners – or at least to try and exclude having it with regular and casual partners not known to be HIV positive.

The study involved three successive Gay Community Periodic Surveys which took place in eight metropolitan locations in Australia between 2007 and 2009.  Before now, national and international surveys have asked gay men whether they use condoms and, more recently, about their and their partners' HIV status.

But this survey also asked whether, in the previous six months, the respondents' safer-sex behaviour was different between regular or casual partners; and it divided the HIV-positive men into those with an undetectable and detectable viral load.

One hundred per cent condom use was still the most popular strategy, but a minority one, being practised by 33.8% of the HIV-negative men, 25.5% of HIV-positive men with an undetectable viral load and 22.5% of HIV-positive men with a detectable viral load.

Read the rest

 

Touring an HIV+ gay sex club, plus the porn stars that got away...

via My Fabulous Disease, by Mark S. King

The idea that HIV positive people still want sex is as old as The Denver Principles, the 1983 manifesto drawn up by gay men with AIDS that demanded “as full and satisfying a sexual and emotional life as anyone else.” The document also stated that people with HIV/AIDS have an ethical responsibility to share their status with others.

Fast forward to today, and HIV positive gay men are as open as ever about their status and their sexual preferences (setting aside, if we can for the moment, the increased stigma and discrimination facing HIV positive people of all stripes who disclose their status these days). And those sexual choices may not include HIV negative people at all, thank you very much.

Last year I taped a tour of a sex club that hosts a monthly “Poz4Play” party, and sat down to interview Bill, the party’s disarmingly unflappable host. In this video blog (the video, above, is PG rated but the language is explicit), I revisit the tour and get an update from Bill about the strong reaction to the original video, which includes a frank conversation on barebacking, the risk of other STD’s, and serosorting.

UK Gay Men’s Sex Survey: new data on age, strategic positioning, condom failure and HIV testing

via Aidsmap, by Roger Pebody

Sexual behaviours that are most likely to result in acquiring HIV are most common in teenagers, while those behaviours most likely to pass on HIV are most common among men in their thirties. These are some of the results of the 2008 United Kingdom Gay Men’s Sex Survey, released last month.

The survey also suggests that more men than ever have tested for HIV (including one in ten at a GP's surgery) but that less than half had done so in the previous year. There is also some evidence of ‘strategic positioning’ during oral sex and information about behaviours which lead to condoms splitting or coming off.

At the same time, researchers have issued preliminary data from a similar survey conducted across Europe in 2010. With over 180,000 men completing the questionnaire, it is the largest sexual health survey ever conducted with gay and bisexual men.

Read the rest. 

Hmmmm, so serosorting may actually work?

[Interesting item, especially in light of the fact so much of the discussion around this prevention strategy has focused on the downsides... Seems it's a bit more complex than that.]

Serosorting Is Associated with a Decreased Risk of HIV Seroconversion in the EXPLORE Study Cohort

via PlosONE

Philip SS, Yu X, Donnell D, Vittinghoff E, Buchbinder S (2010) Serosorting Is Associated with a Decreased Risk of HIV Seroconversion in the EXPLORE Study Cohort. PLoS ONE 5(9): e12662. doi:10.1371/journal.pone.0012662

Abstract

Background

Seroadaptation strategies such as serosorting and seropositioning originated within communities of men who have sex with men (MSM), but there are limited data about their effectiveness in preventing HIV transmission when utilized by HIV-negative men.

Methodology/Principal Findings

Data from the EXPLORE cohort of HIV-negative MSM who reported both seroconcordant and serodiscordant partners were used to evaluate serosorting and seropositioning. The association of serosorting and seropositioning with HIV seroconversion was evaluated in this cohort of high risk MSM from six U.S. cities. Serosorting was independently associated with a small decrease in risk of HIV seroconversion (OR = 0.88; 95%CI, 0.81–0.95), even among participants reporting ≥10 partners. Those who more consistently practiced serosorting were more likely to be white (p = 0.01), have completed college (p = <0.0002) and to have had 10 or more partners in the six months before the baseline visit (p = 0.01) but did not differ in age, reporting HIV-infected partners, or drug use. There was no evidence of a seroconversion effect with seropositioning (OR 1.02, 95%CI, 0.92–1.14).

Significance

In high risk HIV uninfected MSM who report unprotected anal intercourse with both seroconcordant and serodiscordant partners, serosorting was associated with a modest decreased risk of HIV infection. To maximize any potential benefit, it will be important to increase accurate knowledge of HIV status, through increased testing frequency, improved test technology, and continued development of strategies to increase disclosure.

Read the full paper.

Serosorting and sex clubs - Mark King's video blog takes us there

"Ever taken a guided tour of a gay men's sex club? Brace yourself," says Mark King. In his latest video blog entry, Mark gets a personal look at what these clubs are all about -- and dives into the controversial topic of whether it's OK for someone with HIV to have unprotected sex, as long as it's with someone else who's HIV positive.




When I was sleeping around, I gladly shared my HIV status because I preferred other poz partners. It meant less anxiety and probably unprotected sex, which I preferred. While my sex partner count has been reduced to 1 these days, it turns out my former sexual strategy has a name: serosorting. Seeking out partners who share your HIV status.

In one of life's ironies, I remember alarmists in the 80s suggesting that HIV-positive people be sent to an island or otherwise segregated so as not to infect others. Today, many gay men are essentially doing just that, by limiting sex to other poz men.

It's risk reduction in an epidemiological sense, but does it simply allow for risky sex that might promote other STDs? And what of the more psychological effect, that is, limiting our bodies (and our hearts) to only those "similarly afflicted"?

I'll tell you where I stand. Any practice that a) promotes HIV disclosure to partners, and b) reduces the chance of infecting an HIV-negative person, is fine by me. Yes, people lie. But as a general practice I believe it is solid risk reduction.

Sign up for Mark's blog.


Source - The Body.com

How many guys are "sero-adapting" in San Francisco?

via U.S. Centers for Disease Control and Prevention Medical News

Prevalence of Seroadaptive Behaviors of Men Who Have Sex With Men, San Francisco, 2004

The researchers set out to define and measure the prevalence of HIV seroadaptive behaviors among men who have sex with men (MSM). Time-location sampling was used to recruit a community-based, cross-sectional sample of 1,211 HIV-negative and 251 HIV-positive MSM in San Francisco in 2004.

To define seroadaptive behaviors, all episodes of anal intercourse were enumerated and characterized by partner type, partner HIV serostatus, sexual position, and condom use for up to five partners in the preceding six months.

The results showed that 37.6 percent of HIV-negative MSM engaged in some form of seroadaptive behavior: pure serosorting (24.7 percent), seropositioning (5.9 percent), condom serosorting (3.9 percent), and negotiated safety (3.1 percent). Some form of seroadaptation was noted for 43.4 percent of HIV-positive men -- including pure serosorting (19.5 percent), seropositioning (14.3 percent), and condom serosorting (9.6 percent). Consistent use of condoms was reported by 37.1 percent of HIV-negative men and 20.7 percent of HIV-positive men.

"In aggregate, seroadaptive behaviors appear to be the most common HIV prevention strategy adopted by MSM in San Francisco as of 2004," the authors concluded. "Surveillance and epidemiological studies need to precisely measure seroadaptive behaviors in order to gauge and track the true level of HIV risk in populations. Rigorous prevention research is needed to assess the efficacy of seroadaptive behaviors on individuals' risk and on the epidemic."

Check out other LifeLube posts on this topic:

sero-adaptation 

sero-sorting 

seroguessing 

Refusing to Have Sex With HIV-Positive People: Why It's Not a Prevention Strategy

Reposted from Trevor Hoppe's Trevorade Blog

I was having drinks with a friend of mine -- we'll call him Patrick here -- this weekend when the subject of having sex with HIV-positive men came up. "Oh, I would never have sex with an HIV-positive guy," he casually remarked -- as if such a thing were already obvious. I was shocked not just by Patrick's statement, but also by the categorical bravado in his delivery. To have sex with HIV-positive men, as he went on to explain, was to expose himself to unnecessary risk of infection. I've been replaying this conversation again and again in my head. How could he be so outrageously calculating in his cooly expressed exclusionary strategy? Today I want to spend a few moments reflecting on these kinds of statements, because I think many people would uncritically read them as legitimate prevention strategies. I will argue here, however, that in reality that these kinds of strategies that are totally bankrupt in terms of actual risk reduction. Moreover, what I think this kind of statement actually tends to do is not actually promote any real reduction in risk, but rather to reinforce and reproduce harmful stigma against HIV-positive people.

Read the rest...

The End of Condoms? Not so much.

by Daniel Reeders, via Trevorade

It's Friday night, the rain has eased, I've just got back from an enjoyable session at a sauna (that's Aussie for bathhouse) and cracked the top off a Beez Neez -- a Western Australian malt beer brewed with honey. It's been a rough week but right now, life is pretty good.

And then I notice an article about PrEP in The Daily Beast. Danger, Will Robinson, mainstream media coverage of HIV prevention! And sure enough, it's a shocker.

I'm mellowed-out enough to admit there are flashes of insight in the piece. It has all the right pieces of the puzzle, but author David Kaufman has jammed them together trying to make an altogether less optimistic picture of PrEP than their proper placement depicts.

And that's a shame, because there's enough genuine uncertainty to write a balanced piece without leaving any gay boys itching to rush out and score themselves some tenofovir.

A big part of the problem is Kaufman's deathly purple prose. AIDS, he writes, is "caught in a 30-year swirl of sex and morality" -- and he's stirring away furiously. In his article, PrEP is a "necessary evil" but "downright dangerous", "game changers", elation and alarm, and cringing PrEP proponents -- holy asslicking assonance, Batman!

HIV prevention is a big field, and there's an ongoing dialogue about PrEP -- as well as the whole complex of related issues like safe sex, versus serosorting, versus barebacking, versus social network interventions, versus combination prevention.

Read the rest.

Unprotected Sex Between HIV-Infected Partners Keeps Immune Responses Activated

Nice article on the health benefits of sero-sorting for HIV-positive men via IRMA Blog -


By Charlene Crabb
AIDS. 23(11):N7, July 17, 2009.

HIV acts as a ‘natural immunogen’, keeping anti-HIV-1 immune responses boosted in HIV-infected male couples who have unprotected sex, say University of California San Francisco researchers [original article from UCSF researchers: PLoS Pathog 2008; 4:e1000185].

Until now, little has been reported on the consequences of continued exposure to HIV in people who are already infected. But serosorting, the practice of identifying sexual partners based on their HIV status, is a growing trend. It often leads to unprotected sex between HIV infected individuals, which poses the risk of acquiring a drug-resistant strain of the virus.

To shed light on the immunological consequences of continued exposure to HIV, Christian Willberg and colleagues studied 49 men, from a San Francisco prospective cohort of couples in long-term relationships, who were suppressing their virus below the detection level (50RNAcopies/ml) with HAART. Twenty-nine men had partners whose virus was also in check due to antiviral therapy, whereas 20 men had viremic partners whose viral loads were more than 90 000RNAcopies/ml.

Using enzyme-linked immunosorbent spot (ELISPOT) assay to compare HIV-1-specific T-cell responses between the two groups, the researchers found significantly stronger (P¼0.001) responses against HIV-1 protease, reverse transcriptase, and integrase peptides in the men with viremic partners. The magnitude of their responses correlated with a greater frequency of unprotected sex, and in particular with the frequency of exposure through receptive (versus insertive) anal sex. No similar correlations were found in the men with nonviremic partners.

‘Rather than losing responses because their own virus has been suppressed by antiviral therapy,’ explains Willberg, ‘we found that the men are maintaining a response because they are constantly being exposed to their partner’s virus.’

That the amount of exposure drives the boosted HIV-1- specific immune responses was also illustrated in three individuals from the viremic partner group whose T-cell responses dropped significantly a year later. Two had partners who started antiretroviral therapy and were suppressing their viral loads. The third had reduced his exposure. (Seven individuals from the viremic partner group had blood samples available froma 1-year followup.)

The researchers note that superinfection is the most likely mechanism to maintain or boost the HIV-1 immune responses. However, HIV-1 sequencing of all participants in the study found no evidence of superinfection at the systemic level in which a new virus overgrows the existing strain. Willberg, who is now at Oxford University, cautions that the study’s phylogenetic analysis does not rule out localized superinfections in the gut, most likely the rectum.

Furthermore, no one knows whether maintaining a high T-cell response is good or bad. Willberg says that keeping an active HIV-1 immune response might help control viral rebound in a person when antiviral therapy fails for some reason, or it could indicate a compartmentalized superinfection and the increased risk of acquiring a drug-resistant strain. ‘It could be a double-edged sword,’ he says.

Stay Negative

Just found out you’re HIV-negative?


Where you go from here
is up to you.

LifeLube recommended!
via GMFA the gay men’s health charity
Part of the Pan London HIV Prevention Partnership


Your next HIV test could also be negative, or it could be positive.

But you can be in control of that. You can stay negative.

Even though you have a negative test result now, this might not be the case in the future if you put yourself at risk.

That’s why it’s important to develop strategies to help keep you HIV-negative. We’ve written this book to help you.

The information in this booklet was accurate on 1 April 2009
Click here to download the booklet.

Alternatives to condom use can help reduce HIV transmission among gay men

via Fridae - empowering gay Asia - by Jan Wijngaarden

The HIV epidemic among gay men in Asia is continuing to grow. 30.7 percent of Thai men who have sex with men are now infected with HIV in Bangkok; in Cambodia, Vietnam and Indonesia between 5-10 percent of men who have sex with men have HIV. In a cross-sectional study among MSM in Taipei in 2004, the HIV prevalence was 8.5 percent; in Singapore in 2007, 4.2 percent; and in Hong Kong in 2006-7, 4.1 percent. In most places our transgender sisters are even harder hit.

And that while transmission of HIV is quite hard, with a relatively low per-contact-transmission chance – HIV is much less efficient than other viruses, such as the ones causing flu or measles. Preventing HIV is relatively simple – covering our favorite organ with a 0.06 mm thick coating whenever we have anal sex...

Yes indeed, I am talking about condoms. So why are – even in places were significant numbers of men are infected with HIV – significant numbers of men still not using condoms? Are they not thinking clearly or what?

Well – perhaps so. A recent study from Sydney, Australia that appeared in the AIDS journal earlier this year (Jin F, Crawford J, Prestage GP et al, 2009) found that even when men do not use condoms, they still employ certain strategies to reduce their risk for HIV infection (or for transmitting HIV to their partners, if they are already HIV positive). Three of these strategies were found to reduce the chance of getting HIV significantly, compared to men who did not use any strategy (and no condoms).

These strategies are not as effective and not as safe as always using condoms, but nevertheless, they are protective.

What were these strategies?

Read the rest.

CDC Meeting Summary: “Consultation on Serosorting Practices among Men who Have Sex with Men”

Here is a link to the full (short and sweet) summary.

[NOTE: Jim Pickett of LifeLube attended this CDC consultation, held Dec 2 - 3, 2008. He is delighted to finally see this summary published, and will be active in pushing this important conversation forward.]

Select highlights:

- "Serosorting is most often defined as a person choosing a sexual partner known to be of the same HIV serostatus, often to engage in unprotected sex, in order to reduce the risk of acquiring or transmitting HIV."

- "The consultants perceived seroadaptation to be a broader and more inclusive term than serosorting and, more consistent with the broader goal of improving the sexual health of gay and bisexual men in the United States. Discussions also focused on possible ways to frame prevention messages, including breadth and content of the messages as well as specific messages for partnerships in which both members are infected with HIV, partnerships in which both partners are not infected with HIV, and partnerships in which the members are serodiscordant or serostatus is unknown."

- "Regarding superinfection, the consultant noted that few cases have been reported in the literature and that the risk appears highest soon after seroconversion and may decline over the course of infection. Some data discussed by the consultants also indicate limited clinical consequences of superinfection. However, the consultants noted the lack of research among African American and Latino men and on superinfection in general."

- "The consultation highlighted the need to clearly define seroadaptation practices, and particularly serosorting, among MSM, and to understand the differing risks based on a variety of contextual factors. Several areas for future research were recommended. The information obtained in this consultation will inform potential future CDC activities, the development of prevention messages or guidance documents, and the creation of future funding announcements. As follow-up to this consultation, CDC will develop a fact sheet on serosorting among MSM that will include definitions of various seroadaptation practices, the state of the science with regard to behavioral patterns and their potential HIV risk under different situations and with different types of partners, and recommendations for future research. The fact sheet will be released later this year."

Read the whole thing.

New data on sero-sorting reveal different implications for HIV- and HIV+

via Aidsmap

A survey of German gay men has found that ‘serosorting’ – restricting unprotected sex to partners of the same HIV status – does not work as a safer-sex strategy.

The survey found that serosorting in HIV positive men increased the risk of having a bacterial sexually transmitted infection (STI) like syphilis or gonorrhoea more than fivefold. Serosorting was also associated with a five times greater risk of a recent HIV diagnosis than using condoms and/or monogamy as a strategy, and was even more risky than having no strategy.

Here, though, the researchers were unable to determine if serosorting was the cause of the HIV-positive diagnosis or the result of it (i.e. newly-positive men seeking out positive partners). Serosorting did not raise the risk of STIs significantly in HIV-negative men, but then exclusive serosorting – having unprotected sex, but only with men known or assumed to also be negative – was a strategy only adopted by a small proportion (3%) of HIV negatives.

The survey was conducted via gay magazines and the internet during 2007 by the Social Science Research Centre of Berlin and 8,170 questionnaires were analysed. The finings were presented as a poster at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montréal last week.

Read the rest.

Increase in serodiscordant casual sex among Sydney gay men at a time when HIV diagnoses have not increased

via Aidsmap

Between 2003 and 2006, there was an increase in the numbers of HIV-negative gay men in Sydney who reported having unprotected anal intercourse with casual HIV-positive partners, report researchers in the online edition of AIDS and Behavior. However the researchers do not believe that these men form "a core group of high risk men".

Iryna Zablotska and her colleagues from the University of New South Wales analysed data from two cohort studies among Sydney gay and bisexual men: the Positive Health cohort of 760 HIV-positive men, and the Health in Men cohort of 1427 HIV-negative men. Both studies asked identical questions about sexual behaviour in annual surveys from 2003 to 2006, including questions on sex with partners of a different HIV status (rather than, as in some other studies, sex which could have been with a partner of a different HIV status).

Among the HIV-negative men, whilst the number having sex with casual partners decreased from survey to survey, there were small but statistically significant increases in the numbers having serodiscordant sex. Those having sex with casual partners they believed to be HIV positive rose from 11% to 13%, and the number specifically having unprotected anal intercourse with those men increased from 3% to 4%.

The number of HIV-positive men reporting serodiscordant casual partners did rise, but there was no statistically significant rise in unprotected anal intercourse with them.

The study examined a number of behaviours that have been previously found to be associated with sexual risk-taking, and confirmed that serodiscordant unprotected anal intercourse with casual partners was more common among men with higher numbers of sexual partners, men who met partners online or in sex clubs, Viagra users, those who injected drugs, men who used 'party' drugs regularly and those having ‘esoteric’ sexual practices (fisting, sex toys, water sports, bondage etc).

However the researchers note that men who had risky sex did not do so consistently. Over 85% of the men who reported having serodiscordant unprotected anal intercourse only reported it at one of their annual interviews, and they typically reported that behaviour with just one or two partners in the previous six months.

Read the rest on Aidsmap.

Risk reduction strategies are safer for Sydney gay men than other unprotected sex practices - but less safe than consistent condom use

via Aidsmap.

Gay men in Sydney who only have unprotected anal intercourse as part of a risk reduction strategy such as serosorting or negotiated safety have a considerably lower risk of acquiring HIV than men who have unprotected sex in other ways, report Australian researchers in the January 14^th issue of AIDS.

Men who have unprotected anal intercourse only as the insertive partner, and those who ensure that their partner withdraws before ejaculation, also had a lower risk of acquiring HIV than men who don't employ any form of risk reduction strategy when they have unprotected anal intercourse.

Taken together, men using any of these practices were three times more likely to acquire HIV than men who had no unprotected anal intercourse (UAI). However men who practiced UAI without any of these safeguards were almost eleven times more likely than men having no UAI to acquire HIV.

Moreover, withdrawal before ejaculation was the riskiest practice studied. It was associated with a five fold increase in the risk of infection (compared to no UAI).

These strategies have been used by gay men for many years and some scientists consider them to be biologically plausible, but until now there has been limited evidence on their effectiveness in the real world. One important study came in 2007 when Fengyi Jin reported that a third of Australian gay seroconverters had tried to employ a risk reduction strategy.

Read the rest.

How many people will you infect with HIV in 2009?

via Ickaprick and Ironpussy (our new fav blog)

Of all the people living with HIV in North America (1.1 million in the US and 58,000 in Canada), how many of them will transmit the virus to somebody new in 2009? Or, put another way: what percentage of poz people will hit New Year's Eve 2009 and say with confidence, "HIV ends with me. I did not infect any sexual partners this year"?

The answer is important for lots of reasons (like measuring the efficacy of prevention efforts), but one stands out more than others. Tracking transmission rates holds the key to proving or debunking the wide-spread belief that HIV+ people are reckless, selfish assholes who don't care very much if they infect other people or not.

Read the rest.

"Most men don’t use condoms at one time or another..."

You don't need to be a hot, speedo-clad Aussie to take advantage of these sexual risk reduction strategies - via Australia's very cool "Cruising" site - which offer clear, non-judgmental info for sexually active gay men beyond "use a condom every time." The site also features good, practical stuff about saunas (bathhouses), backrooms, sex clubs and crusing online, netiquette, cyber sex - and more.

Check it out.

What I do makes a difference

Most men have heard a lot, even from a young age, about HIV and how condoms are the most effective way to stop HIV being passed on. In Australia, HIV remains heavily concentrated amongst men who have sex with men with more than 85% of current HIV infections occurring amongst them. Almost every HIV infection amongst men who have sex with men in Australia has taken place during times when men have had anal sex without condoms.

Most men don’t use condoms at one time or another. Sometimes these decisions are made wisely with an informed sense of the risk being taken and efforts made to reduce the risk of getting or passing on HIV. Other times, these decisions are made in a less-than-informed way, with not a lot of effort being made to reduce risk. Sometimes we’re not really sure how risky or safe what we’re doing really is or we just don’t want to think about HIV at the time. So it’s not until later that we start thinking about the risks we may have exposed ourselves to.

What follows here is not an attempt to advise you to not use condoms. It is given in the knowledge that while condoms and lube are always the easiest and most effective way to stop HIV transmission in casual sex, sometimes men don’t use condoms. At these times, there are other things we can do to reduce the chances of HIV being passed on. Most of these strategies will reduce risk but not eliminate it altogether.


Want to top?

Some men of different HIV statuses fuck without condoms by having the negative guy “top” (that is, be in the dominant or insertive position in anal sex) and the positive guy “bottom” (that is, be in the submissive or receptive position). Sometimes this is called “strategic positioning”. This idea is based on the assumption that the chances of the negative man getting HIV are reduced if he is the one that cums inside the positive man, rather than the positive man cumming in him. It’s also based on the idea that “tops” (men who fuck, rather than get fucked) are less likely to get HIV. While this is true and the chances of getting or passing on HIV are generally greater if a positive man tops a negative man, tops can still get HIV.

Some men have still caught HIV even though they’ve used this strategy. Around 1 in 5 men who recently contracted HIV were tops. This strategy reduces the chances of HIV being passed on, but it does not eliminate the chances altogether. It also means that sometimes men have to take on positions in anal sex that they wouldn’t normally or that they don’t particularly want to do, simply because of the HIV statuses of the two men. It also means that it’s important that both men know what HIV status they are.

I’m pulling out!

Some men reduce the chances of HIV being passed on by pulling out before cumming when they fuck. While this might reduce the chances of HIV being passed on, it doesn’t eliminate the chances altogether. Pre-cum (the clear fluid that comes out of your dick prior to cumming) can contain HIV and little breaks and tears can occur in the lining of the arse when fucking, making HIV more likely to be passed on. HIV can also enter the head of the dick from another man’s arse.

Counting down…

Some men use the results of viral load tests to make decisions about anal sex. Viral load is a test taken by HIV positive men to measure the amount of HIV in their blood. These tests help HIV positive people and their doctors to make decisions about treatment. There van be other factors besides treatments that affect a viral load test result. Other sexually transmitted infections and other infections like the ’flu can increase a person’s viral load.

Commonly, people with HIV who are well check their viral load every three months. It is possible for a person’s viral load to go up and down quickly depending on what else is happening to their health. So, the results of a viral load test taken weeks or even days ago may be very different to what that person’s viral load is now. The lowest viral load results available are called “undetectable”. This doesn’t mean that there is no viral load (only HIV negative people have a zero viral load) – it only means that the viral load is below the level detectable by current tests. Also, viral load tests are measurements of the amount of virus in blood and no test is readily available to measure the viral load in cum. Lots of HIV positive men are interested in knowing whether a low or undetectable viral load result (for their blood) applies to their cum as well. Many experts say that generally, viral load results can be applied to levels in cum, however there is evidence that suggests there can be quite different levels of virus in blood and cum at the same time. Other sexually transmitted infections for example, can rapidly increase the amount of HIV in cum.

Some men make decisions about the chances of HIV being passed on, on the basis of viral load results thinking that an undetectable test means that there is no chance of passing on HIV. This is not true. HIV treatments cannot make an HIV positive man become HIV negative again. Once a man becomes HIV positive it will always be possible for him to pass HIV on to someone else, no matter how effective HIV treatment is for him or how low or undetectable his viral load is. Remember also that a viral load count only indicates what your viral load was at the time of your last test, not what it might be at the moment.


I don’t know anyone with HIV

Some HIV negative men don’t use condoms because they think there aren’t HIV positive men around the places they go to have sex, like beats or sex clubs and saunas. HIV positive people live in all areas of Victoria and Australia – inner city, suburban, regional and rural areas. A lot of people still think that HIV is an inner city problem and that no one in their suburb or town has HIV. Even if we’re travelling and are in a place we aren’t normally, it’s important not to think that there are no HIV positive men around. Wherever you are, it’s important to not guess that a guy you’re cruising or having sex with has the same HIV status as you.

I didn’t think he was positive

Some HIV positive men don’t use condoms in some sex clubs where other HIV positive men tend to gather. If condoms aren’t introduced into the scene it’s easy to think that the other guy is already HIV positive as well. You can never be sure whether another guy has the same HIV status as you.

A lot of the time we think that if a guy has a different HIV status to us, he’ll say so. But a lot of HIV negative men think it’s more important that HIV positive men tell their HIV status. A lot of HIV positive men get rejected by HIV negative men when they say they’re positive. And lots of HIV negative men won’t have sex with a guy they know is positive. You can’t rely on HIV positive men to say they’re positive when they know they’re likely to be rejected. So don’t assume that you’re going to be told when fucking a guy who has a different HIV status to you. Also some men don’t know their HIV status so they couldn’t tell you whether they were HIV positive or negative. A lot of guys who don’t know their own HIV status assume that they’re negative when they might not be.

A lot of men still think they can tell whether a man is HIV positive or negative by looking at him. Men of all ages and all walks of life are getting HIV. There is not one single “type” of man that is HIV positive. HIV positive men look as different from each other as HIV negative men do. And a lot of HIV positive men don’t look “sick”. Sometimes whether a guy introduces a condom or not is what we use the most to indicate his HIV status. But men interpret wanting to use condoms in different ways.

Some men think that wanting to use a condom means a man is HIV negative; others think it means he’s HIV positive. There is evidence that men read condom use in this way differently in different cities and towns across Australia. There’s no way to tell whether a man is HIV positive or negative from the way he looks, how old he is or whether he wants to use a condom or not.

I must be immune

Some HIV negative men have had sex without condoms with men whose HIV status they don’t know and not got HIV. Others have had sex without condoms with men who they’ve even known were HIV positive and still not been infected with HIV. Sometimes HIV negative men and HIV positive men have knowingly fucked together and the HIV negative man has stayed HIV negative. Some of these HIV negative men even think they are immune to HIV. No one is immune to HIV. HIV only needs one opportunity to pass from one person to another, so the more opportunities you give, the more likely it is to happen. In other words, the more chances you take with your HIV status the higher the chances of you getting HIV. Just because something has happened to you once or twice or even many times before, doesn’t mean the same thing will happen each time in the future. So the more you fuck without condoms and the more men you fuck with, the more likely it is you will get and/or pass on HIV.


Read more on the Cruising site.

If you have chosen to ditch the condoms...

LifeLube spotlights BarebackHealth.net as a nice set of resources to help inform you of the risks, with tips on how to minimize the harms. While we do not advocate barebacking, if you have already made the decision to fuck without condoms, we'd like for you to learn all the ways you can keep yourself as healthy as possible.

As the kids used to say, just keepin' it real...

From the site - "There's no question that bareback sex is natural and feels better. But there is still risk involved, regardless of whether you're HIV-Negative or HIV+Positive. And no matter what position you favor, you still ought to keep on "top" of your health. Bareback sex doesn't have to mean unhealthy sex."

Check these out!

"Safer" Unsafe Sex Tips from BarebackHealth.net:

• LOOK! Jack's Spermometer ~ A visual risk assessment chart
• For the HIV-Negative Male
• For the HIV+Positive Male
• For those who are unsure of their HIV status
• The Reason for Containment
• Sero-Sorting instead of condoms
• The Concern Over Reinfection
• Dipping ~ What is it, and is it good for you?
• "Safer Barebacking Considerations" ~ by Michael Scarce
• Sex and the Consummate Cocksucker
• Viral Load ~ What the term "Viral Load" means and does not mean to the sexual player
• Making Your Bareback Party Safer for All
• HIV Test News ~ The latest improvements in HIV testing
• HIV Testing Schedule ~ Get on a program based on your sex life
• The ABC's of STD's ~ HIV isn't the only concern to barebackers. Here's a short guide to STD's
• Disclosing tips ~ Helpful advice on how to tell your recent partner(s) that you have an STD
  
• IMPORTANT INFORMATION FOR TOPS, as well as all barebackers:
  The Ways Your Body Betrays: Why tops are more at risk than previously believed

Hey, have you heard about rectal microbicides? Still in the research and development phase, rectal microbicides may be gels, lubricants, enemas, douches or suppositories that could provide protection against HIV and other sexually transmitted infections in the absence of condoms. Yes, they could make barebacking a safer proposition! Learn more about the ongoing advocacy and research activities to make safe, effective and acceptable rectal microbicides a reality at the home of the International Rectal Microbicide Advocates.