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great NY times article on testing
Jun 9, 2004

great article

June 1, 2004 The New H.I.V. Test Offers Quicker Results, but the Same Agony By DAVID TULLER/NEW YORK TIMES

Nothing I had done in the two years since my previous negative H.I.V. test led me to think I would come up positive this time around. But I am a 47-year-old noncelibate gay man in San Francisco. And like many of my friends, I try to get checked every now and then as a psychological reminder of the payoff I get from staying safe.

The one-week gap between getting blood drawn and receiving the results has always been harrowing. The wait guarantees a slew of restless nights, but it also focuses your mind and forces you to confront your fears and your past.

You replay your recent sex life on the video screen of your mind, pausing to examine certain moments in excruciating detail. You drive yourself nuts by concocting images of far-fetched but theoretically possible routes of infection. You stumble through the five stages of grief described by Elisabeth Kübler-Ross. When the result comes back negative, the wave of relief helps to quell, at least for a while, the chattering in your brain.

So I wondered how it would feel this time taking the new rapid H.I.V. blood test, which crams the one-week cycle into 40 or so minutes. The Food and Drug Administration approved this new test technology in November 2002, and more recently approved a test that uses saliva instead of blood.

About a third of those who take publicly financed standard H.I.V. tests fail to return for their results, according to government figures. And because many of these tests are anonymous, contacting those who are infected is not an option. Health officials hope the growing use of the rapid test will help to increase the numbers of H.I.V.-positive people who know they have the virus.

At my local health clinic, the H.I.V. test counselor - eager, earnest, spike-haired - looks about 13 but tells me he is 33. He has lost a partner to AIDS, as have I.

He has a pretty tough job. Notwithstanding the remarkable treatment advances of recent years, I would not relish having to inform frightened young men and women that they are infected with a lethal virus.

He explains that they need just a pinprick of blood from my fingertip, not the vial from my vein that the standard test requires. That is a real blessing for needlephobes like me. He also tells me that a negative result is conclusive, but that if it is positive, he will have to draw blood for a test to confirm.

He sends me next door, where a cheerful health attendant jabs my finger. When I return, he begins the usual battery of questions about my sex life.

Condoms? Always. Any broken ones? No. How many partners in the last year? Enough. Positive partners that you know of? Yes. Women? None. Sex under the influence of alcohol? Rarely.

We discuss the relative risks of anal sex (high) and oral sex (very, very low).

I know that one answer to the epidemic for a single gay man is to avoid sex altogether. But I treasure human touch, so celibacy does not feel like a viable option to me.

I could also, I suppose, limit my contacts to H.I.V.-negative men. Straight people recommend that strategy as if it is a no-brainer. But they are not confronting a dating pool so full of potential risk. In my city, lots of the gay men I meet are H.I.V.-positive. Thanks to the current crop of medications, many have successfully kept illness at bay and continue to lead full lives.

To reject such a huge number of people out of hand feels wrong, like rejecting someone for having cancer or diabetes. That sort of discrimination, however understandable, long ago earned a name in the gay community: viral apartheid.

I certainly know men who have come up positive in recent years. Broken condoms. Slip-ups. Impulsive acts fueled by lust and drugs and a hunger for connection. I have known the pain that brought them there - the death of friends and lovers, the loneliness. I see how getting infected might bring some flicker of relief; it's done, the fight's over, you can relax now.

I have found myself so tempted, after so many years of self-restraint, to chuck it all and break the bounds.

But I'm me, so I don't. Because I know that then the tests and drugs and treatment decisions would start for real, and that they would stretch before me without end.

If you are gay, and you live in San Francisco, these anxieties fade in and out of consciousness. But the week of waiting to learn your fate always delivered them in a concentrated dose. This time around, there is little chance for them to gather intensity and power. And the relief, when it comes, feels like an anticlimax.

My 13-year-old counselor goes next door to retrieve my results. My chest tightens. He comes back in. He's grinning. "Well, it's negative, like you thought," he says.

My body sags. I smile. I pull my jacket on, stand up, thank him and pass through the waiting room, where several men sit and fidget. I am still in the clear, but it is likely that someone else will be getting bad news tonight.

Response from Dr. Frascino

Hello,

Yes, I did see this article in the New York Times and I'll be more than happy to post it here for our readers, as well as in the Safe Sex/HIV Prevention Forum. Thank you for sending it in! It raises many very valid points that I'm sure we can all relate to.

Stay well.

Dr. Bob


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