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I'm doing stupid things, over and over
Aug 1, 2007

Hello Doc, Where to begin, well, I am a 43 year old gay man. I have been using safer sex practices (condoms for anal) since the mid 1980s without fail. Now I am becoming more interested in barebacking, see lots of videos, see other guys doing it at parties/back rooms etc. and it fascinates me. In the past few weeks I've also been feeling some depression about life in general and just started thinking "why not have fun at my age, even if I get HIV I'll still live for quite a while and then I can play around all I want without worrying." While at an adult establishment one night, where all of these incidents take place, a guy was rubbing his erection around my rectum and sort of pushing and then we went all the way without protection. It felt so good, since then I have barebacked with three more guys as a bottom and three times as a top. While I'm doing it I want it more than anything and as soon as I'm done with one guy look for another; I have actually bottomed for five guys in one night, although three wore condoms, so only two of those were bare. The next morning I wake up and think "What did I do last night?!" and start worrying about having HIV, then as the day progresses I start thinking about having more sex. I feel like I'm going out of my mind! So, now that you know all this background, I would like to know 1) what sort of risk have I placed myself in bottoming for three guys and topping three guys without protection and 2) any advice on my mental state would really be helpful. Thanks.

Response from Dr. Frascino

Hello,

1. What is your risk for bareback topping and bottoming three guys? Well, for starters, "once, twice, three times doesn't exactly make you a lady." (Sorry, that was a crude takeoff on an old Lionel Richie song, "Three Times a Lady.") The estimated per-act risk for acquiring HIV from unprotected topping or bottoming an HIV-poz partner is 6.5 per 10,000 exposures and 50 per 10,000 exposures respectively. To put it bluntly, it's very risky. Your estimated-risk statistics would be less, as we don't know the serostatus of your buddies. However, any way you look at it, barebacking is sexual Russian roulette and a very bad idea.

2. Regarding your mental state, the key is in your statement, ". . . I've also been feeling some depression about life in general . . . ." There is no doubt depression is playing a roll. In addition, you're feeling guilt ("What did I do last night?!"), because you obviously realize you are placing yourself at risk. Your rationalization of "why not have fun at my age, even if I get HIV I'll still live for quite a while and then I can play around all I want without worrying" couldn't be further from the truth. As an HIVer, I speak from experience! Coexisting with a virus that's trying to snuff out your very existence is not easy or fun. The medication side effects can be brutal and there are no guarantees on how long any of us will live once infected. As for having all the sex you want if you were positive, think again. Once you start disclosing your HIV-positive status, you'll find potential hotties heading for the hills. If you don't disclose, you could find yourself behind bars! (And not the ones that serve martinis!) And I should also add there is always the possibility of superinfection or reinfection (dual infection), whereby you might contract an even more virulent strain of HIV if, even as a pozitoid, you continue to bareback! Add to this the risk of other STDs (gonorrhea, syphilis, etc.) that could cause a well controlled HIV infection to suddenly become worse, further damaging the immune system. Chances are I'm not telling you anything you don't already know. But I wanted to reinforce the fact I don't know a single HIVer who wouldn't give his right nut not to be negative. (And you know how fond we all are of our family jewels.) My advice is that you seek the help of an HIV-knowledgeable/gay-sensitive psychiatrist to help you confront your self-destructive behavior. Stop placing yourself at risk and get HIV tested at the thee-month mark. Forty-three is not too old to find your Prince Charming and live happily ever after.

Dr. Bob



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