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WAKE UP CALL ON DISCLOSURE
Apr 19, 2008

This is more of a statement than a question. I have been a fan of Dr. Bobs for several years now here on The Body, and thought I had learned alot about how to do my best to protect myself from HIV and other STD's. As a BI male, (I Know the lowly BI male) I knew my risk was greater than heterosexual males. I have always done my best to be safe. But recently I was exposed to HIV due to a condom break with a couple who after the fact (after asking 3 times in fact)disclosed that they were HIV poz. Consequently, theres a pretty good chance I'm poz as well now. I have always been in agrement with DR. Bob that one should not rely on disclosure and must assume all partners are poz, as many are and dont even know. But there alot, or at least a significant amount, of gay and bi men out there (as well as str8 Id guess) who choose to lie to thier partners about thier status. The couple I was with told me they were both neg when asked and I still insisted on a condom. They complied, but when one of them topped me they had stretched the conndom for some reason and broke it at the base of his penis, exposing me to precum. When I noticed the condom after sex it was broke and he said it broke only when he was taking it off. I know Dr. Bob says condom failures are usually obvious, but the key word here is usually, and do you want to stake your life on it? I only found out these individuals were poz a week later, far to late for PEP, from someone else and finally they admitted it. In fact one of them had AIDS-not just HIV_and consequently a high viral load. While I take rsponsibility for having sex and knowing that condoms do fail occasionally, it is a moral obligation to inform a partener of any risk they maybe taking knowing that condoms do fail or are intentionally broke. In other words condoms are not 100% effective for reasons other than physical failure. People can and do lie about thier status. Had I known the individuals were poz, I would not have even risked a condom failure with them. Disclosure is a important peice of information people need to have to set thier safety and risk levels. I must vehemently object to any notion that non-disclosure is a trivial matter. It is a matter of life and death. I have heard of this happening to other guys and it seems to be becoming more frequent in the gay/bi community to lie or intentionally break condoms. The bottom line is beware that use of a condom is not a 100% reliable saftey measure-only no sex at all is- esp if guys are going to break condoms on purpose knowing they are poz. And for all you poz guys thinking using a condom is a substitute for disclosure, your wrong. Your partner deserves to know if the condom fails they will definitely be at a serious risk, and let them decide if they will take that risk. You shouldnt decide it for them. Needless to say Im very angry, sad, and scared. This exposure/transmission was preventable with a little thought for ethics. Here I sit 2 weeks later with ARS symptoms, fatigue, headache, runny nose,myalgia ect from a totally selfish act on the part of two people who apparently could care less about the life and health of anyone but themselves. Beware, they are not unique. Becasue I am Bi I have always been cognizant of the risk I put women at by my risky MSM behavior, and never sleep with women unless Ive been tested and am sure Im not in a window period. Even when I do I always have been safe for thier benefit as well as mine. I have lived my life in fear of a disease that I have finally caught. I asked one young gay guy once why he and others barebacked knowing the risks. He told me-"we are all going to get it anyway, may as well get it over with." Consequently many of them have little regard for those of us who do not share that attitude. Looking back on it it seems he may have been right. If you play long enough, a condom will break or someone will break one for you. Sad but true. So Dr. Bob, while I respect your obvious intelligence and expert advice, I think you error in defending non disclosure. I dont think its enough to say that its "better " to disclose before. I think it morally and ethically mandatory. A persons right to privacy does not outweigh the value of a human life. I have oft heard you say that Knowledge is power. Each person should have power over there own risk levels and to not disclose effectively retains that power for the one person, placing the other at risk. If one knows, one should disclose PRIOR to having sex, condom or not. Oral, anal or vaginal. Its just the right thing to do. Becasue one man didnt disclose for fear of losing a round of sex, a son will be without a father, and another life will be snuffed out by this disease. I am devestated, and have yet to come to terms as to how i will tell family and friends, and my child. I am full of hate for this man for taking away my opportunity to decide for myself what risk I am willing to take. Id like to end by saying that I have enjoyed your insights, humor and witty writing style. I wish you the best of luck.

Scott

Response from Dr. Frascino

Hello Scott,

I'm puzzled why you think I defend non-disclosure. If you reread my comments, hopefully you'll realize that is not the case. I strongly encourage disclosure. However, as you recently found out, that doesn't always happen. Plus, it is estimated that at least 25% of the over-1,000,000 HIV-positive Americans have absolutely no idea they are infected. Consequently the critical point I try to make is that you cannot rely on disclosure. Each of us must take responsibility for our actions and take all the necessary precautions to protect ourselves and our partners.

I'm curious why you think the guys who topped you intentionally broke the condom. How do you know they "stretched the condom for some reason"??? If you saw someone improperly using a condom, you should have done something about it right then, not place blame after the fact.

You are correct: Condoms are not 100% reliable in the heat of passion, primarily because they are not used properly. However, when used properly, they very seldom fail. I also tend to doubt your comments about HIV-positive guys breaking condoms on purpose. That indeed would be morally reprehensible.

I should also point out some of your other assumptions are not accurate:

1. ". . . exposing me to precum . . . there's a pretty good chance I'm poz as well now." Actually, no, the odds remain very much in your favor that you did not contract HIV from this unfortunate encounter. Remember, not every exposure leads to viral transmission. In fact the vast majority do not.

2. "In fact one of them had AIDS not just HIV and consequently a high viral load." No, having AIDS doesn't mean you automatically have a high viral load. In fact many "just HIV" folks have much higher plasma viral loads than AIDS patients who often have their viral loads suppressed to undetectable levels with antiretroviral therapy.

3. "Because one man didn't disclose for fear of losing a round of sex, a son will be without a father, and another life will be snuffed out by this disease." I think you're being a bit overdramatic here. You are the one who chose to have sex with these guys and by your own statement you said you agreed with my premise that we "must assume all our partners are poz." So if you assumed they were poz, what difference does it make? You still chose to proceed with your roll in the hay.

I'm not defending non-disclosure; I'm merely pointing out you have no reason to blame others for personal decisions and choices.

No doubt you are indeed "very angry, sad, and scared." You also need to be realistic. Chances are your degree of panic is heightened by the fact your potential exposure occurred while you were being topped by a guy. "Disclosing" this fact may be as uncomfortable for you as disclosing a medical diagnosis. Disclosure is not an easy issue Scott, no matter how much you feel it's an obligation. For instance, I note you are already flummoxed by trying to "come to terms as to how (you) will tell family and friends, and (your) child." I fully realize these are two very different types of disclosure, but I merely wanted to point out it's not so cut-and-dried when you are the person having to do the disclosing!

Scott, my advice is that you get some psychological/psychiatric counseling. You need to begin to deal with some issues, including sexual orientation, guilt, irrational fears, anger, etc. You also need to stop blaming others and man-up to your own behavior and risks. I'm not saying you did anything wrong and yes, the other guys should have disclosed; however, you took the risk (remember, you "assumed they were poz") and subsequently you have to accept the consequences of your actions.

There is an excellent chance you have not contracted HIV from this episode. However, obviously, you need an HIV test at three months and, if negative, a confirmatory test at six months. Whatever the result, I believe you would benefit from counseling.

Good luck.

Dr. Bob



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