The plot has never been quite this complicated. At one time, prevention messaging was simpler and, short of abstinence, centered on using condoms. It was that simple. But things became more complicated when the ability of antiretroviral therapy to substantially reduce the risk of transmission became evident. Not only did people have more choices, but these choices became more -- well, complicated. Frequently they involved knowing more about risk than ever before, more about the science of transmission and more about the comparative effectiveness of various prevention alternatives. Throw in controversy, mixed messages, a little bit of moralizing and proselytizing and HIV prevention choices became a bit of a minefield to navigate for the average Joe or Jill.
I don't pretend that this story is at all unique. I tell it because I suspect it may be part of a growing trend -- HIVers assuming the role of caregivers where previously they thought of themselves as recipients of care. It's a bit of an adjustment.
Last time I wrote on this topic I expressed the thought that with many HIVers now living long and productive lives they would increasingly be required to be caregivers rather than recipients of care. My partner is undergoing treatment for prostate cancer, after all. and while the prognosis is pretty good, the balance of who needs help in our relationship, physical and emotional, and who doesn't, has shifted.
I've never really been a high-maintenance patient myself. Only the odd hospital stay here and there, the odd bouts of depression and anxiety which have largely dissipated as the years dragged on since my diagnosis in 1993. I've put on a brave face since day one. No practical things I couldn't do myself either -- although that's not to say I haven't played the patient card on occasion. No more cleaning of fish tanks for me, no dealing with kitty litter, for instance but that was more because I disliked doing these chores rather than any perceived health hazard, but better to be safe than sorry, right? *wink wink*
Some hook-up sites for gay men make it easy to discuss HIV status; others just muddy the waters. But how reliable is the data for deciding what sex to have, with whom and how safely? And how does barebacking fit in? Bob Leahy looks at two popular sites and arrives at some surprising conclusions.
As editor of a respected online magazine for people living with HIV, I made a choice, rightly or wrongly (probably the latter), so that in our magazine's first year or two we didn't cover barebacking. We thought it was too inflammatory a subject, thought it might encourage people to do it, thought that people would think we were irresponsible.
That changed in a big way when we featured Josh Landale, Josh Kruger, Michael Bouldin, Jake Sobo, Mark S. King and a handful of others for whom barebacking is either part of their lives or they have come to terms with it.
One hundred and eighty degree turns happen in a variety of ways. Sometimes we seize the steering wheel of our lives and in one fell swoop travel along an opposite path. Other times, we take the turn slowly, one degree at a time, gradually realizing the path we are on leads nowhere and we need to go off in radically new directions. That's been the case with my realizing that most of my once fervently held objections to treatment as prevention, in 2013, make much less sense than they once did.
In these times when the conversation is all about NON-disclosure, I'm becoming increasingly a fan of the very opposite. In short, I think many more people need to disclose.
Here's the thing. It's unfashionable to say so, I know, but I think we should disclose, when we can do so safely, in almost all sexual and nonsexual situations where it makes sense.
The place of gay/bi men in our response to the HIV epidemic has changed. (And I say "gay/bi men" because I dislike seeing the term MSM -- men who have sex with men -- outside the realm of epidemiology.) Once, in those early days of the epidemic, we were both leaders and the focus of everything about HIV. But over time, and as other at-risk groups became more affected by the disease, that all changed. It had to.
I've never really heard people ask this question -- strange in itself when it looks like every question about HIV has been asked, and written about, often -- whether people living with HIV are inherently different. I'm talking about more prone to taking risks and thus more susceptible to becoming infected. Sure, we know all about vulnerable populations, social determinants of health and all that, which are often fingered as the culprits in HIV infections. But let's face it; the reality is that many, many people from vulnerable populations and with ALL the social determinants of health looking pretty good DON'T get infected. So what is different about the ones who do?