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A Telling Tale of Trick or Treat: Remember to Spit, Don't Swallow!

By Bob Frascino, M.D.

October 20, 2010

Earlier today I noticed a preponderance of pumpkins, Costco-sized bags chock-full of small boxes of Milk Duds and other dental cavity inducers, and munchkin-sized costumes fit for either a mini Lady Gaga or a Tea Party Rally for Christine "I am not a witch" O'Donnell! With my keen sense for the obvious, I realized Halloween (or a GOP takeover of Congress) was fast approaching. Both are scary propositions.

I also quickly realized it was time to shed my full-tilt-boogie procrastination and generate another blog entry. While I fired up my trusty lap-Mac to tippy tap something out and take advantage of my current caffeine-induced craze, a myriad of potential blog topics raced to mind -- Life? Love? Sex? Coffee? . . . Coffee? How did that crop up into the list? Hmm. Well true, I was finishing my third large nonfat vanilla cappuccino of the morning; could it be I have a monkey on my back and his name is Juan Valdez?

A friend just stopped by dribbling his icy frappuccino on my keyboard (thank you very much) and mentioned I seemed "full of PEP" today. Rather than disclose it was my third cappuccino, I made up some nonsense about having added an extra dose of Vitametavegamin to my morning protein shake. As you can probably tell, I was stalling for time to come up with just the right topic for today's missive.

I wiped the sticky icky frap remains from my keyboard as x$%r6&* appeared on the screen. I then reread my last few coherent sentences and noted the words "pep" and "disclose." Hmm. Perhaps I should write about post-exposure prophylaxis (PEP) or maybe HIV-disclosure issues. It is interesting I chose to make a lame joke about my peppy deportment rather than to "disclose" that excessive consumption of caffeine was the true cause of my zippy-dippy demeanor.

Disclosure of any secret is seldom easy and HIV status disclosure can be incredibly difficult, especially when dealing with a potential new trick -- or treat! So let's discuss when and exactly how should positively charged individuals disclose their HIV status to their partners?

This issue is complex, because when, where, how and with whom we decide to do the dance with no pants is so wildly variable. There are those who believe disclosure isn't really necessary, as long as you stick to safer sex guidelines before sticking it in. They very reasonably argue that all sexually active consenting adults know (or should know) the risks involved and consequently should be taking all necessary precautions to protect themselves and prevent any chance of HIV transmission, regardless of what their partners say -- or don't say -- about their HIV status.

There are also situations of anonymous "cum-and-go" sex in back rooms, dark alley ways, sex clubs or saunas where the wham-bam-thank-you-sam occurs before a "how do you do." A detailed exchange of medical information isn't really a viable or realistic option for a gaggle of horned-up hotties in a jacuzzi. Hopefully those participating in these casual sex-a-thons realize the increased level of risk and take appropriate precautions against STDs, including HIV.

Disclosure becomes more of an issue when an HIVer is starting a new relationship. Some virally enhanced folks choose to serosort (date only other HIV-positive partners). Sure, this may simplify things somewhat; however, it sure can decrease your chances of a great date on a lonely Saturday night. Besides, serosorting just isn't a feasible option for everyone.

So why is disclosure such a bugaboo anyhoo? First of all, revealing one's positively charged status is often an immediate deal breaker for impending nookie. And, let's face it, none of us enjoys rejection or being looked at as if one's touch was toxic. Also, there are plenty of cases where this sensitive private information has been leaked or shared by a loose-lipped or malicious "ex."

Consequently, many poz folks, even those with the best intentions, may choose to delay disclosure until mutual trust and affection are established. This tactic, however, can be a double-edged sword because the longer one waits to disclose, the more likely it is the new partner will feel betrayed, particularly if the relationship has progressed to the horizontal mattress mambo stage.

It's important to realize that being virally enhanced doesn't mean you can't or shouldn't have mind-blowing fusion sex, but it does complicate the logistics, as we need to be continually cognizant of protecting our partners and we need to deal with the potential negative consequences of having our HIV status revealed.

One last note, about rejection: If someone dumps you because you are HIV positive, he is rejecting the virus, not you! Buddha was once asked how to brave his critics' insults and anger. Buddha replied, "If someone offers you a gift and you decline to accept it, to whom does the gift belong?" Buddha was one wise and insightful dude! To rephrase his advice in a less contemplative fashion: If someone blows a load of rejection your way because you are poz, just spit, don't swallow!

Want to get in touch with Dr. Bob? You can reach him through his "Ask the Experts" forum, by sending a message to the Robert James Frascino AIDS Foundation, or by leaving a comment for him below. (If it's a private message, or if it includes personal info such as your e-mail address or phone number, we won't post the comment, but we will send it along to him.)

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See Also's Just Diagnosed Resource Center
Telling Others You're HIV Positive
More News and Articles on HIV Disclosure

Reader Comments:

Comment by: Dave (VA) Tue., Nov. 9, 2010 at 5:39 am UTC
Awesome blog and advice!
Thank you Dr. Bob!
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Comment by: Marco (Mexico City) Sat., Nov. 6, 2010 at 12:17 pm UTC
Dear Bob, Tell Juan Valdez that he's lucky to be on the back of a charming wise man the way we are lucky to be ever reading a load of a sometimes salty, sometimes sour, but always wise and sweet writing that I gladly swallow.
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Comment by: leigh (montréal, canada) Fri., Nov. 5, 2010 at 1:45 pm UTC
i simply adore you!!!
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Comment by: Realize (Los Angeles, CA) Fri., Nov. 5, 2010 at 8:48 am UTC
I had the experience of total disclosure before any nookie took place. Granted there was some french kissing and heavy petting, but one evening,as we sat in the car, my now very ex-girlfriend asked me how one gets me into bed and I told her of my status. It was our third date and I was prepared for it to be our last. She was very compassionate and affectionate. But an email followed saying since she wanted more causal sex and a greater commitment was required because of my status she could not continue the relationship, but wanted to be friends. My reaction was with friends like this who needs enemies. After a brief meeting for clarification with her, I was surprised when a week later she sought out a doc who had some experience with HIV, she was educated on how to have safe sex. Eventually we got together. This was my first sexual relationship since being diagnosed - it had been 5 years and to say I was anxious was an understatement. But I was touched by her desire and commitment to connect with me. What started as compassion turned into the malicious ex you speak of. After the relationship ended she chose to disclose in a very public way my status along with some vindictive false and slanderous statements. Why was a question I stopped asking after her actions took on more sinister and bizarre turn. I realized from a Buddhist perspective she was suffering and not well.
My advice - really get to know someone, take your time. If there are things that perhaps sound a bit off and your desire in shutting down your reason, take a deep breath and ask yourself what you really want. For me I wanted a trusting physical and emotional connection with a women, but my desire to connect physically shut down the signs that all was not right in love land. What this all culminated in was a greater self awareness and love for myself as an HIV+ hetero male with beautiful loving relationships in my life. Through disclosure we know ourselves better and offer love to others.
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Comment by: Felix (New York, NY) Thu., Nov. 4, 2010 at 5:39 pm UTC
I posted an ad on Craigslist for NSA sex while on a business trip, and arranged to hook up with someone in my hotel room. My ad said "safe only", which I thought was generally understood to be code for "I'm HIV+". We started making out in my room, just kissing, and then he asked me about my status, and I disclosed it to him. He completely freaked out, blamed me for not telling him before, and left. An hour later, my Craigslist ad was flagged for removal, I assume by him. Do you think someone posting an ad for no-strings attached safe sex needs to state upfront that he's HIV+? At what point in the sequence of events should I have told this guy about my status?
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Comment by: Elizabeth M. (San Francisco, CA) Thu., Nov. 4, 2010 at 3:54 pm UTC
Could you be more funny?!!!! I love your columns...straight, positive, female that I am. Thank you! Your irreverent style helps to put this (and all you write) into an "in-our-face" perspective, often for me suggesting that I "get past myself". In my case, my husband (tied the knot a few months ago) is working up courage to disclose to his Christian fundamentalist parents. My blog about "Living Biology" is about to go "live" it I am very open about my HIV status and my life. He has not been and it has been 17 years of silence. One memorable moment was listening to his parents discuss family photos, including one of his father's employer, hugely loved and respected, that died of AIDS. It was surreal sitting across the table from them, holding their son's (HIV+ son's) hand, silent. I believe that secrets gnaw at the soul. I believe liberation is earned by being willing to be visible, by owning one's life. Disclosure is a lot about this for me. Certainly, facing a great fear and in some fashion letting go of another's reaction is a courageous act. My husband is working up that courage. Thank you Dr. Bob. Kisses - Elizabeth
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Comment by: Hank O. (Midland TX) Fri., Oct. 29, 2010 at 3:08 pm UTC
I do understand the complexity of this topic, but about a month ago I asked a question of the body and never heard anything back. There are two people living in Odessa and they are intentionally infecting people with HIV. One has been brought in and warned several times by the Midland Health Department, but they can not do anything due to HIPPA laws. I am a third party in this situation. I am not directly involved. I was asked if I had any advise. I am an engineer, but I am not well versed in the HIPPA laws. What would you suggest to be done in this case? I am outraged. I hate to think anyone is condemning anyone to live the viral life I am living. I do understand they anger, but the people being infected are not to blame and should not have to pay this high price.
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Life, Love, Sex, HIV and Other Unscheduled Events

Bob Frascino, M.D., was President and Founder of The Robert James Frascino AIDS Foundation. He had been an outspoken, popular expert in's "Ask the Experts" forums on safe sex and fatigue/anemia since 2000. Once a Fellow of the American Academy of Allergy, Asthma, and Immunology, and the American Academy of Pediatrics, Dr. Frascino served as Associate Clinical Professor of Medicine, Division of Immunology, Rheumatology, and Allergy, at Stanford University Medical Center from 1983 until 2001. He was a member of the American Academy of HIV Medicine and had also been a distinguished member of the executive boards of numerous state and regional associations.

We're inexpressibly saddened to share the news that Dr. Frascino passed away unexpectedly on Saturday, Sept. 17, 2011. Click here to read more and to share your thoughts.

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