Implausible Deniability: Sex and Self-Deception Among HIV-Negative Men

In my last post, I wrote about an experience I'd had some time back. To recap briefly, a guy I'd met at the gym asked me out for a drink one evening, and after we'd spent some time sipping beers at a local bar, it became clear he wanted to get physical. So I did what I always do and disclosed my serostatus. He panicked, and I ended up going home confused and frustrated. While such experiences have been rare for me in San Francisco, just last night I had another one. It's led me to ponder the issue of how HIV-negative gay men think about sex and HIV.

First let me set last night's scene for you. One evening a couple of weeks ago, I met an attractive man named N. It wasn't really our first encounter. N was what I'd call a familiar stranger -- a guy I'd seen at the gym off and on for years and whom I'd occasionally see at my favorite coffee shop in the Castro. I finally introduced myself to him, and we chatted for a while. There was a mutual attraction, and so we exchanged contact information. In the following days, we traded text messages, and I ended up asking him to dinner. N said yes.

We met up at a cozy little French restaurant, and over our meal, we gave each other thumbnail sketches of our lives. I have to say I really liked what I heard from N. You see, N is a doctor and a graduate of one of the country's most renowned medical schools. But rather than taking that prestigious degree and going into a highly paid medical specialty, N chose family practice. An immigrant himself, he went to work at a Bay Area community health clinic where he mainly cares for others from his homeland. His patients are largely poor, and most speak little to no English, so N's language skills come in handy. He told me that he was drawn to this kind of work because it fulfilled his need to give back to people who aren't as fortunate as he is.

I was suitably impressed. Here was a man who possessed so many of the things I look for in a guy. He's smart, attractive, and clearly has compassion for others. We also seemed to share similar views on politics, which is important for a political junkie like me.

After we finished eating, both of us wanted to continue the conversation, so he invited me back to his place. We sat on the couch in his immaculate apartment and talked about our prior relationships, our views of dating, and what we hoped to find in a partner. N seemed more standoffish than he'd been earlier in the evening and appeared intent on keeping his distance. He sat at the far end of the couch and made no move to get closer.

I thought maybe N was just a bit shy, or that perhaps he wasn't sure I was attracted to him. At some point, I decided to break the ice, and I told him I found him handsome. I leaned over to give him a kiss, and although he kissed back, he told me it was important that he share his status with me. I wasn't really anticipating sex on the first date, but I'd certainly planned to disclose if it looked like things were headed that way. Since he'd brought the subject up, I half expected him to tell me he was positive. Instead, N told me softly, "I'm negative." "And I'm poz," I replied without missing a beat. His expression froze, so I asked, "Is that a deal breaker?" He responded, "It has been in the past." (From that, I guess I was supposed to surmise that being HIV-positive was still a deal breaker for him.) It was, he said, a question of his "comfort level." So I told him I respected his wishes, got up, put on my jacket, and said good night.

Now here's what confuses me. I know from our conversation that N is not a monk. He mentioned that he'd been meeting and dating different guys for the last several years. He also admitted to the occasional hook-up. I'm going to assume that he only dates or has sex with men who say they're HIV-negative. I'm further going to assume that he only has protected sex with those men. But if both of those things are true, why is he unwilling to date a guy who's poz?

You might suppose he's trying to avoid becoming infected with HIV. Obviously, I can't argue with that goal, but I have to question N's chosen means of achieving it. If, as I suspect, he's having sex with guys whose serostatus he hasn't actually verified, then he's putting himself at just as much risk as he would by having sex with a poz man. In fact, he may be putting himself at greater risk.

Here's why. HIV is widespread among gay men in San Francisco. Unfortunately, a very significant percentage of those who are infected don't know their status. They may think they're negative when they're not. And if a guy is walking around with untreated HIV, then he's a hell of a lot more infectious than a guy like me, who's on effective therapy and has an undetectable viral load. N could very well have dated and had sex with guys who are unaware of their true status. If he has, then his "comfort level" is all an illusion.

So what is he thinking? My hunch is that he's not. N may well be like a lot of HIV-negative gay men I've met. They're in a certain amount of denial when it comes to the realities of HIV, and their choices are based on their emotions rather than fact. They understandably fear infection, and so they want to limit their sexual contacts to other negative men. Problem is, you just can't be sure of another guy's status unless you insist he be tested before you have sex with him. As any gay man knows, this is hardly a practical solution, and I'm unaware of anyone who actually adheres to it. Consequently, in reality, N and men like him are probably having sex with poz men at least some of the time. Given the number of men out there who don't know their current status, it simply isn't plausible to think you can avoid confronting HIV merely by saying no to men who admit to being poz.

Of course, N's a doctor, and I'm sure he's scrupulous about using condoms to protect himself. But that only shows that on some level he knows he can't just take a man at his word when it comes to HIV status. After all, if he truly believed the guys who say they're negative, then he could dispense with all the latex. So if he recognizes the risk of having sex with a man of unproven serostatus, and he's willing to rely on a condom to protect him against that risk, why can't he rely on condoms when he's with a poz man? At least as far as risk reduction is concerned, I frankly don't see what N gains from refusing guys who tell him they're HIV-positive. And as I said before, N might actually be putting himself at greater risk by hooking up with guys whose serostatus he can't really be sure of.

Mind you, I don't begrudge HIV-negative guys their refusal to date men who are infected. That's a perfectly understandable and legitimate choice. I do think, though, that men who make that choice need to face reality. The reality is that lots of guys who are infected don't know it. There are even a few who know it but aren't honest about it. That means you can't reliably weed out the positive guys just by asking a question. Anyone who thinks he can is simply deceiving himself.

So if you're a negative guy who's hooking up, at least admit to yourself that the guy who tells you he's negative may not be. However emotionally comforting it may be to limit yourself to men who claim to be negative, the fact of the matter is that you may be getting it on with guys who have untreated HIV. The way you protect yourself is by using a condom. And those work just as well with poz men as they do with guys whose status is a question mark.