After 32 Years, Condoms Are Still Key
On July 4, 1981, a handful of newspapers ran a seemingly unimportant news item from the Center for Disease Control in Atlanta. The headline read, "Cancer Linked to Gays."
Today, 32 years later, millions of lives have been lost and billions of dollars in research conducted on what we now know as HIV/AIDS. Over the last three decades, countless hours have been poured into discovering every facet of the virus, from how it is transmitted to how some seem to tolerate it while others succumb quickly.
In the fight against AIDS, the only thing that remains constant is the vital importance for everyone who is remotely affected or at risk of becoming infected to try and stay abreast of the latest information.
The biggest question remains, when is it safe to have sex without a condom? This is the question that is constantly asked but never answered to the satisfaction of those most at risk. The answer, however, has never really changed.
The most recent information from the CDC regarding barebacking (condomless sex) was posted in June of 2012: "Use condoms consistently and correctly." The CDC also warned once again that everyone is responsible for his or her own wellbeing.
In other words, no matter what your partner tells you about his status, you should assume that everyone is positive. Even so, distrust in others becomes confusing and dangerous for sexually active men like Conrad, a 28-year-old public relations representative from San Diego.
"I’m so tired of hearing that I am supposed to go through the discomfort of having the conversation [about status], yet not believe the outcome," he complained in an interview with EDGE. "What is the use? So it is up to me to take the risk or not. It becomes difficult to care about anyone but yourself".
Taking Infection for Granted
As with so many people, this question quickly progresses into, "Why not take the chance?" This, in turn, leads to a trend that has been noted in a series of surveys. A 2012 national survey of a random cross section of the gay community is 12 different U.S. cities concluded that the number of men who admitted to having unprotected anal intercourse in the last year had risen 20 percent since the survey was last conducted in 2005.
"Times have not changed that drastically, unprotected anal intercourse is still, and probably will remain the most dangerous behavior in the transmission of HIV as well as other STDs," according to Dr. Roger Friedkin of Baylor Medical Center. This survey found that unprotected sex is more than twice as likely among men who were unsure of their HIV status.
"It is disturbing to see the rise in risky behavior and HIV new infections in younger men (under 30 years old) over the last five years," Friedkin said. "Possibly this rise is due to the fact that these men did not witness the first 20 years of this crisis. They did not see their friends dying all around them. To them, HIV and AIDS have always been a chronic illness and not a threat to their lives."
This attitude can only lead to a steeper rise in new infections as more time is put between youth and the dark, early days of the health crisis.
Treatment of HIV and AIDS has come a long way since the early days of AZT, a highly toxic therapy which has been said to have resulted in the death of many early victims of the AIDS crisis. In the last 10 to 15 years, the antiretroviral therapy "cocktail" has saved countless lives and restored a quality of life to many who would have been considered doomed only years earlier. A large percentage of persons living with HIV are now classified as "undetectable," meaning that their viral load is too low to be detected by testing.
This is a positive milestone in a patient’s personal battle with HIV, but that does not mean that they are totally free of the virus.
"A low viral load means you are less infectious" noted Heathline Medical Review Board member Dr. George Krucik. "It lowers the risk of passing HIV to your sexual partner, and that’s great news. It is important to note, however, that the viral load test only measures the amount of HIV virus that is currently in your blood. An undetectable viral load does not mean HIV isn’t present in your body and in other bodily fluids. HIV is usually transmitted to a sexual partner through seminal fluid or vaginal or anal secretion."
Another factor to consider is that, between tests, a patient can also experience unexplained spikes in his viral load once again increasing the likelihood of infecting others during sexual activity. In the final analysis, using is a condom is still the best way of avoiding transmission or reinfecting others with the virus.
Possibility of Reinfection, STDs
Reinfection is a theory which was introduced several years ago and was met with skepticism by the HIV community. Many dismissed the reports of "superinfection" as a hoax or government propaganda.
The idea was that a person with one strain of HIV could be infected with one or more other strains of the virus, ultimately creating a strain resistant to treatment. As of the latest published study this past June, there are still more questions than answers regarding reinfections.
Though there are still only a small number of known cases -- and even if these reports were the result of "propaganda" -- the fact remains that this has not been proven or disproven. So the decision is a personal one.
Even with serosorting, that is, having unprotected sex with others of like HIV status, there may still be a threat of worsening the current condition of individuals living with HIV.
New infection is not the only concern. In the eyes of many medical experts, other STDs such as syphilis and herpes open a gateway for transmission of HIV by creating ulcers in the skin and protective linings of the body.
Sam, a 35-year-old HIV-positive portfolio manager in New York, described his experience with syphilis: "I wasn’t scared when I was diagnosed with syphilis. I had heard that it can be cured with three somewhat painful injections. But due to my low CD4 count, I had to have four rounds of those shots to bring the concentration to an acceptable level. Ten years later, it is still in my system. It is not so easy to cure I guess. Worst of all, I am still at risk of infecting anyone I have sex with".
Non-ulcerative STDs like chlamydia and gonorrhea increase the concentration of cells in genital secretions which act as targets for HIV.
A recent study by the CDC concluded that 16 percent, or about 1 out of 6 men in the U.S., are infected with HSV-2 (genital herpes). This figure is even higher for women. Surprisingly, though easily transmitted through non-insertive sexual contact, these figures have remained stable within the past 10 years. This may be due to the fact that herpes can remain asymptomatic for many years. So a large percentage of the population may be infected with the herpes virus without even knowing it.
Probably worst of all is the risk of being sexually infected by Hepatitis C and HPV (Human Papillomvirus). If not treated, both of these conditions can result in a variety of cancers, including Hep C-related liver cancer. This form of cancer, when combined with HIV, results in a very high mortality rate.
The only defense against this is regular testing, early detection and treatment at the recommendation of a trusted physician. It has been reported that up to half of the men in the U.S., Mexico and Brazil carry HPV, and that the virus affects men as well as women. In the same study, a strong correlation was made between genital warts, anal cancer, and head and neck cancer.
Though detection and treatment have come a long way since the bleak 1980s, everytime someone has sexual activity, it incurs the possibility of risk and means a potentially life-or-death decision. Which is why experts recommend everyone needs to have a discussion about HIV and STD status before sexual activity -- especially with a new partner.
"I always make a game of revealing my HIV status," Trent, an HIV-positive 32-year-old dancer in Chicago, told EDGE. "Through casual conversation, I gauge a person’s comfort with the topic. If I detect any resistance, I reveal my status to him immediately in an effort to minimize the tension.
"I never wait for the sexual energy to escalate," Trent added. "At that point, a lot of guys will say anything to get in. Know what I mean?"
It may sound like a clique, but even 30-plus years later, we still have to look out for one another and treat every encounter like someone’s life could depend upon it. After all, that is the truth of the matter, and nothing about it has changed.
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