[S]exual Health Week upon us, which means it’s time to have that awkward STI chat.
You might be in a loving relationship or think you’re a few decades past your sexual prime, but the STI talk isn’t just for teenagers. According to research last year there has been a surge in sexually transmitted infections in the over 45s (with a dramatic 25% increase in STI diagnosis in women over 65s).
Meanwhile, back in December, it was reported that a third of Brits with an STI caught it while in a relationship – the survey also revealed 39% of people didn’t tell their partner they had an infection.
STIs have been with us for centuries. In the past mercury, arsenic and sulphur were used to treat venereal disease – which had serious side-effects, including death due to mercury poising. The introduction of Penicillin and modern medicine in the 20th century meant, thankfully, the big difference now is that greater awareness and modern medicine means they can be treated much more effectively.
Prevention and education is best practice, so here are what you need to know about six of the more commonly-known STIs…
1. Chlamydia
Chlamydia is the most common STI in the UK mainly due to many people not knowing that they have it. Symptoms can vary between men and women and most have no symptoms at all.
Men can experience pain or burning whilst urinating, cloudy discharge from the tip of their penis, and discomfort in their testes.
Women can sometimes experience a similar discomfort when urinating and discharge from their vagina, pain and/or bleeding during or after sex, and heavier or irregular periods. Usually though, they have no symptoms at all.
If chlamydia is untreated it can lead to serious pelvic infections and infertility so it is very much worth getting checked regularly.
How to treat it
Chlamydia can be diagnosed through a simple urine test, and fortunately can be treated with a single dose of antibiotics.
2. Genital Warts
Genital warts are the second most common STI and can be identified as small fleshy growths around the genitals or anal area. The warts are generally not painful, however may be itchy and irritable. While condoms are the best preventative method for genital warts because they are spread by skin-to-skin contact the area around the genitals my still become infected.
Treatment
Creams and freezing can get rid of them.
3. Genital Herpes
Genital herpes is a common infection and is caused by the same virus that causes cold sores (HPV).
Symptoms can occur a few days after infection and can generally be identified by small uncomfortable blisters which can really hurt – making urinating or just moving around very uncomfortable. The blisters go away by themselves after about 10 days but very often come back again whenever your immunes system gets a bit low or distracted.
Treatment
Unfortunately, there is currently no definitive cure for genital herpes, however each attack can be very effectively managed by using anti-viral medications which you can get from your doctor. Try to have the medications on hand because the sooner you use them in each attack the better they will work.
4. Gonorrhoea
Gonorrhoea is caused by bacteria called Neisseria gonorrhoeae or gonococcus. It can spread easily through intercourse, the symptoms are similar to those of chlamydia except usually more pronounced. If the person experiences discharge from their penis or vagina it can either be yellow or green in colour and there can be quite a lot of it.
Like Chlamydia though, the symptoms are not always present.
Treatment
The infection can be identified through a swab or urine test, and can be treated with antibiotics. Unfortunately, bacteria is getting resistant to more and more antibiotics and treatment is getting more difficult. Right now, though it is still well treated with an antibiotic injection.
5. Pubic lice or ‘crabs’
Crabs have commonly been seen as the funny STI and are often the punch line to many a joke. But as with all STIs, the reality really isn’t very funny.
Also known as pubic lice, crabs can be easily spread through bodily contact. They are usually found in pubic, underarm and body hair, as well as in beards and sometimes in eyebrows and eyelashes. The lice crawl from person to person, and can take weeks to become visible. They are usually spotted due to itchiness and in some cases people can find eggs in their hair.
Treatment
Pubic Lice can usually be treated using creams or shampoos which can be purchased readily from pharmacies.
6. HIV
Of all the STIs mentioned HIV probably is the most famous and feared. In the 1980s having HIV was effectively a death sentence and, tragically, it brought with it huge stigma. Thankfully, today modern drugs have had a huge impact on the HIV community, enabling them to live happy and healthy lives. But what is it?
HIV is a virus which attacks the immune system and is most commonly spread through unprotected sex. Many people with HIV appear healthy and do not display any symptoms, but they may experience a flu-like illness with a fever when they first become infected.
The final stage of HIV is AIDS, this is where the immune system is no longer able to fight against infections and diseases.
Treatment
There is currently no cure for HIV – however, modern medicine has come a long way enabling people to live long and otherwise normal lives.
Sex is great, but safe sex is better. If you’re concerned about STI’s visit your local sexual health clinic for a screening.
[T]he sexual revolution of the 1960s and ’70s came to an abrupt and brutal end for many gay and bi men the moment AIDS was traced to sexual contact. In the early days of the epidemic, sex between men was equated with AIDS, not just in the mainstream media, but also in prevention efforts by other gay men. Since AIDS in those days was seen as a death sentence, for men who had sex with men, every sexual interaction carried the risk of death. Indeed, tens of thousands died of AIDS-related conditions.
“I was alive when homosexuality was [still] considered to be a psychological illness,” David Russell, pop star Sia’s manager, recently told Plus magazine. “The two generations ahead of mine, and a good portion of my generation, were completely decimated by AIDS. They’re gone.”
While some men with HIV outlasted all predictions and became long-term survivors, the widespread adoption of condoms is credited with dramatically reducing HIV transmissions among gay and bi men in subsequent years. Yet reliance on nothing but that layer of silicone — a barrier some complain prevents true intimacy and pleasure — couldn’t erase the gnawing dread gay men felt that every sexual encounter could be the one where HIV caught up to them.
There have been, of course, moments when nearly every gay or bi man has allowed their passions to override their fears and enjoyed the skin-on-skin contact that opposite-sex couples often take for granted. Thinking back on those unbridled and unprotected moments of passion filled many of these men with terror, regret, and guilt.
“Shame and gay sex have a very long history,” acknowledges Alex Garner, senior health and innovation strategist with the gay dating app Hornet. “And it takes much self-reflection — and often therapy — to feel proud and unashamed of our sex when everything around us tells us that it’s dirty, immoral, or illegitimate.”
Since the late 1990s and the advent of lifesaving antiretroviral drugs, some of the angst around sex between men faded — and with that came changes in behavior. Condom use, once reliably high among gay and bisexual men, has dropped off in the past two decades. According to a recent study published in the journal AIDS, over 40 percent of HIV-negative and 45 percent of HIV-positive gay and bi men admitted to having condomless sex in 2014. Researchers found the decrease in condom use wasn’t explained by serosorting (choosing only partners believed to have the same HIV status) or antiretroviral drug use. And despite what alarmists say, condom use had been declining long before the introduction of PrEP.
Garner, who has been HIV-positive for over two decades, says he’s almost relieved he acquired the virus at 23, because “My entire adult life I have never had to worry about getting HIV.”
The Rise of PrEP
Now there’s hope the younger generation may also experience worry-free sex lives — without the side effects of living with HIV.
The use of the antiretroviral drug Truvada as pre-exposure prophylaxis, or PrEP (it’s the only medication approved for HIV prevention), has been shown to reduce the chance of HIV transmission to near zero. Since the medication was first approved as PrEP in 2012, only two verified cases of transmission have been documented among those who adhere to the daily schedule (a third, according to HIV expert Howard Grossman, could not be confirmed). New, longer-lasting PrEP injectables should reach market in the next few years. Studies suggest that on-demand PrEP (such as taking it before and after sexual activity) may also be effective.
“This is a revolution!” Gary Cohan, MD, who prescribes PrEP, told us in 2016. “This should be above the fold in The New York Times and on the cover of Time magazine. A pill to prevent HIV?”
Undetectable Equals Untransmittable
Those who are already HIV-positive also have a sure-fire option for preventing the transmission of HIV that doesn’t rely on condoms. It’s called treatment as prevention, or TasP. Those who are poz, take antiretroviral medication, and get their viral load down to an undetectable level, can’t transmit HIV to sexual partners. Last year, The New England Journal of Medicine published the final results of HPTN 052, a study that proved antiretroviral medication alone is enough to prevent HIV transmission among serodiscordant couples. In a Facebook Live interview for AIDS.gov, Dr. Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, noted, “The chance of transmitting [HIV] if you are virally durably suppressed is zero.”
Since Dieffenbach’s statement, a number of HIV organizations and medical groups have joined the “Undetectable Equals Untransmittable” bandwagon, including GMHC, APLA Health, and the Latino Commission on AIDS.
The Centers for Disease Control and Prevention recommends the use of condoms in addition to PrEP or TasP, primarily because neither biomedical approach prevents other sexually transmitted infections like gonorrhea or syphilis. Still, PrEP and TasP make it safer to have condomless sex — and that could jump-start the new sexual revolution. “When the threat of HIV is removed from sex there is a profound sense of liberation,” Garner says. “Sex can just be about sex.”
One hurdle is PrEP stigma, furthered by the myth of “Truvada whores,” and AIDS Healthcare Foundation’s Michael Weinstein’s deliberate efforts to portray the HIV prevention pill as “a party drug.”
“Fear and shame have been ingrained in gay sex for decades,” Garner admits. “And it will take time and a great deal of work to extricate those elements.” But he remains optimistic that “together negative and poz men can shift the culture away from fear and toward liberation.”
He argues that what’s at stake is far more than just a better orgasm.
“Our sexuality is at the core of our humanity,” Garner says. “Our sexuality is as integral to us as our appetite. We can’t advance social justice without including sex. As queer people and as people of color, our bodies have been criminalized, our sexuality has been pathologized, and structures continue to dehumanize us. It’s a radical act of resistance when, as gay men, we choose to find pleasure and intimacy in our sex. Our sex has been, and will continue to be, intensely political. It can change our culture and our politics if we embrace it and run to it instead of away from it.”
[W]hile HIV studies have extensively examined issues related to gay, bisexual, and queer men, one group missing from such research has been transgender men.
Consequently, Vancouver and Victoria researchers undertook one of the first such Western Canadian studies, with the findings published on April 3 in Culture, Health, and Sexuality. This study allowed researchers to take a look at HIV risk for this population, and within the Canadian context of publicly funded universal access to healthcare and gender-related public policies that differ from the U.S.
The study states that trans men have often been absent from HIV studies due to small sample sizes, eligibility criteria, limited research design, or the misconceptions that trans men are mostly heterosexual or are not at risk for HIV. What research that has been conducted in this area has been primarily U.S.–based.
The Ontario-based Trans PULSE Study found that up to two-thirds of trans men also identify as gay, bisexual, or queer.
The researchers conducted interviews with 11 gay, bisexual, and queer transgender men in Vancouver who were enrolled in B.C. Centre for Excellence in HIV/AIDS’ Momentum Health Study.
What they found were several aspects unique to gay, bisexual, and queer transgender men that differ from gay, bisexual, and queer cisgender men and illustrate the need for trans-specific healthcare.
None of the participants in the study were HIV–positive and only two of them knew of trans men who are HIV–positive.
Participants reported a variety of sexual behaviours, including inconsistent condom use, receptive and insertive anal and genital sex, trans and cisgender male partners, and regular, casual, and anonymous sex partners.
The gender identity of the participants’ partners did influence their decisions about sexual risk-reduction strategies, such as less barrier usage during genital or oral sex with trans partners.
While trans men shared concerns about HIV and sexually transmitted infections with gay cisgender men, bacterial vaginosis and unplanned pregnancy were additional concerns.
Almost all of the participants used online means to meet male partners. They explained that by doing so, they were able to control the disclosure of their trans status as well as experiences of rejection or misperception. Online interactions also gave them greater control over negotiating safer sex and physical safety (such as arranging to meet a person in public first or in a sex-positive space where others are around).
When it came to healthcare, participants reported that regular testosterone therapy monitoring and transition-related care provided opportunities to include regular HIV– and STI–testing.
Some participants, however, experienced challenges in finding LGBT–competent healthcare services, with issues arising such as clinic staff using birth names or incorrect pronouns, insistence on unwanted pap testing, and a lack of understanding of the sexual practices of trans men.
The researchers note that these findings indicate the need for trans-inclusive services and trans-specific education, particularly within services for gay men.
Why do men who have sex with men report higher numbers of syphilis?
A further breakdown highlights men who have sex with men accounts for 309 cases per 100,000.
This is in contrast to men who only have sex with women accounting for 2.9 cases per 100,000.
And women with 1.8 cases per 100,000.
Dr Robert Grant, chief medical officer of the San Francisco AIDS Foundation explains why this might be the case.
Grant told CBS News: ‘Now that we have effective therapies for HIV, people who were previously untested and tested infrequently are now getting tested.
‘Sexually transmitted infections tend to go together.
If they come in and ask for HIV testing, we test for syphilis, chlamydia and gonorrhea as well.
‘People have everything to gain and nothing to lose by getting an HIV and syphilis test.
‘This report will help reinvigorate people’s awareness and hopefully send the message that by getting a test and following through with treatment, we can decrease or even eliminate syphilis as a problem,’ Grant said.
[I]’m a gym homo. I love Neapolitan pizza. I hate scary movies. I have six tattoos. I take cock like a champ. And, I’m HIV-positive.
After living with HIV for four years, I’ve heard the same questions over and over. Sometimes I wish I could present quick, pre-packaged answers — a list of “saved phrases” on my phone — but then I remind myself how desperately I asked questions during that first impossible week after getting my test results.
So today, I’m answering the questions that everyone secretly wants to ask an HIV-positive guy. What would you like to know?
1. Do you know who infected you?
I don’t. Most HIV-positive guys I’ve talked to do not know who infected them.
Few people intend to give someone HIV. There are random crazies, but most guys are just doing what I was doing — fucking around, having fun, and assuming everything is fine. You can give someone HIV without knowing you’re positive.
The virus has to “build up” to a certain point in your body to trigger an HIV test, which means you can test negative and still have transmittable HIV.
There’s an ugly myth that HIV-positive folks recreationally go around infecting others. That’s a lie regurgitated by fearmongering, anti-fact, sex-negative, poz-phobic people. It’s likely that the man who gave it to me did not know he had it. I feel for him, whoever he is, because at some point after playing with me, he got news that no one is ready to hear.
I do not, but don’t take that as an indicator of what most HIV-positive guys do. Many HIV-positive men become more diligent about condom use after seroconverting.
In the age of PrEP, condoms are no longer the only way to protect yourself (or others) from HIV — or the most effective. PrEP — a once-a-day, single-pill regimen that has been proven more effective than regular condom use at preventing HIV transmission — is something I urge all HIV-negative guys to learn about.
I play bare. I accept the risks of catching other STIs and STDs as an unavoidable part of the sex I enjoy. I get a full-range STD check every three months, and sometimes more frequently.
3. How did sex change for you after becoming positive?
Since seroconverting, I have more — and better — sex. Forced to see my body and my sex in a new light, I started exploring fetishes and interests I had never tried. In my early days of being positive, I played every week with a dominant. Today, I’m a skilled, kinky motherfucker.
4. Has anyone ever turned you down because of your status?
Many times. When I was newly positive, those refusals really hurt.
I remember one occasion that was especially painful. I was eating Chinese food with a friend and started crying at the table because several guys that week had turned me down on Grindr.
He let me cry for a few minutes, then said, “HIV is something in your blood. That’s all it is. If they can’t see how sexy you are because of something in your blood, they’re boring, uneducated, and undeserving, and you can do better.” He was right.
5. How old were you when you tested positive?
I was 21. I didn’t eat for a few days. I slept on friends’ sofas and watched movies instead of doing homework. Somehow I continued acing my college classes.
I walked down to the Savannah River every night to watch cargo ships roll through, imagining their exotic ports — Beijing, Mumbai, Singapore, New York — and their cold passage across the Atlantic. I wanted to jump in the black water every night but I knew some drunk tourist would start screaming and someone would save me.
I made it through those months, and I’m glad I did. The best of my life came after becoming positive.
6. What does “undetectable” mean?
“Undetectable” is a term used to describe an HIV-positive person who is diligently taking their meds. In doing so, they suppressed the virus in their body to the point that their viral load is under 200 copies/m — unable to be detected on a standard HIV test (hence, “undetectable”). Put simply: the virus is so low in your body that it’s hard to transmit.
“Hard” is an understatement. The PARTNER study monitored 767 serodiscordant (one positive, one negative) couples, gay and straight, over several years. In 2014, the results showed zero HIV transmissions from an HIV-positive partner with an undetectable viral load to an HIV-negative partner.
Being undetectable means the likelihood of you transmitting HIV is slim to none. It means you’re doing everything scientifically possible to be as healthy as you can be, and you are protecting your partners in the process.
7. Have you had any side effects from the meds?
Yes, but side effects today are mild in comparison to what they were in the past. AZT was hard on the body, but we’re past that. New HIV drugs come out every year. We’re in a medical age where new treatment options, such as body-safe injection regimens, are fastly approaching realities.
On my first medication, I had very vivid dreams and nightmares, an upset stomach for a week or two, and I developed weird fat deposits on my neck and shoulders. I switched meds a year in and couldn’t be happier.
There are options. Talk to your doctor if you have shitty side effects and ask about getting on a different medication.
8. What’s it like to date after becoming HIV-positive?
It’s just like dating for everyone else. There are losers and jerks, and there are excellent, top-quality guys I love. My HIV status has never impeded my dating life.
I’m non-monogamous, polyamorous, and kinky, and I think these characteristics drive away interested guys faster than anything else. My status never comes up. I put my status loud and clear on every profile, and I say it directly before the first date. If you don’t like it, don’t waste my time — I have other men to meet.
9. How do you respond to HIV stigma?
It’s an automatic turn-off. Disinterested. Discard pile.
I have active Grindr and Scruff profiles (and a few others). Each profile reads: “If you’re afraid of my HIV status, block me.”
I’m not interested in someone who, in 2017, walks around terrified of HIV. Learn your shit, guys. Learn about how HIV is prevented. Get on PrEP. Use condoms.
Educate yourself and learn how it’s treated, and what the reality of living with HIV is like today (it’s so mild and easy that I forget about it, TBH).
Yes, you should take necessary steps to prevent HIV. However, you don’t need to live your life in fear or abstain from having sex with people merely because they’re positive. I no longer believe HIV is the worst thing you can catch. Hep C is way worse. Scabies is pretty miserable. And bad strains of the flu kill people.
HIV? It’s one pill (or a couple of pills) a day. Yes, you will have it forever. Yes, you will face stigma for having it. But, the people who stigmatize you are ignorant and out-of-date. Dismiss them.
10. What would you tell someone who just tested positive?
Welcome! You inadvertently joined a club you didn’t ask for, but the membership includes some of the greatest minds in history, so you’re in good company. The virus felled many of the greatest campaigners for LGBTQ rights and freedoms that ever lived. They struggled so that you can get up in the morning, pop your pill, and live a long life.
Those who lived and died paid your initiation fees. They fought, protested, rallied and organized so that you can be here — so that you can stick around and enjoy your fabulous, queer life. Always respect their sacrifice and dedication.
You are loved. You will find love. You will find impossibly good-looking men who want to fuck you (or want you to fuck them) who don’t give a shit about your HIV status. And if it’s in the cards, someday you’ll marry one of those fellas.
You have brothers and sisters who share this quality with you. In the words of Sister Sledge, we are family.
Anita Schools wakes at dawn most days, though she usually lazes in bed, watching videos on her phone, until she has to get up to take the HIV meds that keep her alive. The morning solitude ends abruptly when her granddaughter bursts in and they curl up, bonding over graham crackers.
Schools, 59, lives in Emeryville near the foot of the Bay Bridge, walking distance from a Nordstrom Rack and other big chain stores she can’t afford. Off and on since April, her granddaughter has lived there too, sleeping on a blow-up mattress with Schools’ daughter and son-in-law and another grandchild.
Five is too many for the one-bedroom apartment. But they’re family. They kept her going during the worst times, and that she can help them now is a blessing.
Nearly 20 years ago, when Schools was diagnosed with HIV, it was her daughter Bonnie — then 12 and living in foster care — who gave her hope, saying, “Mama, you don’t have to worry. You’re not going to die, you’re going to be able to live a long, long time.”
“It was her that gave me the push and the courage to keep on,” Schools said.
She had contracted HIV from a man who’d been in jail, who beat her repeatedly until she fled. By then she’d already left another abusive relationship and lost all four of her daughters to child protective services. HIV was just one more burden.
At the time, the disease was a death sentence. That Schools is still here — helping her family, getting to know her grandchildren — is wonderful, she said. But for her, as with tens of thousands of others who have lived two decades or more with HIV, survival comes with its own hardships.
Gay men made up the bulk of the casualties of the early AIDS epidemic, and as the male survivors grow older, they’re dealing with profound complications, including physical and mental health problems. But the women have their own loads to bear.
Whereas gay men were at risk simply by being gay, women often were infected through intravenous drug use or sex work, or by male partners who lied about having unsafe sex with other men. The same issues that put them at risk for HIV made their very survival a challenge.
Today, many women like Schools who are long-term survivors cope with challenges caused or compounded by HIV: financial and housing insecurity, depression and anxiety, physical disability and emotional isolation.
“We’re talking about mostly women of color, living in poverty,” said Naina Khanna, executive director of Oakland’s Positive Women’s Network, a national advocacy group for women with HIV. “And there’s not really a social safety net for them. Gay men diagnosed with HIV already historically had a built-in community to lean on. Women tend to be more isolated around their diagnosis.”
There are far fewer women aging with HIV than men. In San Francisco, nearly 10,000 people age 50 or older are living with HIV; about 500 are women. Not all women survivors have histories of trauma and abuse, of course, and many have done well in spite of their diagnosis.
But studies have found that women with HIV are more than twice as likely as the average American woman to have suffered domestic violence. They have higher rates of mental illness and substance abuse.
What keeps them going now, decades after their diagnoses, varies widely. For some, connections with their families, especially their now-adult children, are critical. For others, HIV advocacy work keeps them motivated and hopeful.
Patti Radigan (righ) instructs daughter Angelica and Angelica’s boyfriend, Jayson Cabanas, on preparing green beans for Thanksgiving while Roman Tom Pierce, 8, watches.
Patti Radigan was living in a cardboard box on South Van Ness Avenue in San Francisco when she tested positive in 1992. By then, she’d lost her husband to a heart attack while a young mother, and not long after that she lost her daughter, too, when her drug use got out of control and her sister-in-law took in the child.
She turned to prostitution in the late 1980s to support a heroin addiction. She’d heard of HIV by then and knew it was deadly. She’d seen people on the streets in the Mission where she worked, wasting away and then disappearing altogether. But she still thought of it as something that affected gay men, not women, even those living on the margins.
Women then, and now, were much more likely than men to contract HIV from intravenous drug use rather than sex — though in Radigan’s case, it could have been either. IV drug use is the cause of transmission for nearly half of all women, according to San Francisco public health reports. It’s the cause for less than 20 percent for men.
Still, when Radigan finally got tested, it wasn’t because she was worried she might be positive, but because the clinic was offering subjects $20. She needed the cash for drugs.
She was scared enough after the diagnosis — and then she got pregnant. It was the early 1990s, and HIV experts at UCSF were just starting to believe they could finesse women through pregnancy and help them deliver healthy babies. Today, it’s widely understood that women with HIV can safely have children; San Francisco hasn’t seen a baby born with HIV since 2004.
But in the 1990s, getting pregnant was considered selfish — even if the baby survived, its mother most certainly wouldn’t live long enough to raise her. For women infected at the time, having children was something else they had to give up.
And so Radigan had an abortion. But she got pregnant again in 1995, and she was desperate to have this child. She was living by then with 10 gay men in a boarding house for recovering addicts. Bracing herself for an onslaught of criticism, she told her housemates. First they were quiet, then someone yelled, “Oh my God, we’re having a baby!”
“It was like having 10 big brothers,” Radigan said, smiling at the memory. Buoyed by their support, she kept the pregnancy and had a healthy girl.
Radigan is 59 now; her daughter, Angelica Tom, is 20. They both live in San Francisco after moving to the East Coast for a while. It was because of her daughter that Radigan stayed sober, that she consistently took her meds, and that she went back to school to tend to her future.
For a long time she told people she just wanted to live long enough to see her daughter graduate high school. Now her daughter is in art school and Radigan is healthy enough to hold a part-time job, to lead yoga classes on weekends, to go out with friends for a Friday night concert.
“Because of HIV, I thought I was never going to do a lot of things,” Radigan said. “The universe is aligning for me. And now I feel like I deserve it. For a long time, I didn’t feel like I deserved anything.”
Anita Schools, who says she is most troubled by finances, listens to an HIV-positive woman speak about her experiences and fears at an Oakland support group that Schools organized.
Anita Schools got tested for HIV because her ex-boyfriend kept telling her she should. That should have been a warning sign, she knows now.
She was first diagnosed in 1998 at a neighborhood clinic in Oakland, but it took two more tests at San Francisco General Hospital for her to accept she was positive. People told her that HIV wasn’t necessarily fatal, but she had trouble believing she was going to live. All she could think was, “Why me? What did I do?”
It was only after her daughter Bonnie reassured her that Schools started to think beyond the immediate anxiety and anger. She joined a support group for HIV-positive women, finding comfort in their stories and shared experiences. Ten years later, she was leading her own group.
She’s never had problems with drugs or alcohol, and she has a network of friends and family for emotional support, she said. Even the HIV hasn’t hit her too hard, physically, though the drugs to treat it have attacked her kidneys, leaving her ill and fatigued.
Like so many of the women she advises in her support group, Schools is most troubled by her finances. She gets by on Social Security and has bounced among Section 8 housing all over the Bay Area for most of her adult life.
Schools’ current apartment is supposed to be permanent, but she worries she could lose it if her daughter’s family stays with her too long. So earlier this month they moved out and are now sleeping in homeless shelters or, some nights, in their car. She hates letting them leave but doesn’t feel she has any other choice.
Reports show that women with HIV are far more likely to live in poverty than men. Khanna, with the Positive Women’s Network, said surveys of her members found that 85 percent make less than $25,000 a year, and roughly half take home less than $10,000.
Schools can’t always afford the bus or BART tickets she needs to get to doctor appointments and support group meetings, relying instead on rides from friends — or sometimes skipping events altogether. She gets her food primarily from food banks. Her wardrobe is dominated by T-shirts she gets from the HIV organizations with which she volunteers.
“With Social Security, $889 a month, that ain’t enough,” Schools said. “You got to pay your rent, and then PG&E, and then you got to pay your cell phone, buy clothes — it’s all hard.”
At a time when other women her age might be thinking about retirement or at least slowing down, advocacy work has taken over Schools’ life. She speaks out for women with HIV and their needs, demanding financial and health resources for them. In her support group and at AIDS conferences, she offers her story of survival as a sort of jagged road map for other women struggling to navigate the complex warren of services they’ll need to get by.
The work gives her confidence and purpose. She feels she can directly influence women’s lives in a way that seemed beyond her when she was young, unemployed and directionless.
“As long as I’m getting help and support,” Schools said, “I want to help other women — help them get somewhere.”
Billie Cooper is tall and striking, loud and brash. Her makeup is polished, her nails flawless. She is, she says with a booming laugh that makes heads turn, “the ultimate senior woman.”
For Cooper, 58, HIV was transformative. Like Radigan, she had to find her way out from under addiction and prostitution to get healthy, and stay healthy. Like Schools, she came to understand the importance of role-modeling and advocacy.
Cooper arrived in San Francisco in the summer of 1980 — almost a year to the day before the first reports of HIV surfaced in the United States. She was fresh out of the Navy and eager to explore her gender identity and sexuality in San Francisco’s burgeoning gay and transgender communities.
Growing up in Philadelphia, she’d known she was different from the boys around her, though it was decades before she found the language to express it and identified as a transgender woman. But seeing the “divas on Post Street, the ladies in the Tenderloin, the transsexual women prostituting on Eddy” — Cooper was awestruck.
She slipped quickly into prostitution and drug use. When she tested positive in 1985, she wasn’t surprised and barely wasted a thought worrying about what it meant for her future — or whether she’d have any future at all.
“I felt as though I still had to keep it moving,” Cooper said. “I didn’t slow down and cry or nothing.”
Transgender women have always been at heightened risk of HIV. Some studies have found that more than 1 in 5 transgender women is infected, and today about 340 HIV-positive trans women live in San Francisco.
What makes them more vulnerable is complicated. Trans women often have less access to health care and less stable housing than others, and they face higher rates of drug addiction and sexual violence, all of which are associated with risk of HIV infection.
Cooper was homeless off and on through the 1980s and ’90s, trapped in a world of drugs and sex work that felt glamorous at the time but in hindsight was crippling. “I was doing things out of loneliness,” she said, “and I was doing things to feel love. That’s why I prostituted, why I did drugs.”
She began to clean up around 2000, though it would take five or six years to fully quit using. She found a permanent place to live. She collected Social Security. She started working in support services for other transgender women battling HIV. In 2013, she founded TransLife, a support group at the San Francisco AIDS Foundation.
“I was coming out as the activist, the warrior, the determined woman I was always meant to be,” she said.
Cooper never developed any of the common, often fatal complications of HIV — including opportunistic infections like pneumonia — that killed millions in the 1980s and 1990s. But she does have neuropathy, an HIV-related nerve condition that causes a constant pins-and-needles sensation in her feet and legs and sometimes makes it hard to walk.
Far more traumatic for her was her cancer diagnosis in 2006. The cancer, which may have been related to HIV, was isolated to her left eye, but after traditional therapies failed, the eye was surgically removed on Thanksgiving Day in 2009.
The cancer and the loss of her eye was a devastating setback for a woman who had always focused on her appearance, on looking as gorgeous as the transgender women she so admired in the Tenderloin, on being loved and wanted for her beauty.
Rising from that loss has been difficult, she said. And she’s continued to suffer new health problems, including blood clots in one of her legs. Recently, she’s fallen several times, in frightening episodes that may be related to the clots, the HIV or something else entirely.
Since Thanksgiving she’s been in and out of the hospital, and though she tries to stay upbeat, it’s clearly trying her patience.
But if HIV and cancer and everything else have tested Cooper’s survival in ways she never anticipated, these trials also have strengthened her resolve. She’s becoming the person she always wanted to be.
“A week before they took my eye, I got my breasts,” she said coyly one recent afternoon, thrusting out her chest. Behind the sunglasses she wears almost constantly now, she was smiling and crying, all at once.
Aging with HIV has been strangely calming, in some ways, giving her a confidence that in her wild youth was elusive.
Now she exults in being a respected elder in the HIV and transgender communities. She loves it when people open doors for her or help her cross the street, offer to carry her bags or give up a seat on a bus.
Simply, she said, “I love being Ms. Billie Cooper.”
When you’re gay, it’s hard to talk to your parents about certain things. No matter how accepting or open-minded they may be, gay relationships, gay culture, and the mechanics of gay sex will stay a mystery to them — unless, of course, one of your parents is gay — or both.
Anyone who has been out of the closet for any amount of time knows that “gay” is more than a label to define your sexuality. It is a core part of your identity, and words like “queer,” “bi,” and “LGBTQ” constitute a significant part of your life — your people, your language, and your interests, both politically and socially. These words define a culture that our straight parents will never fully know. They may watch softened depictions of it on Modern Family, but they have never sung drunk karaoke at your favorite gay watering hole or queened out to Britney. They’ve never danced in a sea of sweaty men till 6 a.m. and they have no idea what Nasty Pig is.
Much of our culture can be hard to explain. Poppers and anal plugs will probably never warrant a conversation with mom, but other conversations — about PrEP and nonmonogamy, for example — can lead to greater understandings. Here’s a list of all those things gay men don’t talk about with their parents, with a small smattering of advice on how to do so!
1. Douching
The thought of you having sex with another man crossed your parents’ minds from the moment they found out you were gay. Though they would never admit it, they still wonder about it from time to time. The image flashes when they’re trying to go to sleep, when they’re taking the dog out for a walk. Like many straight people, they may be clueless as to how it all works and may mistakenly believe it to be a very messy business. But douching — the process of cleaning out the anal cavity before sex — is one of those off-limits topics, one I would never bring with to them.
One way to hint at it without having to say anything is to have your parents over to your place for a night where there is, regrettably, only one shower. You must conveniently forget to unscrew the metal douching hose from its attachment at the side of your shower head. I’m not saying you should picture your mother naked, but envision her standing in your shower, looking through your assortment of overpriced sugar scrubs, charcoal-infused body bars, and organic, woodsy-smelling shampoos, and frowning over that dangling hose with the phallic-shaped metal attachment at the end. Then, hopefully, it will click, and she’ll deduce that your sex is not quite as messy as she thought.
2. Poppers
When I’m talking to guys on Scruff whose profiles read “No PnP,” I usually ask, “Do you use poppers?” Most frequently, the answer is, “Sure. Love poppers.”
Poppers, while still a drug, are so mild that many gay men do not consider them in the same “sex drug” category that Tina (crystal meth) and G fall into. They’ve become staples of gay sex, gay culture, and gay history. We’ve been using them since the ’70s for their particular power of relaxing the anal sphincter for a few minutes, just long enough to get sex revved up. But if you try to explain the process of inhaling alkyl nitrites — video head cleaner — to your parents, they will likely conjure the imagine of junkies snorting glue in the school supplies aisle.
As with many items on this list, you could make the reasonable argument that poppers — like most facets of gay sex — never need to be brought up to your parents, since your sex life is not any of their business. But if they ever wonder why you have a few small amber bottles of some chemical that smells like nail polish in the freezer, poppers may inadvertently become a discussion topic in the kitchen.
3. Fisting
Even if you don’t do it, you know someone who does. Fisting has long lost its shock value in gay circles, and has crossed over from dark sex dungeons into the arena of mainstream gay life. Many guys who aren’t regularly seen in leather harnesses now enjoy fisting. But imagine explaining to Dad how some guys take hands (and more) up the anus — especially when the idea of taking an erect penis up there is already outside the realm of his imagination. Many people, gay and straight, do not believe — or have not accepted — that fisting, when done safely and correctly, does not create long-term damage and can be an incredibly passionate and enjoyable sexual experience.
4. Drag
Even though words like “slay” and “werq” have broken into the straight lexicon — primarily thanks to RuPaul’s Drag Race — the art and culture of drag is still a queer creation and belongs to us. Straight people are welcome to enjoy drag shows at their local gay bar, so long as they tip, but theirs is not a history of disenfranchisement and oppression, abuse and homelessness, poverty and sex work — a queer history in which drag emerged as an act of self-empowerment.
Drag can be hard to explain to your parents. It was hard to explain to mine. My parents assumed that all gay men dress up in women’s clothes and sing diva power ballads, so the concept of drag was indistinguishable from the rest of gay life to them. They could not appreciate drag’s cultural importance because it’s not their culture, and they did not understand its complicated history with the transgender movement because they do not understand, and refuse to understand, the concept of transgender identity.
To them, as well as to many others, drag artists and trans people are the same thing — a deeply incorrect assumption that has led to something of a modern cultural rift between trans activists and the drag world. The two camps have an overlapped history, since many trans folks first discovered their true identities through drag. In the ’60s, ’70s, and ’80s, when the concept of “transgender” was not as developed as it is today, many transgender people could only express themselves through drag art. As our cultural understandings both of drag and transgender identity have evolved, the two have split, and the burden has fallen on many transgender folks and trans activists to highlight and explain the significant difference between the two. Many people, my parents included, consider a trans woman to be “a man in a dress” — essentially a drag performer — and the phrase has become a terribly offensive slur against transgender women.
Take your parents to a drag show. Give them bills to tip the queens. (This assumes that your parents, unlike mine, are wiling to set foot in a gay bar.) Let them see drag in all its ferocity and kitschy wonder, then afterward, walking home, highlight the fact that what they saw was performance art, a toss-up between cabaret and camp. Explain to them that even if a transgender person does drag, the drag is the performance, but their trans identity is not. Regardless of what someone does onstage, transgender identity is a person’s authentic identity. “While drag is done for an audience, coming out as transgender is done solely for oneself,” a trans friend once told me. “And it is just as healthy and important to do as any coming-out, any form of self-acceptance that your mental health depends on.”
5. Bears, Otters, and Pups, Oh My!
The labels will be the bane and the delight of your gay life. Gay men have long established the bizarre practice of defining and stereotyping ourselves into labels based on body type and sex practices. In the gay lexicon, burly, hairy men over a certain age are “bears.” Young bears are “cubs.” Skinnier, scruffier guys are “otters.” Young, lean, hairless guys are “twinks.” Guys into puppy play (a kink scene that was listed on my list of 30 kinky terms every gay man should know) who enjoy the “pup” role are “pups,” both in and out of the scene. Guys who prefer condomless sex are “pigs.” Tall, skinny gay guys are “giraffes” (a lesser-known label).
How did we come up with these? Regardless of where they came from, and in spite of their much-debated value, the labels are likely here to stay. While they are common parts of our speak, your parents would probably be confused to learn that you think bears are sexy or that your boyfriend is a puppy.
6. Nonmonogamy
Nonmonogamy works out for gay men. In fact, this writer believes that nonmonogamous pairings, open and semi-open relationships, and relationships with relaxed sexual parameters are ideal for us — much more so than the monogamous alternative. The concept of nonmonogamy may seem foreign to our parents. Having a frank conversation about the parameters of your particular gay relationship with your parents may be awkward, but it can lead to something good. Explaining the distinction between sex and love may not leave everyone in agreement, especially if your parents are religious, conservative, or both. But at the very least, it will be an illuminating window into your life.
7. HIV
Gay men are still disproportionately affected by HIV compared to our straight counterparts. While no one needs to come out as HIV-positive, least of all to their parents, many poz gay men choose to do so at some point, for various reasons. Coming out to my parents about my status was hard; I did it the same morning an op-ed I wrote about coming out as poz was published in The Advocate last December.
Many of our parents remember the early days of the AIDS epidemic, so the news can be hard for them. They may mistakenly believe that the outlook for an HIV-positive person in 2016 is the same as it was 30 years ago. Most well-informed gay men, particularly those who live in urban areas, are up to speed on modern HIV care and know that with antiretroviral treatment, HIV has become a livable chronic illness that is more preventable today than ever before. Our parents aren’t accustomed to seeing testing trucks outside of gay clubs or HIV pamphlets disseminated in chic gayborhoods, so they will probably need some information to alleviate the initial fear. Give them resources and time.
8. PrEP
There may never be a need to talk about your once-daily Truvada pill to your parents, but if they see the medicine bottle by the sink one day when the family is sharing a beach condo, you need to have answers ready.
PrEP is the once-a-day pill regimen for HIV-negative people that has proven extremely effective at preventing HIV transmission. Statistically, it’s more reliable than regular condom use. Upon initial explanation, your parents will likely respond the way many have responded to PrEP and see it as an excuse to have raucous unprotected sex. Even if you are having raucous condomless sex, you will have to explain to them that you are still protected from HIV.
9. Top/Bottom
Just as your parents have been envisioning your sex from the moment they first learned you were gay, they have been wondering “what you do.” When/if they meet your boyfriend, they will wonder “what he does.” They won’t say it aloud, but they wonder, late at night, after the dinner dishes have been put away, whether you’re the top or the bottom. (I always find it remarkable how straight people assume every gay man is one or the other — versatile guys don’t exist in straight visions of gay sex.)
Like douching, this is one I will never talk about to my parents, no matter how chummy we get.
10. Kink
My parents know I am gay. They know I am having sex. They know I date and have sex with other men. But they do not know and will not be told how much I love having used underwear stuffed in my mouth and my wrists tied together with duct tape. The only time I ever came close to explaining my kink practices was at the beach a few years ago when I realized there were still red caning lines on my butt and legs. I lay in the tanning bed to darken the skin around the marks and opted for a pair of baggier, less flattering board shorts.
While kink is not restricted to gay men, we have certainly been longtime practitioners of the rougher arts. Like drag, leather was originally our thing and has by and large remained so. Kink and fetish play are things that gay men of all stripes can at least be familiar with, and have probably dabbled in at one time or another. But it is one area of gay life that our parents may have a hard time distinguishing from rape and abuse, perversion and degeneracy. Explaining it can be tough.
Its accouterments can be hard to hide — all those ass toys and leather gear require storage, and that sling in the bedroom cannot reasonably be disguised as a place to hang laundry. Have a regimen prepared for surprise visits and dinners, and if you enjoy getting backlashes or caning down your legs, try not to do so before a family beach trip.
People who take Truvada, the once-a-day pill that prevents HIV, are no more at risk for dangerous side effects than those who take an aspirin a day to prevent heart attacks, according to a new study.
Researchers compared Truvada and aspirin by looking at the drugs’ risk profiles in large, published studies. Although the two drugs come with distinct side effects — Truvada most commonly causes dizziness, vomiting, and weight loss, whereas aspirin is most commonly associated with bleeding problems — the frequency of side effects is roughly equivalent.
But the drugs have very different reputations, among both doctors and the general public. Century-old aspirin, when taken as a preventative tool against heart attacks, is viewed as an everyday medication, no big deal. But Truvada, also known as pre-exposure prophylaxis (or PrEP), is a new pill, intertwined with the loaded issues of HIV and sex habits, and mired in uncertainty.
“Everyone’s got aspirin in their medicine cabinet,” Jeffrey Klausner, professor of medicine and public health at the University of California, Los Angeles, and lead author of the study, told BuzzFeed News. “But as a physician I’ve seen people come into the hospital and die from aspirin overdoses — people can be allergic.”
The side effects of each drug are markedly different, Klausner noted, and affect different organs. But after crunching the numbers, he said, “it really looked like I could say Truvada compared favorably, in terms of its safety profile, to aspirin.”
An estimated 52% of American adults aged 45 to 75 are prescribed a daily aspirin to prevent cardiovascular and gastrointestinal diseases, including heart attacks and cancer.
Truvada, which was approved by the FDA in 2012, has been shown to have roughly 92% efficacy in preventing transmission of HIV. The CDC estimates that about 1.2 million Americans are at high enough risk for contracting HIV that they should be prescribed the drug. But only about 21,000 currently get it.
According to Klausner, who trains doctors around the country on how to treat and prevent HIV, much of this has to do with ambivalence about prescribing otherwise healthy individuals a daily pill.
“A lot of the concerns I hear from providers are about safety,” Klausner said. “There have been continued voices saying, ‘Wouldn’t it just be better if people used condoms, or reduced their number of partners?’ Those are important strategies, but they don’t work for everyone.”
The issue of doctor awareness about PrEP is one of the biggest barriers to its wider use.
The new study “is an interesting thought experiment,” Dawn Smith of the CDC’s Division of HIV/AIDS Prevention, told BuzzFeed News. But, she added, “I’m not sure it addresses the safety concerns that some clinicians have.”
Smith noted a CDC study showing that in 2015, about one-third of primary care doctors and nurses had never heard of Truvada. Beyond the lack of awareness, she said, doctors don’t want to cause any side effects, no matter how minor, in otherwise healthy patients.
In his analysis, Klausner looked at the “NNH” — or “number needed to harm” — meaning the number of people who take the drug before one person experiences a harmful side effect. The NNH for Truvada in gay men or transgender women was 114 for nausea and 96 for unintentional weight loss. In women, side effects appeared more frequently, with 1 in 56 women experiencing nausea, 1 in 41 vomiting, and 1 in 36 mildly elevated liver enzymes.
Rarer adverse events for Truvada include kidney problems and a small decrease in bone mineral density, but Klausner notes that both of those effects have been shown to be reversible once the medication is discontinued.
In contrast, aspirin had an NNH of 15 for bleeding problems and 20 for easy bruising. Rarer problems included ulcers and other gastrointestinal problems.
Because it’s so much older, aspirin has been tested in many more people with many more years of follow-up, Klausner noted. Because Truvada is a relatively new drug, it will take awhile to accrue the data needed to make its long-term safety bulletproof.
In the meantime, however, Klausner hopes more doctors will educate themselves about the HIV prevention drug. And after that, he said, “we should work to make it the same price as aspirin.”
Survivors of the 1980s AIDS crisis have shared accounts of their experiences.
As the UK celebrates LGBT History Month, users of Reddit revealed what it was like to be living in what felt like a constant state of tragedy.
Real LGBTI people remember the confusion, the lack of information, the lack of support from the government because of the suffering from the virus known only at the time as GRID (gay-related immune deficiency).
‘I’m a 62-year-old gay man. I thankfully made it through the epidemic that started in the early 80s and went right through the mid-90’s. You ask what it was like? I don’t know if I can even begin to tell you how many ways AIDS has affected my life, even though I never caught the virus,’ one user said.
‘By the early 80s, I had what I would consider a really large circle of friends and acquaintances and once the epidemic really started to hit, it was not uncommon to find out three, four or more people you knew had died each month. We set up informal and formal support groups to look after our friends who took sick. Feeding them when they would eat. Changing them. Washing them. Acting as go-between with families who “were concerned” about their sons, nephews, brothers, etc., but wouldn’t lend a hand to help because AIDS was, you know, icky.
‘After they passed, there were memorial services to plan with no real time to grieve because when one passed, you were needed somewhere else to begin the process all over again.
‘I kept a memory book/photo album of everyone I knew that died of AIDS. It’s quite large to say the least. Who were these guys? These were the people I had planned to grow old with. They were the family I had created and wanted to spend the rest of my life with as long as humanly possible but by the time I was in my late 40s, every one of them was gone except for two dear friends of mine.
‘All we have left of those days are each other, our memories and pictures. I hope that statement doesn’t come off as pitiful though. I am fit, active, healthy and you know what? I enjoy every single day of my life. I enjoy it because most of my friends can’t. In my own personal way, I want to honor their lives by living and enjoying mine.’
Another user said: ‘It was flat out scary. every guy you met was like a possible time bomb. especially the early period when we knew very little about it – didn’t know if you could get it by kissing, by holding hands…
‘Then lots of your friends or friends of friends get sick and sicker and then die. And you never ever quit being really really fucking pissed off about the whole thing. I’m alive today due to sheer randomness.’
And another said: ‘If you were living in the Castro in San Francisco, everyone in the neighborhood was gay… So it wasn’t just your friends that were dying, it was your whole neighborhood. One day your mailman would be replaced, the next day that flower shop was gone… You wouldn’t be invited to the funeral, so it was just like people were disappearing.’
‘It was madness. It was terribly cruel,’ another Redditor said. ‘It was inexplicable and unexplained, for a very long time. Research was underfunded, and in many cases large institutions and public figures rooted for it to be happening. People died suddenly of unexplainable things. Toe fungus! Tongue thrush! Rashes. Eyes welling up with blood. Horrible shit.
‘Everyone knew it was hitting gay men, nobody knew what it was. They called it the gay cancer. People were very superstitious. I had handfuls of groceries and man lectured me on not pressing the elevator buttons with my nose because I could catch AIDS from it. Yes. That happened.’
A lesbian of the era said: ‘While I was not ‘at risk’ (per se, we know more these days), we all lost many good friends. It is true that there is a somewhat mystifying (to me) separatist attitude between some gay men and lesbians, especially back then, this tragic time really brought us together.
‘Sitting at the bedside of a terminally ill friend, and just holding their hand when everyone else was just terrified, was a gift I was one of those willing to give.
‘No one should die alone, and no one should be in the hospital on their death beds with family calling to say “this was gods punishment”. My friends and I, men and women, acted as a protective layer for ill friends, and companion to mutual friends juggling the same, difficult reality of trying to be there, and be strong when we were losing our family right and left. Difficult times, that should never be forgotten.’
Another Redditor paid tribute to the role of lesbians, calling them ‘every bit as heroic as soldiers on the front lines of any war’.
‘These women walked directly into the fire and through it, and they did not have to. And that they did it even as some of the gay men they took care of treated them with bitchiness, scorn, and contempt.
‘It was, at the time, not at all unusual for gay men to snicker as the bull dyke walked into the bar with her overalls and flannels and fades. Much of the time, it was casual ribbing which they took in stride. But it could also be laced with acid, especially when lesbians began gravitating toward a bar that had until then catered largely to men.
‘When the AIDS crisis struck, it would be many of these same women who would go straight from their jobs during the day to acting as caregivers at night. Because most of them lacked medical degrees, they were generally relegated to the most unpleasant tasks: wiping up puke and shit, cleaning up houses and apartments neglected for weeks and months. But not being directly responsible for medical care also made them the most convenient targets for the devastating anger and rage these men felt – many who’d been abandoned by their own family and friends.
‘These women walked directly into the fire. They came to the aid of gay men even when it was unclear how easily the virus could be transmitted. Transmission via needlestick was still a concern, so they often wore two or three layers of latex gloves to protect themselves, but more than once I saw them, in their haste and frustration, dispense with the gloves so that they could check for fevers, or hold a hand that hung listlessly from the edge of a bed whose sheets they had just laundered.
‘They provided aid, comfort, and medical care to men withering away in hospices, men who’d already lost their lovers and friends to the disease and spent their last months in agony. They’d been abandoned by their own families, and were it not for lesbians – many if not most of them volunteers – they would have suffered alone. And when there was nothing more medicine could do for them and their lungs began to fill with fluid, it was often these same women who’d be left to administer enough morphine to release them, given to them by the doctor who had left the room and would return 15 minutes later to sign the certificate (a common practice at the time).
‘I knew a woman around that time who’d had at one point been making bank in construction. But at the outset of the AIDS crisis she had abandoned her career to pursue nursing instead, and was close to her degree when we were hanging out. She was a big, hearty drinker, and fortunately so was I. We’d been utterly thrashed at a bar once when someone whispered a fairly benign but nonetheless unwelcoming comment about her. Middle fingers were exchanged, and afterwards, furious and indignant, I asked her, Why do you do it? Why did you abandon a career to take care of these assholes who still won’t pay you any respect?
‘She cut me a surprisingly severe look, held it and said, “Honey, because no one else is going to do it.” I remember feeling ashamed after that, because my fury and indignation weren’t going to clean blood and puke off the floor; it wasn’t going to do the shit that needed to get done.
‘HIV killed my friends, took my lover from me, and tore up my life. During that time, I did what I could. But nothing I did then or have ever been called to do in my life puts me anywhere near the example set by the lesbians I knew in the 80s and 90s. I’ve felt obligated to remember what they did, and to make sure other people remember it too.’
A new study reveals that after 2.5 years, a group of more than 600 San Francisco men who have sex with men (MSM) taking Truvada as pre-exposure prophylaxis (PrEP) have had zero cases of HIV contraction.
The study also finds that many of these individuals are using condoms less and more than half of those in the group study had contracted at least one sexually transmitted infection (STI) within a year.
Researchers at Kaiser Permanente published their findings in Clinical Infectious Diseases. The paper represents a powerful endorsement of PrEP’s ability, in a real-world setting, to prevent HIV infection among those at very high risk of contracting the virus. The lack of new HIV infections among these men challenges the stance of AIDS Healthcare Foundation president Michael Weinstein, who has vigorously campaigned that PrEPshould not be used as a widescale public health intervention.
On the flip side, the Kaiser findings challenge the received wisdom from PrEP clinical trials that those taking Truvada as HIV prevention do not increase sexual risk-taking while on the medication.
“Our study is the first to extend the understanding of the use of PrEP in a real-world setting and suggests that the treatment may prevent new HIV infections even in a high-risk setting,” reports lead author Jonathan Volk, MD, MPH, a physician and epidemiologist at Kaiser Permanente San Francisco Medical Center. “Until now, evidence supporting the efficacy of PrEP to prevent HIV infection had come from clinical trials and a demonstration project.”
It’s important to reiterate that according to Kaiser, though no one using PrEP contracted HIV, there was a very high rate of other sexually transmitted infections (STIs).
After six months, the clinicians at Kaiser surveyed 143 of the cohort about their sexual risk-taking. At that time, 74 percent reported that their number of recent sexual partners had not changed since starting PrEP, while 15 percent said they had fewer sexual partners and 11 percent said they had more. Regarding condom use, 56 percent said they used them at the same rate after starting Truvada, 41 percent used them less and 3 percent used them more.
Because these individuals were not engaged in a clinical trial, there is no control group to measure the change in these men’s sexual risk-taking against. So there is no way to tell if the group would have changed their risk-taking in a similar pattern if they had not been taking PrEP.
One thing is clear, however: These men would have been at very high risk of contracting HIV had they not been taking PrEP while engaging in the same level of sexual risk-taking. The evidence is in their very high rate of STIs. Six months into taking PrEP, 30 percent of the PrEP users had been diagnosed with at least one STI. After a year, half of them had contracted one or more STIs, with 33 percent diagnosed with a rectal STI, 33 percent with chlamydia, 28 percent with gonorrhea, and 5.5 percent with syphilis. As noted, two of them contracted hep C.
“Without a control group, we don’t know if these STI rates were higher than what we would have seen without PrEP,” stressed the paper’s co-author Julia Marcus, PhD, MPH, postdoctoral fellow at the Kaiser Permanente Division of Research. “Ongoing screening and treatments for STIs, including hepatitis C, are an essential component of a PrEP treatment program.”
No one in the group has been diagnosed with HIV.
Our takeaway, PrEP is clearly doing its job in HIV prevention, however we need to remain vigilant in testing and treatment for STIs. The choice to use or not use condoms is up to the individual, but be aware of the risks and ensure that you’re regularly being tested to protect your health and potentially that of your sexual partners. Complete Article HERE!
Name: Bob
Gender: Male
Age: 54
Location: Laguna Beach
As an older man, I’ve started having performance problems. Unfortunately there’s no decrease in my libido. I think some of my problem is psychological. I’m also HIV+. And I find myself worrying about transmission even with condoms. But some of the problem is physical. I do wear a cockring and that helps I guess. Is there anything else I can do to increase my performance to match my libido?
Thanks for your comment and question. Your concern is a familiar one. Men regularly present this problem in my private practice and I also have a personal familiarity with the issue in my own life.
Diminished performance, at least in terms of a perpetually stiff dick, is a natural occurrence as we age. There was a time when I thought this was a major problem. I don’t think like that now. These days I’m helping my older clients (and myself) appreciate the full range of sensuality that is the unique purview of us more seasoned lovers. I’ve always felt that as gay men we are too genitally focused, especially when it comes at the expense of all the other pleasure zones our bodies have been gifted with.
The rushed, hormonally driven sex of my youth has matured into a slower, more relaxed and sensual sexuality that I am thoroughly enjoying. This has been one of the very best gifts of the aging process. It’s even having an effect on my younger partners and they are appreciative.
So I no longer equate performance with a stiff dick. For those times when I absolutely need a rock-hard hardon a cock ring does just fine. I’m aware that I may need more time to achieve this kind of erection, but I’m not just twiddling my thumbs while I’m waiting, if ya know what I mean. I am no longer frustrated by this natural phenomenon, because I no longer have unrealistic expectations.
I realize that many men are using with an erection-enhancing medication such as Viagra, but I suggest that this be reserved for those who are truly experiencing erection dysfunction.
I’m also concerned with the alarming rise of younger men, men in their 20’s and 30’s who are using Viagra or another similar drugs recreationally. This is very troubling. If your young body is having difficulty producing an erection, then you need medical attention ASAP, or maybe you just need some sleep. However, if you’re abusing Viagra just so you can have an erection that lasts for hours that’s a real bad idea for several reasons. Not least of which is your body will habituate itself to that stuff and you will find that, in time, you won’t be able to get it up at all without ever increasing doses of Viagra.
This is gonna fuck up your cardiovascular system big time. In fact, you may very well be inducing the very sexual dysfunction the drug is supposed to help. Consider the person who overuses eye drops or lip balm or any number of otherwise innocuous health and beauty products. Their body will stop making the natural substances that these over the counter products are intended to assist. It’s counterproductive and it’s ill advised. If this is a problem with relatively harmless over the counter products, you know you are playing with fire when you’re abusing powerful prescription meds.
Whoops, sorry Bob, I went off topic there for a minute. It’s just that every opportunity I get to put out a message that will dissuade someone from hurting one’s self, I just launch into it.
So back to you. It is clear from what you tell me, your performance problems do, as you suggest, also have a psychological component to it. You have a fear that, despite being responsible in your sex play and even though you play safe, you could accidentally pass on HIV.
It’s true; one’s brain can indeed override almost every function of our body. For example, we draw each and every breath we take without even thinking about it. However, if a situation dictates our brain can and does override that essential pulmonary function and we can hold our breath. The same is true with our sexual response cycle. Sometimes we can become sexually aroused without really thinking about it. However, if for one reason or another our brain assisted by our conscience interferes with or even shuts down the sexual arousal, that’s pretty much, all she wrote.
Your scruples about the possibility that you could accidentally pass along HIV are interfering with your sexual response cycle. No cockring or an erection-enhancing medication is going to change that darlin’!
In other words, the problem is not in your cock, the problem is in your head. This is something you’re gonna have to wrestle with and finally resolve. This tension between your head and your dick is actually a good thing. Your body is providing you an opportunity to align your moral values with your sexual performance. How will this resolve itself? I couldn’t say. But I know for sure resolution is possible.
I do suggest, however, that you not try to do this in a vacuum. Reach out to a HIV support group or a sex-positive therapist for the help you need in making peace between your head and your cock.
Name: Trey
Gender: Male
Age: 17
Location:
I’m 17 years old. I hit puberty at age 10, so I have had time for my dick to grow, but it hasn’t. I’m 1 inch soft and 4 inches hard. Why? Is it normal? I mean all the other guys have dicks at least 4 inches soft and like 6-8 inches hard. Even one of my of my 13-year-old friends dick is honestly 6 inches soft! What is wrong with me? Why is mine so small? Is it abnormal for my age? I have heard that weight can have something to do with it? I’m about 240 pounds. Can you help? I can’t do surgeries or enhancement pills or whatever. I mean, give some names of medicines and I can talk to my doctor or something.
Normally I wouldn’t respond to yet another question about how one grows his dick bigger. I’ve already dedicated enough ink to this topic to last a lifetime. If you want the 411 on cock enlargement techniques of all types, all you have to do is use the search function in the header and search for topics like: cock size, cock shape and jelqing. Or look for these topics in the CATEGORY pull down menu in the sidebar. You’ll find everything I have to say on the subject. Here’s an example of what I am talking about — Much Ado About Very Little.
But for your benefit, Trey, I’ll summarize. Our dick size is determined by genetics, like our skin color, hair color, stature and the like. Permanent male enhancement by any means, short of surgery, is a fiction. And surgery is an exceptionally risky procedure, often times only making matters worse.
The only reason I decided to publicly respond to your question, Trey, is because you mention your weight. You tell me you are 17 years old and you weigh about 240lbs. That’s astounding, pup. Unless you are 7” tall and built like a brick shithouse, you must be considerably overweight, perhaps even obese. If I were you, darlin’, I’d consider my weight problem to be a much bigger liability then the size of my baloney pony.
Seriously, one sure fire way to add to your dick size is to lose weight. Think about it, if your unit is struggling to peek out from under a big fold of fat hanging down from just above your cock, you could easily add a couple inches if you trimmed the fat. But dick size aside, you’re simply carrying too much weight and at such a tender age. YIKES!
You know you are at risk for diabetes, circulatory problems and cardiac problems, right? Each and every one of these will impact in a very negative way on your sexual response cycle. So even if you could magically grow you dick bigger, your weight will defeat you; making it impossible for you to get it up and get it off.
I encourage you to seriously consider a lifestyle change, pup. Do it so you’ll have a bigger dick, if that’s what you really want. And in the process you’ll also insure a healthier heart making that bigger dick of yours function like it oughta.
Good luck
Name: razor
Gender: Male
Age: 34
Location: Texas
My partner and I have been together for about 8 months now. I can’t even say we had a great, awesome, sex life at first. There was something else. I thought I had found a good person and friend in him. He is very sexy, lean and hung. Honestly, I should really want him. I’m poz, and he’s not. I, wonder if that could be the reason, why I don’t desire him? Afraid that I might hurt him somehow. Or could this be just what I think it is, could I just not want sex?
Mmmm, I’d go with the first option, if I had to pick one. I’d be willing to guess that the disparity between you and your BF’s HIV status is indeed getting in the way of your eroticism. And that’s a big fat bummer, because it doesn’t have to be like that.
Correct me if I’m wrong, but the lack of desire for this hot and hunky HIV- guy isn’t getting in the way of you guys having a good relationship, is it? The reason I ask is that many happy secure relationships are based on other things besides sex. You say he’s a good person and a friend. Maybe that’s all you need to make this relationship work and last. Most long-term relationships wind up being relatively sexless anyway. Instead of sexual fulfillment, the couple finds contentment in the intimacy and stability of the relationship. And that is often more gratifying than a vigorous roll in the hay.
As to your fears about possibly hurting your guy through sex…well life is full of risks, right? Your man is equally aware of the possibility of an accidental sero-conversion as you, right? But he stays with you. Why is that? Maybe he’s willing to take the risk; because he has this other connection with you…ya know the friendship thing. Maybe he is confident about the safe sex he practices. Maybe sex is not all that important to him, considering he’s in a relationship with a good man who is his friend. Maybe you just oughta ask him.
At the same time, there’s loads of very pleasurable sexual activities you guys could involve yourselves in which carry very little to absolutely no risk of an HIV accident. Maybe you just need to get a little more creative in your sex play. Lots of mixed HIV couples have figured this out already.
Fear is an ugly thing, Razor. It can, as you suggest, shut down a person’s entire erotic life. But I encourage you not to let this happen to you. Push past your fears. Work with a sex-positive therapist or an HIV support group, if you must. Just don’t settle for the status quo. Even if your current relationship isn’t dependent on a regular slap and tickle, you oughtn’t live your life like you are some kind of Typhoid Mary. That is if you ask me.
On this the first annual National Sexual Freedom Day, sponsored by The Woodhull Freedom Foundation, I’d like to propose something quite radical. I suggest that our sexual freedoms, here in the United States, are intricately linked to universal sexual rights. And I contend that the notion of universal sexual rights is at its core a respect for human rights and human dignity.
In a world wracked by poverty, disease and war; where we threaten our very existence with climate altering pollution, nuclear proliferation and extreme population growth; is there room to talk about human rights that include sexual rights and sexual freedom?
I emphatically answer yes! In fact, I assert that sexual inequality and oppression is at the heart of many of the world’s problems. I contend that trying to address human rights without including the essential component of sexual rights and sexual freedom is ultimately doomed to failure.
An absence of sexual rights and sexual freedom leads to domestic and societal violence; human trafficking; suicide; a rise in Sexually Transmitted Infections (STIs); unplanned pregnancies, abortion, and sexual dysfunction.
You know how we are always being encouraged to Think Globally and Act Locally? Well while we busy ourselves securing and celebrating our sexual rights here in this nation, I think we’d do well to focus some of our attention on how our struggle binds us to the rest of the human community.
I offer three examples of what I’m talking about. I invite you to consider how a myopic sexual rights and sexual freedom agenda, divorced from the overarching issues of human, economic and social rights, can be ineffectual and even counterproductive.
***
In 2008 the research community was all aflutter about ‘conclusive’ evidence linking HIV transmission and uncircumcised males. While I’m certainly not ready to take this data on face value, let’s just say, for the sake of discussion, that the link is conclusive. A massive campaign of circumcision was proposed as the best means of HIV prevention. The medical community would descend on epicenters of the disease, scalpels in hand; ready to eliminate the offending foreskins from every male in sight, young and old.
But wait, there’s a problem. Most HIV/AIDS epicenters are in underdeveloped countries. In these places, access to enough clean water to drink or attend to even the most basic personal hygiene, like daily cleaning under one’s foreskin, remains an enormous chronic problem. Without first addressing the problem of unfettered access to clean water and adequate sanitation, which according to The United Nations is a basic human right, further disease prevention efforts are doomed.
I mean, what are the chances that surgical intervention would succeed—one that would involve significant and sophisticated aftercare—if there is not even enough clean water for drinking and bathing?
These well-meaning medical personnel suggest imposing a strategy that not only works against nature—our foreskins do have a purpose after all: a healthy prepuce is a natural deterrent to infection. But this intervention would also violate long-held cultural and societal norms—circumcision is abhorrent to many of these same cultures. Wouldn’t this proposed prevention effort to stem the tide actually make matters worse?
***
Indentured sex work is another indicator of how human rights, sexual rights and sexual freedom are intertwined. Until the economic and educational opportunities for women throughout the world improve—which is a basic human right according to The United Nations—women will remain chattel. Families in economically depressed areas of the world will continue to be pressured to sell their daughters (and sons) simply to subsist.
Closing brothels and stigmatizing prostitutes overlooks the more pressing human rights concerns at play here. Sex is a commodity because there is a voracious market. Men from developed nations descend on the populations of less developed nations to satisfy sexual proclivities with partners they are prohibited from enjoying in their own country. Young women (and boys) in developing countries are viewed as exploitable and disposable, because they don’t have the same civil protections afforded their peers in the developed world. And runaway population growth in countries that deprive their women and girls access to education and contraception inevitably creates a never-ending supply of hapless replacements.
Addressing the endemic gender inequality in many societies is key. Equal access to education and economic resources must come before, or at least hand in hand with any serious sexual liberation effort.
***
Finally, people in the developed world enjoy a certain level of affluence and economic stability which allows them to indulge in sex recreationally. Thanks to effective birth control methods we can ignore the procreative aspects of sex and replace it with a means of expressing a myriad of other human needs. Not least among these are status, self-esteem and self-expression.
If we’re trying to prove something to ourselves, or others, by the way we conduct our sexual lives, simple prohibitions against certain sex practices won’t work. If I’m convinced that unprotected sex with multiple partners and sharing bodily fluids is edgy, cool fun, without serious consequence, as it’s portrayed in porn; I will be more likely to express myself the same way. This is especially true for young people who are already feeling invincible.
Case in point: there has been a startling uptick in seroconversions among young people, particularly gay men, which indicates that disease prevention efforts, even in the world’s most affluent societies, are simply not up to the task. It’s not that there is a scarcity of resources, quite the contrary. It is more likely that these efforts are not connected to a fundamental understanding of the role sexuality plays in the general population. I believe that sexual expression and sexual pleasure are the overarching issues here. These too are fundamental human rights.
No amount of safer sex proselytizing is going to prevail unless and until we look at why and how we express ourselves sexually. As we unravel this complex jumble of motivations and behaviors, effective prevention strategies will manifest themselves clearly. We must develop a sex-positive message; one that celebrates sexuality, builds self-esteem and counteracts the prevailing media messages of sex with no consequences.
***
National Sexual Freedom Day brings into focus the micro-strategies needed to combat a macro problem. But it also shows that we cannot work for and celebrate sexual freedom in a vacuum. It’s imperative that we see how global health and wellbeing is completely dependent on basic human rights, including sexual rights that include gender and reproductive rights, the elimination of sexual exploitation and the freedom of sexual expression.
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