Box Turtle Bulletin

i have to vehemently disagree with you here. if you want a policy that requires extreme mandatory hiv testing for men who have sex with men, look no further than uganda’s anti-homosexuality bill, or the hiv prevention bill currently before parliament.

there is no way to mandate testing of msm without extending the tentacles of a police state. that would be far worse than the unfortunate prevalence of hiv among certain individuals and groups who choose not to get tested or simply don’t know about the importance of testing.

public marketing campaigns are the only way to deal with this, i’m afraid.

Timothy Kincaid

tyler,

I’m thinking the role of government would be more in providing tests but that the community self-mandate. Sort of like, “everyone is getting tested this week, when are you”? Perhaps even bars who participate by insisting that patrons show a testing receipt. I’m pretty vague on the particulars and, as I said, I’m just thinking out loud.

Unfortunately, the current public campaigns directed at individuals are simply not working.

Jim Burroway

It’s impossible to even identify every man who has sex with men because of the closet. There are more problems with that than I can shake a stick at.

A better solution which would be to test everyone regardless of risk factors, as a routine part of a physical examination. But then, that would require universal health care to accomplish that. After all, someone without insurance may not want to know what his or her pre-existing conditions are, especially in this job market.

Timothy Kincaid

I’d definitely prefer a “test everyone” strategy. I wonder if that is even something that could be possible under the health system we have now.

It really wouldn’t be that expensive (comparatively).

But, as you note, there are other considerations.

I guess I just want to start a conversation to consider options beyond “more of the same.” 19% of urban men is just too high and if a quarter to half of them don’t know, we’re talking one out of ten.

Ted

I have to say, the old “pr” campaigns have never worked. The only thing that works is being responsible. Get yourself tested regularly, practice safe sex, and partner moderation. Studies show the fewer partners one has, the less likely one is to get an STD. But people lack self-control, and are lazy. Testing takes time, putting on a condom takes time, and no one wants to do it. Until then, people will continue to get STDs and HIV/AIDS and die. Sometimes it seems like we’re our own worst enemy. And that’s sad.

Karen

I know of an inner city clinic that offers the test to every teen and adult that doesn’t have test result on record that is less than 1 year old. Yes, a lot of people decline the offer, but the more it becomes a routine part of medical care the more often it will be done. It is much cheaper to test for HIV than it is to treat HIV.

Joel

WHAT!?
Well what rlly interests me is to what extent does that 18% correlate with age, with the knowledge of being HIV positive ,with heterosexual men, with the(anti-gay setting-if any-) city being studied, with monogamy(or stable relationships) and with all combinations therein.

These figures need to be displayed not just by our opponents, but by the same LGBT ppl. LGBT ppl NEED to know that other LGBT do not condone such negligence of their health which directly affects others. They NEED to know that the one beside them(specially in a one night stand) has an 18% probability of not caring enough for himself or them, maybe not out of evil, but out of ignorance or indifference.

Tone

Well this is ridiculous, how would we identify MSM’s anyway? They’re a huge and mostly anonymous group. I carry a purse and swish a little, does that mean I need to be tested? I’ve never had unsafe sex in my life. The only word I can think of for this idea is wackadoodle.

Chris McCoy

I think the #1 cause for people not getting tested is the stigma of being HIV+.

I’d like to see the survey of HIV+ people on how many of them were dumped when their partner found out their status?

I think the #2 cause is ignorance of the current realities of HIV+ people. Our youth are still being told that HIV is a guaranteed death sentence, and that just isn’t true. Who would want to volunteer to be told they’re going to die young.

Eliminate stigma. Eliminate ignorance.

Jutta Zalud

> how would we identify MSMâ€™s anyway?

Go where they meet. Here in Vienna, the local AIDS/HIV-support organizations regularly go to gay bars to distribute condoms and leaflets and talk to the people + during summer they go to the cruising areas. They are also present in the biggest gay chat. And: they are able to offer free tests. For obvious reasons you will not be able to reach all MSM that way, but you will reach a big chunk.

Additionally, *all* people should be encouraged to test regularly. Why not have doctors and dentists just ask their patients, “When was your latest HIV-test?” just as they ask “How are you?”

Tyler

ok if everyone were encouraged to get tests as part of a regular medical regime, that would be great, but like jim said, everyone would have to have access to health care; it won’t work if health care is a commodity available only to the middle class like it is today.

and it would have to be anonymous. we shouldn’t forget how sensitive information about sexuality, disease, and race, etc. has been used by the state in times not so far passed… not just in Uganda but in the USA, among other places in the West.

Other Fred in the UK

What is the purpose of screening for HIV? To my mind there are two possible answers to this question. Either to enable early treatment of HIV or to reduce transmission by unknowingly infected persons.

If it’s to allow earlier treatment, we need evidence that screening leads to a significant number of diagnoses significantly earlier than would otherwise have been the case.

If it’s to prevent transmission there is not much point in diagnosing unknowingly infected people who were having safe-sex anyway, you need those having unsafe sex to turn up for screening.

However there is a pitfall that we need to have evidence a screening program would not cause. The potential risk is that uninfected persons assume all the infected persons know who they are, and therefore it’s safe to have unsafe-sex.

Lael

Given that I work for Riverside County Department of Health doing HIV testing and counseling… I know a bit about the subject. My frustration is endless. This is one of those situations where I would be delighted to be out of a job but will likely be employed until I retire.

1) It comes down to simple selfishness.
a) Condoms are often not used because: I don’t like how they feel. I can’t get off. I can’t keep an erection. I am allergic to latex. It’s too much effort to keep them around consistently. They’re too small, too big, too short, too long.
b) We don’t ask about HIV/STDs because: it’ll break the mood, it’s their responsibility to ask, they would tell me if they were positive, my partner uses condoms with everyone but me.
c) If I tell someone I am positive: they won’t sleep with me, they won’t want a relationship with me, they’ll tell other people my business.
d) A very small, small percentage of positive men simply don’t care if they infect someone. They either refuse to test knowing they likely have it or do know and still have unprotected sex. Some claim that because they are on meds and their viral load is undetectable, what need is there to disclose?

2) Misrepresentation in advertising is leading younger men to think it isn’t that big a deal any more. The odds of you looking like any of the men in HIV meds ads is not too damn likely. Yet, that is exactly what is depicted over and over and over in every rag I have picked up in the last 10 years.

3) Message burnout. Gay and Bi men are tired of hearing about it. It has been beaten into their heads constantly by all forms of media and health professionals. Much like Charlie Brown’s teacher, it becomes so much “Whah, whah, whah whah wah.”

4) Young gay and bi men are not getting anywhere near enough education in high school about HIV and STDs. Sex ed doesn’t cut it, never has. Most of the school districts in my county will NOT allow full medically accurate education by my department. NONE. If you don’t get the message across while they are young and unsure, you can bet it is really not going to be received once they hit the immortal and sexually gregarious 20’s.

5) The addictions, both drug and alcohol, within our community contribute substantially to getting HIV and STDs. They screw with the immune system’s response and make it easier to get infections at the time you are most likely to get exposed.

6) High stress can lower your immune system substantially. I would be willing to put even odds on our community having higher than average levels of stress in general than the rest of the population. Stress along is enough, but what do people under stress often do? See #5. Then add sex to the end of the equation.

7) Gay men tend to be phobic about less than perfect health. This is not a joke. I have witnessed it too many times and directed at me just because I use a cane. I do not get the same responses when I don’t use it. That isn’t even concerning HIV. The reactions to HIV are even worse.

I am going to stop here before this becomes a full on blog all its own. These are just some of the factors on why it is still such an issue and why we don’t have further progress toward eliminating new infections. It would be nice to have it part of any visit to a doctor or clinic. Won’t happen though.

If you would like me to discuss this further, I am willing. As for HIV information and the internet… I only trust the CDC.gov site at this time. Too many sites have not updated in years or even decades. The CDC has peer reviewed studies and is the most current with their information. The Body can be good but I have seen conflicting information within the same site.

Lael

@ Other Fred in the UK: It is for both reasons. The CDC has decided that they want ALL HIV positive people in treatment, period. Earlier detection does lead to significantly longer lives and better responses to treatment. Because symptom can take over a decade, if a person doesn’t find out or test until they become ill from it, their viral loads are terribly high which can hinder getting it under control as easily as earlier diagnosis. T-cell counts plummet right around the time a person becomes symptomatic. This increases the chances of some pretty harmful secondary infections.

The second reason is the theory that it is harder to transmit the virus when viral load has been driven down to undetectable by treatment. There may be some validity to that but the jury is still out. It will take some more serious studying to come anywhere near something I would be willing to advocate for as a prevention strategy. *shudders* Still, combined with early detection, treatment is in fact the best prevention currently for preventing spread of infection.

Those that do not find out until much later that they are positive have potentially infected others. Let’s be conservative and say 1 partner a year. That is 4 to 16 years of no symptoms and that many potential new infections. Sure, some have few partners and others many, many more during the same time span. True, not every sex act, even the highest risk, automatically causes an infection. Still, the potential is there for things to stay way ahead of our ability to deal with it.

werdna

@Lael
“The second reason is the theory that it is harder to transmit the virus when viral load has been driven down to undetectable by treatment. There may be some validity to that but the jury is still out.”

I appreciate seeing your insightful comments here, it’s always good to get the perspective of folks who have the kind of first-hand experience you do. A small quibble: there’s no doubt that a person whose viral load is undetectable is significantly less likely to transmit HIV to an uninfected partner. That doesn’t mean there’s no (or an acceptably small) possibility of transmission–this is currently a matter of study and debate. Your conclusion is correct, however: providing effective treatment should be considered an important aspect of preventing new infections.

Lael

@ Werdna

I understand your quibble. The thing is that I must go by actual evidence rather than sound theory. We just don’t have sufficient studies to back it up yet. Because I have to do so much education where the tiniest shred of information suddenly becomes the new excuse for unsafe practices (I’m on meds, so screw safe sex, condoms and disclosure) I am obligated to take the highest level of safety precautions when discussing things of this nature. Better to error on the side of conservative optimism than damn someone with faint clarity.

We have some promising lines of research, some mentioned here at BTB, that could bring an end to the whole issue if any of them pan out. I don’t like talking about them with the general public because it is hard to explain about research taking time, plus safety and other concerns. People want hope, not excuses and pleas for patience. I get that.

Matt

How about Dan Savage’s suggestion that if you infect someone new, you ought to be responsible for paying for half of that person’s HIV-related medical care? Kind of like child support.

Here’s one: what about telling people to have monogamous relationships?

Regan DuCasse

I saw that result from the CDC and all of your comments and suggestions are valid and thoughtful.
Black heterosexual women have a stake in this because they are a similarly infected demographic to black gay men. Why they present this way, is the same reason they have for everything else.

1. It’s a neglected demographic, with some measure of distrust of the medical establishment.

2. Lack of information, coupled with misinformation and stigma.

3. A culture of relationship immaturity and hyper sexuality when it comes to sexual responsibility. Young people are deeply affected by images in media and popular culture, which shows lots of sex, with no consequences. Something that’s plagued our society for decades since the early 70’s.

4. Blacks and gays are uniquely marginalized and excluded from the supportive networks that keep individuals hopeful and secure in knowing they are cared for. Blacks and gays have been treated with such dismissal and disconnect, there is a rudderless quality in what should be the most important relationships they can have.

5. I get the latest information from the Elizabeth Glaser Foundation, infant HIV/AIDS and the birthrate among + women, is still among black women mostly. Pediatric AIDS isn’t a growing issue, because there IS testing during the pregnancy to determine infections and so on.

What this all does come down to, is encouraging testing on a regular basis and safe sex. If the medical establishment could assure no health discrimination, it would go a long way in enabling and helping people understand the importance of regular testing and preventive measures for the future.

I used to see ads that told people to ASSUME someone has an infection of some kind, rather than assume they don’t.
In a way, conservatives have discouraged a lot of sensible things. Like HPV vaccines for girls AND boys. Like ads that say assume a potential partner has an infection, and that condoms never and don’t work.
The attack Planned Parenthood and other outreach agencies in their efforts.
Of course, this is to try and push the abstinence only meme, instead of the monogamy and healthy relationship idea for all.

So conservative media, I think, is complicit in sending the wrong message as much as some in the gay community are that the medical establishment is not to be trusted.

Other Fred in the UK

@Lael

Regarding your first point, is there any evidence that screening does lead to a significant number of diagnoses significantly earlier? Are the men who test positive in screening those who would have got themselves tested in the next couple of months anyway? Or put another way would the men who are unknowingly infected bug not get themselves tested turn up for screening?

I accept your second point regarding treatment lowering the risks of infection.

Timothy Kincaid

Lael,

Thank you for providing this information.

Regan,

While I wrote this with gay men in mind, you are absolutely right that black women are also a population that is overrepresented.

AlexH

I don’t know about mandatory testing, but if you have sex — frequently and with multiple partners — you should assume that your partner is HIV + and take the necessary precautions.

Barebacking maybe hot to watch in porn movies, but life isn’t a porn movie.

And for those thinking “live fast, die young, have a good looking corpse” you’ll only achieve one and two, so why risk it?

Lael

@ Other Fred
I will try to find the comparison studies.

To the best of my current knowledge, outreach screening is going to the wayside due to funding issues, at least in California. That type of screening is targeted to high risk populations. We go to the venue and encourage testing. You’d be surprised how many times it is these men’s first test ever. We also tend to find those that test erractically(sp) despite knowing their high risk sexual activities.

Early detection is undisputed as to longitivity of patients. For the reasons I stated. I am lumping all forms of detection together: regular testers, those that just decide to out of fear over an incident and those that have been told they were exposed by a partner. We are working harder on locating those partners to try to find exposures as quickly as possible. It’s the current prevention darling of the higher ups.

TruAgape

To the writer:
I think we should call the problem what it is: “promiscuity”. Calling it ” men who sleep with men” is misleading and characterizes this as a “homosexual” problem of which it is not. It is a problem that both “hetrosexuals”, and “homosexuals” can perpetuate. HIV is transmitted, not created by sex regardless of the genders involved. Yet your classification of the HIV problem as “men who have sex with men” feeds a bigotted ignorant stereotype while ignoring the culprit: “promiscuity”. Some promiscuous sex acts like anal sex are unnatural, disgusting, and unhealthy and many “men who have sex with men” feel the same.

Mark F.

September 25th, 2010

Well, cost is not an issue in San Francisco as both government and non-profit organizations offer free testing here.

Should HIV testing be routine for everyone? I don’t think so–it’s a waste of time and money for 100% straight men who don’t share IV needles. Of course, men who have sex with men and people in other higher risk groups should be encouraged to be tested.

Lael

September 26th, 2010

@ TruAgape

Hold the train!

1) Men who have sex with Men is a risk designation by the CDC. As in, governmental agency which funds a lot of the testing and prevention. Grants specifically target various groups specifically. This is one of them. It is NOT an term Tim made up, so back off. It specifically covers gay, bi and heterosexual identified men.

2) The focus of the paper he sited is, in fact, men who have sex with men. It is entirely appropriate for Tim to restrain his commentary to the study he is siting. It focuses on that specific risk group. It is not denying other risk groups nor is he.

3)”Yet your classification of the HIV problem as â€œmen who have sex with menâ€ feeds a bigotted ignorant stereotype while ignoring the culprit: â€œpromiscuityâ€.
This is pure horse shit. Straight from the horse’s backside. Promiscuity raises chances but it is not the culprit. Not using protection, not testing and not discussing honestly HIV/STD status is the ‘real’ culprit.

4)”Some promiscuous sex acts like anal sex are unnatural, disgusting, and unhealthy and many â€œmen who have sex with menâ€ feel the same.”
You’re the one showing bigotted ignorant stereotyping with that sentence. Anal intercourse is not in and of itself promiscuous! That is your opinion, which I refute. Your personal bias against it has nothing to do with fact and everything to do with your personal distaste. Don’t waste our precious time. I can come with at least an equal number of men who have sex with men, if not many more, who completely disagree with your position.

As someone that does sexual counseling for a living and for many years, I can tell you with certainty: It is ALL normal and natural with one sole exception, that being rape (molestation is a form of rape as well). While you or I might not choose to participate in any particular aspect of sexual behavior, it is no one’s place to judge others, period.

Disgusting is subjective not objective and has no business in the discussion. Unnatural, not hardly. It happens in nature all the time. Unhealthy, well that depends. So, please, choose your words more carefully. Your bias is overpowering whatever actual point you thought you were making.

truthteller

September 26th, 2010

Forcing everyone to get tested like stupid cattle who need a master to look after them is fascist. Are you out of your mind?

What happens to these people if they test positive? Is counseling going to be mandatory? What about their families? Counseling for them too? Is there going to be a record of this in their health record? Will they have to tell their employers? (not everyone works for supportive companies) Who is going to pay for all this? These are important issues and most likely have a lot to do with some people not getting tested.

You seem to forget how traumatic this can be for someone who is unprepared for a positive result and I venture to say that it would drive some men to taking their own life or falling into a life of drugs or alcohol. I’ve seen it!

You are proposing a nanny state for adults and I find your idea repugnant and dangerous. Everyone needs to assume every person they sleep with is positive and take the appropriate protections.

Education is the only way to go when you are dealing with grown men. It is fascist to impose big brother’s rules on private sexual acts between adults.

TruAgape

@ Lael
Buddy calm yourself. No one is attacking anyone or judging anyone so please don’t take my post personally.

I think you misunderstood me because I do not believe nor have I ever believed that “anal sex” equates to “promiscuity.” That dosen’t even make any sense.

I do believe that we are essentially making the same point: “anal sex” dosen’t infect people with HIV just as “men who have sex with men” do not affect people with HIV. And that was the point I was trying to make. So I apologize if I gave a different impression. To me it dosen’t matter if a past study used the terminology of “men who slept with men” or not, my point is that such terminology is misleading and yes it indeed does feed bigoted stereotypes that anti-gay fundamentalists use as ammunition against us. The fact remains that “men who have sex with men” do not spread HIV. Infected people with HIV who have sex spread it. Even if more of the infected people happen to be those who are “men who have sex with men”, it dosen’t make it a homosexual problem, a “men who have sex with men” problem, or any type of problem centered around the gender of the sexual partners. But to the ears of a conservative nut bag, hearing even a gay person refer to this as a “men who have sex with men” problem makes it very easy for the facts to be clouded and packaged as another element of “proof” to the ills of homosexuality. And that’s the last thing we need.

Regarding “anal sex”, I’m entitled to my position. Be it Hetero or Homo, the anus is a disgusting, smelly and disease infested place to commence sex. It sickens me and even angers me to think that such a filthy practice gets equated with homosexuality. I’m gay and that is something that I and many other gays find downright repulsive!

Timothy Kincaid

TruAgape,

“Men who have sex with men” (abbreviated, MSM) is the term that epidemiologists and other sexual health scientists use to track specific methods of STI transmission. It doesn’t matter if you like of dislike the term, that is what the CDC uses.

TruAgape

@ Timothy Kincaid
Thank you for your response. You’re right, the CDC’s use of that term is used irespective of whether I like it or not. I just think that if we’re going to be clear about what the problem actually is, then we shouldn’t muddy it up with misrepresentative terms like “msm”, it gives the worng idea and the wrong impreression.
I don’t mean to be nitpicking here, I just think that we don’t do ourselves any favors when we continue to use “msm” when identifying the problem of HIV transmission. And if that term is going to be used (like in this case in reference to the CDC’s use of it) then we should add a necessary disclaimer of clairification. Just as if I was referreing to a study that referenced homosexuality as an “illness”, I wouldn’t perpetuate such terminology without a caveat. That’s all I’m saying. Didn’t mean to step on anyone’s toes.

Jason D

“Be it Hetero or Homo, the anus is a disgusting, smelly and disease infested place to commence sex. It sickens me and even angers me to think that such a filthy practice gets equated with homosexuality. Iâ€™m gay and that is something that I and many other gays find downright repulsive!”

All sex is filthy if you’re doing it right, and secondly, cleaning off “the back porch for company” so to speak, addresses all the other issues. From what I understand the vagina has it’s own share of issues at certain times which are also solved with the application of basic cleaning practices.

You’re entitled to participate in whatever turns you on, and avoid whatever doesn’t float your boat…but it seems your opinion is based on presumption more than anything else.

TruAgape