I've been poz for at least 25 years, probably longer, judging by behavior. I was there before there was anything to worry about, remember the earliest days vividly, and have lived long enough to be the last of my peers from our 20s (except one). At this point in my life, I'm essentially sound. But I've flatlined twice in my career with the virus and, at 48, am living with many unanticipated consequences of various fashions in medications. These include a diminution in cognitive function, odd redistribution of fat in my face and extremities, chronic pain and a budding cardiovascular condition, having just had my first angioplasty. I no longer make ten-year plans.
I am also a long-standing member of AIDSmeds.com, which is the best place for factual, up-to-the-minute, peer-reviewed scientific information. There is also a support forum which, for the most part, cuts through the bullshit and lays everything out straight. It's not the place for a casual browser or anyone who holds any false illusions about topics like disclosure, blame-seeking or the "manageability" of what remains a terminal condition.
Disclosure remains a private decision at the discretion of the individual(s) involved. Moralistic or ethical mandates insisting one disclose no matter the particulars of the situation will never work in a society where the individual trumps the group.
Before people jump on this post, let me state that I choose to disclose my status before any sexual activity. It's a personal imperative for me --yay!-- good for me! But I understand the reasoning behind not disclosing in certain situations, and it's based on some solid scientific points.
Some activities are totally safe and pose no risk of transmission. These include JO and frot, deep kissing and playing with toys, WS and fisting. None of these activities have even neglible or theoretical risks concerning HIV, though many bacterial infections and STDs remain a possibility.
Getting a blowjob is completely risk free; giving a blowjob remains a theoretical risk, meaning that it has never been conclusively been proven. This remains a hot-button issue which, for the purpose of this discussion, I'd care to avoid, except to say that saliva has enzymes and acids that render HIV inactive, so on top of the theoretical risk of transmission is the theoretical chance of giving a blowjob with no saliva whatsoever in one's mouth, something I've never encountered in over 30 years of sucking cock.
One of the issues with these activities is that many people will not stop with them, and push into other activities that might pose greater risk, the whole "caught up in the moment" argument. It's compelling, but not conclusive to me. And it would seem that if one has the wherewithal to negotiate a fisting scene, for example, it isn't beyond reason that limits could be respected (if they're discussed: another of my imperatives).
I hear guys say all the time that they can't serosort because there are no available poz guys to be found where they are. I have a hard time believing this, frankly, as I've never seen anything similar in my own experience. I think that they (subconsciously or not) reject candidates who seem too obviously poz (through facial wasting, for instance) because of an internalized stigma associated with HIV, among other things.
Because there is a stigma. It's as great now, if not greater, than it was in 1988, when there were no treatments and most people died in fewer than two years from diagnosis. For every guy who's "cool with poz" there are ten who profess "D&D free, UB2". I see those profiles, chuckle and move on; to me they are deluding themselves with a false sense of security and are pushing a kind of undisguised bigotry that, in any other context would be totally unacceptable. Again, I can get all the men I want, but many guys cannot. I've seen guys in tears over this: it's totally real.
Does the sting of stigma justify not disclosing? I don't believe so, but I'm not in their shoes. And since condoms, when used correctly, completely protect someone from HIV (yeah...they do), they can have a few moments of living without the shame, guilt and self-loathing that comes from stigma. It wouldn't be honest to me, but I'm not them, and they have to live with themselves and their wish to escape reality. And since they are not putting anyone at risk, it's essentially a benign lie to everyone except themselves.
This all changes dramatically in my opinion, when condoms are deleted from the picture. Unprotected anal and vaginal sex is playing with explosives: eventually it's gonna hurt somebody.
But there is very good science that suggests that once someone's viral load in undetectable (fewer than 40 parts per ml of blood tested), they are no longer infectious. This is still new stuff, and there hasn't been enough testing to prove it one way or another (such testing would be completely unethical), but it is a theory that is backed by much anecdotal (uncontrolled) evidence provided by serodiscordant (poz/neg) couples. My opinion is that the only protected sex is sex with a condom, but that's just my opinion and one that is at odds with several scientists.
One of the most irritating and over-used expressions in the English language is "You gotta understand...". No, actually, you don't have to understand anything. Much of what I've written might strike you as excuse-making. It's not: I abhor excuses. And I'll not attempt to legitimize behavior that I don't practice, especially when the health and well-being of others is involved. But I can rationalize behavior that I can't personally condone. In a different context, many (probably most) of you can do the same. But the specter of AIDS is such a horror that no one wants to put themselves in the shoes of someone battling the virus every day. The stigma is too intense, the fear is too irrational (however it may be justified), the stakes are too high, and we live in a society that distrusts science (though few even understand the scientific method due to our terrible educational system).
There is also something acknowledged in the HIV community but not discussed outside of it: many, if not most people living with HIV also live with some sort of mental illness. Many many live with addiction issues, are bipolar, take excessive risk, live with depression and who suffer from a complete lack of self-esteem. Many are survivors of childhood sexual abuse. I am certain that the sexual abuse I lived with growing up has altered the way I see myself and has had an effect on my sexual interests, and know many others who have suffered similarly. Again, this is not to excuse antisocial behavior, but it helps explain some of it. And, of course, mental illness comes with its own entrenched stigma. It's percieved as a character flaw to even acknowledge mental illness, but no one considers diabetes to be a "pancreatic flaw".
The fact that HIV/AIDS is still considered a gay disease (despite increasing infection rates in the straight African-American and Latino communities) is particularly unfortunate. It compounds the stigma many already feel about having sex with one's one sex as a man (lesbians have extremely low rates of HIV, it's not their issue). Is it really possible to be a 100% completely well-adjusted gay man in a society that refuses to acknowledge his deepest committment, where one walks a razor's edge of being "masculine enough" every day, and where living one's life with honesty and integrity automatically disqualifies him from nearly all participation in organized religion?
It doesn't surprise me that many of the most materialistic people today are gay men: they find the personal validation in possessions that society denies them more generally. Many obsess on their appearance, their clothes, their jobs, their cars and their homes because it's all they have left. And it's no surprise that such people have unrealistic expectations about sex and drugs, which brings us back to HIV/AIDS.
In the 80s there were calls to tattoo us or quarantine us, or both. It sounds as if there are a few members here who wouldn't disagree with that logic today, even if they wouldn't dare say so in an open forum. There are those who point to an excessive lifestyle and say that those who are infected brought it on themselves through carelessness or indifference, and there are those who think that there are "innocent victims" in the pandemic without realizing that the opposite must therefore be true (and I've had explosive PMs about that here).
But I maintain that HIV is not a consequence of certain behaviors that only certain people practice. The process of infection is the same as that of reproduction (though, admittedly, anal sex mimics it without duplicating it), which is considered life-affirming. The sexual impulse is hard-wired in the reptilian part of our brains. It's not something easily subliminated, and it's not something most of us would choose to live without.
It's a virus, not an indictment and not a judgment. There is no cure, and none of the treatments have been proven to be both benign in terms of side-effects and efficacious in terms of controlling its spread within its host. Wouldn't it be great if it were different? Sure, but it can only really be controlled within the general population through education and pragmatic prevention efforts which, more than 25 years in, still seem as impossible as they were at the beginning.
