Neg Guys Barebacking With Poz Guys = Safe Sex
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30 January 2008 | 14 Comments
Last night I wrote a post saying I think most “neg” bareback bottoms are actually poz. Now today the big news is that poz bottoms are now neg… At least in Switzerland…
OK, not exactly, but… This one is big, so pay attention…
[See the update at the end of this post…]
The Swiss Federal Commission for HIV / AIDS has put out their first ever consensus statement saying they all agree that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious.
That’s right – you can’t get HIV from a poz guy if all of the following are true:
- the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician
- the viral load has been suppressed (<>
- there are no other sexually transmitted infections
That’s huge… They’re comparing this pronouncement to the statement many years ago that you can’t get HIV by kissing someone. It’s impossible to prove it for certain, but they’re unable to find any evidence that it’s wrong.
This has a lot of implications. In yesterday’s post I was saying that I didn’t think barebacking with poz bottoms was all that much more risky than barebacking with neg bottoms since the neg bottoms could have just converted and be highly infectious – looks like I was right on target – at least for guys who have been poz for a while and are on meds.
It also has implications for serodiscordant (poz/neg) relationships… Those couples can now breathe a sigh of relief – and even “safely” bareback each other. They just have to keep on top of those viral loads and avoid STDs for both partners.
But curiously it puts the burden for protecting the community onto the poz guys. I worry a little bit that there will be a pressure for poz guys to take meds earlier and earlier to get viral loads down to absolute zero and stay there. I’m not sure that’s completely fair, but the flip side is that I expect this will have poz guys feeling a bit better about the social implications of being poz.
And I’m guessing you’ll start seeing “undetectable for X months” in profiles to signal to neg guys that the poz guy is “safe”. In a way, this almost makes the poz guy safer than some neg guys to have sex with since the risk is more controlled and predictable. Wouldn’t it be weird if neg guys started preferring poz guys ’cause it was safer than it is with neg guys…
This does change the whole landscape of “safe sex”. Any guesses how long it will take the “condom nazis” to pick up on this news?
UPDATE:
The news is now out a day later that the Swiss researchers only looked at studies with heterosexuals in drawing their conclusions. So presumably most of the sex behind the studies was vaghttp://www.blogger.com/img/gl.link.gifinal sex, not anal. [What were they thinking?]
So what does this mean for us gay guys giving and getting cum up the ass? I think the straight studies are parallels. In other words, if you can say conclusively that straight bareback sex with a poz partner is “safe” then you can say that gay sex with a poz partner is “relatively low risk”. In other words what they’ve shown is that the viral load of the poz partner makes a difference. That’s not going to change for gay guys, but it may not reduce the risk down to, or close to, zero in our case.
For me, it’s about relative risk and I still feel comfortable in hooking up with poz guys with undetectable viral loads. It may not be zero risk, but it’s relatively low risk and consistent. You’ll each need to make your own decisions. Hopefully they’ll look at the data for anal sex and give us a statement on that as well…
UPDATE 2: Please see my post on the video one of the authors of the statement gave…
This confirms the practice that starts to gain popularity in Holland, where guys who confess to their physician that the just cannot refrain from fucking bareback are started on medication solely to protect others and long before their resistance is lowered to the level that was in the past considered as treshold for starting treatment.
I am still without medication and cannot do without fucking bare. Until now I tried to limit myself to guys who are clearly looking for bare fucks without asking questions, considering them to be poz or wanting to get pozzed.
Of course there is the costs of medication and the long term effect of the combo therapy to be considered. It looks like the medicines are improving though; focussing better on the job of solely preventing HIV cells to multiply with ever less side effects.
ad – The idea of putting guys on meds when they don’t need them personally really bothers me. It’s like they’re saying the lives of poz guys are worth less than those of neg guys – that you can harm a poz guy to protect a neg guy… Doesn’t sit well with me at all.
again, I’m not too sure if there really is a case of harming the poz guys, really.
Now I have become poz, I’m just thinking out loud whether the current practice of waiting until the T-cell count gets seriously low before starting medication is a good idea. Is it really good to have the virus reak havoc in a body before really starting the frontal attack? Is it not better to get the virus down to indetectable levels as soon as possible? More research will give us the answers soon I hope.
If this early treatment is given here it is solely on the request of the patient.
I have not made up my mind on this, but dont think the argument that at least it prevents spread of the virus is morally wrong:
all existing vaccinations are based on doing a little harm to do a lot of good.
Ken Meyer is a leading HIV researcher in the nation. He has published more than 300 articles in peer reviewed journals. This email circulated (from Ken) in response.
I think this report is highly speculative and misleading. Here are my concerns:
1. even following 100 couples for a few years is insufficient to prove a negative. Sexual transmission of HIV involves lots of variables, and this kind of report could result in more risk taking and new infections.
2. I particularly take issue with the “no STI” category, since many STI’s are asymptomatic and we don’t have rapid diagnostics, so if someone was insertive with a partner who had pharyngeal gonorrhea or chlamydia, they could then have an STI, not know it, and then if they were an anal insertive partner, they could transmit the STI and HIV to their partner without knowing they had the STI.
3. The asymptomatic STI question is even more relevant for Herpes simplex, which is lifelong and co-infected individuals may be excreting HSV-2 in their semen up to 1/3 of their lives without symptoms. HSV-2 seroposivity is associated with increased risk for HIV transmission and acquisition, and trials are underway to see if HSV-2 suppression with acyclovir helps to decrease HIV transmission and acquisition. There are other STI that affect genital tract inflammation, like CMV, for which we know even less.
4. The report does not discuss STI in the HIV-uninfected partner. These can increase susceptibility to HIV.
Bottom line, if a discordant couple is monogamous, and if they have been carefully screened for STI, and if the infected person has an undetectable plasma viral load, there is a radically reduced likelihood of HIV transmission if there is unprotected intercourse, but we do not know enough to say it can’t happen. Sexual harm reduction strategies may enable the couple to make a decision that they are willing to accept a very low, but probably non-zero risk, but no one has enough data to say that transmission cannot happen. The study we are doing with Dr. Deborah Anderson will help us learn how much residual infection may remain in the semen and other genital secretions of HIV-infected men when their plasma HIV RNA levels are undetectable by conventional assays.
Hope these comments are helpful in explaining why Fenway should not accept the report at face value. Many thanks for letting me know about this. best wishes, Ken
AttemptedRecluse – Thanks for that… I had seen it somewhere else – it seems to be the two response floating around at this point. Curious it doesn’t mention anything about anal sex which seems to be the big hole in their statement (pun intended).
What you just quoted also shows something else – the idea that American scientists and doctors won’t endorse anything unless it’s zero risk. I think the malpractice suits scare people and I think it’s telling that it was a European group that made the statement.
But we don’t live in a zero risk world and I think the scientific/medical community has done a huge disservice to us by not treating us as adults and putting clear numbers out on level of risk – “using a condom 10 to 20 times safer, topping instead of bottomin 8 times safer”, etc.
Even the guy you quote says there are times where there is a “radically reduced likelihood of HIV transmission”. Why didn’t he say that sooner? How is that not one of the most important things to know from a public health perspective?
I don’t know about this. I mean, you draw a definitive statement from the article you quote in the original post (you absolutely can not be pozzed) if three variables with huge variances are adhered to (what if the person skips a treatment here or there? The viral load could vary from day to day, month to month even with effective treatment. As someone said in the comments, some STIs are asymptomatic. Should the person be checked constantly?).
That’s just too much variable for that much constant.
Also, you ask for a categorical amount of risk for various behaviors, but that isn’t how the real world works. Barebackers often use the “I could be killed while driving my car” analogy when it comes to choosing to bareback. But nobody expects to get a statistic on how much risk is actually involved in driving (when you drive down the freeway vs. driving down a city street, when you roll through a stop sign, when you exceed the speed limit). We just all agree that it is “risky” to some degree.
I’ve barebacked with a guy who lied about his status, had a fully detectable viral load, and was erratic (at best) about his medication, come to find out later. We fucked a few times, once hard enough to draw some blood, he came in my ass once. By all accounts, I should be poz. I’m not, and this was over a year ago.
So you never can tell what is going to happen because we do not live in a laboratory-controlled environment. I think it is misleading to say with any certainty that by barebacking with certain individuals or getting immunized by a weak strain of HIV is a way of protecting oneself.
What you said rawTOP!
Why am I not surprised that those Swiss only looked at hets?
In 1986, gay men were told by the public health establishment to use a condom every time. Every time in every circumstance with every person for ever. End of story. No consideration given to how practical that is.
Now, nobody does that. But because the file has been closed on HIV prevention for men who have sex with men, all of us are forced into the position of making decisions based on subjective experience rather than anything with scientific evidence attached to it.
So it’s a crap shoot.
Here’s the way I play. If the guy is poz and I know him and his vl is undetectable, I’ll take his load. If the guy is neg and I know him and feel relatively certain that he’s correct in thinking he’s neg, I’ll take his load. I’ll fuck anybody raw who wants it because the risk of me getting exposed that way is pretty low.
And so far, so good. I continue to test neg.
It is a crapshoot, so if I come up snake-eyes, I’ll deal.
(Incidently, I know a guy who is poz and is totally turned on by the idea of gifting neg bottoms. And he’s encountered several neg bottoms who want him to poz them. But because he’s religious about taking his meds, after trying for years he’s been unable to share his strain with anybody. Yeah, I do have some pretty out there friends.)
Drew – I posted about this on bnskin and one of the guys on there who’s really into gift giving just responded “bugger”. You could hear the disappointment in his response as he realized he’s shooting blanks ’cause his viral load is undetectable.
Austin – A lot of the things you bring up as issues are covered in the study. Day-to-day changes in viral load are built into their findings, etc. But more importantly it’s up to the neg guy to get to know the poz guy before making a decision (like Drew is doing). Yes, there’s a lot of unknowns – but it’s about risk reduction, not risk elimination.
Re poz vs. neg guy safety.
All people are responsible for not harming others. A poz guy is responsible for not spreading a very dangerous disease (yes, even with the meds). It’s his choice to be celibate, sero-sort, play wrapped, or (possibly) zero out his viral load. But he is responsible for doing one of those. The choice of sacrificing pleasure/convenience for safety is his.
I’d accept this as proof that zero viral load poz guys are much safer than significant viral load. Topping a ZL guy would probably fall into the “acceptable risk” category. Bottoming, however, is very high risk and even a significant reduction might still leave it too high.
ropenrideu – where are you from? your logic sounds very european. here in the states it’s up for debate whether stealth pozzing is even a crime (everyone agrees it’s bad, but different places have different laws).
as far as a moral obligation – i personally think that ends with the wishes of the other person. if the other person is a bug chaser, i have no problem with whatever the poz guy does. and if the other person doesn’t really care then i think there’s some room for interpretation – the poz guy has a lot of latitude in that situation…
I’m from California. Maybe I do think like a European. I’m under the impression that there’s not much dispute that intentional pozzing *should* be a crime but rather whether there’s much point when the laws appear presently unenforceable. There’s certainly a place for thing that are wrong but not punished by criminal sanctions. Sometimes sanctions might make things worse, like they do with drugs. That might well be the case with intentional pozzing if it made people stop getting tested.
Pozzing a chaser – well, there are people who might prefer a poz life for relatively rational reasons. But what if they’re on drugs or confused? I don’t see it as something that should be done casually, at the very least.
I prefer taking poz cum in my (so far) neg ass. Theirs nothing more fullfilling then taking poz jizz in my neg ass…I myself am a chaser and cant wait till ive converted over to being hiv poz!!!
Ryanarmymil@yahoo.com
To date, Ive taken well over 130 poz loads in my ass and Im still fuckin neg…I love the feeling of poz cum shooting inside my neg ass with the possibility of becoming infected…I cant wait for the day that my hiv tests come back poz
Ryan4poztops@yahoo.com
i really love to swallow and take cum up my ass, im poz, and guys appreciate me being willing to take it