The other day I had a semi-critical post about some researchers in the UK who seemed to mean well but came out with what sounded like naïve recommendations. I had the following e-mail show up from someone in the UK regarding that post. I don’t know his exact credentials or affiliations, but what he’s saying sounds much better balanced than what I read when I wrote up the first post…

Hi rawTOP

Your site is on my favourites list.

I tried but couldn’t figure out how to post a comment on “Researchers mean well, but…” and thought you might find this article on AIDSMAP helps answer your questions.

[The article basically says in Quebec they’ve found that 49% of new HIV cases were the result of people who were recently infected, 15% were the result of established HIV cases in people who were untreated, and 12% were the result of established HIV cases in people who had/were undergoing treatment, with the remaining 24% unclassified.]

I work for a Manchester, England HIV support charity and two weeks ago attended an expert HIV prevention seminar in London, organised by the National AIDS Trust. They will soon produce a paper outlining our findings. We had expert epidemiologists, virologists, clinicians and in prevention, put together a jigsaw of research findings from the UK and rest of the developed world, for us to discuss and then develop the outline of a new strategy for England.

70% of people who become infected show the 3 main symptoms of early (primary/acute) HIV infection – and for half of these the symptoms are bad enough for tough [sic] normally healthy gay men to seek medical advice, but unless you attend a sexual health clinic it is most unlikely that the doctor will recognise this for what it suggests. If these early infections were instead diagnosed at this early stage, we know from other research that there is then a 50% reduction in unprotected anal sex, and this is much higher in relationships where HIV status is known to be different. People with primary infection are, by a very wide margin, at the most infectious they will ever be. People with primary infection are the source of most of the new infections. By contrast, people monitored on treatment with a viral load that has been undetectable for 3 months or more, and no STIs, are only borderline infectious and only account for about 17% of all transmissions.

The thinking is to radically increase the proportion of people diagnosed in primary infection – by making gay men more aware of the 3 main symptoms of primary infection and the need to do something about it (like you and the young guy in your entry “How HIV teens become positive”), by better diagnosis by clinicians , and by the use of the new 4th generation HIV tests which can pick up primary infection at about 3 weeks. Persuading and supporting people diagnosed to then avoid onward transmission when they are at their most infectious has the potential to make a radical reduction in the numbers of new infections. In the UK people with primary infection can join a early treatment trial on our free National Health Service and this would also reduce infectivity within a few months.

In England we have excellent local and national HIV data and know where all the HIV hotspots are – London, Manchester, Brighton (a South coast city 50 miles from London), and Blackpool (on NW coast near Manchester). The great majority of new infections that occur here are among gay men and in these centres. We also have a national annual gay men’s sex survey so we know a great deal about risk-taking behaviours, awareness and attitudes and how these are changing. http://www.sigmaresearch.org.uk/

Everything the researchers ask for in this article you quote is now known in England and we are already on the case.

Switzerland is going for broke with a radical primary infection campaign – this asks all gay men to only have protected sex for the current 3 months, then all who are undiagnosed to get tested. This would make a radical difference because the temporarily universal safer sex would almost stop ongoing transmissions including primary infections. The testing would help further reduce ongoing transmissions after this, because a positive test result helps change risk behaviour. It will be easy to spot if it works – we will see a big rise in new Swiss diagnoses this year and then in future years a much lower level of new infections and diagnoses. The political/social culture in Switzerland is very different from the UK / USA; like some other small European countries, it has a culture of much greater mutual social obligations and expectations. Any reduction in risk behaviour arising from the campaign will help, even if only a small proportion of gay men take part. We would benefit from something radical here and in the USA, but it will need to suit our more individualist social climates. But we can expect a great deal without this, just by refining what we already do.

One of the things we also need to do in England is to make a big cut in the number of people who are undiagnosed – currently around 30%. Many gay men attend STI clinics but refuse HIV tests here. Half the gay men with undiagnosed HIV in Brighton leave the STI clinic still undiagnosed. Simply getting the gay men who have an other STI to have HIV test would make a difference, because other STIs make HIV transmission much more likely in both directions, and because men with STIs are clearly already taking significant risks.

You are right that stigmatising notices in bars will not cut the mustard. However contact tracing of partners of people who are diagnosed makes sense. This is already done confidentially and routinely here. If we now prioritise the contact tracing of partners of those in primary infection, that would make a big contribution. Research into the mini-bursts in Brighton shows half the men with primary infection were part of these bursts (we call them infection networks) and half of these passed on HIV to 2-4 others, and the other half passed on HIV within about their first year of infection to between 5 and 18 others.

Maybe you might post a few links under your General heading to accurate HIV information sites so guys interested in the things you write about HIV can follow them up?

Here’s an item from Manchester, England, about a successful primary infection initiative in the USA. We are always interested in news and views from around the world which help make a difference. http://www.ght.org.uk/news_and_views_news_article/1651

cheers
skinscribechris

So… The weak spot I see in his plan is how to increase HIV testing. If guys are going into STD clinics, where they’re offered HIV tests, and they refuse them, then how do you get them to change their mind? Obviously you can try to get guys who don’t go for testing of any sort to go in and some of them will get HIV tests. And you can get primary care doctors to do more testing (we’ve had ones who do HIV tests without asking first, not realizing they’re breaking the law by doing so – or they just casually mention they’re going to do one and don’t actually ask if it’s OK)…

But honestly, if guys are refusing HIV tests when they’re offered, that’s not going to change – and those are probably the guys who are in “infection networks”. At least some of those “infection networks” are by design – even if it’s subconscious and outwardly they just tell themselves they don’t care and don’t want to think about it, there are guys who want to get infected and others who want to pass on their HIV. I mean there are whole web sites that are devoted to bug chasing and gift giving…

Still I wish them luck (since they don’t seem to be advocating fascist methods to achieve their goals) and it’s obvious they’re thinking about things as realistically as they can. But it’s a difficult task, to say the least… These days the cards are stacked against them. My one suggestion is to get members of the bareback community onto their community advisory boards… They need a reality check for some of their assumptions…

UPDDATE: The guy got back to me, told me his credentials (he’s the real thing), and commented on some of my comments…

So why do guys refuse a test?

In England, tests at STI clinics are currently offered on an opt-in basis and sometimes not enough is done to advocate the advantages of testing. However when testing is offered instead on an opt-out basis and normalised, testing rates shoot up. For example, when pregnant women were offered the test, midwives tended to make assumptions around risk depending on the woman in front of them. Rates of accepting tests were low, in one health district locally the average was only about 40%. The national Department of Health was faced with significant numbers of babies born with HIV, so it set a national target to raise this antenatal testing rate because of the risks of onward transmission to the baby, resulting in testing rates in that area exceeding 90%. That helps ensure a lot of babies don’t get HIV. When we studied the test acceptance rates achieved by different ante-natal clinics and for individual staff, there was a huge variation. Some retraining was needed to help the midwives overcome their reluctance to strongly advocate for testing, and this is an easier sell (compared with gay men) when the health risks to the unborn baby are pointed out and what can be done to minimise transmission to the baby. With testing and appropriate care and treatment for mother and baby, the transmission risk is now down to only about 1%.

The proposal is now to normalise testing at STI clinics, so the nurse would say we’ll test for all the STIs and list them and ask is that OK? People will continue to have the right to say no to any particular test, but the message will be that this is what we normally do in an STI clinic, that’s what we are here for, and to strongly encourage all to agree for these reasons….. . At the moment the script tends to be we’ll test you for x, y, z and would you like a HIV test too?

Another problem here has been a gross lack of capacity at STI clinics for testing because STI clinics are a cinderella health service. People a couple of years ago could wait 6-8 weeks for an appointment. Capacity is now very much better and still growing. There is a national target for access within 48 hours of asking and this is near being reached. The lack of capacity has inhibited major testing campaigns – these tend to attract the worried well in large numbers.

Clearly some guys will still refuse, and that is their choice. There are some men in sex / party networks who will say no, at least for the time being. Once people get ill with symptomatic infection, almost no-one refuses when their life and well-being is at significant and immediate risk.

The bug chasing and gift giving websites and networks contain a heady mix of fantasy and reality. Investigation here a few years back showed that they were largely fantasy. Some guys get off on the ideas, and raw sex is really appealing – as I know myself because I am old enough to have had a condomless sex life before HIV appeared, and the reappearance of a great deal of bareback porn shows very well.

When investigators attempted hook ups they were almost always unsuccessful. Maybe they were not reaching the right men and there are strong reasons (including prosecution) why most gay men will not ‘fess up to investigators – courts here can and do order the release of clinic / researchers’ data about men, when the police have to investigate after someone complains of having been recklessly or deliberately infected. Investigators and researchers are now unable to do this type of work because they can’t get ethical approval due to the risk their research data will be used against the men they interview.

UK culture rules out compulsion because of the high value our health service puts on personal autonomy – your right to decide exactly what to do with your own body. People can’t be forced to test or have treatment. But the culture is shifting – there are high profile campaigns about smoking with a ban on smoking in public buildings and workplaces like bars and clubs, around obesity and eating healthily, and about safe drinking because of our international reputation for drunkenness. But there is a world of difference between strong campaigns and compulsion.

Thanks for your suggestion about asking barebackers to help advise and guide us. Not easy with the risks to the men of their details being passed to the police after a court warrant, but we’ll try to find another way that won’t land gay men in legal shit. Many of these profile and and hook up websites want nothing to do with any attempts from HIV awareness and prevention services to reach the men using them, and the commercial ones usually want paying and the community HIV sector doesn’t have much money to pay advertising rates pitched at highly profitable porn providers.

Opt-out vs. opt-in… Hmmm… I can definitely see where that can be a help in the straight community where people may not realize they’re at risk, It will be interesting to see what effect it has in the gay community. Gay men know they should get tested. It’s not like ignorance is a big factor like it might be in the straight community. So going from opt-in to opt-out is just applying social pressure to not say ‘no’ to what the doctor wants. I’m wondering if anyone has really examined who the half of guys are who have HIV who leave without getting tested? Are they scared they’ll be poz? Do they think they’re in a monogamous relationship? It will be interesting to see what the effect is. I doubt it will be nearly as dramatic as it is with pregnant women and babies…

The lack of capacity at health clinics is just wrong. In NYC you can get completely anonymous testing the same day if you’re willing to show up early and a wait a few hours. And even at places like Callen-Lorde, where I usually go, you can often get an appointment the same day or the next day. In another post I said the US health care system isn’t all that bad (if you have insurance) and stuff like this just proves my point. Socialized medicine is supposed to be good at preventative care, but in this case it’s clearly not as good as it should be.

I’m not understanding the difficulty of having barebackers on community advisory boards. Perhaps you don’t have CABs in England like we do here in the States. I was on one for Project Achieve which is one of the HIV vaccine trial centers here in New York. Essentially I was put on a board which met with the senior research staff once a month. We made a commitment to serve for at least one year. The research staff would pass ideas by us that they had been thinking about the previous month and basically Project Achieve didn’t do anything without CAB approval. We were brought up to speed on absolutely everything they were doing (of any significance).

In the case of HIV prevention policy, you’d have a CAB and bounce ideas off them.We’re not talking about a research study where you confidentially get people to tell you what they’ve done, or a form of “outreach” to change people’s behaviors, but rather a policy committee that approves what you’re planning to do in their community. It’s important that you not take any action without their approval – otherwise they’ll think it’s a waste of time. You’ll want a mix of people on the committee – everything from barebackers to condom nazis to people who are indifferent, neg guys, poz guys, young guys and old… It’s your responsibility to make sure no one group dominates the committee and alienates the others. I can’t see that anyone could get in legal trouble for what they say in a policy committee, but if that’s really a concern just don’t record the names of who said what in your minutes of the meeting.

The benefit of having a CAB is that you get to bounce ideas off “average” people – see if they think what you’re planning makes sense, or if they have ideas and points of view you hadn’t thought about…

As far as the bug chasing web sites… Were your researchers pretending to be tops or bottoms? I’m guessing they’d have more luck as tops… But either way – watching the sites (one in particular) I’ve seen a shift over the last year or two. There are more stories that don’t feel like fiction, and more guys participating… Sure, there’s still a heavy dose of fantasy, but fantasy eventually turns into reality for many guys. You start reading stories and jacking off and end up not asking for a condom or even asking the guy to pull out when you know he’s poz…

But a lot of the young guys aren’t so much bug chasers as they’re addicted to cum and getting loads. They actually don’t want to think about getting pozzed, but still know it will happen eventually. I’d guess you’ll find a hundred of those for every one full-on bug chaser.

Load 2008-22

My apologies it’s been 10 days since I last fucked someone… Life’s been pretty busy…

A guy was supposed to come over after work last night to do a 3-way with my bf and me, but he didn’t show up. It’s not the first time plans with him have fallen through, so it didn’t surprise me when he didn’t show up. The guy I’ve fucked a couple times before – the one who’s a bit nervous and neurotic – had been e-mailing me pretty consistently since the last time we hooked up. He’d even e-mailed that morning. So when the other plans fell through I e-mailed him and then when I didn’t hear anything, I texted him. Immediately I get a call and he said he’d be over in a half hour. He could tell my bf was around and asked how many guys he’d be servicing. I said it would just be me since my bf had already jacked off after the first guy didn’t show up. For getting a text out of the blue he was immediately ready. Sorta felt like I was ordering pizza or something (“be there in under 30 minutes or your pizza’s free”)…

True to his word he was over here really quickly. In the meantime my bf had seen his pics and was interested in fucking him. When he got here I asked him if he was up for playing with my bf as well, and his response was like a little kid (even though he’s in his upper 40s) “OK, sure…” He then followed it up by “Is he neg?”

He stripped off his clothes, asked if he should keep his jockstrap on (I said yes), and he got on his knees and started sucking my dick. You could tell he was hungry for dick, but it wasn’t the best blowjob. After a while I turned him over to my bf and he sucked my bf’s dick while I played with his hole. His hole was all puffy – so I’m guessing he was playing with dildos when I called…

We then switch places and he’s sucking my dick again and this time my bf gets on his knees behind him and starts fucking him. Even though my bf had cum earlier, he was rock hard (which is typical for him)… We do that for a while and when my bf pulls out we reposition and this time I fuck him… We get him on the bed legs up, I spit on my dick and shove in. As usual, he’s a good bottom – takes my dick easily…

I gotta back up a little bit and say he’s been doing poppers almost constantly since he started sucking our dicks. So he asks my bf to administer the poppers. The problem was it wasn’t an easy task since he didn’t have his head turned to the side. My bf tried, but at one point he managed to spill a little bit of poppers on him and it ran into his eye. You can imagine how that would have felt. Everything stopped. We ran to the bathroom I got a handful of water, rand back to the bed and basically poured the water into the guy’s eyes. Then my bf followed up with a wet towel. The good news was that pretty quickly the crisis was over and I had my dick back up his ass…

I then flipped him over onto his belly (he could control the poppers himself in that position), and continued to fuck him until I came. It had been a few days since I had cum (yes, I jacked off – I know I shouldn’t waste my cum, but…) so I gave him a nice big load. When I was done my bf went back to fucking him, the guy was literally begging for another load, but since my bf had jacked off earlier, he couldn’t cum.

The weird part about this guy is that he’s really nervous and scattered. I tried to be affectionate with him as he dressed, but he didn’t respond. He was still really sweet and eager to please, but there’s a chemistry that’s lacking with him… In a way it would be really convenient to have him over on a regular basis since he’s up for serving me and my bf, but I think my bf wants more of a “connection” with the guys he fucks – he wants kissing, and eye contact, cuddling, stuff like that… So we’ll see if we do a repeat…

Back in the early 90s right after I got to New York, when the City was run by Democrats, if you went to the Eagle (a leather bar) you’d have a hard time using the bathroom ’cause it was filled with guys having sex… Last night I went to the Eagle and, as usual these days, not much of anything happens there sexually any more despite the bar being packed with horny men. All that happens these days is little bit of quick stuff, like briefly jacking someone’s dick. I did get about a 30 second blow job, but then the monitor came in and things had to end. Which is about how things went back in August when the monitor came in right after I started fucking someone.

So after I came home I figured I’d see if there was any activity in the park that’s next to where I live. Usually you can find someone there 24/7/365, but last night it was completely desolate. Absolutely no one was there. A few nights ago we drove through the park and saw a couple vans full of cops and a half dozen police Cushmans at the entrance to the park – they were apparently about to do a raid of the park (both gay and straight people use the park for sex).

All the crackdowns started with Rudy Giuliani… Hopefully some day soon things will lighten up and we’ll have public sex in New York again…

And if that’s not enough reason to vote Democratic in November, here’s another…

After the study the other day saying HIV infections are skyrocketing among gay kids ages 13-24 I thought I’d tell you about a chat I had yesterday on BarebackRT.com. The guy’s an absolutely adorable/hot 19 year old kid who lives in the middle of nowhere. Pretty quickly he starts telling me about himself…

HIM: i never have topped. i only take it bareback. my cherry was popped bare and never let any guys fuck me safe

ME: when did you take your first load? any idea how many loads you’ve gotten since then? how many different guys have cum inside you?

HIM: i took my first load at 15, maybe 75-100 different cocks in me.

ME: You must have problems hooking up being out in the middle of nowhere…

HIM: i do have 5 fuck buddies, 2 are 25ish and 3 are 35+. the 5 guys fuck me alot. the 2 25ish guys breed me around 2 times a day, with the others its once a day. i have 3 loads in my hole now, plus a load of piss in my tummy

ME: damn! you’re doing well for being in the middle of nowhere. i can’t imagine how much cum would be in your ass right now if you were here in nyc…

HIM: i was in Seattle two weeks ago and got fucked silly at a bathouse, first time ever in one. cum was pouring out of my hole. my whole body had cum on it. there were condoms there, but once one dude fucked me bare, everyone did. some men fucked me more than once. but i took 12 different cocks, my hole was totally raw from all the fucking. men had no problem fucking me and leaving. not saying a word. is that common?

ME: depends on the setting. if it’s truly anonymous sex then yeah, that’s pretty normal. i have had discussions with guys in bathhouses (even met two boyfriends there – still with one of them after 10 years), but it’s more normal to just fuck, unload and go. did you like being treated like a cumhole?

HIM: yes, i liked that i was a cumhole. i liked the anon fucking, but some men fucked me brutally hard, then shooting there cum in my hole. several men had pierced cocks, which made my fuckhole even more raw. plus, most had no reserve in pissing in my mouth, even tho i never asked for it

ME: sounds like they were trying to poz you… so you liked getting fucked and taking loads, but would you want it to be so brutal next time? did you like the guys pissing in your mouth?

HIM: i liked guys pissing in my mouth, but everyone did. i was filled with piss. the guy at the counter, said the same thing about the men trying to poz me.

ME: i take it you’re ok with getting pozzed… sounds like it’s going to happen one way or the other given what you like sexually…

HIM: if any of them were poz, they got me. my hole was gapping open, totally raw inside. i knew when i first bb, that i would get bred one day poz

ME: well, it’s usually 2 or 3 weeks after getting bred that you get the fuck flu – so who knows – you might find out soon…

HIM: i have the flu now, do you think its the poz cum? i get chills, then hot. yesterday, was when i started feeling bad

[He avoided other questions about him possibly going through seroconversion… It’s like he doesn’t look forward to it, he just accepts it, so I moved on to other topics…]

ME: so if a really hot guy wanted to fuck you with a rubber what would you do?

HIM: id tease them with my hole and body, but if that didnt work, then id suck him off. but not let him fuck me

I reordered the conversation a bit to make it more narrative, but those are the details… He knows what he likes sexually, he knows it means he’ll become poz one day. He might just have the flu right now – or he could be seroconverting… If it doesn’t happen now, it sounds like it will happen soon enough…

UPDATE: I just added a story to the fiction section about a 21 y.o. who got pozzed in a bathhouse. I’m not sure how authentic the story is, but I suspect it’s true. Hell, for that matter I don’t know that the guy above wasn’t just making up a story when he was talking to me…

BarebackRT.com had a contest a few weeks ago to see who could refer the most new members. Thanks to you guys I won which means I’m now the owner of a red, 1GB iPod Shuffle that has “Congrats from BarebackRT” engraved on the back.

Thing is, I’m not a big iPod person, so I’m going to give it away to you guys – since you were the guys who basically won it for me in the first place…

Here are the rules for the contest…

1. The contest ends 3/31/08. We’ll pick a winner April 1st.
2. You have to be a BarebackRT.com member. This only makes sense since you’re getting an iPod with BarebackRT engraved on the back…
3. You need to do a buddy link with me on BarebackRT.com – it should be a “friends only” link – my profile name is ‘rawTOP’ (as you might guess).
4. You need to purchase either a site membership or DVD from one of the links on this site, and then e-mail me with all of the following:
   • Your BarebackRT.com profile name
   • Which site(s) you purchased from
   • What you purchased (membership, DVD)
   • The date of your purchase (valid dates are 3/20 to 3/31)
   • The amount of your purchase (before and after tax/shipping, if you’re getting DVDs)

The more you purchase, the greater your chances of winning. Dollars spent on DVDs will count 1/3 of the dollars spent on site memberships (sorry). This is for new purchases only – rebills don’t count, and neither does pay-per-view. And please only purchase from the sites I link to. Some sites link to other sites and those sales may not be counted if I can’t confirm the sale on my end.

Here some sites I’d recommend:

If you like average guys who are good nasty pigs…

• All Real Bareback (a brand new site with some nasty European pigs)
• Bareback That Hole
• Hot Barebacking

If you like twinks…

• Ace’s Bedroom
• Cum Into My Ass
• Chillout Boys
• Epic Men

And by the way… As far as the whole “Buddy Link” thing on BarebackRT.com… The guys who I list as “fuckbuddy only” are guys who’ve gotten my cum in their ass and I’d do ’em again… Whereas “friends only” I’ll do with anyone who wants it…

For the record, no one entered the contest… Oh well…

I came across an article on a report about HIV infections in London. I’m taking things out of order when I quote here, but it gets the point across…

“What we have discovered is that some of the spread [of HIV] occurred in bursts, with groups of people becoming infected within a short period of time.”

“The tightness of clusters that we have found is frightening.”

…many men who became infected with the virus passed it on within a few months, often before they themselves had been diagnosed as HIV positive.

…the study findings indicated that the safe sex message was “not getting through”

“If we can find out how and where these clusters are occurring then we could target the appropriate groups.”

“It is important that information on the virus is available to gay men in the local areas where they are known to meet, to try to arrest the spread of HIV and AIDS.”

…bars and nightclubs could be targeted, as could the Internet.

While these researchers mean well, the flaw in what they’re saying is that if the guys don’t know they’re infected when they’re spreading it, then you can’t catch much of the mini-burst as it’s happening. You can only really spot a mini-burst after the damage is done. And as they pointed out, general safe sex messages are not effective.

It’s hard to say what will work. Perhaps compiling a list of sexual partners when someone is diagnosed and then as confidentially as possible contact those partners. I’ve heard of it being done, and it’s a bit dicey to do without stepping over the line, but it could be worth a shot.

But I can’t see putting up a sign at a bar saying “someone who recently tested poz spent a bunch of time in the backroom at this bar”. That’s going to lead to the department of health wanting to close the place down. Don’t like that option at all… People know the risks when they get fucked in the backroom of a bar or sex club…

I don’t know how large these “mini bursts” are. But I could see signs going up saying “An unusually large number of guys tested poz last month in this neighborhood. Please be extra careful…”

I don’t have a degree in public health, so can’t say what’s best. But I can say the researchers, while they seem to mean well, have some relatively naive recommendations…