It surprises me to still hear gay men talk about HIV and say things like, “but you don’t look positive”, or “you don’t look sick”, or my personal favorite, “Oh, I can usually tell just by looking if someone has it or not”. We probably all have our own preconceived notion about what the ‘typical’ HIV-positive person looks like. Before becoming positive myself, the mental picture I naively painted tended to be an older, mustachioed gay man, very skinny, wearing mostly leather, and involved in the types of drugs and sexual adventure that I was too scared to consider. Oh, and don’t forget about the poppers… my HIV-positive mental-man was a total popper fiend.

In all seriousness, a trained physician that specializes in treatment of HIV/AIDS can sometimes spot signs of opportunistic infections, drug therapy side-affects, or other conditions such as wasting in advanced cases of the illness. But most gay men don’t have this training and most HIV-positive men do not have any outward appearance that would indicate infection, even to the trained professional. HIV-positive folks can be very young, very old, and every age in-between. They come from every race, religion and ethnic background. And most of the HIV-positive gay men I speak with appear completely healthy.

A common misconception, especially among younger gay men, is to think that HIV is mostly a disease of older gay men, using statistics that indicate a higher infection rate among older gay men to give them a false sense of security when dating other young gay men. In terms of absolute total numbers that statistic is indeed true (the longer you live, the more chance of being exposed), but that should not give anyone a false sense of security. This statistic from the CDC should encourage younger readers to challenge this dangerous assumption:

“In the 13-to-24-year-old group, the average annual increase was 12 percent (newly diagnosed with HIV infection), compared with a 1 percent decline in 25-to-44-year-olds, and a 3 percent rise in gay men 45 and older.”

The article also implies that younger gay men have not had an opportunity to witness the serious consequences of HIV/AIDS. Most did not grow up seeing friends waste away and die around them, like those living in gay communities in the 1980s.

HIV should not be viewed as just another nuisance condition that can be easily treated by simply popping a pill. It’s not necessarily the death-sentence it was just 15 years ago, but it’s not a walk in the park either. It can be emotionally devastating, extremely expensive to treat and future progression of the disease, even with the fabulous new medications, is indefinite and full of potential health issues.

How could that sweet, innocent looking 18 year old boy possibly be HIV-positive? Well, maybe he’s not the complete virgin you think he is. In fact, maybe he’s the pass-around-party-bottom, just off the plane from a party week in Palm Springs, and just can’t get enough cock. He hasn’t ever been tested, so as he gazes at you with those big doe eyes and bats those long lashes at you, he’ll say with complete confidence, “I’m negative”.
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Since this column is intended to address HIV/AIDS issues, and most of us have had the ‘safe-sex’ rules ingrained in us from various resources, it might be more useful to approach this topic from a slightly different angle. Instead of going over how to avoid HIV for the umpteenth time, lets review on a couple of the more common behaviors or assumptions that can contribute to the “surprise” HIV diagnosis.

These are all examples I have heard from men who are newly diagnosed, so hopefully others can learn from these mistakes:

#1: Go to a bath house

To put it bluntly, a bathhouse is the perfect storm of drunken clubbers, meth heads, sex addicts, closet cases, an assortment of out-of-towners ‘on the down-low’ and the occasional stray ‘good boy’ looking to get laid… all coming together to create a veritable Petri dish of nastiness. There is a very good reason you might feel a little nasty and dirty walking home in yesterday’s club clothes at 5:00 AM from a place like this -- it’s because you have been a nasty, naughty little slut, and that tingle you are starting to notice in your throat (or on your dick or in your ass) is probably the beginning of a happy new colony of disease, delighted in your decision to look for quick, easy sex.

If you do insist on going, just assume the person you are having sex with is HIV-positive. If you expect men participating in these venues to announce or otherwise make you aware of any health related issues they might be experiencing, then you would also be advised to make sure you have a good health insurance policy, a great doctor and you might as well bump up your life insurance policy while you’re at it. You can and certainly should ask about a person’s HIV status *every time* before engaging in sex, but if you are participating in anonymous sex, don’t expect to get an honest answer every time. The reason it’s called ‘anonymous’ is because you will probably never see the person again.

#2: Assume only bottoms will contract HIV

You can get HIV from topping and from blowing, so don’t say you were never warned. Guys hate it when I tell them they can get HIV from giving a blow job, but I am here to tell you it happens, and not just to me, but others that went through the same experience. Personally, when I was initially diagnosed with HIV, my Primary Infection Clinic doctor had a million questions for me, but the obvious one is how I contracted the disease. When I told him about “the worst sore throat of my life” after an oral sex episode a few months earlier, he rolled his eyes and let me know he’d heard this story before. The fact of the matter is, you CAN contract HIV through oral sex. Although considered “low risk”, oral sex is not “no risk”… and that was my very big mistake. This is nearly the same story I have heard from other newly infected men as well, and the conversation almost always includes something like, “I thought it was almost impossible to get HIV from oral sex/topping” -- which can be answered by, “It is almost impossible”. However, if you give enough blowjobs, top enough bottoms without a condom, or happen to run into a person with a very high viral load (usually due to lack of treatment, failed treatment or someone going through an initial primary infection period) the statistics start working against you.

#3: Assume Every HIV-positive man will disclose their HIV status

As shocking as it may sound, many men will lie outright, be overwhelmed with the initial shame and not know how to talk about it, or just refuse to be tested, so they cannot be labeled ‘poz’. Also, don’t forget that all-important three-month window, where a person can test negative, but be infectious and just not have developed the antibodies that the HIV test is looking for. “But they are legally required to tell me if they are HIV-positive!” you say? Of course they are, and it is also illegal for people to drive drunk…. so try to keep your head in the real world and not the idyllic world of consequence-free sex as you would like it to be.

One last tip: When you do ask someone his status, do it in a way that will probably give you a better chance at an honest answer. “Are you clean?” is not the right way. We are not living in the Old Testament and HIV-positive people don’t like being called “unclean” any more than you like to be called a “sodomite”. You are much more likely to get an honest answer if you use just a little positive affirmation when asking the question. Example: “You are really hot and I want to mess around with you anyway, but I always like to know if the person I am playing with is HIV-positive.” See how that works? And believe it or not, there are a lot of safe and fun things you can still do with the person, but that’s a topic for another column. :-)
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“You’re Positive.” It was the afternoon of June 21st, 1995 and I can vividly remember the exact tone and inflection of the doctor’s voice as he delivered the two words that would forever change my life. I can remember the smell of the office, the pitying look in his eyes as he uttered the words, the ugly wave a nausea that swept through my stomach, and the light dizzy feeling in my head as my brain began to grasp the meaning of this new nugget of information.

“How could this possibly happen to me?” was the question repeating in my mind as I sat absorbing the shock. “People like you don’t get HIV,” my first gay friend had told me only a few days prior to receiving my test results. I didn’t go to bathhouses, didn’t do meth or any other hard drugs, I didn’t even sleep around that much. In fact, my gay dating life had barely gotten off the ground and I wasn’t even out to my friends or family yet. For crying out loud, I hadn’t even tried being a bottom yet! “You don’t fit the profile!” the logical part of my brain screamed in my head. This simply cannot be happening or my life might as well just end right here and now.

“Now you’re not going to do anything stupid are you?” the doctor asked between my sobs as he begins writing a prescription for thirty extra-strength tranquilizers. “Some people can become suicidal after getting this kind of news and I need to know that you will not be trying anything like that.” I shake my head to indicate no, still unable to speak. After another twenty minutes of sobbing and asking several times if this might be some kind of awful mistake, the doctor gives me a hug, a prescription for Xanax, and what I would come to refer to as “The Welcome Packet” from the Department of Health. I walk from the office, literally numb from terror, and somehow make my way back to my new little condo in the gay ghetto. Tucking away my Welcome Packet, I thought about how I now had to call the guy I had been seeing and let him know.

Over twelve years later and here I am today, happier and healthier than I have ever been in my life, looking back and labeling that first year or two of being HIV-positive as “the dark ages”. I am much stronger for the journey, even if it was an unintended one. Facing your own mortality is terrifying, but it can make every day seem like a blessing if you can make it through the initial shock. Oh…and the guy I had to call that first horrible evening? He ended up being the best thing to happen to me, struggling together we overcame a whole lot, and we are a couple still today.

My hope with this column is that I can use my personal experience with HIV to give hope to those struggling with the disease, expose some of the common challenges faced by HIV-positive folks, and provide insights to the HIV-negative readers here about how to stay that way.

So, if you are HIV-positive and are struggling to make it through the first year or two, or have made it through and have some advice to share with others, we would love to hear from you. Over the last several years, I’ve had a great opportunity to act as peer counselor to other newly diagnosed HIV-positive men and it makes a big difference when you are able to talk or learn from someone going through the same journey, struggling with the same issues as yourself. If you are HIV-negative and would like to learn how to stay that way, we would like to hear from you too. In this age, ignorance can kill, or at least ruin a couple years of your life. Even simple things like knowing how to ask someone his or her status, or hearing why it can be so difficult for an HIV-positive person to disclose his or her status, can make a big difference.
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