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Author Topic: Negative top positive bottom  (Read 8930 times)

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Offline numbers

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Negative top positive bottom
« on: February 09, 2011, 08:34:43 PM »
I am looking for some information that I can provide to a friend who is negative but thinks it's fine for him to have bareback sex with bottoms who are positive as long as they are undetectable.  He does this a lot, and quotes some Dutch study that apparently validates this behaviour.  He's already had syphilis and is studying to be, of all things, a nurse.  I tried telling him that viral load in the blood might be undetectable but can be higher in other fluids but that didn't seem to have any effect.  Does anyone have any good web links that I could forward to him that could help demonstrate the risk to him of unprotected sex as a top?  Thanks for your help!
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline surf18

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Re: Negative top positive bottom
« Reply #1 on: February 09, 2011, 08:42:59 PM »
tell him to come here and read these freakin posts and see how our lives are. if he still wants to do it raw hes a freaking idiot and no link will save him.

Offline numbers

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Re: Negative top positive bottom
« Reply #2 on: February 09, 2011, 08:52:18 PM »
I agree with you surf.  It is both ignorant and rude for him to tell me that he is exempt from HIV that the rest of us have to deal with.
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline Ann

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Re: Negative top positive bottom
« Reply #3 on: February 09, 2011, 09:15:50 PM »
Numbers, it was a Swiss study and it only looked at vaginal intercourse where the woman was poz and only for the purpose of having a baby. It is NOT a licence for tops to go bare.

Does he also quote the bit of that study that said the woman must not only have an undetectable viral load for six months or more, but they must also be STI free? If he's out there picking up syphilis, his tricks are obviously not all STI free. For all he knows they might not even be undetectable.

By the way, does he test regularly? He may only be assuming he's hiv negative. There's a lot out there who make that assumption, but all the while they're actually poz. I'm not suggesting he's lying about his status, I'm just saying he can't really accurately know his status.

Even if he tests every three months, he could have been infected the day after his last result and be out spreading hiv to any negative tricks he may pick up for the next three months. A person's viral load is normally sky-high in the early months of infection. Whoo-hoo.

He could even have been infected three or four weeks before his last test and not be showing enough antibodies and so be out there infecting others for even longer. So you see even if he is testing often, all he can ever really do is assume (hope) he's still negative. Scary stuff.

Bottom line - if he continues barebacking, the loaded chamber is going to get him sooner or later.

I hope you can talk some sense into him before he's joining you in the waiting room at your clinic. :-\
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline numbers

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Re: Negative top positive bottom
« Reply #4 on: February 09, 2011, 09:44:34 PM »
Thanks Ann, I will make the point to him about not knowing whether his partners are STI free.  He says he's aware of the 6 month limit and that he tests regularly - but as you say a test is not prevention and it may be too late by that time.  I am afraid his casual attitude is shared by too many people - hey, if I get it no big deal I'll just take some pills and everything will be fine.  We know better!  I am hoping there is some authoritative source I could direct him to that would demonstrate the risk he is facing in a much more coherent fashion than I can.
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline surf18

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Re: Negative top positive bottom
« Reply #5 on: February 09, 2011, 09:49:44 PM »
numbers i didnt realize you were positive. heck all the more reason for your friend to wrap it, he gets to see this up close and in real life.

Offline Ann

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Re: Negative top positive bottom
« Reply #6 on: February 09, 2011, 09:59:12 PM »
Numbers, something I should have elaborated upon in my first post. The reason I pointed out the fact that the study focused on heterosexual intercourse for the purpose of procreation is the difference between the anus/rectum and the vagina.

The vagina is a rather sturdy, thick walled organ that is difficult to damage during intercourse.

The anus/rectum is a rather more delicate and very thin mucus membrane that is easily damaged during intercourse.

And of course the obvious difference here is the greater possibility of blood being present during anal intercourse.

I recall reading something recently about the levels of hiv in rectal mucosa but I'll have to try and dig it out in the morning - it's nearly 3am here. (woke up, tossed and turned, ready to go back to bed now!) In fact, try googling rectal mucosa and hiv - that's what I'd do as that is the terminology I recall being used.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline numbers

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Re: Negative top positive bottom
« Reply #7 on: February 09, 2011, 10:08:08 PM »
You're right surf, this is what makes me angry about his casual attitude.  He knows I wasn't able to sleep for almost a year because of the depression brought on by my diagnosis, and that I had to suffer through the summer in long sleeves because of the KS on my arms, and all of the doctor's visits, and he still has a casual attitude (and did I mention he's a nursing student!).  I need to make a point!  Ann, thanks for the clarification I thought that's where you were going, I will try searching as you have suggested to see what information I can find.  This is a great help, thanks!
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline Ann

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Re: Negative top positive bottom
« Reply #8 on: February 10, 2011, 01:43:40 AM »
Numbers, here's a study for your mate. He won't like it, but he needs to read it. He also needs to have a closer read of that Swiss Statement too, because of what I mentioned above.

http://www.natap.org/2004/HIV/062804_11.htm
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline newt

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Re: Negative top positive bottom
« Reply #9 on: February 10, 2011, 06:25:45 AM »
I am reminded of an old saying or two: pride comes before a fall and vanity of vanities, all is vanity.

It's really hard to get people who behave like this to see sense, because they are insensible about the whole thing.
"The object is to be a well patient, not a good patient"

Offline numbers

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Re: Negative top positive bottom
« Reply #10 on: February 10, 2011, 11:33:26 PM »
Newt you are so right!  And Ann, thank you again for your help, I am going to use this in some thoughts I am going to send to my friend tomorrow.  I hope he listens.
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline tednlou2

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Re: Negative top positive bottom
« Reply #11 on: February 11, 2011, 12:50:20 AM »
Numbers, here's a study for your mate. He won't like it, but he needs to read it. He also needs to have a closer read of that Swiss Statement too, because of what I mentioned above.

http://www.natap.org/2004/HIV/062804_11.htm

Have there been other studies, since this was published in 2004, to answer some of the unanswered questions the study mentions?  I ask, because I know Dr. Gallant seems to give the green light (maybe a yellowish/green light) for unprotected sex between committed partners, where the poz partner's vl has been UD for a long time and consistantly.  I believe he does give the disclaimer that you are still taking a risk, because you couldn't be 100% sure you were UD at any given time.  But, he seems to believe it would be very unlikely to transmit the virus after on HAART and UD for a long time.  This, of course, is in regards to committed partners who would have to decide whether they want to take the risk and where there is trust. 

Offline cardsfan69

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Re: Negative top positive bottom
« Reply #12 on: February 11, 2011, 08:01:41 PM »
Hmm I've always been told by my doctor one of the reasons they like to get people tested and if they are poz and have viral loads............to get them on meds to get them undetectable. My doc says being on meds and being undetectable helps fight the spread of hiv/aids..................if you have bareback sex with someone who is poz but undetectable it makes it harder for the virus to spread. Now my doc says of course there is risk but it's much less if someone is undetectable and he says this in no way is a green like to have bareback sex between poz/neg guys. But he does always stress to me that people being on meds.......does......help fight the spread of hiv.

My doc has been an HIV specialist for 20yrs and attends hiv/aids conferences all over the world.

Offline jkinatl2

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Re: Negative top positive bottom
« Reply #13 on: February 11, 2011, 08:13:55 PM »
Hmm I've always been told by my doctor one of the reasons they like to get people tested and if they are poz and have viral loads............to get them on meds to get them undetectable. My doc says being on meds and being undetectable helps fight the spread of hiv/aids..................if you have bareback sex with someone who is poz but undetectable it makes it harder for the virus to spread. Now my doc says of course there is risk but it's much less if someone is undetectable and he says this in no way is a green like to have bareback sex between poz/neg guys. But he does always stress to me that people being on meds.......does......help fight the spread of hiv.

My doc has been an HIV specialist for 20yrs and attends hiv/aids conferences all over the world.

All this is true. I suppose it just depends on the level of risk a person is willing to take upon themselves.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Ann

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Re: Negative top positive bottom
« Reply #14 on: February 11, 2011, 09:11:09 PM »
Of course being on meds helps to cut the transmission rates due to a decreased or undetectable viral load. BUT - (and this is what it sounds like the OP's friend is doing) - when a person is having multiple partners and barebacking them he's increasing his chance the more he does it.

Sooner or later he's either going to come across a guy who's rectal muscosa's viral load is high due to rectal  gonorrhea or chlamydia or other STI, or come across a guy who's experiencing a viral rebound and doesn't know it. Or he's going to come across a guy who is lying about being on meds or being undetectable.

It's one thing to bareback within a committed relationship where you know your partner is seeing his doctor regularly and is adherent with his meds and isn't out getting STIs up his bum, but it's a totally different matter to go out barebacking random tricks.

I'm not slamming going out fucking random tricks, just the barebacking random tricks and it's not a moral judgement on my part either. It's just the fact that if you keep putting your dick in the fire, one day you're going to get burnt. Put a damn oven glove on, for goodness sake!


Ted, that was the only study I could find that specifically looked at the VL of rectal mucosa in both treated and untreated men.

However, I did read through several studies about hiv in the digestive tract and they all pointed to a middle to high amount of viral activity whether or not the person was on meds.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline Matty the Damned

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Re: Negative top positive bottom
« Reply #15 on: February 11, 2011, 09:18:40 PM »
Hmm I've always been told by my doctor one of the reasons they like to get people tested and if they are poz and have viral loads............to get them on meds to get them undetectable. My doc says being on meds and being undetectable helps fight the spread of hiv/aids..................if you have bareback sex with someone who is poz but undetectable it makes it harder for the virus to spread. Now my doc says of course there is risk but it's much less if someone is undetectable and he says this in no way is a green like to have bareback sex between poz/neg guys. But he does always stress to me that people being on meds.......does......help fight the spread of hiv.

I think that approach is valid from a harm minimisation POV but we still need to be inculcating a culture of personal responsibility into the mortals (ie HIV negative folks), coz they be powerful dumb.

Quote
My doc has been an HIV specialist for 20yrs and attends hiv/aids conferences all over the world.

Nice. My HIV doctor has killer tits, so nyah. :P

MtD

Offline surf18

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Re: Negative top positive bottom
« Reply #16 on: February 11, 2011, 09:24:10 PM »
i dont know. knowing what i know now, as far as being dx'd and what im going through mentally , id never plow  a positive guy raw. not worth it.period.

the gut thing is interesting.its funny but i was dx'd with acid reflux proably a little after i came in contact with this thing. had scope etc and they just said acid reflux heres nexium.twice a day. well once i went on meds, ive been taking the pill one a day so i often wonder if the acid reflux was not real and it was the infection wrecking havock pre meds on my gut

Offline Assurbanipal

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Re: Negative top positive bottom
« Reply #17 on: February 12, 2011, 09:44:41 AM »
Does your friend only go raw with poz undetectable guys?  Or does he top guys who think they are neg bareback too?

All the science suggests that he is a lot safer sticking with the poz undetectable group.  That's not to say safe -- but a lot safer

That's because up to a third of the guys who think they are neg (but are barebacking) really aren't neg anyway.  They tend to have quite high viral loads and to be quite infectious.  And after one of them gives him the bug he will likely (at his own high infectivity stage) infect a lot more of them.

So, if you can't get him to use a condom with everyone, getting him to go bare only with poz undetectable guys is probably a good reduction in his potential risk and a sizable benefit to the community.

5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline tednlou2

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Re: Negative top positive bottom
« Reply #18 on: February 13, 2011, 03:02:09 AM »
Numbers, I've been thinking about the situation with your friend.  I actually discussed it with a couple people tonight at dinner.  Here is what we all wondered:

Is your friend actually being more socially responsible?  If he exclusively barebacks with poz bottoms (and granted taking the risk of becoming poz himself), wouldn't he be keeping the virus from spreading outside of people who are already poz?  This would only hold true as long as he only barebacked with people who are poz. 

If someone just refused to wear condoms and only hooked up with people who are poz, that actually seems more socially responsible.  If your friend will not wear a condom and only barebacks with poz guys, perhaps that is something that should be applauded.  I know many will take a different point of view.  But, it just seems better than going around barebacking with various people just assuming they are negative and then passing the virus on and on and on. 

After thinking about this, I think your friend is actually doing the right thing--assuming he will just never wear a condom and only has sex with poz guys.  He's taking a risk, but he wouldn't be spreading the virus to others.  Maybe if everyone who loves barebacking sought out poz guys, we'd see a big reduction in infections.  Again, they would be taking the risk of becoming infected themselves even with an UD viral load.  But, they wouldn't spread the virus outside of those already infected.  We know everyone who hooks up with a stranger believing they are negative is just fooling themselves.  They will finally run into the virus and then hook up with someone negative who hooks up with someone negative--and now we have many more poz.  Oh, if someone is honest about being poz, most of them would probably be honest about whether they had an UD viral load.  I would take that over someone telling me they are negative but who barebacks with 100 guys a year. 

Ok, just our thoughts as we discussed it tonight.  Maybe we are failing to see something that would put a huge dent in this logic.     


Offline numbers

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Re: Negative top positive bottom
« Reply #19 on: February 16, 2011, 11:47:30 PM »
Tednlou it sounds like you had some interesting dinner discussion!  I understand the points you and Assurbanipal are making however I don't think my friend exclusively seeks out UD poz guys for his raw adventures.  I think we need to consider the good points Anne makes about unknown viral rebounds and STI's increasing viral loads - so a guy who thinks he is UD might not actually be so.  And we need to consider what Matty says about people being powerful dumb - and liars to boot (as I found out the hard way).  In a perfect world perhaps it would work but I am with surf on this ... knowing what I know now after a lot of mental anguish and a year with little sleep, it's just not worth it.
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline Assurbanipal

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Re: Negative top positive bottom
« Reply #20 on: February 17, 2011, 07:51:55 AM »
Numbers, I guess I was trying to give you the ammunition to have a different conversation with your friend.  You've already tried the argument that there is some risk to him -- this thread gives you some more ammo for that argument, but it sounds like he is pretty hardened to arguments about his own level of risk.

So if that argument fails, there is a second one -- one that looks not just at the risk to himself, but to his partners.  Many people don't like to see themselves held up in a mirror as someone who is putting people they love (or even just those they shag ) at risk -- its an unattractive self portrait.  And lots of people don't get any symptoms when they become infected -- so it is not as if he will suddenly know he needs to get tested or to stop having unprotected sex.

Best wishes
A

5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline numbers

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Re: Negative top positive bottom
« Reply #21 on: February 17, 2011, 09:13:10 AM »
Thanks Assurbanipal for the good point, I hadn't thought to take that approach with my friend but I will give it a shot however self-centered he may be.  I think I have had some success so far with the ammunition provided here as he has become a bit more thoughtful with his replies.  But several times he has argued that he "gets tested frequently" which seems ridiculous to me because when you test positive it's too late to do anything about it for yourself or your victims!  I have heard the "frequent testing" excuse from more than one person, I hope this is just isolated stupidity but maybe it is more common for people to mistake testing for prevention?
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

Offline sharkdiver

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Re: Negative top positive bottom
« Reply #22 on: February 17, 2011, 09:22:55 AM »
  But several times he has argued that he "gets tested frequently" which seems ridiculous to me because when you test positive it's too late to do anything about it for yourself or your victims!  I have heard the "frequent testing" excuse from more than one person, I hope this is just isolated stupidity but maybe it is more common for people to mistake testing for prevention?

I'm just a little concerned about you using the the phrase you and your victims.

I hope you don't really mean that

Offline numbers

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Re: Negative top positive bottom
« Reply #23 on: February 17, 2011, 09:52:14 AM »
Shark, sorry for any misunderstanding, I didn't mean that any of us (my friend included) is looking for victims, it was meant to emphasise the point that he could be spreading HIV through his behaviour which I don't think he has considered.
Tested positive Feb. 2010 VL 181K CD4 161
Started Truvada, Prezista, and Norvir
Sept 2010 VL UD CD4 380
Jan 2011 VL UD CD4 450 I can sleep now thanks to Cipralex!
March 2011 VL UD CD4 490
September 2011 VL UD CD4 500

 


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