When I was at school, the only time HIV was ever covered as part of the curriculum was as part of one health and physical education unit. This was a very brief overview of a range of sexually transmissible infections (STIs) covering symptoms, diagnosis and treatment. Teachers spoke about STIs, but in the context of heterosexual relationships, and it didn’t really seem relevant to me.
I entered various internet chat rooms throughout my teenage years in search of information about sex, sexuality, and anything relating to being gay really. I learnt a great deal from chatting to a wide variety of guys from around the world. From this, I felt empowered by information I received to take steps to look after myself as a young gay man.
The first sexual relationship I had was at the age of 16. I had been chatting to a guy who worked as a nurse at one of the hospitals for a while.
We met in the city centre and hung out, chatted and walked around the city. He was very good looking and I enjoyed my time with him talking about things that weren’t necessarily important at the time, but enough to have my heart skip a few beats.
The following day we met up again, he drove me to a motel and we tried many things…. If I had not suggested using condoms for anal sex, I wouldn’t have worried. I was young, naive and HIV was something that affected other people. It wasn’t something I had to worry about, especially with this guy who I felt so good about.
Fast forward to my first relationship. We decided to stop using condoms very quickly after first meeting. I trusted that this extremely good looking, toned, athletic guy didn’t have any STIs, especially HIV.
Fortunately for me he didn’t, but honestly I wouldn’t have known. Although many people experience seroconversion illness (flu-like symptoms during the period of time when HIV antibodies develop and become undetectable), many guys that are infected with HIV have no idea that they carry the virus.
My BF and I regularly had STI tests and thankfully I remained HIV-negative throughout the relationship. It was quite a shock, however, to learn that a young, talented softball player who played in the same team as my boyfriend, contracted HIV when he was in his teens. I felt for him and wondered how he could possibly live his life as a HIV-positive man. What potential challenges would he face? Would he be able to overcome them?
After my seven year relationship ended, I worked for a few years in Australia, saved some money, got the travel bug after my first Contiki trip abroad and decided to live and work overseas for a few years. It was so incredible to be able to experience such beauty throughout Europe, immerse myself in the culture, fail miserably at trying to speak various languages, and to meet some very handsome European guys along the way.
I understood the importance of consistently using condoms to prevent HIV, and for years, thanks to them, consistently received HIV-negative test results. I must admit, each time I underwent STI testing there was a certain sense of fear and apprehension about receiving the results.
I regularly visited an STI testing clinic attached to one of the hospitals in my home town in Australia and saw an amazing sexual health doctor from the UK. I felt confident that I’d consistently remain HIV-negative and be okay.
In July 2014, I was back visiting family in Brisbane from living in Europe. It was great to see everyone in the short space of time I had to catch up with friends and family. I decided to have my routine STI tests with my trusted doctor as normal. I spoke about the risk of HIV-transmission and he showed me statistics in a table regarding the level of risk depending on whether you were top or bottom, for anal and oral sex.
I had chosen to serosort three times while overseas – choosing to have unprotected sex with other ‘negative’ guys. Unfortunately for me, I received a call a few days later that most guys would dread… I was HIV-positive. It was simply devastating. I found it extremely difficult to comprehend. How would I tell my family and a future partner?! I felt lost, confused and vulnerable.
I’ve come a long way over the past two years. I’ve gone from being depressed about my diagnosis, to being empowered as a HIV-positive individual to make a meaningful difference in the lives of others.
I chose to start HIV antiretroviral treatment shortly after returning from working abroad and I adhere to it. I take one pill a day, Triumeq, and my viral load became undetectable in six weeks. This means the level of virus in my blood is so low that I’m extremely unlikely to transmit the virus to others.
I still remember my S100 (HIV prescriber) doctor saying that there are few things working as a GP that bring him more satisfaction than a patient becoming undetectable. In fact, latest findings of the PARTNER study have demonstrated the effectiveness of treatment as prevention (TasP) for reducing transmission risk of HIV and Dr. Michael Brady from the Terry Higgins Trust recently posted online that, “We can now say with confidence that if you are taking HIV medicine as prescribed, and have had an undetectable viral load for over six months, you cannot pass HIV on to a partner, with or without a condom”.
The main challenges I’ve faced over the last two years are stigma i.e. when guys stop chatting to you on apps following disclosure, or simply tell you that they’re after someone ‘clean’; and discrimination – two international employers withdrew offers of employment following forced disclosure on medical forms.
Although the meaning of HIV has changed significantly over the last couple of decades and it is now classified as a ‘chronic manageable condition’, a HIV-positive diagnosis can impact upon many aspects of an individual’s life: health status; relationships; health insurance options; travel and job opportunities.
Too often I hear HIV-positive friends complain about the utter ignorance of guys using applications such as Grindr and Scruff about HIV. HIV-positive guys frequently experience rejection and are the victims of vindictive, hurtful, and nasty comments.
Many of us are tired of educating other guys about the risk of HIV transmission. There is now a very solid body of research about the effectiveness of TasP, the antiretroviral medication HIV-positive guys take to look after their health and reduce their viral load, a stopping onward transmission. Examples of studies include: HTPN0521, PARTNER Study2, Seroconversion Study3, and You, Me &HIV4.
The irony of people rejecting HIV-positive guys on treatment is that it would be safer to have sex with an HIV-positive guy on treatment, than with a random guy who says that they are negative.
At the 2014 International AIDS Conference, UNAIDS set the following treatment targets: 90-90-90. This means that by 2020, 90 per cent of all people living with HIV will know their status, 90 per cent of people will be accessing antiretroviral treatment, and 90 per cent of people accessing treatment will have a suppressed viral load.
According to the Kirby Institute, we have only met the third treatment target in terms of viral suppression. We need to have more guys testing to know their status and more guys that are HIV-positive accessing treatment.
Unfortunately, according to findings from the Gay Community Periodic Survey in Perth (2016), 27.3 per cent of respondents hadn’t screened for STIs in the twelve months prior to the survey, the minimum testing frequency recommended for Men who have Sex with Men (MSM).
Without testing for HIV, there is no way to know your status. We can all work towards increasing testing by reducing stigma related to HIV. If the fear of being positive and facing rejection is lessened, it will be easier for guys to get tested.
Another very important finding from the Gay Community Periodic Survey in Perth (2016) was that for the first time since the survey has been administered, the number of guys who had reported sex without condoms with casual partners was higher than those that reported sex without condoms for regular partners (42 per cent vs. 40 per cent).
This is significant. You can’t know whether the other guy has tested recently – and even if he has been tested, he may have been in the window period for HIV transmission meaning there is a chance he’s HIV-positive; and you can’t tell whether the other person is telling the truth in the ‘heat of the moment’.
In summary, while you can now lead a long, happy, healthy life as a HIV-positive individual, the road ahead isn’t so easy, with many HIV-positive people around the world experiencing isolation, stigma and discrimination.
It’s critical that as a community we don’t discriminate based on status. HIV-positive individuals that have an undetectable viral load are looking after their health, and others, by disclosing. Let’s give some credit to people for being responsible for their health and acknowledge that TasP is a highly effective risk reduction strategy.
Adam
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References
Grinsztejn B, Hosseinipour M C, Ribaudo H J, Swindells S, Eron J, Chen Y Q, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. The Lancet. 2014 April; 14 (4): 281-290.
Roger A, Bruun T, Cambiano V, Lundgren J, et al. HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER study. Conference on Retroviruses and Opportunistic Infections – CROI 2014; 2014 Mar 3 – 6; Boston. Abstract 153LB.
The Kirby Institute. Experiences of HIV. The seroconversion study annual report 2014 (document on the internet). Sydney: University of New South Wales; 2014. Available online.
Centre for Social Research in Health. Youme&hiv (document on the internet). Sydney: University of New South Wales; 2016. Available online.
UNAIDS. 90-90-90. An ambitious treatment target to help end the AIDS epidemic (document on the internet). 2014. Available online.
Centre for Social Research in Health. Gay community periodic survey: Perth 2016 (document on the internet). Sydney: University of New South Wales; 2016. Available online.
https://twitter.com/hashtag/undetectable
