Gay Man Trying to Be Safe - Your thoughts?

[massguy]

I am 32 year old gay man living in the Boston area.  I have always had anxiety about HIV and try to always play safe.  I know I am in a HIV risk category and while I have accepted the fact that I am gay, I still get anxious about sex. Here is what I do:

1. I think I follow your advice to a T, I always ask my sexual parters their HIV status, if they have ever been treated for an STD and when they last tested (some of them look at me like I am crazy - but I don't care).  If they don't know, or say yes to what I ask. I don't have sex with them, I walk.  But then again, some people lie or say they are hiv neg when they truly don't know - but I treat them like they have every STD known when I am intimate with them.  I rarely have have anal sex and if I do it is mostly in a dating relationship after I know them.  I ALWAYS use a condom (I am a top), use lots of water-based lube and thankfully, I have never had a condom rip, break or come off, never!

2.  I do, on occassion have oral sex with men.  My previous doctor (who recently retired from the Fenway Community Center) told me that if I do this without a condom the risk is extremely low for HIV, as long as I don't allow ejaculation in my mouth.  And the risk is off the charts if allow someone to have oral on me.  I know pre-*** can contain HIV virus particles, so I try to avoid it but sometimes it's hard.  Is my risk, really low?

3.  I do, on occassion rim.  however, I examine the area first and only do it lightly (no bitting).  I have been vaccinated for heps (of course not C since there isn't a vaccine).  I hear that rimming is not an act in which HIV is known to be passed - is that true?

I have never had an STD - I do get tested yearly at the Fenway.  Most of the time, the people taking the test after hearing what sexual activities I participate in say I am at extremely low risk - but I still get nervous.  Giving up sex is an option to help with my HIV anxiety, but I think sex is important so I just stick with my safe sexual boundaries.  I just don't want to ever put myself at risk.  Just so you know, I don't go to bath houses, don't go to bars, have never had sex while drunk or even heavy drinking and I never do drugs.  And I always (sometimes it turns them off - but thats their problem) "quiz" my sexual partners on their history, HIV status, risks, etc.  I guess I am doing everything right, with the exception of not having sex, but that is not an option.

What do you think about my risks, my practices and if you have any suggestions as to lower my risks further - I would love to know.

You run a great service here Doctor, I not only admire you're work, but I greatly respect your honestly and forthright.

Take care, and thanks for taking the time to read my post!

Bruce

[H. Hunter Handsfield, M.D.]

1,2)  My main response is congratulations!  You are being just about as safe as a gay man can be, short of either being celibate or in a permanent, mutually exclusive relationship with another HIV negative man.  That you have remained STD-free over the years is a testament to the effectiveness of what you are doing.  (Remember that all STDs are much easier to transmit, by all sexual practices, than HIV.)  Barring any change in your behaviors and practices, I expect you to remain HIV-free forever.

3)  As far as rimming is concerned, you are right about no documented HIV transmissions.  That doesn't prove it hasn't happened, but the practice undoubtedly is fairly low risk for HIV (although the highest of risk for enteric infections such as salmonella, campylobacter, amebiasis, and hepatitis A).

Finally, as you know--but for others who might not know it, particularly if they live in New England--Fenway Community Health Center, Boston, is one of the country's premier resources for excellent lifestyle-specific health care for gay men (http://www.fenwayhealth.org/site/PageServer).  You can rely on their advice about sexual safety and related issues.  Fenway also runs an online forum on sexual safety and related issues, "Ask Dr. Cox".  I believe it is new and I cannot vouch for it, but considering the source, I'm sure it is an excellent resources.

Thanks for the thanks about this site.  Best wishes.  Stay safe--

HHH, MD

[Radak]

1. Giving up sex is an option, but 2. not having sex is not an option. Do I have that right?

General Rules:
1. Giving oral is more risky than receiving oral.
2. Being a bottom is more risky than being a top.
3. Rimming is not without risk and doing an examination beforehand will not lessen the risk.

Asking questions might be a good thing if the truth was always told or even known. (A person could become + AFTER the last test and BEFORE the next one) Does this enhance your experience?

The rule here is to always treat partners as if they were positive and act accordingly, i.e. never have unprotected sex.

Good luck with your decisions.

[massguy]

Thank you so much for your response.  The Fenway Community Health Center is a great place.  They not only treat you with such respect - they listen to their patients - and take the time to answer questions and respond so you go away knowing the facts (and believe me they correct you on the myths!).  So I second what you say, if anyone in the New England area do check them out.  And, my doctor was 72 when he retired. Worked in private pratice, retired, then made his way over to the Fenway.  He was top notch when it came to STD questions - always relieved your anxiety and taught me the facts about Safer Sex.  When I told him I was thinking about planning on giving up sex because of my fears of HIV - he took me outside,  made me cross a very busy street and told me to walk back.  Then he told me my risk was higher crossing that street than the "safer" sex practices I practiced.  He was a gem!  

Thanks again, thanks for your nice comments..and belive me doctor, I will stick with these practices and never go outside those "unsafe" limits.  

Take care,

Bruce

[Parker1500]

Just a quick question in the interest of clarity.  You say "And the risk is off the charts if allow someone to have oral on me."  Off the charts usually means "so high that it can't be calculated."  Do you mean this or do you mean "off the charts" as in "so low that it can't be calculated."  I believe receiving oral is very low risk.

[massguy]

Sorry -  Off the charts meaning so low there is no real reason to test at all.  Actually, they tell me that giving oral is extremely low risk (without ejacuation) and receiving oral the risk is so remote, my doctor wouldn't even recommend testing.