Risk of MSM sex

[JohnnyV]

Dr. Handsfield,

I want to thank you for your wonderful website.

I am just now coming to the close of a drawn-out HIV scare, having tested negative at 6 & 9 weeks and going into my final test at 12 weeks. My potential exposure was through unprotected oral sex with a series of men between January and early May of this year. Since I am a man and they were men, I assume that I was (and am) at high risk.

I've been following the advice online and I have to say, everything looks so bleak for men who have sex with men. Everything we do is now considered high risk, we have to get tested at the frequency that other people get oil changes, and we're told to have few sex partners and get in long-term relationships that the gay scene (as it currently exists) makes almost impossible to find. I know a few people in long-term relationships, and most of them ended up getting HIV anyway through their boyfriends. AIDs somehow made them closer and more committed.

I was advised to avoid any anal sex, even with a condom, so I got into the habit of only oral sex. But it is impossible to get men to put a condom on before you give them a blow job.

If my 3-month HIV test comes back negative this week, I never want to have sex with men again. Since you're an expert in this field, Dr. H, do you think things are as bleak as they seem to me? Or should I just give up, engage in unprotected sex, and join the ever-growing club of positive MSM, so I can at least avoid this constant state of alarm?

Thanks,
J

[H. Hunter Handsfield, M.D.]

I would say things are serious but not quite as bleak as you imagine.  Most gay/bi men do not get HIV.

As I have said previously on this forum, but it bears repeating:  A resolve to never have sex with people of the gender to whom someone is attracted is, in most people, doomed to failure.  Most humans are not able buck their primal desires over the long run.  And such resolutions--like virginity pledges in teens--in the long run may actually increase the risk of infection (or, in teens, unwanted pregnancy).  Why?  Because when those primal desires finally exert themselves, the pledger is without a condom, often has been drinking, and the social context (bar, party, etc, etc) often tends to selection of risky partners.

Every person has to balance life's pleasures with its risks.  Not getting in a car is the only way to assure not dying in an road accident, but we mostly choose the "pleasure" of driving and take certain precautions while doing do.  Only you can judge your own balance between sexual safety and sexual and relationship rewards.  But a good starting point is to be selective in whom you choose to have sex with, which includes knowing someone well enough to have a trusting conversation before hopping in the sack; insist on knowing potential partners' HIV status and sharing your own; using condoms for anal sex, until/unless you know for sure about infection status, potential commitment, etc; and avoid obviously tempting situations (pick-ups in bars, etc).  I can't say with certainty you will avoid HIV if you follow these guidelines, but they will dramatically lower your risk.  (Perhaps it is obvious that this advice doesn't apply only to gay/bi men, but makes sense for everyone.)

Good luck--  HHH, MD

[BenG]

I know how you feel as I a bi male and I had one oral sexual encounter with a guy and I was told there was a small risk of HIV transmission from performing oral sex on a guy. It is interesting that there have been no reported cases of catching HIV from performing oral sex on a woman, but there are for men-on-men.
Regarding anal sex, I have to tell you that i cant imagine doing this as the risks are too high. Condoms break and if they do, you are pretty much screwed (I just realised the unintentional pun) if they have HIV. Not sure of the risk but I no anal sex carries a high risk. The same risks just don't apply with men-on-women sex.
I do believe there are gay men that are interested in a long-term relationship, if you look in the right places (dating websites?).
The only time I would possible engage in anal sex is if they got tested and i was in the room when the doctor gave the results!
My history with men is one episode of oral sex (both ways). I got NGU (unlucky!) but nothing else. I had no idea you could catch HIV from oral sex (however rare) so I was terribly anxious for like 2 months until I got a negative result.
My conclusion? Like you, I'm not sure I can handle the anxiety of MSM.
Guess I'll have to take cold showers for the next few decades!

[JohnnyV]

Dear Ben,

I'm glad someone else out there shares my sense of the problem. Everywhere I look -- online, in magazines, in pamphlets -- there's this contradictory and unrealistic message the prevention people give to MSM. They tell you to fear any kind of sexual interaction and then they wonder why you can't enjoy your sex life. I think most of the newly infected MSM are people who just gave up and stopped trying to fight the inevitable.

In some ways, if my 12-week test comes back positive I'll feel better because I'll never have to take an HIV test again and I can just be rid of all the anxiety, and then finally I'll be able to have anal sex, which I dream about having but can't, for all the same reasons that you avoid it.

I know that abstinence is hard, but I think it might be possible and I'm ready to give it a try. Maybe you and I both need to channel our energies into career, hobbies, other things; and indulge in the occasional phone sex or porn-assisted masturbation session.

J

[BenG]

Hi, thanks for your reply. I know what you are going through.
I don't know if you are aware, but a (modern) negative test at 6 (let alone 9) weeks is 100% reliable (Dr HHH as said this many times), so your 12 week result will be the same.

I can totally identify with your fustration, but being able to have plenty of anal sex with HIV is not a great scenario. It is a serious virus that gradually destroys your immune system. Apparently, I have a distant relative who has it (mum won't tell me who it is as she is sworn to secrecy!).

Dr HHH is so right - I kept my sexual fustrations inside for so long that eventually I just gave in and did something that I would NEVER do with a clear head - I met a stranger from the internet. Although I did oral sex only (which I stupidly thought was safe), I had to endure 2 months of severe (and I mean severe) anxiety worring if I had HIV. I lost weight, wasn't sleeping well, had stomach problems). I was eventually diagnosed with NGU, which I am taking antibiotics for.

Personally, I think you ought to find a dating website where there are people looking for a relationship. Then if you meet someone, make sure you find out their HIV status (although being the paranoid person I am, I wouldn't trust them even if they said they were negative. I would want evidence). I guess a lot of it comes down to trust, something with Dr HHH said.
Hope it all works out for you, but try to balance out your sexual needs with any risks.

The more I read of Dr HHH's comments, the more informed I become - there is nothing worst than ignorance. He providing everyone a fantastic service - so thanks Dr HHH!

Ben

[JohnnyV]

Thanks for your support. Even though I don't know you, it helps a lot. And yes, we should all thank Dr. HHH because he's the only sane voice on the internet, or at least one of the few.

My 12-week test is in a few days and I'll post again when I get it to let you know whether I'm pos or neg. I feel like I just need to reach the 3-month mark because that's what the "official line" is. It's overly cautious and probably unnecessary, but partly ritualistic. Maybe I needed three whole months of contemplation.

What's NGU?

Thanks & blessings from the other side of the Atlantic.

[JohnnyV]

Hi,

I don't know if you'll pass over this thread again, but I just wanted to let you know that I did indeed come up negative at 12 weeks, as you said I would. My regime of cold showers starts today.