Saturday, November 19, 2005

...many people who suspect that they have been infected do not feel comfortable walking into AIDS clinics - or even confiding in family doctors.



> Rapid AIDS tests that yield results in 20 minutes
> have revolutionized outreach counseling and greatly
> improved efforts aimed at slowing the spread of
> infection.

> ...

> Some AIDS outreach workers are wary.
>
> They believe that people who test positive should
> hear the news from counselors, who can cushion the
> shock, direct them to medical care and explain the
> precautions that are needed to avoid infecting
> others.
> http://www.nytimes.com/2005/11/19/opinion/19sat3.html

They want to control their proprietary positions, their
proprietary jobs. It's like an industry.

by John Sandy Bartlett. by Eric Rofes.

By John Sandy Bartlett

Thanks for your suggestion. Getting tested together for before sex is
an excellent idea which I often recommend. Had I, rather than the
GayHealth.com editor & MD, written the entire first 8 paragraphs
myself, I probably would have included that.
(I'd NEVER have used "phenomena" as a singular noun! :-)
My message, however, would probably have been just
a bit different from yours:

In almost 20 years of HIV/STD education and counseling, I've been led to be much more flexible and pragmatic about people's sexual behavior. One of the toughest lessons that AIDS prevention counselors had to learn, early in the epidemic, is that if the "demands" of safer behavior choices are TOO burdensome or complex (i.e., if the advice is too absolutist), then they are likely to be ignored, pretty completely. (Hence, the accusation of "Sex police!", but that's another discussion...)

Regarding HIV/STD testing before sex,
the observed reality-norm is that either
(a) it's too late -- sex is already happening; or

(b) the couple is not willing to wait for intimacy.

So........the BACK-UP is to advise condom use for the first 3 months;
then test; and if the results are all negative,
no symptoms are present, and
the relationship is trusted as monogamous -- OK, dispense
with the condoms IF that's important.
(Obviously, needle use changes the equation.)

Granted that condoms are not perfect against all STDs, but they come close enough for most folks, especially horny gay men. Besides, some of the conditions you've listed as "STD" can be transmitted without sexual contact. (I once found 'crabs' crawling around on the weights bench at my recently-gender-integrated gym; and caught scabies from sharing a towel with a university rowing teammate. Molluscum can spread without intimacy, especially among children in daycare to parents, and so can almost anything carried orally, symptomatic or not.)

I read your "Draft" of May 13 --
excellent and very thorough discussion.
[ at http://notb4weknow.blogspot.com/2005/11/getting-std-hiv-testing-before-having.html ]
BTW, your points about STDs frequently being non-symptomatic were excellent and cannot be stressed enough. As a practical matter, however, I have a couple of reservations about tone.
(1) See above about why advice is ignored;

(2) Gee, you take all the fun out of gettin' hot'n'sweaty with someone
      by making it sound as if everyone is (at least potentially)
      crawling with nasty germs.

Of course, I agree cognitively with most of what you say.
But, if a reader accepted everything you write, he'd be scared to touch anyone intimately without dressing up like a rubber-clad frogman.
(Hmmm, now that presents some interesting images... :-)

The challenge, then, is in making this excellent information user-friendly to the reader, who then is much more likely to incorporate it into his/her decisions and behavior. Life, sex and relationships included, is not without risks -- the key is in
(a) learning to manage the risks; and

(b) learning what one is comfortable with and
      setting behavior limits accordingly.

Appropriate testing is an excellent tool. You touched on communication in relationships, but one thing you overlooked is communication with one's physician -- especially for gay men.
The most common reason(s) "not all sites are tested" and
"not all STDs are test for" is because
(a) the patient was not frank about what he/she had done; and/or

(b) the clinician was ignorant or possibly biased about the stated
      behavior and its consequences. And unfortunately, given the
      present political realities in the US, public health clinic resources
      are so strained that they are NEVER going to do some of the more
      expensive tests.

Just a couple of errors:
1. Yes, there is a test for HPV, even if it isn't "automatically" done;
     type of HPV is usually included, which is important. (You also list
      anogenital warts separately -- they are almost always HPV.)

2. At one point, you state that an HIV-ab test is reliable at 3 months;
several sections later you say one must wait 6 months. Your first
statement was the more correct: by 3 months, accuracy is in the
99% range; like all medical tests, it will never be "perfect".

3. Yes, molluscum can be "tested for", although not in the absence of the
symptomatic bumps, from which a sample must be taken. In the absence of
symptoms, there's not really a lot of reason to test for it, as it is
overwhelmingly (exclusively? -- good research question) transmitted
through the bumps. (Since it is a virus, I would expect that some
company like Quest or ViroLogic will market an antibody test in time.)

Well, I've blathered on enough. (Feel free to post, with correct
attribution, any of the above that's useful.) Thanks for your intelligent,
interesting site [ at http://www.seedwiki.com/wiki/not_b4_we_know ] -- keep it up!
Sandy

P.S. John James rules! He and Martin Delaney are the most intelligent,
informed and insightful writers on HIV in the country!

John Sandy Bartlett
Information/Education Coordinator
AIDS Services of Austin
P.O.Box 4874
Austin Texas 78765
512 458-AIDS dir 406-6163 fax 452-3299
http://www.ASAustin.org Sandy.Bartlett at ASAustin.org
_______________________________________

By John Sandy Bartlett
http://www.gayhealth.com/templates/0/news/index.html?record=1033
Even HIV-negative partners in long-term relationships should give
each other a present by getting tested together to ensure that
they are both still negative. It is a sad but all too common
phenomena where one partner has sex outside the relationship and
brings HIV back home.
_______________________________________

> By Eric Rofes
> http://whitecranejournal.com/66/art6605.asp
> "Gay Men are healthy, happy, and life affirming."

All except for that unknown subset who are HIV positive
and infecting and killing some part of that community.
_______________________________________

15 October 2005 Boston Globe had an obit about Leroy Whitfield,
a non-believer in HIV as the cause of AIDS. As he got closer
to dying his beliefs started changing--but not quickly
enough to save him.
http://www.boston.com/news/globe/obituaries/articles/2005/10/15/leroy_whitfield_36_author_wrote_about_effect_of_aids_on_americas_black_community/
_______________________________________


Have you seen the well-to-do having sex like me and you?
http://faculty.mville.edu/comberiatic/images/Courses/muh1015/Disc%205/Music%20in%20American%20Culture/17%20Puttin%27%20On%20the%20Ritz.wma
They're afraid of STDs and unwanted pregnancies
The AIDS scare's reached it's apex
But who cares? I want my safe sex
You feel that way too? Then the Ritz is the rubber for you

If you screw and you don't know who you do screw
Why don't you use the brand that fits
Puttin' on the Ritz

Girls, you'll see, will be receptive
They don't want the contraceptive pills and kits
If you're puttin' on the Ritz

Other brands? Well, friends, you can't compare theirs
When you can wear the brand that Fred Astaire wears
And the Care Bears

It's a glitzy, ritzy condom
Worn by even Stephen Sondh'm who admits
To puttin' on the Ritz

You won't need no diaphragm to trap her
Just slap your Mister Happy in that wrapper
And you'll look dapper

With your playmate you will get much more play
She'll help to put it on you during foreplay
At work or play

Keep a few right in your wallet
If you do then I can call it quits, that's it!
Puttin' on the ritz
_______________________________________


Stay tuned for... All of Me
the parody version, the strategy version.

Getting STD & HIV Testing Before Having Sex. Draft.

Draft



Getting STD & HIV Testing Before Having Sex

One strategy for reducing the risk of getting a sexually transmitted
disease (STD) is for you and a partner to get STD testing (including
testing for HIV) before having sex.

Getting STD & HIV testing is always a good thing, IF the meaning of
the test results, and what they imply regarding risks and risk
reduction, is understood.

Getting STD & HIV testing before having sex also shows concern for
your own health and the health of your partner, and indicates a desire
for openness and communication, which are good things.

However, it is important to understand that getting STD & HIV
testing before having sex might tell you little about the risks of
giving something to or getting something from your partner.
____________________________________________________________________
If testing before sex leads to a false sense of security and sexual
practices that are more risky (for example, not wearing condoms when
you fuck), then it is a BAD thing.
__________________________________

Before discussing getting tested, it is worth visiting the other
strategy--not getting tested.

____________________________________
Not getting tested -- a bad strategy
____________________________________

Many people feel that they do not have to get tested for STDs.

"I know my body. If I had an infection, I would know it."
Unfortunately, this is FALSE.

Many STDs can be present and transmissable without causing any
symptoms.

The majority of people with HIV probably acquired the disease from
partners who thought that they did not have HIV.

Sometimes the symptoms of STDs are slight,
or are not recognized for what they really are.

Often the symptoms go away without treatment
(even though the STD itself does not go away).

Given all of this, getting testing for STDs, even when symptoms are
not present, is an important part of staying healthy, and keeping
partners and the community healthy.

But, as you will see from the following sections, getting testing for
STDs and HIV before having sex tells you less than you might think.

"Knowing yourself" is no guarantee in you or in your partner that
you do not have STDs.

Your ability to detect an STD is actually quite poor.

Urethral infections
gonorrhea and
chlamydia in the throat
or butt,
syphilis,
warts,
molluscum, and
herpes are often not noticed by the people infected,
or are not recognized for what they are.

If you have had unprotected contact with a partner for some days,
weeks, or months, and have not gotten anything from him or her as best
you know, then:

You might already have gotten something from your partner and failed
to recognize it

You might have not gotten something from your partner that he/she
has, but you might get it the next time you have sex.

________________
Common Fallacies
________________

Many people who come to a clinic for STD testing expect
(1) to be tested for everything,
(2) that tests are 100% reliable, and
(3) that the test tells them their situation right now.

Unfortunately, none of these are true.

This is not Star Trek.

________________________________
Tests do not exist for some STDs
________________________________

No tests (in the sense of DNA tests, antibody tests, or cultures)
are available for
anogenital warts,
molluscum,
lice, and
scabies.

___________________________
Not all STDs are tested for
___________________________

Testing for STDs often does not include one or more of the following
tests:

A urine sediment that can detect evidence of some kind of infection in
the penis

Throat and rectal swabs that detect both gonorrhea and chlamydia

Tests for hepatitis

Tests for endoparasites

No clinic or doctor tests for all STDs.

There are no tests for the human papilloma virus that causes
anogenital warts, and for
molluscum.

If these bumps are present, and the healthcare professional looks for
them, then they might be detected.

But no healthcare provider can see viruses.

There are also no tests for the causes of urethritis other than
gonorrhea and chlamydia when the infections are in the throat or butt.

What tests are done vary.

Not every healthcare setting tests for chlamydia in the throat and
butt, for example, or does a urine sediment.

________________________
Not all sites are tested
________________________

Many clinics and doctors omit tests of the throat and butt for STDs,
or do not offer the tests to everyone who has sexual contact at those
sites.

_________________________________________________
Some STDs can only be found by visual examination
_________________________________________________

STDs that can only be detected by a visual examination include:

Anogenital warts

Molluscum

Lice

Scabies

For each of these, there are stages of infection that are
undetectable.

Also, the thoroughness of the healthcare provider in performing the
examination plays a central role.

If the healthcare provider omits the visual examination, then the
probability of their finding an STD falls to zero.

_______________________________________
STDs take time to reveal their presence
_______________________________________

In all cases, there is a period of time between when a person is
infected with an STD and the person has symptoms, and until the STD
can be reliably detected by STD tests or visual examination.

This period is often referred to as the window period.

STD tests taken today tell you your situation somewhere between
several weeks and 6 months ago.

For HIV, they tell most people their situation reliably 3 months ago,
and essentially everyone 6 months ago.

For warts, the window period can range up to a year or more, and some
people with the wart virus do not develop visible warts, though they
can still pass the infection to their partners.

____________________________
Tests are not 100% sensitive
____________________________

No STD tests are 100% sensitive, that is, none detect the STD 100%
of the time.

Amplified DNA tests are in the high 90s, as are a blood test for
syphilis when the person is in the secondary stage and an HIV test 6
months or more after exposure to HIV.

Even these tests are not 100% sensitive because of the possibilities
of errors in collection, labeling, storage, and transport of samples,
as well as of laboratory errors.

Other tests fall dramatically in sensitivity, especially if
infections are recent.

For STDs that can be only be detected visually, the sensitivity of the
test falls to zero percent if no signs of the STD are visible, or if
the healthcare provider does not look.

For STDs for which there is a test beyond visual examination, STD
tests offer a reasonable degree of reliability (perhaps 95 percent)
for the things that are tested for 3 months after the most recent
exposure (counting sexual contact with any partner).

___________________________________
Results Do Not Equal Your Situation
___________________________________

There is a difference between knowing the results of a test and
knowing your status.

A test can be negative, but that does not mean that you do not have
the STD.

Negative test results only mean that no evidence of the STD in
question was found.

If your last sexual contact before taking the test was before the
window period for the test, then the result of the test probably
reflects your situation.

But if you have had more recent sexual contact, then the result of the
test tells you less, and maybe nothing, about your current situation.

Rapid tests versus standard ones are no different with respect to
the information they give you about your status.

_______________
Which Partners?
_______________

If you are entering a relationship with a primary partner about whom
you are not concerned STD-wise (because you know him, and he knows his
body, and you are both getting tested), and you are getting tested
because you are concerned about other contacts, you need to understand
that you can also get STDs from your primary partner and, if he/she is
still in the window period, then the chance of detecting the STDs is
reduced.

From the standpoint of STD testing, what determines risk is what you
do with each partner, and what they have done with prior or other
current partners.

_____________
Communication
_____________

Communication in the relationship is probably more important than
testing.

Knowing what infections a person already has, and whether the
relationship is open or closed, is important.

Even when getting tests now, you will often have to rely on the
honesty of your partner to give you the results.

______________
Best Practices
______________

Best practices regarding STD & HIV testing for all open
relationships are:

Get tested routinely (for example, every six months) irrespective of
whether you have symptoms, and encourage all of your partners to do
the same.

Get tested if you notice (or a partner notices) any new symptoms that
might indicate STDs
(urethral symptoms, or
new bumps, sores, or
rashes)

Wear condoms when you fuck, inside and outside the
relationship.

Optimally, use them for oral sex.

Best advice for relationships where you want to bet your life on the
monogamy are:

Get tested for STDs (including HIV) at zero months (before having
sex).

This might pick up some infections.

For six months, wear condoms when you fuck.

Optimally, use them for oral sex.

Get tested again for STDs at 6 months.

For another six months, wear condoms when you fuck.

Optimally, use them for oral sex.

The point of this is to make it less likely that warts will be
undetected (though it does not guarantee this).

After this, you can discuss not using condoms when you fuck.
But remember, it is always safer to wear condoms.

_________________
Recommended Tests
_________________

We recommend the following STD screening tests every time you seek
testing, if they are available:

Blood test for syphilis

Urine sediment for white blood cells that are evidence of infection
in the penis

Amplified DNA testing for gonorrhea and chlamydia in the urine

If you have gone down on a male or female partner, DNA testing for
gonorrhea and chlamydia in the throat (amplified or nonamplified)

If there has been any sexual contact with a male or female partner
using your butt, including fingers and toys DNA, testing for gonorrhea
and chlamydia in the butt (amplified or nonamplified)

Visual examinations for STDs:

Lips and
mouth

Genital area in front (between the navel and half way down the
thighs),
including the lower abdomen,
pubic hair,
penis,
urethral meatus,
scrotum, and
groin.

External anal area and
buttocks

Checking lymph nodes in the groin for swelling
or tenderness

by John Sandy Bartlett. By Eric Rofes.

By John Sandy Bartlett

Thanks for your suggestion. Getting tested together for before sex is an
excellent idea which I often recommend. Had I, rather than the
GayHealth.com editor & MD, written the entire first 8 paragraphs myself, I
probably would have included that. (I'd NEVER have used "phenomena" as a
singular noun! :-) My message, however, would probably have been just a
bit different from yours:

In almost 20 years of HIV/STD education and counseling, I've been led to be
much more flexible and pragmatic about people's sexual behavior. One of the
toughest lessons that AIDS prevention counselors had to learn, early in the
epidemic, is that if the "demands" of safer behavior choices are TOO
burdensome or complex (i.e., if the advice is too absolutist), then they
are likely to be ignored, pretty completely. (Hence,
the accusation of "Sex police!", but that's another discussion...)

Regarding HIV/STD testing before sex, the observed reality-norm is that
either
(a) it's too late -- sex is already happening; or

(b) the couple is not willing to wait for intimacy.

So........the BACK-UP is to advise condom use for the first 3 months;
then test; and if the results are all negative, no symptoms are present,
and the relationship is trusted as monogamous -- OK, dispense
with the condoms IF that's important.
(Obviously, needle use changes the equation.)

Granted that condoms are not perfect against all STDs, but they come close
enough for most folks, especially horny gay men. Besides, some of the
conditions you've listed as "STD" can be transmitted without sexual
contact. (I once found 'crabs' crawling around on the weights bench at my
recently-gender-integrated gym; and caught scabies from sharing a towel
with a university rowing teammate. Molluscum can spread without intimacy,
especially among children in daycare to parents, and so can almost anything
carried orally, symptomatic or not.)

I read your "Draft" of May 13 -- excellent and very thorough discussion.
[ at http://notb4weknow.editthispage.com/2005/03/14 ]
BTW, your points about STDs frequently being non-symptomatic were excellent
and cannot be stressed enough. As a practical matter, however, I have a
couple of reservations about tone.
(1) See above about why advice is ignored;

(2) Gee, you take all the fun out of gettin' hot'n'sweaty with someone by
making it sound as if everyone is (at least potentially) crawling with
nasty germs.

Of course, I agree cognitively with most of what you say.
But, if a reader accepted everything you write, he'd be scared to touch
anyone intimately without dressing up like a rubber-clad frogman.
(Hmmm, now that presents some interesting images... :-)

The challenge, then, is in making this excellent information user-friendly
to the reader, who then is much more likely to incorporate it into his/her
decisions and behavior. Life, sex and relationships included, is not
without risks -- the key is in
(a) learning to manage the risks; and

(b) learning what one is comfortable with and setting behavior limits
accordingly.

Appropriate testing is an excellent tool. You touched on communication in
relationships, but one thing you overlooked is communication with one's
physician -- especially for gay men. The most common reason(s) "not all
sites are tested" and "not all STDs are test for" is because
(a) the patient was not frank about what he/she had done; and/or

(b) the clinician was ignorant or possibly biased about the stated behavior
and its consequences. And unfortunately, given the present political
realities in the US, public health clinic resources are so strained
that they are NEVER going to do some of the more expensive tests.

Just a couple of errors:
1. Yes, there is a test for HPV, even if it isn't "automatically" done;
type of HPV is usually included, which is important. (You also list
anogenital warts separately -- they are almost always HPV.)

2. At one point, you state that an HIV-ab test is reliable at 3 months;
several sections later you say one must wait 6 months. Your first
statement was the more correct: by 3 months, accuracy is in the
99% range; like all medical tests, it will never be "perfect".

3. Yes, molluscum can be "tested for", although not in the absence of the
symptomatic bumps, from which a sample must be taken. In the absence of
symptoms, there's not really a lot of reason to test for it, as it is
overwhelmingly (exclusively? -- good research question) transmitted
through the bumps. (Since it is a virus, I would expect that some
company like Quest or ViroLogic will market an antibody test in time.)

Well, I've blathered on enough. (Feel free to post, with correct
attribution, any of the above that's useful.) Thanks for your intelligent,
interesting site [ at http://www.seedwiki.com/wiki/not_b4_we_know ] -- keep it up!
Sandy

P.S. John James rules! He and Martin Delaney are the most intelligent,
informed and insightful writers on HIV in the country!

John Sandy Bartlett
Information/Education Coordinator
AIDS Services of Austin
P.O.Box 4874
Austin Texas 78765
512 458-AIDS dir 406-6163 fax 452-3299
http://www.ASAustin.org Sandy.Bartlett at ASAustin.org
_______________________________________

By John Sandy Bartlett
http://www.gayhealth.com/templates/0/news/index.html?record=1033
Even HIV-negative partners in long-term relationships should give
each other a present by getting tested together to ensure that
they are both still negative. It is a sad but all too common
phenomena where one partner has sex outside the relationship and
brings HIV back home.
_______________________________________

> By Eric Rofes
> http://whitecranejournal.com/66/art6605.asp
> "Gay Men are healthy, happy, and life affirming."

All except for that unknown subset who are HIV positive
and infecting and killing some part of that community.
_______________________________________

15 October 2005 Boston Globe had an obit about Leroy Whitfield,
a non-believer in HIV as the cause of AIDS. As he got closer
to dying his beliefs started changing--but not quickly
enough to save him.
http://www.boston.com/news/globe/obituaries/articles/2005/10/15/leroy_whitfield_36_author_wrote_about_effect_of_aids_on_americas_black_community/
_______________________________________



Have you seen the well-to-do having sex like me and you?
http://faculty.mville.edu/comberiatic/images/Courses/muh1015/Disc%205/Music%20in%20American%20Culture/17%20Puttin%27%20On%20the%20Ritz.wma
They're afraid of STDs and unwanted pregnancies
The AIDS scare's reached it's apex
But who cares? I want my safe sex
You feel that way too? Then the Ritz is the rubber for you

If you screw and you don't know who you do screw
Why don't you use the brand that fits
Puttin' on the Ritz

Girls, you'll see, will be receptive
They don't want the contraceptive pills and kits
If you're puttin' on the Ritz

Other brands? Well, friends, you can't compare theirs
When you can wear the brand that Fred Astaire wears
And the Care Bears

It's a glitzy, ritzy condom
Worn by even Stephen Sondh'm who admits
To puttin' on the Ritz

You won't need no diaphragm to trap her
Just slap your Mister Happy in that wrapper
And you'll look dapper

With your playmate you will get much more play
She'll help to put it on you during foreplay
At work or play

Keep a few right in your wallet
If you do then I can call it quits, that's it!
Puttin' on the ritz
_______________________________________


Stay tuned for... All of Me
the parody version, the strategy version.

Tested together. Negotiated safety.

In quotes, enter the phrase...
tested together
at
http://blogsearch.google.com
_______________________

Negotiated safety is not same as the strategy of let's get tested together before we have sex for sexually transmitted infections.

By implication negotiated safety involves each other saying to
one another that they are negative.

People making claims about their status.

They each make the claim that they are negative.

The strategy is for them before having sex to get tested together
in a transparent way. Make the results of those tests available
to each other
http://NotB4WeKnow.blogspot.com
http://www.seedwiki.com/wiki/not_b4_we_know

With claims, there is no transparency. either one could be lying
for example.

The strategy of let's get tested together before we have sex
for sexually transmitted infections is not the same as what
> ...is called "Negotiated Safety"... it is a
> process by which two uninfected men decide together
> to not use condoms.
>
> Negotiated Safety was first described in the
> professional literature by Kippax et al in 1993 from
> research they conducted among gay men in Sydney,
> Australia.
>
> It is an agreement between two gay men in a
> relationship to have a process of getting ready to
> stop using condoms when they have anal sex.
>
> The basis of this agreement is an explicit
> understanding that both know each other's HIV status
> and are both uninfected.

There's ambiguity when you say
explicit quote "understanding" unquote.
There's not transparency.
Which means there's a wink involved when you use the word
"understanding" in this context.

Because there's a way for both people to have the same knowledge.

It doesn't mean that the information could be false,
but there's no mendacity in it.
The test could be false, the doctor could be wrong.
But the same tests are used to ensure the safety of the blood
supply.

The strategy is about passing the information
to the other person.

No objection for people to choose to have sex when one or both
have an infection.

The problem today is that people have no idea if they are
infected or when they got infected.

The moral equivalent of saying about your blood donation,
no don't test that blood, I don't care just give me the blood I
need, no testing. How many people would take a blood transfusion
under those conditions today? A very small number.

No amount of negotiation will generate concrete knowledge about
somebody's status.

How much talk between two people, for example, will give you the
same results as a test? There isn't any amount of talk.

> In order to insure the men go together to be tested
> at least three months after either has had any
> unprotected sex.

Okay, it's complicated.

Why the three month figure?

For example, with the blood supply they don't wait three months
after the test.

They test once when they get the blood.
They test immediately.
They try to use the blood as soon as possible.
Why the three month wait?

> They also go together to get their HIV test results.
>
> The only time that both partners do not use condoms
> is when they have sex with each other, making this an
> acceptable safer sex option.
>
> There must be no unprotected sex outside the
> relationship; if either partner does so, then he must
> immediately inform his partner prior to their having
> sex again.
>
> They resume using condoms until subsequent HIV tests
> prove that the partner who had unprotected sex is
> still negative.
>
> Follow up research has shown that 90% of men in
> negotiated safety agreements adhere to them, making
> this an effective risk reduction strategy.

Sure just like the strategy, of course it would work
provided you follow it.

The problem is the complexity
with this whole arrangement, this protocol.

> But the 10% who are not compliant with this agreement
> are a major source of new HIV infections.

Because you're dependent on interviews how can you possibly
come up with ten percent?...

> One study showed that young gay men in committed
> relationships in the Netherlands were becoming
> infected at high rates by their partners.

They have created this complex process involving a lot of time
and trouble between two people where the real problem is the
compelling nature of sexuality. When what you need to do is
reduce the complexity and the amount of time because sexual urges
compel you to act in spite of all the danger.

So, get the tests together before having sex, learn the results,
then you can make a decision
http://NotB4WeKnow.blogspot.com
http://www.seedwiki.com/wiki/not_b4_we_know

> Davidovich, Udi
> de Witt, John B.F.
> Stroebe, Wolfgang
> (2004) Behavioral and cognitive barriers to safer sex
> between men in steady relationships:
> Implications for prevention strategies.
> AIDS Education & Prevention,
> v16n4, 304-314 August 2004
> http://www.extenza-eps.com/GPI/doi/abs/10.1521/aeap.16.4.304.40398

> Kippax, Susan
> Slavin, Sean
> Ellard, Jeanne
> Hendry, Olympia
> Richters, Juliet
> Grulich, Andrew E
> Kaldor, John
> (2003) Seroconversion in context.
> AIDS Care,
> v15n6, 839-852 December 2003
> http://journalsonline.tandf.co.uk/link.asp?id=a20d9e8ub0d4ctp3

> Xiridou, Maria
> Geskus, Ronald
> de Wit, John B.F.
> Coutinho, Roel
> Kretzschmar, Mirjam
> (2003) The contribution of steady and
> casual partnerships to the incidence of HIV infection
> among homosexual men
> in Amsterdam.
> AIDS,
> v17n7, 1029-1038 May 2, 2003
> http://www.aidsonline.com/pt/re/aids/fulltext.00002030-200305020-00012.htm

> Crawford, June M
> Rodden, Pamela
> Kippax, Susan
> Van de Ven, Paul
> (2001) Negotiated safety and other agreements
> between men in relationships:
> risk practice redefined.
> International Journal of STD & AIDS,
> v12n3, 164-170 March 2001
> http://tinyurl.com/ako6d

> Davidovich, Udi
> de Witt, John B.F.
> Albrecht, Nel
> Geskus, Ronald
> Stroebe, Wolfgang
> Coutinho, Roel
> (2001) Increase in the share of steady partners
> as a source of HIV infection:
> A 17-year study of seroconversion among younger and
> older gay men.
> AIDS,
> v15n10, 1303-1308 July 6, 2001
> http://www.aidsonline.com/pt/re/aids/fulltext.00002030-200107060-00013.htm

> Davidovich, Udi.,
> de Wit, John B.F, &
> Stroebe, Wolfgang.
> (2000) Assessing sexual risk behavior of
> young gay men in primary relationships:
> The incorporation of negotiated safety and
> negotiated safety compliance.
> AIDS,
> v14n6, 701-706 April 14, 2000
> http://www.aidsonline.com/pt/re/aids/fulltext.00002030-200004140-00009.htm

> Kippax, Susan
> Noble, Jason
> Prestage, Garrett
> Crawford, June
> Campbell, Danielle
> Baxter, Don
> Cooper, David
> (1997) Sexual negotiation in the AIDS era:
> negotiated safety revisited.
> AIDS,
> v11n2, 191-197 February 11, 1997
> http://www.aidsonline.com/pt/re/aids/fulltext.00002030-199702000-00009.htm

> Kippax, Susan
> Crawford, June M
> Davis, Mark
> Rodden, Pamela
> Dowset, Gary W
> (1993) Sustaining safe sex:
> A longitudinal study of a sample of homosexual men.
> AIDS,
> v7n2, 257-263 February 1993
> http://tinyurl.com/b3u9k

Thursday, June 16, 2005

Authority. Citations. Sources.

The strategy. Potential sex partners get tested together before having sex... for sexually transmitted infections.

Analogous cites. Analagous authority.
. Syphilis laws
. Testing before marriage license
. Vaccination protocols for immunization
. Medical testing

Informal observations. Unofficial observations.
. Dartmouth College student health services clinicians

Writers recommend the strategy.
. by syndicated columnist Ann Landers
. by Jay Wiseman http://www.greenerypress.com/101.htm
. by Peggy Post. Emily Post's Etiquette 17th Edition 2004
  page 75 chapter Six Dating, Part Two Relationships

. ...?
? ...