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
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!
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
AIDS Services of Austin
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
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
> "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.
Have you seen the well-to-do having sex like me and you?
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.