>"It's a new standard individuals seeking the benefits of sex must employ if they (we) really      > want to be safe. I say No more test drives before you buy. Check what's under the hood      > first."

An interesting approach to the testing strategy.

     > Yes I do suggest people Google Tested Together, and look at the fear mongering drivel you posted in your Blog on January 3,2012 titled “Has anyone ever tried to kill someone by infecting them with HIV?”

          http://goo.gl/RHRzTy

          https://www.google.com/search?q=court+case+hiv+as+a+weapon+tried+to+kill

    > It just drives me nuts how people respond to Pozzies. For some reason the first thought that enters the mind for a large portion of Neggies is “You’re mad as hell at the world for getting HIV, and you’re trying to get even by infecting as many people as possible.” I always wonder about those guys. Is that what they’d do if they got it? They thought of it first. Remind me again, which one of us is supposed to be the sociopath?

          You can take credit for thinking first that I'm

          mad as hell, although I'm not HIV positive,

          and want to infect other people.

          Why would that be your first thought about me?

          Are you possibly a sociopath?

    > Are you one of those people?

          I don't think so. But you get credit for being

          the first to think that of me.

    > Time to update your blob, it’s been over a year since your last entry, but you’ve had plenty of time spam this same message several times in this thread, and several others I’ve read.

          Eclectic reading will help you see that there

          are a lot of ways to think about this subject.

    > Tested Together dot org is about straight couples starting a relationship. For gay couples there is a pilot program in Chicago and Atlanta. What about the rest of the gay world?

          I've been working on the "get tested together"

          issue for over thirty years. It takes a long time

          for this way of doing things to change. But it

          is finally happening.

    > With high rates of seroconversion among gay male couples, primary partners are an often unrecognized and under-studied source of new HIV infections. Many young gay couples stop using condoms as soon as they officially decide they’ve begun a relationship.

          Its almost as though they think being in love

          can cure AIDS. Ah, young people and their

          silly ideas about love!

    > If you’re starting a new relationship, and want to stop using condoms:

    > A. Get tested at the same time – Together if the local system permits

          You don't need to repeat my ideas here - although

          repetition is a good way to learn something.

    > B. Keep using rubbers for three months

          Ditto.

    > C. Test again.

          Ditto.

    > D. Have a serious discussion negotiating safety for both of you. Agree that if either of you slips up and plays outside your relationship you will use a condom. If a rubber isn’t used, you will both talk honestly and openly about it. Be realistic – it might happen. Promise not to freak out if it does. Recognize that you will feel hurt. Remember that by discussing it openly you are showing each other love, respect, and protecting each other. Acknowledge to yourself that you just might be the one that slips up. Be firm and confident in your agreement. Maybe even write it out and sign it.

          This is looking like a complicated series of steps

          that only an absolutely rational at all times person

          could manage. Complexity and irrationality is how

          the world will end up with a new HIV+ case.

    > E. If the second set of tests are Negative for HIV and other STIs, then decide if you still want to stop using condoms.

          In a perfect world with perfect people...

    > F. If/when a slip-up happens, keep calm and remember your agreement. Discuss the incident openly and honestly. Get couples counselling if you need it.

          Couples counseling doesn't cure AIDS. Probably

          better to consider a drug regimen.

    > G. Immediately start using condoms again.

          Maybe you should make a wall chart, covered

          with plastic, that everyone can put on a wall

          in their bedroom and/or bathroom. I smell a

          brand new business!

    > H. Test – condoms for thee months – Test again.

          And they are gonna need a countdown clock,

          or maybe an app for their phone, synched, so

          they both know where they are in this regimen.

    > I. Go back to letter D, and re-negotiate you mutual safety agreement.

          I'm thinking a youtube video. Here's a chance

          for Hollywood to step up.

    > J. Repeat as needed for hopefully a very long, loving and happy relationship.

          That repeat thing means an increase in the

          probability that someone is going to be a new

          HIV+ case. Hope is just another irrational plan.

          And this:

               http://goo.gl/iyIHIW

               https://www.google.com/search?q=how+long+do+marriages+and+couple+last+gay+and+straight

    > Just “Testing Together” at the beginning of the relationship isn’t enough.

          Finally, something we both agree with.

Has anyone ever tried to kill someone by infecting them with HIV?
http://www.huffingtonpost.com/2011/12/30/david-dean-smith-michigan-hiv-grand-rapids_n_1177103.html

http://www.woodtv.com/dpp/news/local/grand_rapids/hiv-spreader-may-have-calif-victims

http://continuedat.blogspot.com
http://aidshivstds.blogspot.com

A single test can find an HIV+ person, or someone with another infection that needs to be treated. Then both people can make a decision from that point. One course might be for the uninfected person to not go forward. Right there you have one less HIV infection. And the positive person can then consider their future, therapies, giving up sex, etc. Again, another possible reduction in future infections. The epidemic will be ended by one non-infection at a time.

A new blood test can diagnose HIV as soon as 14 days after infection, thus reducing the length of the "window period" between infection and when the virus can be detected
http://www.youtube.com/watch?v=tpEZgjdHP58

What are 10 reasons why AIDS prevention advocates don't experiment, don't even try the strategy of "BEFORE we have sex let's get tested TOGETHER for A VARIETY of STDs then make an informed decision."?

1. Obviously, I may not end up not having sex.
. The clinic's not open at 2am.
. There's no clinic in the middle of the park.
. There's no clinic in the back of my van.
. The free testing center won't take my credit card.
. You can get HIV from testing.
. I can tell if somebody has AIDS.
. I'm an sex educator. I know what works.
. There're no studies but I'm sure it doesn't work.
. I'm already HIV positive, thank you, whoever.

http://getstdtested.com

Post sex STD tests are a strategy--but what do they cause a person to do? Give up sex? Have less sex? Have more sex in order to "get even"?

Testing before sex is a way to keep some sex from happening, and, consequently, prevent an STD. Post sex STD tests don't do that. Pre sex STD tests will save some lives--some people will back out of the possibility of sex with that partner. Others may be way more cautious. Still others might wait for non-HIV STDs to be cured, if available.

Charlie Rose Jun 19, 2009 A conversation about Personalized Medicine with Anne Wojcicki
http://www.charlierose.com/guest/view/6626
https://www.23andme.com/health/pre_hiv/

http://www.google.com/search?q=23andme+hiv
http://www.google.com/search?q=23andme+aids

http://www.techcrunch.com/2008/03/02/my-23andme-dna-results/

Getting thrown out from a lot of online interactions gives me a certain perspective about those folks claiming to lead and advocate.

People I know who died from acquired immune deficiency syndrome

People I know who died from acquired immune deficiency syndrome
. Larry
. Don
. Scott
. D's brother

by Stacy Morrow
Sex As a Deadly Weapon? Jury Says Yes
http://www.nbcdfw.com/
news/local/Jury-Decides-Fate-of-Man-Accused-of-Spreading-HIV.html

Have you observed POTENTIAL sex partners coming in saying we haven't had sex yet and want to get tested TOGETHER, for A VARIETY of STDs?...

>
http://www.stdpreventiononline.org/index.php/forum/posts/35,15
> Testing
> Absolutely! I've heard it over my years in this field and I suggest doing it in my risk reduction portion of my DIS or HIV counseling interviews. I also train new DIS [Disease Intervention Specialist] to include it instead of simply focusing on condoms. Too many counselors/DIS focus only on condom use. There needs to be alternative discussions, since condom use is not realistic for everyone!
>
>
> definitely
> That's a lot of what our clinic does, yes. And of course we applaud it!
>
>
> Partners Testing before Starting a Sexual Relationship
> While I routinely advise patients to bring their new partners into STD Clinic I have only had one couple that mentioned they specifically came to the clinic for that reason. A young MSM couple in their early 20s. After both received an evaluation, they went on to get Rapid HIV tested. One of the partners was Reactive and the venous draw was confirmed. It put such a cloud over "Doing the Right Thing." I still recommend it and now utilize this example with patients coming into clinic as to the importance of knowing not only their STD status but also their HIV status.
>
>
> Of Course
> All the time! The last time it happened it was an elderly couple who were both ready to have sex, and get married. They just wanted to make sure that they both were HIV free. It was cool because I also gave them some really good information about transmission and older adults which they volunteered to give to friends.
>
>
> Potential partners attending together
> Absolutely! It's quite a common reason for attendance at Australian Sexual Health Clinics (my experience is with public free clinics, but I think it's the same in private clinics). Here in Cairns I have seen many over my years working here. It's important to establish ground rules over results though first up and whether both members of the partnership are happy to let partners know their results! When I first encountered a young 'heterosexual' couple quite a few years ago who attended for this reason (when it was less common) and requested a joint consultation and testing, we hadn't discussed that the delivery of results would have to be separate; the young man's HIV result came back unexpectedly positive (and it subsequently became clear he was bisexual and had had more experience and some unsafe sex with other males than with females - a fact he hadn't disclosed in the initial joint consultation)! The result giving required delicate handling and in the event it worked out OK in that he was keen for the prospective female partner to know his result, but the whole event would have been much better handled if I'd laid some ground rules from the start! I learned a valuable lesson!! Cheers
>
>
> Observing potential sex partners getting tested together.
> YES...On the 2nd and 4th Fridays of each month I run a "youth only" test site and I have seen men and women, who are with their partners come in and get tested together. I highly encourage that among the youth. That helps them come up with ways together to reduce their risks of contracting not only HIV but STD's as well.
>
>
> testing together
> As a health educator, I recommend this to the teens I work with. I think it shows that each partner sees this as a normal step in any relationship that is going to become sexual. Also, even if one person knows their STI status, they volunteer to go with their partner and also be tested so that testing doesn't become a lack of trust issue.
>
>
> testing before sex
> Yes, at my private STD clinic we see this all the time! A large part of our practice is testing people who have no symptoms, but wish to begin a sexual relationship knowing what one "brings to the table".
>
>
> 1st date at the Health Department
> I have seen two over the last year- both have come from group presentations on STD/HIV by a DIS. In both cases, it was the women generating the appointments and noting that the STD presentation made such an impact that testing for both of them made sense. Here is some of the logic used: - you don't know where your potential partner has been - you don't know if your potential partner ahs an infection and it is asyptomatic - such an offer (to get tested) is a great discriminator... if the potential partner has a fit- then get rid of them now- before you have sex - the subject promotes an honest discussion about sex and sexual history BEFORE exposure - testing as a couple implies a committment and level of concern about each other BEFORE sex - reinforces that sex is not the relationship but is something that can be planned as part of a relationship
>
>
> HIV Testing
> We are more likely to get partners who say they want to stop using condoms and come in for testing to be certain each is HIV negative.
>
>
> partners testing together prior to sex
> I have, but not that often. My recolition over the past 10 years I would say approxamently a dozen couples of all ages,
http://www.stdpreventiononline.org/index.php/forum/posts/35,15
>

How to think and learn about stuff

http://www.trainingindustry.com/sales-training/articles/
tips-for-mastering-the-art-and-science-of-
asking-effective-questions.aspx

STD testing information

http://www.iwantthekit.org/

Post sex STD tests are a strategy--but what do they cause a person to do? Give up sex? Have less sex? Have more sex in order to "get even"?

Testing before sex is a way to keep some sex from happening, and, consequently, prevent an STD. Post sex STD tests don't do that. Pre sex STD tests will save some lives--some people will back out of the possibility of sex with that partner. Others may be way more cautious. Still others might wait for non-HIV STDs to be cured, if available.

Axel Schmidt
1021
HIV Serosorting among German Men Who Have Sex With Men. Implications for Community Prevalence of Sexually Transmitted Infections and HIV Prevention

Axel Schmidt*^1,
U Marcus^2,
J Töppich^3, and
M Bochow^1
1Social Sci Res Ctr, Berlin, Germany;
2Robert Koch Inst, Berlin, Germany; and
3Federal Ctr for Hlth Ed, Cologne, Germany
http://www.retroconference.org/2009/PDFs/1021.pdf
http://www.retroconference.org/2009/Abstracts/33962.htm


Background:
Serosorting, i.e. seeking to only engage in sexual activities with partners of concordant HIV serostatus, has been described as a risk reduction strategy increasingly used by men who have with men (MSM).

If replacing condom use, the implications of this practice for the risk of HIV transmissions are controversial.

Few data exist on the effect of serosorting on the incidence of bacterial sexually transmitted infections (STI).


Methods:
In Germany, large national cross-sectional surveys on "Gay Men and AIDS" have been conducted since 1987.

In 2007, a self-administered questionnaire was distributed via magazines and Internet sites for MSM.

Questions included risk reduction strategies, condom use, numbers of sexual partners, and communication about HIV test results.

We analyzed 8170 questionnaires.

Adjusted odds ratios were calculated to estimate the influence of serosorting on frequencies of bacterial STI and HIV.


Results:
A substantial minority of participants engaging in anal intercourse with casual partners reported their last intercourse was unprotected because of presumed seroconcordancy (self-reported HIV– 16%; HIV+ 20%).

Pure guessing accounted for 55% of serostatus estimates among HIV+, and 36% among HIV– MSM.

However, among MSM not diagnosed HIV+, 62% had a test result older than 18 months or were untested.

Contrastingly, 3% of HIV–, but 21% of HIV+ MSM reported serosorting as a main risk-reduction "strategy."

Compared with traditional safer sex strategies and adjusted for the number of sexual partners, serosorting was strongly and significantly associated with a recent history of bacterial STI among HIV+ MSM (OR 4.3, 95%CI 2.2 to 8.3); and with a recent HIV+ result among all participants with a recent HIV test (OR 5.0, 95%CI 2.7 to 9.4).

Recent syphilis diagnoses were reported by 26% of MSM with a recent positive, and by 3% with a recent negative HIV test result, suggesting high rates of co-infection.


Conclusions:
Serosorting is not uncommon among German MSM, but seems to qualify as "strategic" only among MSM who are HIV+.

However, serosorting is frequently based on assumptions instead of disclosure.

(Effective) serosorting among HIV+ MSM increases incidence and prevalence of bacterial STI, and hence the per contact risk for HIV transmission.

Serosorting among MSM who believe they are HIV– is highly ineffective and therefore may further increase the risk for HIV transmission.


Session 189 Poster Abstracts
Recent Discoveries in HIV Transmission
Session Day and Time: Monday, 1-2:30 pm
Poster Hall

16th Conference on Retroviruses and Opportunistic Infections
Home
Search Abstracts
View Session
http://www.retroconference.org/2009/PDFs/1021.pdf
http://www.retroconference.org/2009/Abstracts/33962.htm
Axel Schmidt

Incidence is the number of new HIV infections in a given year (say, in the US).

Prevalence is the number of people living with HIV in that year (say, in the US).

Transmission rate is incidence divided by prevalence (and then multiplied by 100)….this tell us, for every 100 people living with HIV in a given year in the US, how many transmission are there to HIV negative partners.

.
        > Getting tested together may be a viable prevention strategy for some. However, this depends very much on the nature of the sexual relationship. If sex is occurring spontaneously and/or anonymously, mutual health screens would not be a viable prevention strategy.

Nevertheless, you would know something about your potential partner.


        > For those who are more intentional about their sexual relationships this can be a valid option. However, there are some pitfalls. If the relationship is to be ongoing, will it be monogamous and how do you assure that? Also, when the HIV/STD tests are conducted, what length of time has passed since the last possible exposure? In view of these questions, mutual health screens can present a false sense of safety or security.

Especially for those who imagine an HIV test protects you from
AIDS or cures it! People have to start taking the first steps towards
being responsible for themselves and others. If they don't then I
predict that the AIDS crisis marches on.


        > Unless, there has been some honest and open conversation prior to entering into the sexual activity, every negative test in the world cannot protect you from disease.

And no imaginary "honest" conversation will detect or predict or
cure any of the diseases a potential partner may have. Tests are
predictably "honest". Conversation should never be relied on for
honesty. Would you like a list of dead people who believed in
"honest" conversation?


        > You must first establish a rapport with the partner that allows for honesty, trust and open communication.

We know from reality/experience just how well that has worked out.
Check your above list of dead people.

        > Unless that is happening, other prevention strategies (condoms, abstinence, etc.) should be considered.

How has that been working out? Know any dead people who "said"
they "always" wear a condom or practice abstinence?

.
        > and honestly..In my experience, even as a safe-sex activist, as men who are horny, we want to have sex right away-

Then you're not a safe sex advocate as you thought you were. http://www.google.com/search?q=all+hat+and+no+cattle All hat and no cattle that's called. Say one thing and do another is that train of thought.


        > I get that that might be the problem, but there's a very small chance that either party is going to get tested before giving or receiving a casual blowjob.

Right there... casual. Still not a safe sex advocate.


        > How about "Educate yourself before hooking up.

Hooking up... right there. More unsafe sex.


        > Discuss status and your interests in sex BEFORE having sex?"

Yeah, forget the testing before sex

.
        > I have not seen any data that gives an answer to your question.

It's important to continue looking into all enquiries as premise of the program you're offering, including the enquiries you want to get and you've prepared scripts for and the enquiries that appear contrary to your own point of view. Some ideas remain the same. Some ideas change.


        > Getting tested together may be a viable prevention strategy for some. However, this depends very much on the nature of the sexual relationship. If sex is occurring spontaneously and/or anonymously, mutual health screens would not be a viable prevention strategy.
        >
        > For those who are more intentional about their sexual relationships this can be a valid option. However, there are some pitfalls. If the relationship is to be ongoing, will it be monogamous and how do you assure that?

Ankle cuffs.

The strategy "Let's get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs.", a sexual health checkup reduces ambiguity/risks and can be like anything else POTENTIAL sex partners do together. The strategy is getting tested to share information about existing infections and using the information.There's no test for mutual fidelity.


        > Also, when the HIV/STD tests are conducted, what length of time has passed since the last possible exposure?

The length of time before any latency is a lot more time, than the window period. If you don't get tested together, that doesn't provide opportunity to get information about the STDs that could've been detected. If you don't get tested together there's no opportunity to know that persons status. The words that come out of a person's mouth provide no real information about that person's status and neither does their imagination.

        > In view of these questions, mutual health screens can present a false sense of safety or security.

That's true only if you believe testing only cures aids or prevents you from getting it. It's what you do a moment after you take the test that matters. If you go on and do something irresponsible after you do something responsible getting the test it completely nullifys what you did.


There's no evidence of lack of efficacy. You wrote you haven't seen any data. To make that claim is the same logical fallacy represented by attempting to make that claim. There's plenty of evidence for lack of efficacy for so called safer sex practices and condoms. 20 years of pushing it. After all the years of the campaigns the epidemics rage on out of control, see
http://www.cdc.gov/hiv/topics/surveillance/incidence.htm
http://www.cdc.gov/hiv/topics/surveillance/incidence.htm


        > Unless, there has been some honest and open conversation prior to entering into the sexual activity, every negative test in the world cannot protect you from disease. You must first establish a rapport

rapport doesn't cure or prevent aids



        > with the partner that allows for honesty, trust and open communication.

neither honesty, trust, open communication cures or prevents aids.


        > Unless that is happening, other prevention strategies (condoms, abstinence, etc.) should be considered.

Condoms, abstinence and other prevention strategies are clearly what has not worked.


That's what the strategy getting tested TOGETHER BEFORE having sex, for A VARIETY of STDs does. It raises the standard of health for POTENTIAL sex partners. You need to know about infections to reduce the ambiguity and communicate openly.


It also changes the consciousness of the two people involved. Would a genuinely responsible person refuse to get tested for example?

.
    > This is a really good idea. The trick is to somehow get this to be
    > a social norm so that people aren't scared and embarrassed about
    > asking for this. As things are now, asking your significant other
    > to get tested before having sex would probably come across as
    > offensive to many people, therefor most people probably won't
    > ask. Hmm maybe a Planned Parenthood public service
    > announcement or something?

Until there is a cure-for-certain vaccine, or enough people die, testing is not likely to be the norm.

.
            >> Sounds like it would work well for some folks, not so well for a hookup.

    Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?

    > I was pointing out that there are common situations in the real world where the strategy you're touting wouldn't be especially helpful.

Not washing hands before operating was also once a very common strategy--even a standard practice.


    > Do hookups have something to do with the AIDS endemic? I suppose you could look at it that way.

I'm going out on a limb here, but will guess yes.


    > The broader question I'm asking is whether it is helpful to look at AIDS as the sum of behaviors and biologic test results (as current epidemiology & public health practice tend to do), or whether it might make sense to back off a bit and ask whether we might make more of a difference by laying off the moralism inherent in behavioral approaches

I'm going out on a limb here, but will guess that things like clean water, sterilized instruments, and washed hands have little to do with moralism.


    > and focusing on some of the structural forces, such as homophobia, gender hierarchies, racist ideologies, and poverty production that also obviously have huge impacts on the AIDS endemics across the world.

I'm guessing that some of the stanard practices mentioned above would work for homophobes, non-homophobes, racists, non-rascits, poor or rich people, etc, all over the world.


            >> I guess what I'm trying to figure out is how people react to the concept of risk,

Irrationally is the word I think you're looking for.


            >> and whether 'public health' might not better be focused on some of its more traditional success strategies that involve systemic changes, rather than individual coaching.

I'm thinking that people become infected one at a time.


    With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...

            >> ...Traditionally, public health has had its greatest success{es} with things like water, sewage, & poverty remediation.

    and testing...

Individuals have to take care of the testing part.


    > Tuberculosis is a great example of how structural changes far outstripped the ability of medicine and individualized behavioral messages to curtail the spread.

Today everybody deals with it, first, by testing.


    > Arguably, the first successful steps in curtailing the spread of tuberculosis included addressing slum dwellings where people lived in extremely close quarters, pasteurization of milk, and various other public health approaches. (e.g. AJPH 1998 88(7):1105-1117)

Its still time for individuals to get tested...


A L Fairchild and G M Oppenheimer
Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis
http://www.ajph.org/
cgi/content/abstract/88/7/1105
http://www.ajph.org/cgi/reprint/88/7/1105

    > Testing in NYC began in the late 1880's, well after tuberculosis incidence had started declining rapidly. It probably helped somewhat after that point, but we have tended to overlook the relatively larger impacts of structural interventions that preceeded testing and continued to affect the incidence of tuberculosis afterwards as well.

Once all the reading is finished you still need to go get tested.

        > I don't know how common that
        > strategy is. Sounds like it would work
        > well for some folks, not so well for a
        > hookup.

Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?


        > I guess what I'm trying to figure out is
        > how people react to the concept of
        > risk, and whether 'public health' might
        > not better be focused on some of its
        > more traditional success strategies that
        > involve systemic changes, rather than
        > individual coaching.

With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...


        > I don't know if there are home tests for
        > chlamydia. By systemic changes I mean
        > addressing homophobia, sexism,
        > racism, wealth extraction
        > (redistribution to the rich), etc.
        > Traditionally, public health has had its
        > greatest success with things like
        > water, sewage, & poverty
        > remediation.

and testing...

.
        > Because I think it's always good to
        > be prepared for sex.

A thought experiment
http://en.wikipedia.org/
wiki/Thought_experiment

How widespread is the phenomenon?... The strategy of
"Let's get tested TOGETHER
  BEFORE we have sex, for A VARIETY of STDs."

Sexual health checkups reduce ambiguity/risks and can be like anything else POTENTIAL sex partners might do together.


_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
> And also that brings up a very important thing.
>
> This is good that we're having this conversation.
>
> Because I think it's always good to be prepared for sex.
>
> Okay, you want to have all the tools you need by your bedside or potentially in a carryall, allright, in your purse, allright, so you're prepared for sex.
>
> And that's why we're having this conversation.
>
> Because if we don't talk about it first right we're very un likely to be unprepared when it comes time for sex.
>
> That's why communication's really important with your partner.
>
> And also the boy scout motto of "Be prepared" is essential which includes condoms and water based lube.
>
> That's what's recommended.

Please note that in my remarks I made no reference as to which test or tests, the individuals using this approach should take.

Please note that by making reference to the blood supply I have indicated a personal knowledge about how blood is tested differently from the standard clinic test for "HIV".

          > Hi. You are obviously free to make
          > whatever decisions you want regarding
          > your safety and your body. But we did
          > want to point out a serious
          > misunderstanding that you might have.
          >
          > You wrote that it is not necessary to
          > worry about the three month window
          > period, because the blood supply is
          > safe and they don't wait three months.
          > The problem with that thinking is that
          > you are confusing two different types
          > of tests.
          >
          > The blood supply is screened for HIV
          > using a variation of a viral load test
          > (p24 antigen test), and the blood
          > samples collected are *pooled* in order
          > to test them for HIV. This is a very
          > different test, and pooling blood
          > samples changes the accuracy results.
          > This is *not* the test that someone is
          > given when they go for an HIV test.
          > Those tests are HIV anti-body tests,
          > and anti-bodies can take up to three
          > months to show up accurately on the
          > test, so that's the reason people are
          > told they should wait as close to three
          > months as possible.
          >
          > Individuals are not given the same type
          > of tests that the blood supply
          > undergoes because that test has not
          > been approved by the FDA for diagnostic
          > purposes, and individual samples cannot
          > be pooled due to the timing of each
          > person requesting a test.
          >
          > So please understand that if you merely
          > get an HIV test and a negative result,
          > and then discontinue practicing
          > safer-sex (which we believe is what you
          > are implying) you are putting yourself
          > at a higher risk than necessary for two
          > reasons. One is what we've already
          > discussed -- due to the three month
          > window period, it is possible that
          > someone was recently infected but it is
          > too soon to register on the test, and
          > so you will receive a false negative
          > result. The other reason is that if
          > someone should expose themselves to HIV
          > any time after the test, and the two of
          > you are not playing safely, then one
          > person can infect the other. Sadly, we
          > have had many calls from people who got
          > infected because of that reason.
          >
          > So our goal is not to get into a debate
          > with you, but rather to make sure you
          > understand our perspective, so that you
          > can make an informed decision about
          > what you want to do. We hope this
          > additional information is helpful for
          > you and we send you our best wishes.

.
          > We can't really tell you how widespread
          > that particular strategy is, because
          > with so many gay and lesbian people,
          > it's difficult to know what everyone is
          > choosing to do.
         
          > But getting tested is certainly
          > important. However, we would stress the
          > importance of not using negative test
          > results as a reason to start putting
          > yourself at risk.
         
          > If you and a partner decide to get
          > tested together and both have negative
          > HIV results, for instance, that's great
          > news. But because it can take up to
          > three months before HIV infection shows
          > up on an HIV test, the test results you
          > are getting are always three months
          > out-of-date. There really is no way to
          > know for sure what someone's HIV status
          > is at the moment you may have sex with
          > them.

If this three month rule were the case then why
is the testing of blood donations so effective?
Look here:

http://www.google.com/search?
q=%22how+long+can+blood+be+stored%22

It seems that testing is extremely
reliable--which accounts for so few cases of HIV
via blood transfusions.

There is some risk of infection from any
encounter even if both partners turn out
negative. However, you are more likely to die in
an automobile accident driving to an encounter
than you are to die from HIV from a
just-tested-negative individual.

Again, its not RISK FREE! But many other things
in life are far more risky


          > That's why we encourage people to
          > always assume it's possible that the
          > person they are with might have been
          > exposed to HIV either within the last
          > three months (and before it could show
          > up on a test) or at any time after they
          > were tested. So if you always play
          > safe, then you are taking
          > responsibility yourself for your own
          > body, and not relying on sometimes
          > outdate test results to keep you
          > healthy.

Always "playing it safe" is far more risky than
sex with a just tested negative person. There is
only safer sex--not risk free sex.

The only way you can be sure you haven't killed anyone with
HIV (assuming you are positive) is to test every one of your
sexual contacts over the course of their life. If they get sick
or die, then it is still possible, with the best of current technology,
to determine if they died from a strain of the virus they got from
you. So, unless you've done this level and intensity of testing,
then you can't say for certain if anyone has died or gotten
sick after having sex with you.

What probably happens, in reality, is that uninfected people
have sex with a number of infected people and get the virus
from one or more of them. So it then becomes possible for
any one HIV+ person to say, with some belief, that they did
not pass HIV on to a given person--so responsibility is lost
in the crowd. There is the possibility for each infected person
to say some other person didn't get the virus from them. This
is nature's way of saying that having sex is more important
than being responsible.

Unless a complete fix is found for HIV, then you can look
forward to the epidemic continuing largely unabated.

http://gaymenshealth.ning.com
The Gay Men's Health Summit is a national call to all LGBT/ queer communities and our important allies from across this nation.

http://www.fenwayhealth.org/
site/PageServer?pagename=FCHC_ins_fenway_EducPro_modules
...we encourage feedback from clinicians, clinical educators, students from all health professional fields, and LGBT patients.
Please read through our modules, and/or try them out with students or colleagues, and let us know your thoughts on content, format, etc.
Email us at: professionaleducation at fenwayhealth.org

http://www.aac.org/
site/PageServer?pagename=malecenter_resources_events
http://malecenter.org
The MALE Center 571 Columbus Ave Boston Massachusetts 02118 USA 617 450-1987
The Men’s Action Life Empowerment Center MALE is a community resource and wellness center for gay and bisexual men in Boston. We conduct outreach and a wide variety of other activities that promote health and community

Couples based HIV testing

Attitudes Towards Couples-Based HIV Testing
among Gay and Bisexual Men

Are you a gay or bisexual man
in a relationship with another man?

Howard Brown is running focus groups to better
understand attitudes toward couples-based HIV testing.

This type of testing would allow you and your partner to
receive your HIV results together.

Participants will be compenstated $20-$50 for their time.

Focus groups will be held on
Saturday, October 4th, at
Howard Brown Health Center
4025 N Sheridan Road
Chicago Illinois 60613
USA
http://howardbrown.org

Please call 773 388-8880 to participate!

You must be at least 18 years old to qualify.
All information will be kept confidential.

This study has been approved by the Institutional Review Boards
at both Howard Brown Health Center and Emory University.

Investigators:
Rob Stephenson PhD Emory University
Patrick Sullivan PhD DVM Emory University
Beau Gratzer MPP Howard Brown Health Center
Blase Masini PhD Howard Brown Health Center

          > Some of us seem to be unable to move forward in
          > our dialogues or our conceptual contexts for our
          > work, and I think actually it is that rigidity
          > and fundamentalism that damages our community
          > most.

I should have thought that dying from acquired immune deficiency syndrome or getting sick from it would damage a community most.

Rather than some abstract concept.

Cliches of cliches, cliches piled on cliches, how many times have we heard all this stuff really.

People are not going to answer
  a) Is it considered a so called safer sex practice?... having
      greater numbers of multiple sex partners.
  b) Is it considered a so called safer sex practice?... having
      less numbers of multiple sex partners.
because they can't.
Nature has a power over us.
Beyond their own experience or these very typical cliches
they continually deny the facts of life.
This force is built in, because we have to do these things,
as it is for any given species.

Condoms can prevent pregnancy for example but the problem is failure and failure rates.
People just deny the power of nature over and over.

Have sex with an infected person or not have sex with him.
It's an option. Companions and friends are dying optionally.
That doesn't change the facts that companions and friends are dead and dying.
Call the words asinine until the cows come home and companions and friends will be dead and dying into the future.
Turn into a petri dish for this disease by serosorting and having sex only with positive people.
People are turning themselves into petri dishes for this disease where new variations, new varieties are getting created because they have new genetic material to work with, new bodies to work with.
Some people may find that unpalatable but it is a point of view in which two species are gaining ground.
Where in fact this tiny little unconscious virus is gaining ground on millions of our species.
You've got your death list of companions and friends as have I.

by Lawrence K. Altman
H.I.V. Study Finds Rate 40% Higher Than Estimated
http://www.nytimes.com/2008/08/03/health/03aids.html
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
http://orthoprax.blogspot.com/
2008/07/informed-consent-for-hiv-testing.html

http://www.edwinjbernard.com/writing/hivlaw.html

          > What about the window period, the latency?...

Getting tested now, today lets potential sex partners know more about prior encounters over the years. Getting tested again later can detect change in testing results and set a time frame for recent exposure to infection, useful information for optimizing treatment.

The Home Access® Express (next day) HIV-1 Test System
http://www.homeaccess.com/ExpressHIV_Test.asp

Rapid HIV testing
http://www.cdc.gov/hiv/topics/testing/rapid/index.htm

http://www.sextextsf.org/

http://www.posornot.com
http://www.caps.ucsf.edu/projects/SafeinCity/SICstory.php

by Carina Marquez
Nicola M. Zetola, MD
Jeffrey D. Klausner, MD, MPH
HIV testing: an update
http://www.mlo-online.com/articles/0208/0208cover_story.pdf

Recently in the mail...

          Not sure what you mean.. but if I guess correctly then if
men are going to be tested for HIV before they embark on a sexual
relationship (as 'negotiated safety' recommends they do) then
there is every reason to suggest that they get tested for STIs as well.

However whether such a test should not preclude regular STI testing
during the relationmship (see below).


          Within the strategy the partners decide to have unprotected
sex (anal intercourse) within the relationship but 'safe sex'
outside the relationship: they may decide that the 'safe sex'
outside the relationships is:
(1) no sex outside;
(2) no anal sex outside;
(3) if anal sex outside then only and always protected anal outside.

If the partners decide and commit to (1)
then there is no likelihood of any STI infection occuring
(unless one was present at the outset of the relatiosnhip).

On the other hand if (2) or (3) are decided on then an STI is always
possible during the relationship ... Men (indeed anyone) who engages
in sex with numbers of partners are advised to have regular STI checks..

> Within the strategy the partners decide to have unprotected sex
> (anal intercourse) within the relationship but 'safe sex'
> outside the relationship: they may decide that the 'safe sex'
> outside the relationships is:
> (1) no sex outside;
> (2) no anal sex outside;
> (3) if anal sex outside then only and always protected anal
> outside.

the correct term is always... safer
there's never zero risk.
if we don't even get the word right, how can we expect people to use
these safer sex practices?


> If the partners decide and commit to (1)
> then there is no likelihood of any STI infection occuring
> (unless one was present at the outset of the relatiosnhip).

if they keep the commitment. that's implied in the word commit.
people make a commitment. time passes. other things happen.
you've got to have testing. you've got to decide it's
the right thing to do.

Who?... or what groups?... with prevention expertise have looked at the strategy?... of
let's get tested TOGETHER BEFORE we have sex
for A VARIETY of sexually transmitted diseases

Will you and your next potential sex partner be getting tested TOGETHER for STDs BEFORE you have sex?...

Will you and your next potential sex partner be getting tested TOGETHER for STDs BEFORE you have sex?...

by Edwin J. Bernard

By Edwin J. Bernard
Criminal HIV Transmission by Edwin J. Bernard
NAM Publications, London 2007
http://nam.org.uk/cms1231141.asp
ISBN 978-0-9551678-3-6
9780955167836
NAM
Lincoln House
1 Brixton Road
London
SW9 6DE

Endangered dozens of partners

During his trial, prosecutors alleged Willie Atkins knew of his condition yet endangered dozens of partners by rarely using condoms, and that there was no evidence that he warned anyone that he was HIV-positive.
http://news.yahoo.com/s/ap/20070507/ap_on_re_us/sex_offender_hiv_1

by Chandler Burr

by Chandler Burr
The AIDS exception: Privacy vs. Public Health
http://www.chandlerburr.com/articles/
...It is evidence, however, that medical interventions
make a palpable difference -- and is all the more reason to start
subjecting AIDS, from a public-health perspective, to
more-systematic procedures.

By Dan SavageRoutine HIV Testing--Just Say Yes

By Dan Savage
Routine HIV Testing--Just Say Yes
http://www.thestranger.com/blog/2006/05/routine_hiv_testsjus.php

571 Columbus Ave near Massachusetts Ave Boston

by William Henderson
http://www.innewsweekly.com/innews/?class_code=He&article_code=1013

MALE Center Director Ben Perkins with Outreach and
Education Coordinator Mark Forry:

"If you cant articulate [what community is], then how do you know
its not there?" says Perkins.

(photo: Eric Hess)

HEALTH

William Henderson
December 21, 2005

The MALE Center tools up
http://malecenter.org

SINCE ITS JUNE OPENING, BOSTON'S LOCAL COMMUNITY
CENTER HAS A GROWING FOLLOWING AND HOPES TO OPEN A
CYBER CAFE SOON...
...
...In the next couple of months, Perkins sees the Center unveiling
its cyber cafe, making desktop and laptop computers with Internet
access available for men to use, and additional
entertainment-specific events are also in the works.


But perhaps what Perkins is most proud of is the increasing
number of men using the Center for its rapid-result HIV test.

Offered on Tuesdays and Thursdays each week, men can take this
test, receive HIV risk management counseling, and learn their
status all within the span of an hour.

It's just one of the revolutionary advancements pioneered by
the employees and volunteers who staff the Center...
...

The Male Center is
open Tuesdays and Thursdays from 2 to 8 p.m.
Wednesdays from 3 to 8 p.m.
Fridays from 9 a.m. to 5 p.m.
on the first and third Saturdays of each month from 12 to 6 p.m.
and is closed on Sundays and Mondays.

It is located at 571 Columbus Avenue, near the intersection of
Massachusetts and Columbus Avenues
http://maps.google.com/maps?oi=map&q=571+Columbus,+02118

While no appointments are needed, services are made available
on a first-come-first-serve basis.

For more information e-mail:
malecenter@aac.org
malecenter at aac.org
or call 617 450-1987
http://malecenter.org

E-MAIL THIS STORY
http://www.innewsweekly.com/innews/?class_code=He&article_code=1013
by William Henderson

...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.