Is There Something I Should Know? (Please, Please Tell Me Now)

A disclaimer: I am an HIV/STI educator and counselor. I am HIV positive since 2006, undetectable, with a high cd-4 count. What I am not is an expert or a doctor. The posts in this category are suggestions from my experience as a counselor and educator, and as one of many living positively with HIV. It is not meant to take the place of your doctor’s advice.

I’m here to learn and share. If you’ve found a particular practice works for you, please share. There’s plenty of room on my blog page, and in the vast blog-sphere, for more than one solution.

That being established, I’d like to provide some answers to FAQs I tend to get asked in counseling, particularly by newly infected clients, and clients who are at high risk for contracting HIV and STIs. I will also include some links I find useful in my work. Please visit these links to learn more:

I visit them weekly, and encourage you to do the same. Like School House Rock used to say every Saturday morning, “It’s great to learn, ’cause knowledge is power!”

Oh, and lastly–another thing you should know about me is that I have a tendency to title my posts after song lyrics. Thanks.

How frequently should I get tested for HIV and STIs?

Short answer: The CDC (Center for Disease Control) recommends testing for HIV and STIs at least once per year.
What I recommend: Rule of thumb–you’re only as negative as your last risky, unprotected sexual encounter with a different, non-monogamous sexual partner. With this in mind, I recommend testing every six months, or every three months, depending on an individual’s level of sexual activity, and their sexual behaviors. *I’ll break this down in the questions that follow.

How do I define “risky” when it comes to HIV? 

I often get this question when I do pre-test counseling for HIV testing. It’s useful in helping a person define their level of acceptable risk behavior. So let’s break it down from “most risk” to “very little risk” to “no risk at all”.

Most risk (aka “not a good idea”):

  • Unprotected (without condoms) receptive (being a bottom) anal or vaginal sex with a person who is HIV positive and has an unsuppressed, untreated viral load, where blood/ejaculate or pre-ejaculate may combine. 
  • Unprotected insertive (being a top) anal or vaginal sex with a person who is HIV positive and has an unsuppressed, untreated viral load, where blood/ejaculate or pre-ejaculate combine.
  • Unprotected receptive or insertive (top or bottom) anal or vaginal sex where either person is unaware of their HIV status, or has had risky sexual encounters since their last confirmed negative HIV test.
  • Sharing needles during intravenous drug use–whether using legal or illegal drugs. The type of drug you’re using doesn’t make a difference. It’s needle sharing that puts you at risk for HIV. Whether you’re shooting heroin, or getting a tattoo, if the needles are “shared”, and a clean needle isn’t used with each new injection of drug or ink, you’re putting yourself at risk for HIV, and also Hepatitis C infection.  **Getting a tattoo? Ask the tattoo artist to walk you through his/her steps for sanitizing and insuring that health department compliance measures are followed. Ask to see their updated and recent health department certifications. Most reputable tattoo shops have them displayed proudly.

Okay, why?

  • The tissue inside the anus is very thin (kind of like tissue paper), with many mucous membranes, and tiny blood vessels near the surface. It’s easily torn with the friction that occurs when we’re in the throws of passion, knocking boots, getting our freak on, etc. When that thin tissue gets torn, mucosal membranes are exposed, and bleeding, even on a small scale, often occurs. When that happens, and when pre-cum or cum with a high concentration of HIV virus gets released into that fragile, dark and protein rich environment, infection can occur.
  • The tissue at the tip of the penis is also a thin, membranous area with an opening for virus and bacteria to enter. If a man has unprotected anal or vaginal sex as the insertive partner with an HIV positive partner who has unsuppressed virus, the man is at risk of contracting the HIV virus, even as a “top”. It’s a myth to say, “I’m 100% top, I never bottom, so therefore, I can’t get HIV.” You can–the head of the penis can “suck up” infected blood, HIV infected vaginal fluid, and other bacterium/virus. An open cut or sore on your penis is a pathway for infection, too.  As a result, you can also get every other STI out there, too.
  • Having an STI already, especially one where there is a sore, or inflamed area during unprotected sex will put you at greater risk for contracting HIV because you’ve already created an infected, open sore pathway right into your bloodstream. When skin is broken, cut, inflamed, has a chancre sore, or blisters from an untreated STI, you’re creating an opening for HIV transmission. You’re also exposing your sexual partner to your existing STI through unprotected sex.
  • A syringe is an “air-tight” environment. When you inject a drug intravenously, you may also draw a small amount of blood back into the needle, or into the syringe. If you have an unsuppressed, untreated HIV or Hepatitis C infection, and you share that same needle without taking the time to clean your works, or use a brand-new needle and syringe, you can very easily inject some of the infected blood along with the drug you’re using, thus infecting your needle-sharing partner with your virus or bacteria.

I just had unprotected oral sex. Am I at risk for HIV infection?

This brings me to the next category–Little to no risk. (or, proceed with caution.) Doctors used to recommend using condoms or dental dams for oral sex as a risk reduction for HIV. While it’s definitely a way to reduce the risk of HIV transmission, oral sex, (either mouth to penis and/or mouth to vagina) has been proven to be of negligible risk. 

Okay. Why? 1st, HIV doesn’t live for very long (less than a minute) when it hits the air and has no direct contact with blood vessels or mucosal membranes inside the body.  For more on this from Dr. David Wohl, UNC-Chapel Hill Medical Center, go here: http://www.thebody.com/Forums/AIDS/SafeSex/Q219717.html?ic=2003
2nd, stomach acids will destroy HIV. With this in mind, there’s a LOT of air inside the mouth, so there’s much less risk of HIV transmission. HOWEVER–and these are the kickers: Check before you have oral sex. If you have, in the last minute or so, JUST flossed, JUST bitten your tongue or your cheek, or have a mouth ulcer, cold sore (which is a type of herpes, by the way), chancre sore, or any kind of open wound inside your mouth, AND if your partner has a recent, bleeding active cut on either their penis or vagina or anus, AND if either of you have an unsuppressed, untreated HIV infection, you MAY be exposing your sexual partner to HIV infection. So it’s probably not a good idea to floss and two seconds later give your partner a blow job.  I’m just sayin’.

While the risk of contracting and transmitting HIV via oral sexual activity is a negligible risk, there are FIVE OTHER STIs that are VERY EASY to give and get through oral sexual contact.

  • Herpes Simplex 1&2 (HSV 1/2) which is treatable, but not curable
  • Human Papilloma Virus (HPV) also treatable, but not curable (there is a vaccine for a few types of HPV that is being used for kids before they become sexually active)
  • Syphilis, which is treatable and curable with an aggressive round of antibiotics
  • Gonorrhea, and
  • Chlamydia, both of which are treatable and curable with an aggressive round of antibiotics.

Oh! By the way–the above STIs are easily transmitted via unprotected anal and vaginal sex, too.

Less risky also includes: Unprotected, anal or vaginal sex with an HIV positive person who knows their status, has a viral load that has been suppressed at an undetectable level (less than 40 copies of the HIV virus) for AT LEAST one year or longer, and is currently on ART (anti retroviral therapy)…WHAT? AM I CRAZY? UNPROTECTED SEX WITH A KNOWN HIV POSITIVE PERSON IS LESS RISKY?

Read what I wrote again, please. Unprotected anal or vaginal sex with an HIV positive person who is undetectable, with a high cd-4 count, who is on their meds and not missing doses, and whose virus is classified as suppressed (less than 40 copies of HIV detectable at any time), is less risky. There is still a 3% chance the virus can be transmitted, so, if you want zero risk, USE A CONDOM.

Also, keep this in mind. Of the 1.3 million people who are infected with the HIV virus in the U.S., less than 325,000 of those fall into the category of virally suppressed for over one year with a high cd-4 count. And, while your risk of contracting HIV may be low, it’s still possible to pass along other STIs, or contract a new, different strain of HIV if the other partner doesn’t know their HIV status.

So what’s No Risk, then? (or, Green Light means GO FOR IT):

  • Protected, insertive anal and vaginal sex with a condom, REGARDLESS of the partner’s HIV status
  • Kissing, touching, hugging, mutual masturbation
  • Sharing a bed, utensils, shower, food, a drag off a cigarette (although smoking is very bad for you. In case you’ve been living under a rock.)
  • Treating a cut from an HIV positive person with cold water, pressure, topical antibiotic or alcohol and a band-aid–zero risk.
  • Caring for a person who is HIV positive, or a person who has AIDS.
  • Loving, dating, being friends with, and being in a long-term, sexually monogamous relationship with a person who is HIV positive

Remember–You’re only as “negative” as your last unprotected, risky sexual encounter. I recommend:

  • The 3 Ps–Protect your Pink Parts. Use condoms and condom safe (silicone or water-based) lubricant when you have insertive anal and/or vaginal sex.
  • Know your status by getting tested. Encourage your partner(s) to get tested. Don’t assume your partner is negative just because they tell you they are. In North Carolina alone, it is estimated that there are 7,000+ people who are infected with HIV and are unaware they’re infected.
  • Get tested at least once a year, but I’d recommend getting a test every six months. Hey–you’re supposed to go to the dentist twice a year, which takes longer and can cost more. Why not get tested twice a year, too?

There’s more to share. Next time, I”ll talk about the differences between rapid tests and confirmatory blood draw testing.

Thanks for stopping by. Please feel free to leave your questions and feedback!

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