Lifestyle

Pride Comes Before The Fall?

Jack Summerside talks sex

The Pride season is upon us. It used to be a season of political activism, of standing proud and open about who you were as a gay man or a lesbian, often for the first time in your life. Of fighting for rights and equality. Plus a dance along with Jimmy Somerville and a word from Red Ken, some warm beer, and possibly a bit of sex. Yes, all that dull political-type stuff.

With a lot of those battles for gay rights won (depending on where you live or your perspective) the Summer Pride season may seem little more than an opportunity for marketing folks to target gay men with the latest pop group, fancy new drink or some over-priced underpants. Oh yes, and for some of us an opportunity to shag our way through the Summer. So we thought it might be a good time to think again about what to watch out for, and whether condoms need to be in your little bag.

If you use condoms consistently, and aren’t having difficulties sticking with them, then good for you. If it’s working for you, then the best advice is to keep on going with them. For some of us, however, condom use can be difficult or impossible for a variety of reasons. If you struggle to use condoms consistently, find the damn things (or your partner) won’t co-operate, or you and your partner feel that exchanging fluids is a vital part of sex, then you might want to think about how to minimise the possible downsides for your and your partners’ health.

Rule breakers?
We’ve been told penis-inserting sex without a condom is mad, bad and dangerous for nigh on 25 years. There’s no doubt that condoms greatly reduce the likelihood of HIV being transmitted. Statistics on this can be misleading so I’ve not dug any out. Condoms also make a physical barrier for sexually transmitted infections (STIs) like syphilis, gonorrhoea and hepatitis C. We all know using them is better for your health, so why don’t we?

The reasons some of us have it away without a condom aren’t really shrouded in mystery. Being honest, some people’s fondness for condom-less sex is the reason many of us (those infected sexually, and with some degree of consent) became HIV positive in the first place. Talking to prospective partners about using a condom can be tricky. Just mentioning the word can be a passion-killer for many. If the partner doesn’t know your HIV positive status, insisting on condoms can arouse suspicion. The fear of disclosure and rejection can be enough to make some of us close our eyes and cross our fingers.

It’s human nature to take risks, for some of us more than others. The bedroom (or your venue of choice) is generally no place for analytical risk-assessment, and in the throes of passion rational thought is often discarded quicker than your knickers.

Sex without a condom is called barebacking by some and just normal by others. Giving unprotected sex a fancy name maybe increases the sense of it being taboo. Some ‘experts’ claim this gives it an extra appeal. I don’t entirely buy this theory, but reckon it makes it all the harder to talk about the importance that rubber-free shagging has for many of us.

Damage limitation
The condom thing simply isn’t that straightforward for many of us living with HIV. Accepting this, it is probably best to know the facts. Aside from the possible legal implications, (see www.tht.org.uk or pg19 for a current summary of the legal situation about criminal prosecutions and HIV transmission) its worth your while considering about how to reduce any potential harm to yourself or your partner if you’re putting it in, or having it put in, without a hat on. The main one we get told about is the risk of being super-infected with a drug-resistant or more harmful second strain of HIV. But a far more immediate health risk is some of the other sexually transmissable infections you could get.

Like a lot of positive people you may feel having HIV already means you have the last word in sexually transmitted infections; anything else seems just inconvenient and pales by comparison. But gonorrhoea, syphilis, chlamydia, herpes, hepatitis C and genital warts can be a much bigger deal for us than you might think. The bottom line is that prevalence of some STIs is very much higher amongst diagnosed positive people, with some infections high in certain groups and rare in others. The prevalence of syphilis, for instance, is high among some groups of positive men (men into fisting, sex groups and what you might call ‘unconventional’ relationships), but not among positive gay men across the board or other HIV positive people. Have a look at the statistics from the Health Protection Agency (www.hpa.org) if you’re interested in numbers or disbelieve the facts.

High days and holidays
Brian and his partner, Jon, had always had sex without condoms since both being diagnosed with HIV in 1998. They hadn’t thought there were any real potential problems, even though they both enjoyed sex with other people.

“It was a shock when Jon got hep C. At first we tried using condoms but the intimacy and fun kept just going down the pan. We’ve sort of reached a compromise: we don’t use them when I’m fucking him and sometimes do when it’s the other way round. It is rare if we go as far as him cumming in me. I guess we save that for high days and holidays. We know it’s an imperfect solution, but it’s a balance we know we can achieve. It’s better than setting ourselves up to fail, because then you just give up altogether.”

A viral snapshot
Studies have shown that having a low HIV viral load has some relationship with how infectious you might be to someone else, especially for men who cum inside their partners arse or vagina. But unfortunately it isn’t so straightforward for those of us who have more than one partner (or if your partner does) and particularly if the condoms are ditched when either of you play away from home. An undetectable viral load result at your last test does NOT necessarily mean you can’t pass on HIV today.

• Your viral load is only a snapshot of how the virus is behaving on the day the blood was taken, not how it is today
• At best, your knowledge of your infectiousness is already a fortnight out of date by the time you get the numbers
• Viral load only measures the amount of HIV in your blood
• Even with an undetectable blood viral you load may still have high levels of HIV in your cum or vaginal fluid
• You might even have a different type of HIV in your blood than in other bits.

You could use your last viral load test result as some sort of guide, and many of us do just that, but its not something you can have complete confidence in. It’s more useful as a guide if you are stable on treatment or are lucky enough to have a consistently low viral load without meds. But you can never be totally certain whether it might have changed since your last test. And probably the biggest single thing that can alter your HIV viral load in between tests is catching another STI.

Would like to meet similar
Many of us choose to only have relationships or sex with other HIV positive people so that means there’s absolutely no risk of someone getting HIV from us. But positive-on-positive sex can have other complications that mean it is not that simple:

• Although opinion is divided, it appears possible though rare for someone already HIV positive to catch a stronger or drug-resistant strain of the virus through condom-less sex.
• Unfortunately there are few hard facts about this. All of us will have to reach our own conclusions about how to balance these facts against what kinds of sex you enjoy.
• There’s a far greater chance of some STIs being passed (to you or from you) if you’re not using a condom
• Having HIV can make us more susceptible to some STIs and they can be more harmful until treated, and harder to diagnose and treat.
• Prevalence rates of some STIs are much higher among HIV positive gay men who have many different partners. That isn’t some kind of political correctness - it’s a simple statistical fact.
• Hep C (acquired during sex) is being diagnosed among HIV positive gay men at an increasing rate and is especially prevalent among gay men into fisting and more ‘challenging’ sex toys.

So, these are just some of the facts you might want to take into account as you have fun over the Summer. And by all means do have fun, just remember indiscriminate hedonism can mean increased likelihood of getting something nasty. It’s pointless pretending that making the transition to using condoms when you’ve not been in the habit of them is easy, but its definitely worth thinking about them again. There’s little really useful practical support or guidance on how to make that transition, and at PN we’d be happy to hear any suggestions that you’d like to share with other readers in future editions of the magazine. PN

This feature is an update of material that first appeared in PN editions 126 and 127.

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