| Don Saklad 2005-06-27, 8:48 am |
| 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/...tml?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.
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