The AIDS generation

Seven Things You Need to Know about HIV But Probably Don’t — From An Expert

2Q==Despite vast improvements in the treatment and prevention of HIV in America, ignorance still abounds, both in urban gay male communities and well outside.

We asked our friend Perry N. Halkitis, author of The AIDS Generation and an expert on gay men’s health, to round up some critical truths everyone should know about HIV and AIDS in America.

Here are seven things you should know about HIV…

1. 50% of Americans living with HIV are 50 and up

3o years ago as a young man coming of age in New York City and watching so many young people die (many my friends), I dreamed that one day people could grow old living with HIV. And now they can.

2. Some 14 percent of HIV+ Americans do not know they are HIV+

Here’s the thing. Most poz folks are seeking care and on treatment. So the real danger in transmitting HIV is from people who don’t know their status or are “the mythologically negative”—those that have not kept up with routine testing despite active sex lives. That is why so many agencies including the New York State AIDS Institute embrace the concept of Target, Test, and Treat.

3. Being HIV positive can increase the likelihood of anal cancer

For any HIV-positive gay man, exposure to certain strains of HPV (the virus that also causes anal warts) can lead to anal cancer if untreated. But there are actions to you can to cut down the risk. First, regular anal checkups and testing for HPV is a sure fire way to catch irregular cells before they turn into cancer. Second, there is some evidence that even if you are exposed to HPV, vaccination may be helpful. Talk to your doc.

PS: This is true for HIV-negative guys, too.  And all young gay men should be vaccinated for HPV before they start having sex. (This one’s for you Dr. Goldstone!)

4. Gay men represent 2-4 percent of the U.S population but over 60 percent of HIV infections

I know HIV can affect anyone, but as I state in my book, The AIDS Generation, “Despite the prevalence of HIV/AIDS in all segments of the population, the epidemic in the United States has always been and still is, and likely will continue to be, primarily a gay disease.”

5. A 20-year-old who tests HIV positive before the virus compromises the immune system and who accesses care and adheres to treatment is likely to have a normal life expectancy.

Lesson: Find out your status, get into treatment, and take your meds as prescribed.

6. There are at least two known cases of people on PrEP who have developed resistance

PrEP is great tool in our fight against HIV. In fact some recent studies have shown that PrEP can reduce the risk of HIV by 86 percent. But like all tools, PrEP has its limitations. In a recent study in Africa, two HIV-negative patients on PrEP developed resistance to the drug and acquired HIV. To date only one medication is approved for use as PrEP-Truvada. The good news: Resistance is a rare occurrence, and other meds are being tested to use as PrEP including long-lasting injectables that wont require remembering to take a pill every day.

7. Meth use does not precede HIV seroconversion. Lack of safer sex practices do.

We want simple answers to why HIV continues to affect gay men over 33 years. The use of the drug Meth is one simple answer but too simple an answer. Yes, meth use creates risk. Men who have sex on Meth are less likely to use protection or to know the status of their partners. No one denies that; and it likely increases the chances of acquiring HIV because of the sexual risks you might take while high. But so does any drug, including alcohol, which is enjoyed by far more gay men. Just because someone uses meth doesn’t mean they will become HIV-positive automatically. In fact, some men who use meth practice safe sex or are on PrEP. The truth is many poz men turn to meth as a way of dealing with HIV after they become infected.

Perry N Halkitis is an internationally recognized expert on the intersection between the HIV epidemic, drug abuse, and mental health burden in gay and bisexual men. He is the author of The AIDS Generation: Stories of Survival and Resilience

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32 Comments

  • Giancarlo85

    Safe sex is hot sex… which I believe Chi-Chi La Rue said. Wrap it up guys.

    Really the best prevention of HIV is knowing your partner(s) and using condoms.

    The reason why HIV continues to affect gay men the most is because the lack of safe sex practices. Globally, however, this is a disease that mostly affects heterosexuals… again down to the lack of safe sex practices. As much as we criticize Uganda for their horrific social policies on LGBT rights, they did distribute condoms and that reduced the incidence of HIV (not abstinence as the religious right wing likes to claim).

  • QNetter

    Humans do not develop resistance to anti-retrovirals. The virus does. Two different people in studies, at least one of whom was less than solidly adherent to the PrEP regimen, were infected with strains showing some resistance to one, not both, of the drugs in Truvada.

    And this hardly seems like THE thing you need to know. It’s about very dramatic risk reduction, not about an iron-clad guarantee. Just like condoms, but if you miss a condom, of course, you’re not protected at all…

  • Jody

    I’m going to jump in here too and say pointing out that PrEP has limitations is a distinction without a difference. -Every- safer sex technique has a limitation. Condoms break, they don’t work if they aren’t used. PEP can still be ineffective. People virally suppressed can still blip and be infectious. An HIV test that says you are negative can report a false result.

    Not to mention, seatbelts can break and airbags can fail to deploy.

    The point of any of these prevention tools is how well they work: A condom works more of the time at blocking HIV than it doesn’t. Viral suppression knocks out nearly every case of infectiousness in a positive person. PrEP works as well as condoms and at a population level, works better. All are incredibly effective methods at preventing HIV — and better than no method.

    Sometimes you can tell -a- truth but not -the- truth.

  • Bromancer7

    @Giancarlo85: Correct. It’s estimated that 1.2 million Americans have HIV (0.4% of the population), 14% of which (about 168,000) don’t know it.

  • QNetter

    @Giancarlo85: That particular line of propaganda was a necessary shared belief – but actual experience contradicts it – for many of us, condoms kill spontaneity, intimacy, erections, and/or the ability to come to orgasm. Whether or not those are worthwhile tradeoffs is another issue – but generalizing about “hot sex” turns lots of people off to any other safer-sex messaging.

  • Giancarlo85

    @QNetter: Actually it isn’t propaganda. At least not when I have had sex. I would never go without one, even if it isn’t a 100%. Condoms don’t destroy intimacy.

    If you choose to bareback, then please know your partner(s). I am not going to judge or try to take some moral high route. People can do what they want… But all I say is common advice.

  • Clark35

    #1 is not correct either as a lot of younger bi and gay men who are 18-mid 30s have it. PrEP is just used by foolish guys who think that they can do it raw/bare and not get infected; but that’s not true.

  • bbg372

    @QNetter & @Jody: That there are strains of HIV that are resistant to one or both drugs in Truvada and therefore, it is possible to become infected even with optimal adherence is something people should know.

  • Jody

    @Giancarlo85: Knowing or not knowing your partner doesn’t make a lick of difference as far as HIV is concerned.

    Condoms, PrEP, viral suppression, and, to a lesser degree, PEP are the only things that stop HIV from spreading. Names have no impact on HIV transmission.

  • Giancarlo85

    @Jody: Yes it does matter. If both get tested often in a relationship the chance of infection is reduced.

    But then again, a simple condom can reduce the chance too.

    Nothing is 100%. Nothing is fool proof.

    But condoms do in fact reduce HIV infection significantly. I hate citing Uganda, but they reduced the infection rate by promoting condom usage. Not abstinence.

  • Jody

    @bbg372: Sure, anything is possible. Is it possible you will get struck by lightning while in your house, watching TV? Yes. Is it likely? No.

    Is it possible a meteorite can strike and kill you while walking down the street? Yes. Is it likely? No.

    In the transmissions the article refers to, both were in people where intermitted drug use couldn’t be ruled out. (See Lehman, 2015 Journal of Infectious Diseases.)

    Whatever possibility of resistant transmission exists, it’s exceedingly low. Really, really, really, really, really, really, really, low. You are far more likely to have a piano fall on your head walking down the street. Like condoms, PrEP protects damn near perfectly everyone who uses it consistently.

  • Giancarlo85

    @Jody: Agreed 100%. I do some courier work for my job… If I drive safely it can be safer. But I could still get into an accident and hurt or worse. But driving safely mitigates risk greatly. The same applies here in a sense.

  • vive

    @Giancarlo, I can’t feel enough through a condom to come, assuming I can even stay hard with one on. So no, PrEP is my only option.

  • DonW

    @Clark35:
    “#1 is not correct either as a lot of younger bi and gay men who are 18-mid 30s have it.”
    #1 says 50% of HIV+ men are over 50. That means 50% are 50 or younger, which leaves plenty to account for the 18-mid 30s you cite. What is incorrect?

    “PrEP is just used by foolish guys who think that they can do it raw/bare and not get infected; but that’s not true.”
    You need to cite sources when you make such blanket claims. PrEP is used by a multitude of different people, including negative partners in serodiscordant relationships. I use PrEP as well as condoms — which means I’m even less likely to get infected than you, unless you’re celibate.

  • Austin77

    @DonW:
    “#1 says 50% of HIV+ men are over 50. That means 50% are 50 or younger, which leaves plenty to account for the 18-mid 30s you cite. What is incorrect?”

    The percentage itself seems suspect. The CDC states: “Persons aged 55 and older accounted for 19% (217,300) of the estimated 1.1 million people living with HIV infection in the United States in 2010.” So, unless a whole lot of people crossed into the 50+ group really quickly, it’s not likely that 50% of the HIV-infected population is over 50. Especially as that group was only 5% of new infections (same page) and thus isn’t growing nearly as fast as the younger population.

  • Austin77

    … following up on myself. It looks like the estimates based on projections (as stated here) are that by 2020, half of all people living with HIV will be 50 or over. This is apparently based on the largest cohorts being in the 35-54 range in 2009, with a single largest block in 40-44 in 2009, and accounting for the fact that most new infections are in younger populations.

  • Jacob23

    @Giancarlo85: How many sexual partners have you had in your lifetime?

  • Giancarlo85

    @Jacob23: Four. And yes I am 29. Why does it matter? Are you going to insult me?

  • bbg372

    @Jody: The likelihood of HIV transmission while on PrEP is not the issue. QNetter seems to be of the opinion that people do not need to know that HIV transmission while on PrEP is possible and that it has been documented at least twice. That knowledge or lack thereof affects the choices people make. Or do you believe a man who thinks it is safe for someone to cum in his ass because he is on PrEP knows that he could be infected?

  • Jackhoffsky

    Number seven was just a big “F.U” to Peter Staley… and an absolutely brilliant answer. I cannot tell you the dangers that come when everyone focuses attention on the easiest target while ignoring the more common target. Meth is A problem, but it is not THE problem. So THANK YOU.

    Number five actually applies to EVERYONE, as proven by the first point. Less and less people are dying and more and more people are living longer, fuller lives. It’s a great turn-around.

    Also, regarding the second point, 14% is actually down for the long-standing 25%. This is great, but it needs to get better. Testing is now looked at less shamefully (NOT the case in parts of Africa, mind you), and for that normalcy, I think that a 11% drop in those who are unaware they are positive is great progress.

  • Saint Law

    @Giancarlo85: With all the time you spend on here I’m surprised it’s that many.

  • kvitka

    Where will be total extermination of the virus in a human body ? So much research, but… What?

  • jason smeds

    I think it’s very homophobic when a gay man refers to AIDS as a “gay disease”. It suggests a degree of self-loathing or self-hate as far as I’m concerned.

    Unfortunately, there are many gay men who hate themselves. They hate themselves because they’ve come to realize how empty and soul-less the gay scene is. It’s like being presented with a glitzy package only to find that there’s nothing in it, especially as you age and become less physically appealing to those around you. You realize that all the nasty qualities of straights are also present in gay people.

    The funny – but still sad – thing about gay male activists is that they insist that “we need more research” when it comes to AIDS. Honey, you need to keep your zipper less open…period.

  • Giancarlo85

    @Saint Law: Funny as you seem to spend more time on here then me, moron.

  • Jody

    @bbg372: I think they should know their likelyhood of being infected by HIV If a guy cums in their ass while on PrEP is the same as if someone came in their ass while wearing a condom or if their partner had their HIV virus suppressed through meds: pretty much zero.

  • Jacob23

    @Giancarlo85: No, of course I am not going to insult you. In fact, I was impressed by a comment of yours on another thread about how you were bullied in high school but nevertheless stood up for yourself. I admire that courage, so the last thing I would do is bully you about your sex life. I was asking b/c some people (not you) who pound the table and insist that condoms are “the” solution to the problem HIV transmission are looking for a reason to avoid discussing every other factor and condition which goes into the continuing high infection rates.

  • Giancarlo85

    @Jacob23: There are multiple options. I am mot sure if I would call them solutions. Condoms do help, but only if people use them correctly. I think there are multiple social issues at work as to why high HIV infections continue. How should we address these problems? By being open and talking about them. Unsafe sex is a major issue in the gay community.

  • o.codone

    @Austin77: “the estimated 1.1 million people living with HIV infection in the United States”. 35 years ago they said there were a milliom ppl living with HIV. are you telling me that it’s still just a million after all this time? somebody’s lying here. given the nature of this epidemic it’s naive to think that after 35 years the figure is still just a million. do the math baby. and trust our instincts. no, it’s not just a million. it’s twice that.

  • Giancarlo85

    @o.codone: And your proof of that is…?

  • vive

    @bbg372, just to add to other responses regarding resistant strains. The problem of preventing initial infection is not the same as the problem of treating established infections. A drug may still work to prevent initial infection with a strain even if it may not work to suppress established infections of that strain.

    Case in point – the two drugs in Truvada appears very effective at preventing initial infections, but ALL established infections are “resistant” to Truvada alone, since to treat established infections you need at least three drugs, i.e., Truvada plus at least one another drug.

  • alphacentauri

    @Jody: No it’s not zero. A lot of the fools on PreP think that they can bareback like it’s the 70s and that they’ll stay neg and free from other STDs but these people are idiots with death wishes.

  • Stached1

    A lot of these claims are dubious, and a lot of men who are bottoms who have anal warts/HPV up their ass get anal cancer that way. For a so called “expert” this guy really should have done his homework.

Comments are closed.