Thursday, December 6, 2007

Serosorting, Barebakers and +'s- %'s Oh My!

Have you ever read an article about the rise or fall of HIV infection rates and when you reach the end you're either scared shitless, angry or have no idea what the hell is going on? Yeah, me too. All. the. time.

After reading this incredibly muddy article by 365gay.com entitled: "Study Suggests Shift In Attitude Among Newly Infected Men With HIV Regarding Partners" I again had that, "uhh, what?" feeling. But lately, do to having some incredibly bright and educated people around me I've grown skeptical of the way percentages and statistics are reported and thus my post-article freak-outs have declined.

Here's the dilly:
The article is saying that some poz men are barebacking or men who happen to be barebacking, are positive, but in some cities (like SF) they're beginning to only bareback with other positive men. This is otherwise known as "serosorting."

Serosorting, as defined by wikipedia is "the practice of seeking to only engage in sexual activities with partners who are of the same HIV status as you. In April of 2006, the Los Angeles Times reported that the practice of positive-positive serosorting is partially responsible for the decline in new HIV infections in San Francisco.

Serosorting is the reason why it is possible to see a simultaneous increase of barebacking stats with the decrease of HIV infection rates. Men who choose to not use condoms aren't changing their sexual acts but they are changing their sexual partners, and that in itself is a way to avoid spreading HIV. The trend here is that positive men are barebacking each other and not negative men.

Now listen up and listen up real good. I'm not advocating unsafe sex. I'm not saying that it's a good thing that poz on poz men are choosing not to use condoms (there's a TON of other health related issues with that alone.) I'm simply clearing up a hard-to-decipher article before we start stigmatizing the entire positive community as barebacking orgy-fueled deviants. Trust me, as I've reported before, a lot of gay men, even myself at one time, came spring loaded with that defense. And, yes. Yes. Yes. Yes we can talk about how this trend might make barebacking seemingly more acceptable, that it isn't foolproof and that negative men might get caught up in this, but it is none-the-less, an interesting trend and attitude shift to note.

I feel as though this is neither good nor bad news and proves how complicated statistics, percentages and HIV reporting can be.
Case in point- the article states:

Two separate studies presented earlier in the week at the National HIV Prevention Conference, however, found that more than 35 percent of men who have sex with men continue to have unsafe sex.
Everybody freak out, right?

Hold on a second. As a friend of mine pointed out when discussing this article:
How many of those guys are poz guys who have unprotected sex with poz guys only? In terms of HIV prevention, those guys should be counted out of the equation.
How many of those guys are in monogamous longterm neg couples? In terms of HIV prevention, those guys should be counted out of the equation.
How many of those guys were having non-penetrative or oral sex? In terms of HIV prevention, those guys should be counted out of the equation.

The real question is: How many NEGATIVE men fail to use a condom when they have ANAL sex with someone whose status was uncertain or POSITIVE? But nobody ever asks that question.

See that's just the thing. In many of the safe-sex surveys I take or the questions I answer when getting tested, I'm always asked, "Did you use a condom the last time you had sex?" The answer is almost meaningless without a follow-up question: "Were you and your last partner both already poz? Were you and your last partner both neg men in a longterm monogamous relationship? Was the last time you had sex a strictly oral/J.O. encounter?"

Hell yes. Complicated! But important.

I'd like to be clear about something. You can disagree with me all you want but I feel it is tremendously important that we do not look at postive and negative like black and white cards or a pass/fail on a college exam or a yes/no answer. In order to really begin combating this virus we need the ability to acknowledge and comprehend everything it involves. With anger and sympathy being both important factors, it is simple understanding that will eventually be the key factor winning out.

15 comments:

Anonymous said...

what you're failing to realize, eric, is that the virus mutates repidly. rapidly as in A PERSON. in other words: two positive barebacker partners aren't safe. they are sharing with each other two DIFFERENT versions of the virus. THIS IS NOT A GOOD THING. i thought you were more intelligent than this. enough already.

mike
mdpowelson@yahoo.com

LifeLube said...

Actually, the jury is rather out when it comes to re-infection and what the consequences are. Look at the literature, or the lack thereof...

And as for sero-sorting, I prefer the term sero-adaptation, which goes beyond the idea of simply selecting sexual partners by sero-status and includes other harm reduction methods around positioning during sex.

We have posted a lot about sero-adaptation on LifeLube, all of which can be found at the following link, if you are interested:

http://lifelube.blogspot.com/search/label/sero-adaptation

We really need to stop reflexivley pathologizing men who want to have sex - natural sex - without a condom and seek to understand the motivations (not assume them) and find innovative ways to reduce the potential harms

We should not be satisfied with only the condom to protect ourselves during sex. We need other methods, other new prevention technologies, such as rectal microbicides (www.IRMWG.org), pre-exposure prophylaxis and vaccines...

And since we all seem to get so frickin'hung up on "barebacking" among gay men... When was the last time we read an article or a published study that looked at the intentional condom-free intercourse that occurs among heterosexuals? All those cute babies in their carriages and double-wides, after all, are a direct result of barebacking. And for heterosexuals, sex without condoms is a primary means of transmitting HIV...

Somehow, we don't automatically screech at them...

I, too, am not suggesting people ditch their condoms. If they are willing and able to use condoms, they are absolutely fantastic at preventing HIV, and other STD, transmission.

But we need to look outside of this very narrow box, meet people where they are at, and support the research and development of NEW prevention technologies that go beyond latex, as well as harm reduction techniques such as those found in sero-adaptation.

Thanks.

Jim de LifeLube
www.LifeLube.blogspot.com

bstewart said...

Jim makes some very valid points, but these facts remain:

- existing biological threats will evolve, because that's what they do
- new biological threats will present themselves
- people are still seroconverting (through various processes)
- apart from abstinence (ugh), barrier-protection sex remains the most effective way to combat infection and seroconversion

All this talk of needing to understand motivations for unprotected sex and to call for innovative new methods for reducing potential harm is well and good, but at some point -- like today, this evening, when we're faced with a concrete decision as to whether we roll the condom down or not roll the condom down -- utopian wishes and psychological understanding divert attention from the need for a clear answer for those who haven't digested all the information (or lack thereof).

And, right now, today, the clearest answer is: use a condom. Always. And that should be the clear message that's disseminated, since the potential harm from deviating from that message today is, indeed, being realized. Today. In continuing and, in some demographics, increased infection rates.

Eric "ELeven" Leven said...

Hey Mike-
Did you READ the article I wrote, the part where I said I don't advocate safe sex nor do I think it's a good thing that poz on poz men are barebacking?

How about the fact that this isn't about the health of condomless poz on poz men but rather the SPREAD of HIV?

Or did you get angry and jump the gun?

LifeLube said...

Hey guys, lots of data suggest that actually, men are getting infected from their main partner, not from being wanton hussies necessarily. Many, many of us choose to not use condoms with our long-term partners (boyfriends, lovers, husbands, whatever you call them)... There is absolutely nothing utopian about trying to figure out new ways to reduce men's risk NOW in ways that don't include condoms - 50% of gay men are not using them regularly - and to look to the future for new prevention technologies.

A condom will likely ALWAYS BE OUR BEST BET. But they only work when used CONSISTENTLY and CORRECTLY.

Why is it that we demand choice in every other part of our lives (double-cupped extra hot soy latte with Splenda, anyone?) but don't do the same for something as important as protecting our health during sexual relations?

We don't only rely on seatbelts to protect us while driving - which is very dangerous, btw. We also have speed limits, stop lights, dividers on highways, etc...)

We need to address HIV prevention at not only the individual behavioral level, but at the community/societal and structural levels...

xxoo
Jim

bstewart said...

Thank you, Jim, for including the sentences:

"A condom will likely ALWAYS BE OUR BEST BET. But they only work when used CONSISTENTLY and CORRECTLY."

...because I'm always concerned when the other, less-clear messages are presented in an equal-timey fashion, which diminishes its simplicity and importance -- and I'm not suggesting you or LifeLube do that, I'm speaking generically.

I'll cop to sounding a tad smug about using condoms all the time, since I've made peace with that reality (and have discovered the awesomeness of female condoms for assfucking), even with my long-term boyfriend-thingie, every time.

It's just... the men in my age group (40s/50s) from whom I've heard anecdotal reports of seroconversion, thought they had a monogamous, throw-away-the-rubbers thing with their partners, and discovered in the worst way that "monogamy" is a fluid concept. Literally.

Anyway, thank you, again, for restating the message which should be front and center. I do not disagree with all the other yeah-buts or the reasoning behind INFORMED decisions to go without barrier protection, I'm just leery of presenting those choices on an equal footing with the hard-line choice, to an audience of whom we're not sure has all the information they need to make those choices.

CraigF said...

Re-infection is a reality. So is inherited drug resistance via exposure to someone taking different meds.

Result? A virus which is effectively immune to any drug therapy currently available.

This is seriously current thinking. Two HIV+ men barebacking is just plain fucking dumb. For them. For me. For everyone.

LifeLube said...

Many people who contract drug resistant virus see their virus morph into "wild type" over time, and no longer resistant. Reistant virus is much less hardy than the "wild type."

This is also the case with re-infection, we have seen.

So, it is not as clear cut as you purport, craigf.

I am not advocating any type of behavior here - just stating the facts.

YOU may think two POZ guys barebacking is dumb. And your opinion is just that. It is not necessarily born out by the research/data/experience as of now.

the zak said...

Whole article good
http://www.newyorker.com/reporting/
2007/12/03/071203fa_fact_specter?currentPage=8

aroundthewayboy said...

YOU may think two POZ guys barebacking is dumb. And your opinion is just that. It is not necessarily born out by the research/data/experience as of now.


Uh, I think the science bears out the widely held opinion that rampant unprotected sex among poz guys will lead to rapidly evolving, potentially drug-resist strains of HIV. Which is bad for everybody.

A good friend of mine here in Brooklyn recently contracted a strain of HIV (from topping his boyfriend, who had cheated on him) that turned into full blown AIDS within a month. And he's already had to change his drug cocktail multiple times. This is happening. NOW. TO US.

It is not a wise public health strategy to back down on advocating condom use, even for poz-poz couplings (not that anyone on this blog has, thus far).

LifeLube said...

No one is suuggesting backing down on condom strategies. If there are gay men who are using them well, KEEP ON USING THEM.

But we have to provide more options for folks, because let's face it, about half of gay men are not using condoms consistently (much higher percentage than heteros, btw)...

Yelling and gnashing will not change that fact --- as good and superior as it makes you feel.

In these cases, harm reduction methods like sero-adaptation are worthy of exploration, and indeed have shown efficacy (of course, not at rates similar to condoms, but some level of efficacy and harm reduciton nonetheless) and for the future, new prevention technologies such as rectal microbicides, vaccines, and pre-exposure prophylaxis.

As for drug resistant HIV being passed, I am very sorry for your friend and what he is going through, but we do know that many folks who contract or acquire drug resistant HIV see their strain revert back to wild-type virus (which is much hardier than drug resistant) and therefore become treatable once more.

A story we NEVER hear about is the one about the guy in NY who was demonized a couple of years ago by the NY Dept of Health for being a crystal addict and contracting and possibly spreading a multiply drug resistant strain of HIV.... He had quickly progressed to AIDS after testing positive and there was much hysteria about him in press outlets and the general community across the country...

Well, he is now doing fine, did you know that? And he is being treated by a standard regimen of highly active anti-retroviral therapy... As the strain of HIV he acquired reverted back to the dominant wild-type...

Not as sexy a story, I guess. But reality.

Jim de LifeLube

LifeLube said...

No one is suuggesting backing down on condom strategies. If there are gay men who are using them well, KEEP ON USING THEM.

But we have to provide more options for folks, because let's face it, about half of gay men are not using condoms consistently (much higher percentage than heteros, btw)...

Yelling and gnashing will not change that fact --- as good and superior as it makes you feel.

In these cases, harm reduction methods like sero-adaptation are worthy of exploration, and indeed have shown efficacy (of course, not at rates similar to condoms, but some level of efficacy and harm reduciton nonetheless) and for the future, new prevention technologies such as rectal microbicides, vaccines, and pre-exposure prophylaxis.

As for drug resistant HIV being passed, I am very sorry for your friend and what he is going through, but we do know that many folks who contract or acquire drug resistant HIV see their strain revert back to wild-type virus (which is much hardier than drug resistant) and therefore become treatable once more.

A story we NEVER hear about is the one about the guy in NY who was demonized a couple of years ago by the NY Dept of Health for being a crystal addict and contracting and possibly spreading a multiply drug resistant strain of HIV.... He had quickly progressed to AIDS after testing positive and there was much hysteria about him in press outlets and the general community across the country...

Well, he is now doing fine, did you know that? And he is being treated by a standard regimen of highly active anti-retroviral therapy... As the strain of HIV he acquired reverted back to the dominant wild-type...

Not as sexy a story, I guess. But reality.

Jim de LifeLube

LifeLube said...

A little more on "super-infection" from an aidsmap.com story published in november... While not unheard of, it is relatively rare:

"Superinfection has been reported in over 20 HIV-positive individuals around the world. These cases show that infection with one strain of HIV does not always provide a protective immune response against the acquisition of a second strain. This has important implications for HIV vaccine development as most other viruses for which vaccines exist provide protective immunity against subsequent infection.

"It is still unclear how often HIV superinfection occurs, with studies providing contradictory findings regarding incidence. Nearly all the cases of superinfection reported to date involve individuals recently infected with HIV, but there has been a reported case of superinfection in a chronically-infected patient, meaning that it is uncertain if the risk of superinfection is restricted to the few years after primary HIV infection.

"In most of the cases reported so far, the superinfecting strain of HIV has been from a second distinct subtype. Detecting superinfecting strain of HIV from the same subtype can be much harder."

the zak said...

A thought experiment http://en.wikipedia.org/wiki/Thought_experiment
Two uninfected men are having anal sex. Is it true or false one or both of them could get infected?...

See also
http://notb4weknow.blogspot.com

apostle said...

THE CURE for HIV/AIDS.......AMBUSH

THE IDEA that AMBUSH cures AIDS
is being proven by the more than 400 individuals who have taken a dose of 60 ml three times daily for 21 days. The result is that AMBUSH 'KILLS' the virus by causing the protein envelope to rupture and the viral particles are discarded by the white blood cells. AMBUSH is able to 'KILL' the virus that are 'hiding' in the lymph system by its 'natural radioactive' properties. This process allows the body to 'return to normal health' with a corresponding immunity to that or those strains of the virus.

What is AMBUSH ?
AMBUSH is a radioactive isotope of uranium that is found in the 'palm' plant of which there are more than 3000 species. When ingested, AMBUSH causes the body temperature in the trunk area to rise to about 102 degrees when the individual is sleeping. The preparation takes four hours per batch, which is then given to the individuals for consumption 60 ml three times daily for 21 days. AMBUSH is a herbal preparation in this form but it contains an active ingredient which is a 'NEW' crystalline substance, a drug from the 'palm plant' similarly to ASPIRIN originating from the willow tree bark

RESULTS:
After 21 days on AMBUSH, ALL the individuals experienced a decrease in viral load to undetectable, an increase in cd4, increase in RBC, an improvement in general health such as more color to the face, decrease in Buffalo hump, an increase in gluteal muscles, a decrease to having no joint pains whereby individuals can bend to touch their toes, and walk up steps are but a few examples. There is also a dramatic increase in their sexual appetite beginning after the first week of therapy

DISCUSSION:
In any plant concoction such as percolated 'tea', there are 30-40,000 compounds, whi ch would take the scientific community twenty years to isolate one particular ingredient if they knew what they were looking for. The LORD GOD has given me seven steps to isolate the active ingredient, which is soft and metallic in nature and has a carbon- uranium-sulfur-(classified)-phentolamine configuration or structure. This is similar to Federick Kekule and the discovery of the benzene ring where he dreamt the structure.

As an antiviral and 'natural radioactivity' producing agent, AMBUSH is also effective against leukemia, lupus and HPV. Here I am saying that I have 'GIVEN' AMBUSH in the same 'strength' and dosage to patients with leukemia, lupus and HPV. A 35 year old male with HIV found it difficult to impossible to urinate was put on 'green tea' and water while the doctors contemplated prostrate surgery. One of the doctors gave him my number , I sent him a supply of AMBUSH an d he has not been given any more ARV's, since taking AMBUSH 18 months ago, is in 'good' health and has expressed a willingness to be examined by HIV investigators like many others who have taken AMBUSH.

I have sent this 'IDEA' to most HIV research agencies, scientist of the field, universities, hospitals, clinics, politicians and news agencies to which it is REJECTED because the name of THE LORD GOD is mentioned. He has steered me scientifically through the processes such as which plant and how to produce the active ingredient. What are the odds of a Florida Pharmacist picking a plant would contain the CURE for HIV/AIDS ?
I have never charged any of the people for their supply of AMBUSH but a life saving has been spent on the project with NO renumeration from any sources because AMBUSH falls outside the walls of modern medicine and research.

PROPOSAL:

My proposal is that I PROVE that AMBUSH CURES HIV/AIDS by giving it to a number of END-STAGE or DRUG-RESISTANT people and the scientific community watches their recovery. This proposal addresses the problem in that I have already outlaid the results to be obtained.

This IDEA is unconventional in that the scientific community has rejected AMBUSH because I say it is GOD given. Secondly if I wrote it according to certain standards, then it might be peer reviewed. However, THE LORD GOD has also shown me that there are five enzyme systems associated with the virus, reverse transcriptase, protease, fusion and two more of which causes the virus to be AIRBOURNE. This means that without DIVINE intervention mankind and ALL warm- blooded mammals will be extinct in a number of years.

The PROOF of what I am saying is found in scientific papers wherein it is found that when the protease cuts the viral strands, it cuts it at DIFFERENT lengths EVERY time, to which it should always be a valine at the end but is a different amino acid every time. This is why it is IMPOSSIBLE to produce a VACCINE.

Since this is NOT a hypothesis but there are about 400 individuals who have taken AMBUSH, here lies a vast area in which to check, recheck and confirm that AMBUSH CURES AIDS. Let it be mentioned that during the HIV reproductive cycle, reverse transcriptase converts viral RNA into DNA compatible to human genetic materials. Thus the human DNA has been 'hijacked' and since each person has a DIFFERENT DNA, then the new viral copy is unique to that person which shows that each individual has a DIFFERENT STRAIN of the virus. Consider two HIV positive people swapping viral strains and increasing its complexity with multiple partners.
It can also be proposed that they be revisited as proof that the strain or strains that they had were 'killed' at the time of taking AMBUSH considering that a person can catch as many different strains as there are people who are infected by HIV.
I am also willing to work with the scientific community in identifying those individuals who took AMBUSH and wish to be identified with this process notwithstanding that some are stigmatized while others are jubilant,

Once AMBUSH is verified as being able to accomplish that which is aforementioned then the next stage might be the natural and artificial synthesis of the substance.

Finally, if this is accepted or not, believed or not, THE LORD GOD always wins and this is the heavenly truth to which AMBUSH was divinely given to mankind for the CURE of HIV/AIDS and it will be here forever. Apostle Shada Mishe.

apostleshadamishe@gmail.com

Here is a video taped presentation that I gave at t he Martin Luther King library in Washington

http://www.youtube.com/watch?v=8V53D1w__Po
http://www.youtube.com/watch?v=vPwuwlVBOV0
http://www.youtube.com/watch?v=ZejptOwMTzQ
http://www.youtube.com/watch?v=CqcTgIAhrhc
http://www.youtube.com/watch?v=f7HPKcT_iwY
http://www.youtube.com/watch?v=W9iQfgiYAnw
http://www.youtube.com/watch?v=i3RzRS6tJDM