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There are specialized services that can wash/clean your sperm with essentially no risk of spreading the virus to the mother. They are expensive but definitely allow you to safely have children.

Great questions. A majority of (or at least a large part) your immune system is in your GI tract is it has a large surface area and needs to constantly fight off infections. The damage from unchecked HIV is real. It is harder to cure with a bigger viral reservoir, but the main idea is to keep the total amount of virus in the body to a minimum. This maximizes immune function. This extends life. Great point about guys who take frequent loads to "work out" the immune system. This is reasonable and probably something to it - but only probably for guys who are on meds. See there is working out and then there is trying to lift a MAC truck and tearing the shit out of your muscles. You need to allow your body to rest at some point. Uncontrolled HIV infection keeps your immune system turned on all the time - no rest - no recouperation. It wears you down quickly. it will kill you in 10 years or so if you are not on meds. If you are on meds - those loads/viral exposures do expose you to SMALL AMOUNTS OF VIRUS WHICH REMIND THE IMMUNE SYSTEM WHAT HIV LOOKS LIKE AND ARE THEN QUICKLY CONTROLLED BY THE MEDS. This is different then your own infection constantly attacking your immune cells 24/7. Try lifting weights to the MAX twice a day for the rest of your life and you will destroy your body. Your body needs rest. Meds give it rest. Taking loads WHILE ON MEDS may very well exercise the immune system. I'll buy that. But the meds and your body quickly suppress the new infection. If you are not on meds, you are just adding fuel to the fire. Your immune system can remember infections it has seen already. After the first time the immune cells interact with something that matches their receptors a "switch" is turned on which makes it easier to "re-activate" that cell so the next time it sees the invader its ready to go. Your body can forget over time however - think of your tetanus vaccine. You need one every 10 years. Why? The immune system needs reminded what tetanus looks like since it doesn't see it every day. I can see this happening with HIV in men who are suppressed long term on meds. I think staying on meds and taking poz loads is OK. I'm not to worried about it. Who knows, like you say it may be good for you! There is a set number of times a single immune cell can replicate before it kicks the bucket. Cells age and get less and less healthy as they age just as people do. You will kill cells if you "work them out" 24/7 for years and years. Meds prevent you from doing this. Very few people are "Elite controllers" or "long-term non-progressors" and will live much longer than average without meds. These are quite rare, and you will be able to tell most likely based on viral load at time of diagnosis. Not always. I would not take a 1 in 100 or 1000 or whatever chance that you dont need meds. Docs are now arguing about starting meds in these folks too. Some say yes, some say no. Even these "Elite controllers" or "long-term non-progressors" have only one immune system and will eventually die - almost without exception - it just takes longer. A healthy 40 year old on meds can expect to live near normal/normal life expectancy if he is undetectable. A 40 year old who isnt well controlled will most likely not. Cancer/heart disease/infections all take people before they should go. Newer meds have minimal side effects (for many/most) and risking your life or health because you think you can beat the odds is, on average, not going to turn out well. Just look at Vegas, all those buildings and things, that is from gamblers' money that they LOST. I hate to say it, but if you are off meds, on average , almost without exception, THE HOUSE ALWAYS WINS. You loose And its your life not just poker chips.

First of all, you will be fine. And you don't need to start meds the second you are diagnosed, but as soon as you can get them and stay on them. it is VERY RARE that meds won't work for you. VERY RARE. i wouldnt worry about that. There are many options - but Isentress/Truvada is very well tolerated- perhaps more so than any other regimen. It is a well studies "newer" regimen. It is two separate meds (isentress is taken twice daily). The is a new medicine that combined the Truvada and a similar drug, but it is newer and I like to wait a bit longer before trying something new. Again, you can talk with your doctor, but if you can afford it Truvada/Isentress (please take it twice a day not two pills at once it doesnt work as good this way!) is a great, well tolerated option with lots of good data to back it up. Talk with your doctor as any health problems you might already have can determine the best medicine for you. If you dont think you can tell your family right now thats OK. Only tell them when you are ready as people can freak out. If there is no one you can talk to (it feels REALLY GOOD to be able to get this off your chest), find a counselor if you can find/afford one. Its very rare that people will shun you once they find out - but I have heard of it happening. I don't know what to tell you about that, but you will definitely find out who your true friends are once you tell them based on how they act. Your previous PEP won't matter. As long as it was out of your system by the time you got infected, it will not effect meds moving forward. Even if it was in your system, very unlikely it will matter. Dont sweat it. As far as re-infection goes, it is something to think about. Standard answer is always play safe - even with other poz guys. Well......I suppose that is OK advice. It is uncommon for guys to get resistant strains. Not impossible, though. You might get a normal strain and probably will never know since the meds you take will likely work for both. I would be more worried (or at least as worried) about other STI including HEP C. Please get tested for HEP C and Tuberculosis and Syphillis/Gono etc regularly if you are having unprotected sex. Especially HEP C if you parTy with guys who slam/use IV drugs. You cant always tell by looking at someone if they have HEPC or HIV. HEPC is very treatable and curable in most, but dont let it go. Same with syphillis (very curable). Don't do injection drugs. Ever. BooTy bump is "safer" than injecting or even smoking (fucks lungs up much quicker than smoking but probably not too bad for infrequent users). In my opinion, be "selective" about who you sleep with, but something has got to kill you, so you might as well enjoy bareback sex. It does feel awesome! Do your homework and be persistent when asking for help/fighting for your access to meds. Be persistent, plan ahead, and never skip your appointments. People will want to help you if they like you, and missing or not showing up for appointments is a red flag. Find a good HIV social worker - they can work miracles. You will be fine. Try to find SOMEONE TO TALK TO - if you feel comfortable. It helps ALOT!!!!!! MAKE SURE YOU TELL ALL PARTNERS YOU ARE POZ. IN MOST STATES IT IS A FELONY TO HAVE SEX WITH SOMEONE WITHOUT TELLING THEM. Right or wrong that is the law. Most guys are cool and will still sleep with you. Don't end up in prison because you withheld info from them. Its not only wrong, but it can really bite you in the ass. Especially take it easy on drugs and alcohol - you dont need to totally avoid these unless you are easily addicted to things as many poz guys drown their sorrows with boze and drugs to avoid life which only makes it worse in the end for many. Again, some guys can drink/party and keep their shit together. Some cant. Know which one you are!. Enjoy your sex life - it will be good and you dont have to worry about HIV any longer! Give yourself time, it may take months/years until you are comfortable with everything. But you will do well and live a long life if you take care of yourself. Best of luck- you'll do great!

Sorry - one more thing. This information is relatively new. For those who go to doctors that keep up on the latest info, this will come as no surprise. Some doctors who might be a bit behind on their reading may not practice in this way. There are still a few holdouts (those docs who know about the data but still choose to tell patients it is OK to wait). I am not saying that someone is wrong or right, but if I were you, I would go to someone who is as up to date on HIV as possible - or at least one who will start you on meds now. I have several doctor friends and they are all in agreement - early initiation of therapy will allow you to live as long as possible. Its up to you if you want to act on that info. It sucks that money is the reason some dont start meds. There are programs in each state/Ryan White etc or local HIV agencies that can help. HIV is not a death sentence, and if you are detected early, start meds, and stay undetectable, you will probably outlive your doctor! Good luck!

Let me clarify. Anyone certainly has more than two choices, and needs to make a decision for himself. Those who wait to go on meds may "have done well" , obviously much better than if they never took them, but they can do better and live longer if they start meds earlier. Here's why: When we are born, we have a compliment or set of immune cells that recognize all different kinds of antigens or invaders. We only have that set- including many that recognize HIV, HEP, bacteria, etc. Now these cells we are born with can replicate and make more of themselves over time - but only a set (not sure how many) number of times. The immune system can get "burned out" and loose the ability to recognize certain antigens - not just HIV as cells die off. You see, it technically not HIV that kills people, its opportunistic infections and cancer, cardiovascular/kidney disease that does them in. Infections include pneumonia, meningitis, bacteria in the blood (blood poisoning/sepsis), etc. If HIV is left unchecked, it will eventually decimate the immune system's ability to fight even the easiest infection - i.e PCP/PJP when counts are below 50. This is why all HIV men should talk to their doctors and make sure thier PNUEMONIA AND MENINGITIS ANS WELL AS HEPATITIS VACCINES ARE UP TO DATE! The immune system also finds and destroys cancer cells. People with lower CD4 counts 350-499, even with undetectable viral loads, are more likely to die of cancer or other causes. You see active HIV infection causes inflammation that results in higher rates of cardiovascular disease, stroke, etc. The immune cells HIV kills might have stopped a cancer from forming, but they cant do that if they are dead. Higher rates of smoking in HIV+ men also contribute to these risks. Some HIV meds mess up cholesterol but we are not sure how much that affects things - probably at least somewhat. A recent study of over 3000 HIV positive people with CD4 350-499 were 77% more likely to die than their non-HIV counterparts. THIS DOES NOT MEAN THAT 77% ARE GOING TO DIE - just that for every 100 HIV negative people that die, 177 with HIV will die during the same time. Once CD4 got above 500, the study authors did not find extra mortality from HIV in those with undetectable loads. This does snot mean that there is no benefit in these folks with counts above 500 (as I would bet cash they do benefit), just that the study might not have had enough people in it to detect a difference. We only get one immune system. HIV destroys it slowly over time. Once its gone, its gone. Starting treatment definitely improves outcomes and fewer and fewer people are dying of AIDS which is great. That does not mean that HIV is not causing more deaths. As I said before, cancer, heart attacks, etc also kill people with HIV. Its kinda like smoking - not everyone who smokes will get cancer. But those who do smoke are more likely to get cancer. Those heavy smokers are more likely to get cancer than light smokers. But light smokers still have a higher chance of getting cancer than non-smokers. Not all people who smoke will get lung cancer (about 20% will) but they can also get lung problems, heart attacks, etc. So to answer your question although some guys who start meds later (light smokers) do OK, not all do. Statistically, they are likely to live shorter lives. Now while only 20% of smokers get cancer, etc, damn near 100% of HIV+ guys will die if untreated. So my smoking analogy is not the best, but hopefully you get my point. If someone is newly infected and wants to live as long as possible, he should start meds immediately (assuming he will take them as directed). Waiting is an option, and many do it this way because they are afraid of side effects, are diagnosed years after their infection, or their docs think that is OK (it was generally though by docs to be OK until very recently but most are changing their tunes with the new data coming out). They will not live as long as had they started earlier, on average. By many years. You see when guys start meds their absolute CD4 go up, but this is just the complement of cells they do have multiplying- those cells that already died from HIV cannot reproduce. This is why we look at CD4/8 ratios. Absolute counts can be misleading. Only 25% of HIV + men in the US have undetectable viral loads and 1 in 5 are unaware of their infection. This is sad as no doubt many will die unnecessarily. Just want to give the best info possible. Oh , and RawTop, please don't censor me, but I would happy for you to dump a hot load in my butt as punishment. :-)

Actually, mounting evidence suggests that if you test positive and are committed to staying on meds YOU SHOULD START MEDS IMMEDIATELY. The evidence suggests that the sooner you start, even at CD4 count of 500, not the old 350, the longer you will live. The "old" recommendations were more based on superstition than on solid medical evidence - people didn't want to start everyone on meds due to the side effects (much better with newer meds) and the fear that people would develop resistant strains which didn't turn out to be much of a problem for those who CONSISTENTLY TAKE MEDS. If you are gonna fuck around and skip doses every few days, even once a week, etc do yourself and anyone you sleep with a favor and don't take meds half-assed and develop a resistant strain. Good luck. People who start on meds early in their infection and stay undetectable are estimated to live as long, or nearly as long, as the uninfected. If you take no meds, most will be dead in 10 years from the date of infection. You are much less likely to spread the virus to others if undetectable on meds, as well. You'll be fine. Get care, listen to your doctor (find one you like/trust/specializes in HIV) and TAKE YOUR GODDAMN MEDS KID.