To What Degree Does "On Meds" = "Undetectable"?

[Poz1956]

You just answered your own question - because tops are at much lower risk. 7 times lower risk to be precise. Hence their claim at being neg is more likely to be true.

Statistical chances per sex act are only relevant to epidemiologists. They are useful in making predictions for a community overview, population wide, but meaningless when it comes to an individual. Each time a guy fucks he COULD be that ONE in the 1/XXXX chances.

Every single one of us Poz guys, at some point said, based on statistical chances, I don't think I'm at much risk.

I actually remember having that conversation with a friend in spring 1982. I didn't live in a multimillion population centre. I almost never went to the tubs. I wasn't sucking or fucking and taking 25 loads a night. Hell, I only got laid once or twice a month. I wasn't doing drugs. I wasn't snorting poppers. (Those were ALL of the risk factors back then.) I was sure the chances of me catching it were extremely low. And yes I was topping - thought that wasn't recognized as a lower risk factor back then.

Based on what we know now about seroconversion symptoms, I caught it six to eight months later.

I'm not quite sure what you're current though is. Hover over just the status Neg and get the last test date, or are you still planning a "Neg, Recently Tested" with other possible descriptors for longer periods of time since the last test?

I'm just going to throw this out there.

You were very lucky for a lot years (thank God). And now you're on PrEP so your chances are extremely low. Is your opinion on downgrading "Recently Tested" possibly being tainted by your own personal experience?

You really shouldn't give other tops a false sense of security. If you're going to facilitate hook-ups, it's better to reinforce the best testing practices, public health message. It's for the protection of all the other neg guys.

I don't think you ever want the situation where some guy says "RawTop said I didn't need to be tested yet, so I though I was Safe." In the overly litigious USA I can actually picture that as a defence somebody spews in court.

And lets be honest here, safe because a guy is on PrEP, for the foreseeable future, is going to be a very rare exception.

Most of the guys doing it raw will still be thinking "I don't think I'm at risk because _________." And they will fill in that blank with anything they can get their hands on. Especially youth, who already think they are Immune and Im-mortal. (The straight ones think they're Infertile too.) We all know they're not getting tested nearly enough.

Lets not allow them to fill in the blank with "Because BBBH says I'm not."

(I now Im-mortal is spelled wrong - for some reason it kept getting replaced with *******)

Edited March 14, 2014 by Poz1956

[rawTOP]

Statistical chances per sex act are only relevant to epidemiologists. They are useful in making predictions for a community overview, population wide, but meaningless when it comes to an individual. Each time a guy fucks he COULD be that ONE in the 1/XXXX chances.

You're seriously going to tell me that per-incident risk is irrelevant to individuals? Seriously?

So walking across the street in a rural town where you can't see a moving car is the same as running across the street on an icy New York street when there's a bus coming that doesn't have time to stop? You treat both situations the same exact way? There's no difference to you personally?

Bullshit. Per incident risk is totally relevant to individuals - you live your life that way - calculating "how much risk am I really taking right now?" Everyone has their personal threshold of risk that they're OK with. You'll run across the street against the light when it's just you, but not when you're accompanying your sister's kid, etc.

Sorry, but around here science is king.

So getting back to the original point - my differing times were based on the average length of time that someone can claim to be neg. People build up a certain amount of cumulative risk. Bottoms accumulate risk faster than tops, so they can't claim to be neg as long as a top.

Science. Facts. Let's stick to those please.

[Man4manplay]

I think to stop hiv stigma, the whole poz/ neg question should be eliminated, Is a bareback site who cares if the guy is pos or neg we are looking for bare sex and loads period. any guys tha bareback is at risk of hiv and stds. I barebacked long before I turned poz, I knew the risks and I assume the consequences and enjoy bareback sex I don't care if you load is pos or neg as long as is a great fuck.

[TigerMilner]

I think to stop hiv stigma, the whole poz/ neg question should be eliminated, Is a bareback site who cares if the guy is pos or neg we are looking for bare sex and loads period. any guys tha bareback is at risk of hiv and stds. I barebacked long before I turned poz, I knew the risks and I assume the consequences and enjoy bareback sex I don't care if you load is pos or neg as long as is a great fuck.

Here, here. Well said, M4Mp!

[rawTOP]

I think to stop hiv stigma, the whole poz/ neg question should be eliminated, Is a bareback site who cares if the guy is pos or neg we are looking for bare sex and loads period. any guys tha bareback is at risk of hiv and stds. I barebacked long before I turned poz, I knew the risks and I assume the consequences and enjoy bareback sex I don't care if you load is pos or neg as long as is a great fuck.

I proposed not showing HIV status on BBBH.com and people didn't like that idea at all. So then the question was how do I best display it in a way that does reduce HIV stigma. For example, I want to communicate that sex with poz guys on meds is safer than sex with a guy who thinks he's neg. At the same time I don't want to make people think about the issue too much since it's a bit of a turn off.

[Poz1956]

You're seriously going to tell me that per-incident risk is irrelevant to individuals? Seriously?

It's relevant to the choices a guy will make. But it's totally irrelevant to his actual chances of catching HIV.

I've given you two examples of guys I've spoken with since December 1, 2013, on a Non-BB focuses site.

The uncut top had a 1 in 161 chance per exposure to HIV of become Poz. In 1 out of 1 bareback fucks he became Poz.

The cut guy had a 1 in 909 chance per exposure of catching HIV. In 1 out of the 2 bareback fucks he had in his entire life, he became Poz.

Sorry, but around here science is king.

So getting back to the original point - my differing times were based on the average length of time that someone can claim to be neg. People build up a certain amount of cumulative risk. Bottoms accumulate risk faster than tops, so they can't claim to be neg as long as a top.

Science. Facts. Let's stick to those please.

I am sticking to the scientific facts. I just have a broader view on them than you do.

If you want to talk about cumulative chances, then you better count the number or BB fucks. A guy who BB's once a month in a closed circle of buds has a lower accumulated chances of exposure over the year, than a top fucking a random hook-up several times a week, or a power bottom taking ten loads a night at the tubs. Time alone is has no bearing on that.

Tell me, what's your cumulative chance of winning the lottery today verses two years ago? There is no cumulative increase in your chance. Your odds of winning the lotto is exactly the same each and every time you play it. It doesn't matter how many times you play it, your per ticket chance of winning says exactly the same.

I don't understand how a per exposure risk, translates into "an average length of time that someone can claim to be Neg." Explain the science of that calculation. You may have a reference I haven't read.

The bottom has a 1 in 71 chance of catching it, per exposure to HIV. The uncut top has a 1 chance in 161 exposures. The cut top has a 1 in 909. Those numbers don't change over time.

You're thoughts on downgrading are based solely on the risk of CATCHING HIV. In your view, the bottom has the bigger responsibility to get himself tested.

Regardless of the 1 in XXX chances, ANY exposure to a high viral load Pozzie, could actually be THAT ONE.

Lets flip it around and look at it from the risk of TRANSMITTING the virus.

The bottom had a 1 in 71 chance of catching HIV. Once he's got it, even though he doesn't know he is Poz yet, he only has a 1 in 909 chance of transmitting it to a Neg cut top, and a 1 in 161 chance of transmitting to an Neg uncut top.

The newly Poz tops, regardless of foreskin status, now have a 1 in 71 chance of infecting their Neg bottoms.

Viewed from that perspective the tops have a greater responsibility to keep up to date on their status than the bottom does.

But under your suggested system, he could unknowingly be spreading HIV, until the system more or less forces him to go get tested in 18 or 24 months.

I would certainly hope that everyone would take the personal responsibility to get tested on a regular schedule. But we know many people don't do it. If it takes a hook-up site's status downgrade to talk someone into getting tested, so be it. But set a high bar. Use the standard "best practice" recommendation, which is especially important for guys who BB.

I say everyone has an EQUAL responsibility to get their HIV status tested frequently. The guys on PrEP have the responsibility to take their pills daily, and have their serostatus and kidney functions checked checked every three months. Us Pozzies have the responsibility to take our pills daily, and have their viral load checked (at least where I live) every four months.

Again I suggest, first downgrade at three months. "Unknown - Overdue for Testing" at six months. And yea, that's very blunt and "in your face." Sadly, it needs to be, because guys aren't getting tested, and the uptake on PrEP has been relatively slow. But maybe you have to tone that down a bit for anti buzz kill purposes.

Nobody hears the old "Condoms, Condoms Condoms" message. Heck, ignoring that message is what this site and BBBH are about. Lets present guys with a new mantra, appropriate to what they are actually doing. "Testing, Testing, Testing!" Because it's different, they might actually HEAR it.

Look, I'm relatively new here, and don't have the street cred for you to give a damn about what I have to say. Bear is a long time member, and his knowledge and opinions are well respected. Have a PM conversation with him, and ask if I'm totally off base.

In the end BBBH is your site. You have the final say as to what info is there, and what status is display, and how downgrades will happen.

I'm just trying to frame a discussion in the best interests of the broader BB community.

My reference for the numbers I used: Putting a number on it: The risk from an exposure to HIV

[rawTOP]

Poz1956 - I used to teach stats when I was in grad school. I know what I'm talking about. I'll just point out one flaws in your thinking that sorta goes to the heart of the issue…

Tell me, what's your cumulative chance of winning the lottery today verses two years ago? There is no cumulative increase in your chance. Your odds of winning the lotto is exactly the same each and every time you play it. It doesn't matter how many times you play it, your per ticket chance of winning says exactly the same.

If you're playing a lottery where you win 1 in 100 times and the lottery I'm playing I win 1 in 1000 times. We both play every week. Who's most likely to win their lottery first? Now if we both put something in our profile saying "haven't won the lottery", which one is most likely to be wrong first? How long is a reasonable time to put such a statement in a profile? I'd say I can put it in for a period of time that's 10 times longer than you can because you're 10 times more likely to win your lottery.

The per incident chance doesn't change, but the cumulative chance does. Do the math. Yes, I could win the lottery the first time out, but that's 10 times more likely to happen to you. Hence, in coming up with community guidelines I have to take you as an average person playing your lottery and me as an average person playing my lottery. The guidelines have to use averages even though individual results may vary.

I'm just trying to frame a discussion in the best interests of the broader BB community.

Misinterpreted stats helps no one.

Edited March 15, 2014 by rawTOP

[txlaw69]

rawTOP, I agree with the concept of some sort of expiration date on HIV-negative status. However, I think that you are giving guys too much credit when you change the expiration date based on their self-professed status as top/bottom/vers. We all know that there are a lot of guys who don't like to admit to being a bottom -- this especially frustrating to those of us who would prefer to bottom. I am generally list myself as versatile -- I would prefer to bottom, and when I do search profiles on BBRT, I pretty much exclusively search for tops or vers tops -- I rarely even talk to versatile guys -- nonetheless, in the last 3 years 90% of the time I end up topping, because when I show up to meet this guy who claims to be a total top, he ends up deciding that he's "curious" about bottoming -- and strangely, the "tops" who are "curious" about bottoming always end up wanting me to cum in them (and I am a big cummer). Those guys should not be getting test LESS often just because they claim to be a top. But I think most bottoms out there will tell you that the number of true tops out there is much less than half of the number of professed tops.

I will also point out that the actual tops in my life seem to all just want blown, but everyone I've been with who wanted to blow me ended up wanting me to cum in their ass. So, even though I would prefer to bottom, over the past 3 years I have bottomed exactly 3 times (unfortunately, twice with a condom) but I have came in a large number of guys.

Finally, I can point you to a "straight" guy on BBRT who bottoms less than once a month, but EVERY time I have seen him on BBRT looking for tops he's traveling to one of 10 cities for work and is setting up a gangbang where he's the bototm. So, he only bottoms once a month, but his parties that I've been to each had 10-20 tops.

So, why should my negative status expire sooner (based on my bottoming once a year) than the status of the "tops" out there who are bottoming much more than I am but just don't want to admit that they are a bottom? For a large number of guys out there, there is a coming out process as a bottom beyond just coming out as gay. I would strongly suggest you set the same expiration period for everyone regardless of what they call themselves.

One other suggestion that I would make . . . perhaps put some status for other STDs -- or at least the STDs (like herpes) that don't go away. As a guy with herpes, I will tell you that I serosort because 12 years ago I gave herpes to a guy who had HIV -- we had talked about it and he was OK with the risk because I have never had an outbreak (just a doctor who was insistant on testing everyone) -- a few months later the guy ended up in the hospital for 2 weeks with no feeling his legs because the herpes virus has flared up in his spine. I will also tell you that guys on BBRT who are "pos friendly" are freaked out when I mention the herpes (even though I've never had an outbreak and I have been taking Valtrex daily for over 11 years -- though I still have to disclose it because 1/2 of the guys who herpes don't know it and 3/4 of the people with herpes get it from someone who is showing no symptoms). So, for someone like me, it would be great if you would allow me to list that status, so that I didn't have to go through the "fun" of talking with a guy and thinking I was going to get to bottom for him only to have him change his mind when the herpes talk comes up.

[Guest]

I was diagnosed May 2008, with a Vl of 47,000. Started meds in June and was undetectable by September. I've been undetectable ever since without even a blip. I'm on once a day Atripla and never missed a dose...quite easy actually....Anecdotally almost everyone I know who is on meds has been consistently undetectable...and according to the latest studies...virtually uninfectious.

[Guest]

On 3/14/2014 at 7:25 AM, Poz1956 said:

Statistical chances per sex act are only relevant to epidemiologists. They are useful in making predictions for a community overview, population wide, but meaningless when it comes to an individual. Each time a guy fucks he COULD be that ONE in the 1/XXXX chances.

Every single one of us Poz guys, at some point said, based on statistical chances, I don't think I'm at much risk.

I actually remember having that conversation with a friend in spring 1982. I didn't live in a multimillion population centre. I almost never went to the tubs. I wasn't sucking or fucking and taking 25 loads a night. Hell, I only got laid once or twice a month. I wasn't doing drugs. I wasn't snorting poppers. (Those were ALL of the risk factors back then.) I was sure the chances of me catching it were extremely low. And yes I was topping - thought that wasn't recognized as a lower risk factor back then.

Based on what we know now about seroconversion symptoms, I caught it six to eight months later.

I'm not quite sure what you're current though is. Hover over just the status Neg and get the last test date, or are you still planning a "Neg, Recently Tested" with other possible descriptors for longer periods of time since the last test?

I'm just going to throw this out there.

You were very lucky for a lot years (thank God). And now you're on PrEP so your chances are extremely low. Is your opinion on downgrading "Recently Tested" possibly being tainted by your own personal experience?

You really shouldn't give other tops a false sense of security. If you're going to facilitate hook-ups, it's better to reinforce the best testing practices, public health message. It's for the protection of all the other neg guys.

I don't think you ever want the situation where some guy says "RawTop said I didn't need to be tested yet, so I though I was Safe." In the overly litigious USA I can actually picture that as a defence somebody spews in court.

And lets be honest here, safe because a guy is on PrEP, for the foreseeable future, is going to be a very rare exception.

Most of the guys doing it raw will still be thinking "I don't think I'm at risk because _________." And they will fill in that blank with anything they can get their hands on. Especially youth, who already think they are Immune and Im-mortal. (The straight ones think they're Infertile too.) We all know they're not getting tested nearly enough.

Lets not allow them to fill in the blank with "Because BBBH says I'm not."

(I now Im-mortal is spelled wrong - for some reason it kept getting replaced with *******)

Very informative, And I also find it interesting that you are 10 years older than I am. I have always wondered How I would have made out, if I was sexually active, with other men, through the late 1970's and 1980's.  

[Guest]

hello forum, I've been chatting with a guy for scruff, his VL is 40, I would like to know his opinion on the risk of ifnectional having sex with him, either BB or with a condom

[BootmanLA]

5 hours ago, negboyslut said:

hello forum, I've been chatting with a guy for scruff, his VL is 40, I would like to know his opinion on the risk of ifnectional having sex with him, either BB or with a condom

The risk of HIV infection in his case is pretty low if that number is correct and stable (ie not changing regularly up and down, which it might if he's not diligent about his meds). It used to be that anything below 50 was considered undetectable, because that's the lowest level that could be measured at the time. Now with improved techniques, it's possible to measure down to around 25, and that's where "undetectable" generally starts now.

[Guest]

4 hours ago, BootmanLA said:

El riesgo de infección por VIH en su caso es bastante bajo si ese número es correcto y estable (es decir, no cambia regularmente hacia arriba y hacia abajo, lo que podría ocurrir si no es diligente con sus medicamentos). Solía ser que cualquier cosa por debajo de 50 se consideraba indetectable, porque ese era el nivel más bajo que podía medirse en ese momento. Ahora, con técnicas mejoradas, es posible medir hasta alrededor de 25, y ahí es donde "indetectable" generalmente comienza ahora.

thanks for your answer man

[fskn]

@negboyslut, if he takes HIV medications reliably, is in the care of a doctor, and consistently has such a low viral load (he should be testing periodically), then the research indicates no chance of HIV transmission.

The PARTNER study, done in two phases in the 2010s, established no risk of transmission within opposite-status heterosexual and homosexual couples who don't use condoms for vaginal or anal sex, when the HIV-positive partner has an undetectable viral load. At that time, the threshold for undetectable was even higher than what BootmanLA mentioned: it was 200 copies per mL of blood.

If you are still worried, you could add further protection by starting HIV pre-exposure prophylaxis for yourself. It's very likely that there are PrEP clinics in D.F. You would have the option, subject to practices in Mexico, of intermittent dosing (taking 2 Truvada pills 24 to 2 hours before sex, then 1 pill every 24 hours for 48 hours after the sex sexual encounter) or daily dosing (7 day lead-in recommended to achieve maximum concentration in blood and in rectal tissue, but no data on penile tissue concentration, for tops).

If you are curious about PrEP, you may find the US Centers for Disease Control PrEP Guidelines, 2021 updated edition, informative. The US CDC guidelines are long and technical at first glance, but they are organized in such a way that you can find answers about specific aspects of PrEP care. They reference, and are based on, the best available research.

[think before following links] [think before following links] https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

You could then compare equivalent information resources from Mexican health authorities.

One suggestion: Please don't hesitate to open a new thread with a question like yours. The present thread is so old that the information has changed significantly. When this thread was active, the PARTNER 2 study for gay men had not yet been completed. Even now, there are new developments in HIV prevention and treatment every day.

If you choose to start a new thread about a topic that was discussed years ago, you can insert a link to the old thread in your first post in the new thread. You can also add a post to the old thread with a link to the new, as a cross-reference.

Last but not least, your regular medical professional, or a medical professional at a gay-friendly health clinic, is a good resource for medical questions. Online forums are not a substitute for professional medical advice.

Happy fucking! 😈

 

Edited February 24, 2022 by fskn
Typos

[NYBBGUY58]

On 2/2/2014 at 4:50 PM, rawTOP said:

Question for those of you who are poz and on meds… How often are you not undetectable? Are poz guys on meds usually undetectable (or close to it)?

I've been thinking about how HIV status will be handled on BBBH.com and I'm thinking I won't offer "undetectable" as an option. Instead, like here, I'll just have "on meds" available. If people want to say more about status they can do it in the text of their profile.

But going a step further I'm going to simplify the search options and let guys search by risk level, not by particular HIV statuses. I'm thinking "low risk" would be the neg guys on PrEP plus the poz guys on meds. But if poz guys on meds often aren't undetectable, then being on meds may not make you low risk.

So talk to me about viral loads while on meds. Are you undetectable (or close to it) most of the time while on meds?

I have been mostly undetectable or very low viral load for about 5 or 6 years since I switched doctors. One guy who I topped bare was a nurse, and his benchmark was anything below 1000(?).  I had been consistently lower than that for years on the prior medication regimen, but with the current set of meds, I don't think my viral load has gone higher than 40, perhaps 60. For reference, less than 20 is when you're now considered "officially" undetectable.