Very Inexperienced Question?

[MaxC]

I guess I qualify as a bisexual "top" who has only one experience topping with a condom. 

 

I want to meet a FWB and get into a barebacking scenario, but still want to be as safe as possible.  I do not want to get HIV.  I know as a cut top the risk is low, but I still need some advice.

 

1. Say I meet a partner(who admits to barebacking before but tests negative), we take an HIV OTC 20 minute tests prior (which I think are readily available?), and we are both neg.  Is it possible that my bottom is still HIV pos, and not showing on the test (assuming it is accurate) ? 

 

2. So he shows neg, and we enter into a fully monogamous FWB barebacking arrangement, and assuming he is not cheating with a pos, should we still test routinely due to the possiblity of HIV becoming more active at some point (if he was pos and undetectable prior?)

 

I am more than willing to pay for the home tests prior to an episode, as I am that concerned and fearful of becoming a pos.

 

Thank you for your time and concern regarding this. 

 

[Poz1956]

All HIV tests have a window period.  That's the time between an infection, and a possible Poz result.  Tests that look for antibodies have a longer window period.  Some people who catch HIV start producing antibodies later than average. Around 90+% of people with HIV will test Poz by six weeks after exposure.   More than 99% will test Poz by three months.  Here are the window periods most of the tests in use.

 

Pooled NAT RNA test = 10-14 days  (Only available at specific clinics in some large cities)

Fourth generation Antibody / P24 Antigen test = 3 weeks (Vial of blood drawn ans sent to a lab)

Third generation Antibody test = 4 week (Vial of blood drawn ans sent to a lab)

Rapid Antibody tests = 5 weeks (Tiny drop of blood from a finger prick - Test time ranges from >1 to 20 minutes
Western Blot test (usually used to confirm a Poz result) = 6 weeks

Oral fluid Antibody test = 6 weeks

 

While I can see where for a first time encounter the OraQuick test is attractive, it's also the assay with the longest window period.  A lab test is much better than an OraQuick.  You interview process might need to include how long since his last sexual activity.  Between the test, and too much interview it might kill the buzz, and you might end up with no nookie.

For your second question, ALL gay men should get routine testing a minimum twice a year.  If they're very active four times a year.  Lab test are better than home tests.  The tests should include all the other STIs too.  (Blood test for HIV, Syphilis, Hep A,B & C -- First Void urine sample for Gonorrhea & Chlamydia -- Throat and Ass swab for Gonorrhea & Chlamydia)  If you're not vaccinated against Hep A & B get it done now!  Hep B is 50-100 more transmissible than HIV, but nobody asks about it.

 

Here's an HIV 101 fact that I'm sure you don't know.  A person who acquired HIV very recently (within the last 2-3 weeks) is at their most infectious.  As you can see from the window periods I listed, depending on which test is used, that newly Poz guy could still test Neg, but have a very high chance of transmitting the virus.  He'll have a viral load that could be as high ans 10,000,000 viral copies per ML of blood.  Some estimates are that about 54% of new cases of HIV are caused guys in the acute phase of infection (first three months).  Another 30+% are from guys who have transitioned to the chronic phase of infection with viral loads in the 30,000 to 120,000 range, but they don't know it because they haven't been tested recently.   Only about 20% of guys are getting tested per annum.

Your safest bet would be to hook up with a guy on PrEP.  He's on an HIV prevention pill, and gets screened for HIV and other STIs every three months.  (Or you could go on PrEP.  You don't say if you're a married Bi guy.  That might be hard to explain to the wife.)

 

I'd be willing to bet that like most Neg guys, you think that playing with a Poz guys has a transmission risk of between 50% and 100% per encounter.  Since our standard campaigns have never discussed this, people have an extremely infatuated sense of risk.  From a Poz guy in the chronic phase of infection, the "High Risk" described by our prevention campaigns starts a 1.4% per exposure to a bottom and go down from there.

What we know about HIV has changed tremendously over the last few years.  Quite literally there is a complete paradigm shift happening.  Some of the things our standard prevention campaigns have always taught, turn out to be wrong.  Due to the window periods, high viral loads, and low testing rates mentioned above, the standard advice to "Always ask status" (serosorting to Neg guys, and rejecting anyone who tells you they are Poz) can actually INCREASE your chances of catching the bug.

You're probably going to think I'm crazy, because the next bit runs contrary to everything you've been taught for the last 20+ years.  The science is sound on this, and I can provide dozens of links to back it up.

 

A Poz guy who is on treatment, and has had an undetectable viral load for more than six months, is only bettered on the safety meter by a guy on PrEP.  It's ironic that us undetectable Poz guys, who Neg guys fear the most and immediately reject, are turning out the be the ones least likely to infect them.

 

They call the concept Treatment as Prevention (TasP).  The concept of TasP is simple: Get as many people tested as possible. Start the ones who test Poz on treatment as soon as they ready to commit to the daily medication.  Treatment lowers their viral load.  A low viral load means they are less infectious. When their viral load reaches undetectable, they are for all intents and purposes, not able to pass on the virus.

 

You will start to see education campaigns featuring this idea within the next couple of years.

 

I'm a little too tired to write too much more at the moment, but I'll leave you with homework of reading the document I'll link to below.

 

In September, the Australian based HIV service organization ACON issued a position statement titled  "What is Safe Sex?" (They choose to use the word Safe rather than the more widely accepted Safer)  ACON's area of responsibility is Sidney, and the rest of New South Wales.  In it they put Condomless sex with a guy whose viral load is Undetectable, Comdomless sex with a guy on PrEP, and sex with Rubbers all on an equal footing.  They are ALL safer sex.
www.acon.org.au/sites/default/files/What-is-Safe-Sex-Position-2014.pdf

[MaxC]

Thank you so much for taking the time to write that I think I need to read it again to fully understand it!  A lot to review-

 

So only certain tests reveal pos/neg only during certain time periods?  So to be sure, one would need a battery of tests and a six week waiting period to properly determine status?

 

So is it possible that sometime in someone's life, they could unknowingly contract HIV, never know it, and never pass it as well?  And years later still not be detected?

Edited December 13, 2014 by MaxC

[Guest JizzDumpWI]

Max, taking this to bottom line...  If you serosort to POZ guys who have been on meds for some time (6months at least, a year+ better); and assuming there is a reason you are not on PreP yourself, you'll be least likely to acquire HIV.  

 

If a "neg" guys is not on PreP; you really have to interpret that information as "status = unknown".  

 

If everyone on the planet did this; new infections would plummet to virtually zero.  

 

Thank you so much for taking the time to write that I think I need to read it again to fully understand it!  A lot to review-

 

So only certain tests reveal pos/neg only during certain time periods?  So to be sure, one would need a battery of tests and a six week waiting period to properly determine status?

 

So is it possible that sometime in someone's life, they could unknowingly contract HIV, never know it, and never pass it as well?  And years later still not be detected

[Giftundpozempfangb]

Do what you want, whether condom or without as a top you it determines whathappens. Without if or but, so do what you like

 

[Pitt1988]

Dont listen to giftundpozempfangb, he hasn't taken into consideration that you are BI, meaning who knows in the future you may want to settle down and get married and most importantly have kids, if you become poz; it will be almost impossible to have kids; that is something you want to think about, me as a gay man, when all of my friends where out giving and taking loads, and living for the moment, i decided to wait it out, even though im a top; slipped a few times, but i decided to wait it out till something like PREP came along; now my wait has paid off and i can pursue endless barebacking adventures worry free, now most of my friends are poz, and riddled with health issues, such as high blood pressure, inflamed lymp nodes, and they catch the flu like a cat catches a mouse, make the smart decision and go on prep; 10 years from now you will be happy you did. 

[MaxC]

My future does hold a woman and children.  I just desire to fuck bare and seed a man regularly in the same situation.  This might just be a once in a life time thing, and if it works out well very long term.

 

But safety is my primary concern, and I seek to mitigate it through OTC testing.  So OTC aids test is negative right there in the bedroom, and we fuck, what are the chances of HIV being present in my partner?  Sorry if I appear obtuse; I appreciate your input on the subject.

[drscorpio]

That's not really an answerable question. If his OTC test is negative, you can be almost certain that he was uninfected 6 months ago, you can be reasonably certain he was uninfected 6 weeks to 6 months ago, but it tells you nothing about what has happened in the last 6 weeks. Guys who believe they are HIV- even with a test you just took are always a crap shoot because if they are recently infected (the last couple of weeks), they will most likely be very infectious with huge viral loads. 

 

Your safest approach would be to go on Truvada for PrEP which would essentially eliminate your risk or to only fuck guys who are HIV- and on PrEP. You next safest approach would be to only have bare sex with guys who are HIV+ but in treatment with an undetectable viral load; these guys cannot infect you.

[hungry_hole]

Because MaxC is in a relationship with a woman or plans to be in one with the ultimate goal of raising children, HIV should not be his only worry. Herpes, Hepatitis and many others are also of concern. Some infections affect women in ways that they can never bare children.

[MaxC]

I am currently single and STDs would be a concern with either sex. 

 

So how does one detect a recently infected person? 

 

OK so we go to clinic, would a blood test know a recent infectee?

 

Again thank you for you responses, it seems NO ONE IS talking about this on the hetero side!!!

[MaxC]

So is there a test that works within weeks of infection?