“Seed is a gift, it’s love, it’s acceptance. Taking a man’s cum – in your ass, down your throat, rubbed into your skin, whatever - even if you don’t know his name, is closeness. It’s an act of love and trust.  Even if yawl just met. Both the bottom and the top will walk away smiling . . . and content. Now it’s a sleazy affair that boys get cracked out of their mind for. Like it’s an embarrassing nasty secret thing to want. This is so fucked.”

From HIV-positive bareback blogger Geek Slut, quoted in "Unlimited Intimacy  . .". .

Recently writer Tim Dean gave a presentation on the subculture of barebacking and its mores to an attentive audience of 200 at the Gay Men’s Sexual Health Summit in Toronto.  PositiveLite.com editor Bob Leahy caught up with him afterwards and sat down with him for this frank talk.

Bob Leahy: Tim. Thank you for talking to PositiveLite.com – and welcome to Toronto. I’d like to talk to you about your book first of all.  Tell me, how did you come to write about barebacking? What interested you there?

Tim Dean:  I came to write that book because I was living in the Bay Area of San Francisco and I was going out a lot and having a lot of sex – this was in the late 90s – and what I encountered in public sex environments were lots of guys who wanted me to cum inside of them. There was never a conversation about status, there was never a conversation about condoms, and I realized fairly quickly that this was something new in the history of the epidemic that I needed to think about — to think about what was involved and what had changed.

There is a substantial body of research that went in to the book.  Tell me about your research method.  How did you gather the information - through conventional methods?

I would say they were not very conventional methods. Much of the information was what I gleaned from personal experience, that is, hanging out in sex bars, sex clubs, bathhouses to a lesser extent, and also talking to people. That’s something I do in my life and I was using that material to reflect on. I also got very interested in bareback pornography and was able to use my training as a critic to analyze what is going on in this kind of pornography, what makes it different from other kinds of pornography.

Let’s talk about the bareback porn industry in a minute. Writing the book, you chose very consciously to be non-judgemental, is that right? You could have injected your own views in to it, but you chose to be descriptive.  Why did you do that?

That was a very important decision on my part, influenced by two things. One was to take a kind of anthropological approach to the study of sexual subcultures, where you limit what you can learn if you decide ahead of time whether something is good or bad, positive or negative. The other was a kind of psycho-analytic influence where the suspension of judgment allows thinking to achieve its full potential so that it was very, very important to me not to judge.

And what was the reaction to that approach? In your refusal to judge, did people think it sounded like you were endorsing barebacking?

Yes, some people did. And the fact that I wanted to write about this subculture without judging it and on the other hand saying that I’m also participating in this subculture, the refusal to judge was often understood as a kind of backhanded way of endorsing or excusing what I was doing.  I didn’t see it that way at all.  For me, it was an ethical decision to suspend judgement. Some people got that.  Some people read it differently.

So did it feel comfortable writing from the perspective of a participant in the barebacking culture? It’s kind of brave, I think.

It seemed sort of inevitable, in the sense that a lot of what I found out, I found out by doing it. Certainly in the literature I read at the time on “unsafe/unprotected sex” it was always assumed that somebody else was doing it, it was others who barebacked. It was very important to me to dispel that illusion. I was not going to be closet-y about the fact that I was barebacking. There is still a stigma attached to it and it’s hard to come out as somebody who enjoys bareback sex. But I don’t think we actually get anywhere by pretending we are not doing things . . . 

OK, let’s talk more about this. We haven’t defined barebacking.  Are we talking about people who identify as barebackers, part of a barebacking culture, or people who slip up occasionally - or both?

I used the decision when writing the book to use the term “barebackers” very broadly, to cover both the subculture and also people who may not consider themselves ‘barebackers” but who sometimes or occasionally do have sex without condoms, or want to have sex without condoms. It’s too easy to place the blame on a small subset who are very committed barebackers and I wanted to avoid that by using the term broadly.

I wanted to ask you about the allure of barebacking. There are so many stigmas and potential risks, why do people do it?

I think there are lots of reasons. The first and most obvious is that men often prefer sex without condoms, it feels better . . .

You called it “enhanced genital stimulation”.

Yes. That’s the most obvious reason. Beyond that there are all the meanings that are attached to exchanging semen, to receiving someone else’s cum. I think HIV prevention discourses have not been very good at acknowledging how important semen is to gay men – their own and other peoples’. Sometimes you want lots of guys’ semen inside of you.

Well, you’ve talked a lot about disgust with bodily fluids, and you mentioned spit as an example, but semen must be the same kind of thing, that we have a sort of love/hate relationship with it - in that in some contexts these fluids are very hot and in others they disgust us.

I think that’s true. I think that semen, because of HIV and the epidemic, has become even more loaded with meaning, in becoming dangerous, in becoming dirty . . .

Toxic.

Yes, In becoming toxic it has become potentially hotter. That is, on the one hand we are told we must absolutely keep it outside of our bodies, and on the other hand it becomes something very exciting to get inside.

Well, let me throw out a quote from you on that. I think you said “the fact that sex may be unsafe may be the sexiest thing about it.” Is that true?

I think for a number of people that’s absolutely the case. It’s a mistake to think we don’t like risk. Risk can be very exciting.

I suppose you can think then of public sex. We think public sex is very hot because we might get caught. But are we saying bareback sex is hot because we could get infected with HIV?

In some cases, yes. Your question makes me think of straight couples who like to fuck in the bathroom of a plane. There is a risk involved, it’s not comfortable, maybe the sex isn’t all that gratifying because of the conditions, but there is a risk involved which makes it very exciting. And that translates for some gay men in terms of HIV too.

Is the transgressive thing important in bareback sex too, the chance of something bad happening.

Yes, and also stepping away from being a normal responsible adult in our society, and everything that goes along with that. You know part of the appeal of public sex is that it happens outside the house, it happens in a space where someone can be somebody different. Therefore it’s hot. We are also inundated with safe sex messages and sometimes for that very reason stepping away from that and doing something that is “unsafe”,  that’s ”risky”, can be the hottest thing to do.

The other allure you’ve described is in the title of your book. “Unlimited Intimacy.” That’s important for barebackers, isn’t it?

Yes, I think it is. Men who have a lot of casual sex with a lot of casual partners are not in flight from intimacy but actually searching for a particular kind of intimacy. The phrase “unlimited intimacy” came from a barebacker in an interview I read and that seemed to me to be a perfect way to encapsulate intimacy beyond the couple.

So there is nothing more intimate for some people than exchanging bodily fluids?

Right.

Sometimes we talk about casual sex, but it sounds like what you’re describing is very intense sex.

It’s incredibly intense. It’s very meaningful, completely spiritual. If you are having sex with a bunch of strangers, group sex can be something that feels like communion.

I think you’ve mentioned too in the book that there is very much a sense of belonging.

Sure. It’s about finding and making a community with people you don’t necessarily need to get to know to be part of.

OK I want to find out about barebackers and what is their relationship to risk. I think what you say - and this is probably grossly simplifying – is that this is an equation, where barebackers recognize the risk, but then balance it against the pleasure. Is that what’s going on?

Sure, I think that’s part of it. But one of the other things I want to add that’s going on is that the majority of barebackers do NOT want to infect sero-negative guys. They are not trying to put other people at risk. They are interested in an experience of risk for themselves that is maybe more a risk in fantasy than in actuality in some cases.

So they do care about the possibility of HIV transmission?

Yes.

Do you think people think they don`t care.

I do. It's hard for people to wrap their heads around the fact that people can be barebacking and still wish to reduce transmission. I think it's a mistake to think about barebackers as simply irresponsible hedonists.

Tell me why you’ve been using the word “disgust” a lot lately.

I’ve become very interested in disgust for various reasons.  One, in the world of academic theory I inhabit, people don’t talk about disgust, they talk about shame. Shame is connected to identity.  For me, disgust is connected to acts and in order to have a discourse about sexual acts we need to think about and talk about disgust.  Disgust is really complicated because disgust in the context of food simply pushes you away from food.  Disgust vis-à-vis sex or bodily fluids can draw you to those things. Sometimes sex can be intensified by doing things that you actually feel can be kind of disgusting.

Or that other people find disgusting?

Which is why large amounts of bodily fluids, especially semen, are important in the subculture and within some of the porn. One of the things that interests me is that some people find “sloppy seconds”  disgusting, that is using multiple loads, using cum as lube. But a lot of guys, including straight guys, find it very hot.

And isn’t it a staple of bareback porn? I’m thinking of the porn classic Dawson’s 20 Load Weekend?

Absolutely.

Tim, I think one of the take-home messages I got from listening to you is that if we find an act not to our liking, it becomes morally wrong.

I want to make the distinction between moral disgust and sexual disgust so that we can hold on more tightly to the idea that just because you don’t like something does not make it morally wrong. That seems to me very important.

Is anything morally wrong in sex?

Absolutely.

Give me an example of what is morally wrong in the context of barebacking?

I think coerced sex is morally wrong. I think lying to people is morally wrong. I think treating people badly is morally wrong. The ethics have to do not with the act you are actually doing, but how you treat your partner. To me it’s very important in the book — and in my life — to understand that other people are not objects to be used for one’s gratification. Other people are not sexual commodities. We may play out a fantasy in which I use you as my sexual slave and we both may enjoy that, but within the broader context of our encounter I treat you like a human being with respect, etc.

Let’s talk about the breeding, gift-giving subculture. Some people have played it down and suggested it’s mostly fantasy and that it’s very hard to track down real bug-chasers for research, for instance. Is this really a big part of bareback culture?

It’s certainly a big part of the fantasies that animate the subculture. In that way it seems to me important. I think in the process of writing the book and when I was giving lectures, people wanted to know, “How many gift givers, how many people are there out there doing this?” I don’t think that can be answered because the fact is it’s a very exciting fantasy for a lot of people but how that translates into practice is very, very hard to know.

But are there some people out there who really want to be poz?

I think so, yes. They see being poz as an inevitability, as giving them licence to bareback without worrying.

How do you feel about that?

Well, I think part of the reason I want to talk about fantasy is not so much that I’m psycho-analytically oriented – although I am – but because American culture does not have a very good way of talking about fantasy. Therefore it does not have a very good way of distinguishing between what is a fantasy and what is something you actually want to do. I’ve done some work on this around rape fantasies.  A lot of people have a fantasy about being raped, but that doesn’t mean they want to be raped. It means they want to enact a fantasy; and it seems to me you can make an analogy with guys out there who say they want to become poz.

OK, I want to talk about bareback porn.  It’s very different to mainstream gay porn, isn’t it? It looks different, I’m thinking in particular of Treasure Island Media  (NSFW link) which has a home-made feel. Actors can be overweight, older, not conventionally attractive. Why is that?

I’m very interested in Treasure Island Media and Paul Morris’s whole politics, ethics and aesthetics of making porn. He sees himself as a documentary pornographer, documenting what guys are already up to and therefore the guys in his films should not be some kind of fantasy ideal with perfect bodies.  

They should look like us?

They should look like us. They should look like the guys we are and the guys we meet.  Some people don’t like his porn for that reason.  They say the guys in it are ugly. That’s not my view on it. The range of body types makes it real.  It makes it hot. It’s clear you can be older, overweight, you can be hairy, you can have an imperfect body, you can look like a poz guy – and still be a porn star, still be the subject of sexual pleasure. That’s important.

Do you have any views, Tim, on the role of barebacking porn in encouraging or stimulating bareback behaviour?

People want to be able to draw a very clear line between pornography and behaviour – and I don’t think you can draw that line. I think it’s been proven again and again that watching pornography, of whatever kind, will not simply translate into imitating those behaviours. It’s not that pornography has no influence. Of course it has influence over what we find exciting, what our fantasies are.  But what interests me is that even with this iPhone you are recording this interview on we can go in to the bathroom and make pornography and put it on line . . . .

Want to?  (laughs)

(laughs) So that is to say we can all — and lots of people do – make our own porn and put it on XTube and I think that’s an incredibly interesting development.  We can all be pornographers.  If you don’t like the mainstream porn that’s out there, make your own porn – and I think that’s a great thing.

OK. I want to finally get to the intersection between barebacking and HIV prevention efforts. The language of HIV prevention uses words like “intervention” and “counselling” which essentially relate to efforts to change behaviour, or even stop various behaviours. Is there any scope for the world of counselling and interventions to interact with barebackers or do they have their own rationale for what they do and have made up their minds? Are the two worlds apart?

I think there is space for an intersection. When I wrote the book it was very important for me to not to write about barebacking with the desire to understand it in order to stop it. I do think, though, that what counselling offers is a space to think through what one’s desires are, what one’s fantasies are. I think to the degree that counselling makes a space available to sort through the confusion that all of us have in our minds about sex, desire, desirability – that’s good. But if counselling goes in to a situation with the sole attempt to stop something, then it closes off the space in which people can figure out their lives and what kind of sex they would actually like for themselves.

What we’ve seen here is applying a harm reduction approach to barebacking in terms of talking about techniques that might reduce the risk of transmission.  Does that make sense to you?

Yes, it does. But I don’t think it’s all or nothing.  For a long time it was pitched as “use condoms all the time or you are going to become a crazy reckless barebacker who is going to become poz and spread the virus”. It’s not either/or. Thinking in terms of harm reduction makes much more sense.

That’s likely a good place to end.  Tim, thank you so much for talking to us.  You’ve been incredibly honest and forthright about something that challenges many of us.  This has been so useful. It’s been a real pleasure talking to you.

Thank you, Bob

Tim Dean’s book “Unlimited Intimacy, Reflections on the Subculture of Barebacking” is available on Amazon here. 

Tim Dean is professor of English and director of the Center for the Study of Psychoanalysis and Culture at the University at Buffalo. He is the author or editor of several books, including Beyond Sexuality, also published by the University of Chicago Press.

This article was originally published in TheBody.com here

An undetectable viral load: the point at which HIV, though still present, cannot be found in a person's blood with the most sensitive tests available. It's a powerful concept with profound implications to the life of a person living with HIV (and his or her partner). However, according to CDC's treatment cascade, for a host of complex reasons, 75 percent of people living with HIV in the U.S. have not reached the point of viral suppression. (Among some specific groups in the U.S., that number is even larger.) For many of those that have, reaching that point was a major milestone in their lives. We asked people living with HIV to contribute thoughts and stories about getting their own viral loads to undetectable.

Minister Rob Newells, Oakland, Calif.; Diagnosed in 2005

Reaching undetectable never seemed like a significant milestone to me. I waited for my CD4-cell count to drop below 400 (about 18 months after my initial diagnosis) before I made the decision to begin antiretroviral therapy. My viral load, which was never extremely high, has been undetectable on every test since I started HIV meds in 2006.

For a long time, I thought viral suppression was a normal result of taking the medications. I expected nothing less. The HIV treatment cascade was a visual wake-up call that I am in the 25 percent minority. Clearly, we have much more work to do to increase retention in care and adherence to the medications that both improve the health of people living with HIV/AIDS and help to prevent transmission of the virus.

Meta Smith, Baton Rouge, La.; Diagnosed in 2001

At the time I was told I was HIV positive, I was placed on meds and did not have any idea how being undetectable would help me. When I had been on the meds for at least three months I returned to the doctor after lab work and was told I was undetectable. I knew I was feeling better after the meds; but after being told what undetectable was and how it would affect my life, I need to say I was on TOP OF THE WORLD and have stayed that way since then. It meant the world to me and changed my life, for the better. I got busy living.

Nelson Vergel, Houston, Texas; Diagnosed in 1986

I'm on the last combination I can try. I take a lot of pills. ... There's a part of me that's been very frustrated, extremely frustrated, with the fact that I've had it really hard when it comes to HIV. I've never had an undetectable viral load until three years ago ... Twenty-six years with virus in my blood, no matter what I did, no matter how many conferences I went to, no matter how many papers I read ... I felt like a loser, like a failure -- really, they call us "failure patients."

Watch Nelson's full "Day in the Life" video.

Bernadette Berzoza, Denver, Colo.; Diagnosed in 1989 

Over the past few years I have really fought and struggled to get my viral load down. It's been 23 years that I have been positive, and in the beginning it was just keeping your T cells up. Then the viral load was added. I was so freaked out when they told me my viral load was in the millions and we needed to change my meds to get it to undetectable. I did what was recommended but it wasn't working for me as they thought it would.

Read Bernadette's full story of getting her viral load down after many years.

Joe Ohmer, Bronx, N.Y.; Diagnosed in 2002

Eight months after I was diagnosed with HIV, my gastroenterologist that was taking care of my liver issues did some blood work, and my HIV viral load was undetectable without any medication. I didn't realize that that was anything significant or insignificant at the time, until maybe eight or 10 years later when my GI doctor mentioned it to me. I went on a regimen of Epivir (lamivudine -- also used to treat HIV, in different combinations with a higher dose) and Hepsera (adefovir) for my hepatitis B, which since I've been on it has been undetectable as well. Except for one blip, my HIV viral load has been undetectable.

Recently, my GI doctor, who's the same one who saw me initially, brought up that I was undetectable before I went on any regimen.

Read the rest of Joe's unusual story of being undetectable without medication.

Melissa Baker, Mechanicsville, Va.; Diagnosed in 2007

I was diagnosed August 2007. By January 2009, I made the count-dependent decision to start meds. It took me longer than three months to become undetectable. If it had taken me any longer my provider was going to change my regimen, fearing a possible resistance. The day I heard "undetectable" finally came before he had to, and my virus has remained undetectable since. :) I was ELATED!

Reggie Smith, Atlanta, Ga.; Diagnosed in 1984

After being sick in 2005, I have been taking the antiretroviral combination that has kept my virus at undetectable levels, and allowed me to enjoy really good health. With God's grace, and enough desire to live well, I have been able to adhere pretty well to this regimen. My oldest granddaughter was 2 years old at the time. Now she is 9, and I have two other granddaughters, a grandson, and a set of boy/girl twins! I play softball and golf, take flying lessons, I am of service to my community, and I am blessed to share my experience and hope with you.

Read Reggie's full story of coping with being tired of taking HIV meds.

Lillibeth G., New York City; Diagnosed in 1992

When I was told my viral load was undetectable I felt 100 pounds lighter. My greatest challenge was getting to an undetectable status. I had multidrug resistance so getting to undetectable was a milestone.

I was diagnosed in 1992 and it was difficult for me to adhere to my treatment since I was in denial and angry at myself (I should've been more selective of my partner). During one of my doctor visits he found a clinical trial I was able to join for both Isentress (raltegravir) and Intelence (etravirine). I was determined to bring my viral load to undetectable since I have so much to live for; I needed to live for my son, my mom (she was alive at the moment), myself most of all; I have things to do, people to educate. After a 17-year fight, I got the GOOD news: "I'm undetectable!" It makes me feel so alive.

I have a whole new look at life: I'm going to live; I have a fighting chance. Now I can talk to others about the importance of getting to that point -- it gives you hope. I'm always smiling and laughing; life is so different for me now -- I have HOPE.

Pastor Andrena Ingram, Philadelphia, Pa.; Diagnosed in 1989

THAT was another day, I remember with clarity. Waking up and dreading my doctor's appointment, because I knew I was going to get my blood-work results, and because I was about sick and tired of injecting myself. I was tired of Fuzeon (infuvirtide, T-20), I was tired of medication, I was just tired of it all.

I sat down in her office, and she pulled out my chart and looked at the labs, and smiled. I was like ... OK, what is my CD4? And it had been explained to me months before that they were beginning to look at this thing called "the viral load" ... and how that was more important than the CD4 count. She told me what my CD4 count was, which had peaked a bit ... but she was still smiling. And then she said: Guess what Andrena? Your viral load is under 50 copies! She was cheesin'! Grinning from ear to ear! I still didn't understand what that meant, until she stopped grinning long enough to tell me. That it meant that the virus in my body was undetectable …

Even though she explained it to me, I still didn't quite get it, until a few days later ... my mind had to process it. It meant that the Fuzeon was working. It meant that I was NOT gonna die (anytime soon). ....

I was ecstatic!

Read Pastor Ingram's full story of getting to undetectable.

Shannon Southall, Denver, Colo.; Diagnosed in 1992

February 1996, four years after being given my HIV diagnosis, I found myself lying in a hospital bed, and hearing that I now have AIDS. My CD4 count was 131. I needed to add more medication. When I was initially diagnosed in 1992, I had 896 CD4 and my first doctor put me on AZT monotherapy. After a friend found an infectious disease specialist I was switched to Zerit and Epivir.

Now lying in the hospital my doctor came in and said there was this new drug available called Crixivan and he strongly recommended that I add this to my current regime. My viral load was 159,000 and these new meds show that they can reduce the virus in my system, therefore prolonging my life. So of course I said yes. By August, my viral load was undetectable, less than 200, and my CD4 count was finally up over 200. ...

A few years ago I started to wonder about switching or stopping meds for a while. Then I met the man who would become my husband. He is HIV negative and I know that keeping my viral load down is crucial to maintaining a healthy sex life and reducing the risk of transmission to him.

Read Shannon's full story of 21 years on HIV meds.

I hadn't talked to my cousin David in close to fifteen years.  This phone call was a flashback to when we were both living in Manhattan in the 1980’s and our frequent dinners eating cheap Chinese, talking non-stop and laughing with our mouths full of food. 

We had an unusual way of deciding who would pay for dinner. He was a commercial photographer and we'd meet at his studio in Manhattan’s Photography District, near the famous Flatiron Building.  

We’d hang out on a corner of Broadway for five minutes and have a contest. Whoever spotted the most cars filled with Hasidic Jews heading downtown to Brooklyn would get a free meal.  No doubt this sounds odd if you don’t know Manhattan, but there are lots of Hasidim especially in that part of the city and because of their close-knit community – both at work and back home – cars filled with bearded men in black hats were not quite but almost as common as taxicabs. 

On the phone we spoke for nearly an hour, catching up on the last fifteen years. Work, his kids, my writing, our parents, the old days, the recession - and then he asked about my health and I told him how good it was.  

"Do you know how lucky you are," he said, repeating it twice. I readily agreed, knowing that he too had many other friends who died hard deaths. We acknowledged the unfathomable randomness of life.  We discussed my great fortune and other friends, those who had it all only to be struck dead, without warning – Jake while windsurfing, Stan a vicious type of brain tumor, others from car wrecks, kidney disease and other maladies.  

I don’t always feel lucky so the reminder was a gift, one that I’ll take as I head back to New York for my 30^th college reunion in June.   

I’m excited to go. I’m looking forward to it, but wish I had more on my resume. Among the friends I’m excited to see for the first time in decades are a U.S. Congressman, a lawyer who is one of the leading activists in the fight for marriage equality, successful artists and professors too.  

And me, a writer who spends too much time not writing, with declining freelance revenues that have led me to anxiously scour Craigslist looking for more catering work, gladly serving and bartending even though I’m making the same hourly wage I made when I catered between jobs in the late 1990's.  

Swiss Chard Beggar’s Purse, Maam? 

I like the work if not the pay, but passing kobe beef sliders, swiss chard beggar's purses or pouring cocktails isn’t a bad way to make things happen. I’m proud of my resilience, my ability to put things together to pay the rent even while I am occasionally embarrassed by seeing people I know who are surprised to see me holding a tray of champagne at a wedding reception.   

After all I’m the guy who drove a taxicab in New York City after graduating from college with honours. The guy who never worried much about earning money for the future, a creative sort, who didn’t fit in the box.  

Sometimes I can’t sleep and lie awake worrying about everything from the NY Mets bullpen to what will happen when I’m too old to work. I wish I’d done things differently, made more money and saved it, bought a house, wore suits to work, could take vacations every year. Was my lack of concern about money because my upper middle class upbringing left me deluded that things always work out or because I thought I’d be dead before I reached 40? 

Would whoever threw up in my bed clean it up? 

A month ago I lost my black necktie, the one I need for catering and was enraged at my carelessness. It would cost me another $7.99 at Ross Dress for Less to get a new one; that’s half an hour’s pay. I berated myself for the stupidity. My fury got worse. The only one Ross had in stock cost $16.99, $18.48 with tax. Determined not to spend that much I spent two hours scouring half a dozen thrift shops looking for a bargain before I returned to buy it.  I found the missing tie the following week.   

I frequently joke that I have my retirement plan almost in order. It has four parts, and three are taken care of. The three pieces in order are a hot plate, a space heater and an inflatable aero-bed. The only thing missing is a friend with a garage I can live in that has an electrical outlet that can support all three appliances without blowing a fuse. I'll be the old guy sweeping the sidewalk in front of their Victorian, whom the neighbors bring leftovers too and kindly listen to my stories about the old days, before getting away relieved. 

In college, early in my freshman year, I earned the nickname "Ralph". If you don’t know the slang, to ralph is to vomit. By October I had twice thrown up and blacked out.  When I was told I was the one who puked in the shower I thought it wasn't true because the guys in the dorm figured I was wimpy and would clean it up without much debate. The second time I woke up on a Saturday morning smelling of vomit, furious about the fact that someone threw up in my bed. 

When my roommate said it was me I didn't believe him.  After all I wasn’t a big drinker, had never listened to Neil Young before college and wasn't a sloppy drunk. 

Of course I was the culprit.  But lucky for me, my stomach couldn’t handle too much booze and despite the roster of world-class drunks on both sides of my gene pool I was spared the family affliction of alcoholism.  

Though spared the fate of becoming a drunk, the nickname lasted all four years of college. There were people who thought that was my name, including Fran, one of the nicest of the sweet ladies who worked in the dining hall. 

On graduation day she was beaming as she gave me a hug. 

“Ralph you were one of the nicest kids I ever met.  I hope life treats you well.” 

It has. Even if I’m passing trays of champagne and sleeping on an inflatable mattress in someone’s garage when I'm old it has treated me very, very well.  

Oh yeah and if you need to borrow a black necktie, let me know.  I’ve got an extra.

The challenge for the new Safe Sex 2.0 effort will be trying to capture the attention span of someone who lives life and thinks in 140 characters. In this Internet age, we in the HIV+ and HIV- community (basically that is everyone) have been given the dual-edged sword of the internet as a tool for advocacy and outreach.  The internet is definitely useful in finding the answer to almost anything, and it has exponentially increased the means by which information can be disseminated to the masses.  However, the internet has also created vast, huge, and deep canyons between us, where we are only as connected as our wi-fi signal allows us to be. 

Back in the “old days”, we in the older gay community used to go to gay bars.  At those gay bars there were bowls of free condoms.  They were right there on the bar or by the door so that they were always on hand. Back then, we cared about protecting our community.  Back then it was not as controversial or offensive to talk about or insinuate safe sex. Safe sex was viewed as a normal, healthy part of the greater gay conversation. 

At some point though, this changed. Bars are no longer the meeting places of gay men.  Grindr, Scruff, and Adam4Adam have taken their place. Face to face caring was replaced by the cold glow of a computer screen.  Our community became diffused and fragmented and it dispersed like smoke in the wind. There were always those that didn’t go to the gay bars, just as there are those who do not go online today, but they were in the minority I believe.  

Our sense of community has been replaced by a transactional approach, where one’s personal opinions seem to trump the collective wisdom that has been tempered by experience.  Collaboration and compromise have been thrown down the toilet, to be replaced by the louder squeaky wheel of personal, selfish freedoms.

Now, if you were to talk about safe/safer sex or condoms, a method that is clinically proven to reduce HIV and other STDs, you are yelled at, or someone posts a pages long diatribe about how out of touch you are, and how it is their God-given right to have unsafe sex. They pull one tenuous statistic (that successful HAART treatment prevents 96% of HIV transmissions) and they have built an amendment to the sexual constitution, much like gun proponents clutch onto the 2nd Amendment. They ignore the fact that an undetectable viral load in the blood is NOT equal to an undetectable viral load in semen or in anal fluids/tissues. 

And so, the uninformed and unwilling shun proven methods of safety: condoms, HIV testing, non-sexual forms of intimacy.  (Apparently in the age of Grindr, intimacy seems to be an outdated concept as well.)  And then when they contract HIV, they then have this sense of confusion and incredulity, knowing in the back of their mind that they knew their risk all along but chose to ignore it and live in the moment.  There is even a hashtag for that, #YOLO (You Only Live Once).  

Because one in five urban gay men do not even know their HIV status, it is imperative to again find a way to encourage HIV testing and to advocate condom use. People proceed with actions based upon their perception of risk, as opposed to the actual risk at stake.   Stigma is still very high and the pervasive HIV stigma within the gay community (as well as outside of the gay community) prohibits those at the highest risk for HIV from getting tested. When those at highest HIV risk continue to contract the virus year after year after year, there should be a more aggressive approach to HIV testing and condom use.   

It is ironic that studies have shown that when a person is diagnosed with HIV, that person’s sexual behavior becomes safer. They care more about not wanting to infect others. But on the flip side of that is the callous carelessness that pervades young gay men, who believe their greatest source of angst is over what to wear to a Lady Gaga concert.  These guys repel conversations about HIV/risk/safety like Teflon repels an egg.  If you try to mention HIV, they all the sudden stop texting you back, or they fade from your Facebook...they become silent and they disappear.  

I believe there needs to be a new call to action, one in which the new ways of the internet and the social media expertise of the young are merged with the proven, effective methods of prevention.  And through all of this we must figure out how to burn of the fog that has settled on everyone regarding HIV:  for the older people who are tired and exhausted from 30+ years of advocacy and for the young, know-it-all youth who live in ignorance and bliss.

I wish I had the answer on how to do that, because until that answer is figured out, I fear we will again see a rise in HIV infections.  I believe the coming storm will rival the pre-HAART era. Before HAART, people died because there was no medicine.  Now, I believe stigma and indifference has become just as deadly as those early days. 

About the author: I am 38, a gay male from Knoxville, TN who is not ashamed of my HIV+ status. I am optimism personified. I am strength realized. I am just me.

Website: embacingpozitivity.blogspot.com.Twitter @jjemcdonald 

Click here to read the first installment.  

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). How did I end up in this situation where I feel like I need PrEP?

As I mentioned in my previous post, a look back at the phases of my sex life gave me some clues about why PrEP makes sense for me now. After more than 20 years of being sexually active, I only recently found myself veering away from perfect 100% condom use.

How did that happen?

Ironically, this is in part because I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. I know what the research is telling us about HIV transmission. I know what proportion of new infections is driven by people who are undiagnosed. I know what undetectable viral load means for transmission risk.

I started serosorting, but not in the conventional sense. More and more, I’ve been dividing guys up into 3 categories.

1. The first category is small. With HIV-negative guys I know and completely trust, we arrive at a form of negotiated safety—if we have been tested for HIV and all STIs recently, and not yet had sex with others, we usually have condomless sex.

2. The second category has been steadily growing—positive guys. We have discussions about treatment, viral load, STIs and decide how to proceed from there. Sometimes without condoms.

3. The third category is basically everyone else—HIV unknown or undisclosed, and HIV-negative men I don’t know well. I consider guys from this third category as potentially being in the acute infection phase, whether they know it or not. This is the category of men with whom I am most adamant about condom use. All too often, their prevention strategy is dubious at best (e.g., “r u clean? how big r u? wanna bb?”). If I see another highly stigmatizing "disease free"/"no poz" message on an online profile, meant to be some kind of stand-alone, ill-informed HIV prevention strategy, I might reach through the screen and cyber-throttle someone.

So gradually, I’ve found myself feeling much less worried about having condomless sex with a positive guy after a conversation with him about treatment and viral load and STIs than about having condomless sex with a guy who says he is negative, but could be in the acute infection phase with sky-high viral load without even knowing it.

Paranoia? Rational, effective, evidence-based risk-reduction strategy? Both? You be the judge.

But let’s be honest. I also started “slipping up” more and more often because, well… sex feels better without condoms. *gasp* That’s right folks. Sex without condoms feels freaking amazing. You heard it here first.

So while I still maintained a relatively high rate of condom use, I found myself having condomless sex every once in a while. Of course, I also know how effective inconsistent condom use is over time (i.e., not very).

An illuminating peek inside the Little Black Book

Three years ago, I started to keep track of my sexual encounters in a proverbial little black book. (OK fine, it’s blue and has a Global Campaign for Microbicides logo and a Rectal Pride for Microbicides sticker on it. It’s super pretty and seemed appropriate). Every time I have sex, I write down what we did, what I know about my sex partner’s HIV status, and whether or not we use condoms. Yup, every time for 3 years. I do this partly so I have very accurate information at my fingertips to relay when I get tested for HIV and STIs. Partly so I have very accurate information at my fingertips when I start to worry. I can look at my list since my last tests and say: look, you had this many encounters, this is what you did with whom, this is how often you used condoms, and this is what you know about his HIV status. Sometimes that helps alleviate the occasional panic attack and insomnia. Sometimes.

I had never seen myself as being “high risk” for the first 20+ years of my sex life. But I’ve been working in HIV for 20 years. So I know the behavioural characteristics of “those people” at high risk. Armed with about 3 years of hard data about my own newly evolving behaviour (i.e., my stylish little blue book), I decided to look at it objectively.

• Multiple sex partners? Check

• History of STIs? Check

• Partners of unknown or HIV-positive status? Check

• Inconsistent condom use? Check

Well then. It’s hard to ignore what this spells.

I like to think I’m at least moderately intelligent. I know how HIV is transmitted. I know how effective condoms are.

I like to think I understand the consequences and the stakes. Yes, people living with HV are doing much better today. But I saw my dad die of AIDS in front of my eyes. I saw countless other friends, colleagues and clients become HIV-positive or die of AIDS. That leaves an impression, to say the least.

I like to think I’m a responsible person. I get tested frequently. I stay informed.

I like to think I have high self-efficacy. I have several years of experience using condoms consistently, and I am more often than not the one wearing the condom, so little to no negotiation is required.

I’m not depressed. I never drink. I don’t so drugs. My judgement is not clouded by any of those.

I’m not in denial. I know that the combination of inconsistent condom use, multiple partners, history of STIs and having partners of a different/unknown HIV status is a very strong predictor of seroconversion over the course of a few years.

If all of this doesn’t make me an ideal candidate for consistent condom use, I don’t know what more it would take, short of using Super Glue to permanently bond a condom to Mr. Happy.

Yet here I am.

So as a smart, responsible, well-informed, sexually active gay man with good self-efficacy and good access to healthcare and accurate information, I’ve come to the conclusion that PrEP makes sense for me at this point in my life. I don’t know how long this new “PrEP phase” will last. But I am glad it is available to me while I need it.

To be continued . .

About the author: Marc-André LeBlanc has worked in the community-based HIV/AIDS movement for 20 years.  He does community engagement, capacity-building and policy work related to biomedical HIV prevention research, both in Canada and globally. He is a co-founder of International Rectal Microbicide Advocates (IRMA), serves as secretary on their steering committee, has authored two reports on the global state of rectal microbicide efforts, and leads IRMA’s global efforts to ensure the safety of sexual lubricants. Marc-André loves movies. He got a film studies degree while working full-time, just for the sheer fun of it. He is now leading advocacy efforts to get ice cream and popcorn recognised as new basic food groups in Canada’s Food Guide

This article first appeared on My PrEP Experience here.