Friday, April 15, 2011

Poz Friendly

OK, I'm not a medical doctor. I hope you know that. Many of you also know that I am HIV positive and have been for some 17 years. My viral load is undetectable and my T-cell counts are in the normal range for a healthy person.

I seldom write about HIV, except that I often remind people to play safely, get tested for STDs often, and have a doctor they can talk to about their sexual lives. For your information, "poz friendly" means that you are willing to have sex with a person who is infected with HIV.

This column was prompted by the frequent comments I get while seeking another slave. Simply put, in spite of the wealth of good information and online access to it, there is a lot of bad information about HIV transmission. Fear of infection is a good thing, paranoia isn't. So let me lay out the facts as I understand them.

You can take the facts I write as that, search for information to prove or disprove what I write, or print out this essay and discuss it with your doctor. In any case, please make an informed decision about HIV. Living in ignorance, in doubt, or in denial is no way to maintain a healthy life.

For those of you who want to "bareback," i.e., fuck without a condom, I will remind you that you are playing a dangerous game. Even if there are drugs to control HIV, they are not perfect. The disease will still play havoc on your body, the side-affects of the drugs will make you miserable, and the medication alone, not to mention doctor and testing costs, will run about $21,000 a year.

The argument that you can bareback with a person who is not infected is fallacious since no one, except a person who is truly celibate or truly monogamous, can ever guarantee that they are actually HIV negative. The following safety guide does not apply to couples who are monogamous and HIV free. Remember though that to be sure you are HIV negative takes two tests separated by some six months, since one test may not detect a recent infection.

HIV transmission is, thankfully, a rather difficult task. You are much more likely to get syphilis, gonorrhea, or hepatitis A, B, or C more easily than HIV. You are also liable to get Herpes or the flu. Nothing is without risk. Nothing is "safe." All we can do is to make things "safer." That said, take reasonable and necessary precautions and then have fun. Unfortunately none of us is getting out of this world alive. Precaution is advised, paranoia is not.

HIV is a virus that is transmitted through the bodily fluids of blood, semen, and breast milk.
Pre-cum presents at most a tiny theoretical risk, not a practical one. Neither saliva nor sweat contain the virus and therefore are safe. HIV can live outside the body for a number of hours. It is easily cleaned with antiseptic soap and running water. You can disinfect with Clorox in a one-to-ten ratio.

Skin is an effective barrier against HIV transmission. Therefore ejaculating semen on to healthy bare skin is safe. The only caveat is that the skin is not broken. HIV can enter the body through a cut, abrasion, or wound. For that reason, when fisting is done, use surgical gloves to insure that there is no transmission through minute cuts in the fingers.

Since HIV is very sensitive to air and light, the risk of transmission through pre-cum is low. Lube will also reduce the risk of transmission through pre-cum. That said, never insert a penis into a vagina or anus without the protection of a condom.

HIV is not transmitted orally. It is safe to suck a penis without protection and to ejaculate into your partner's mouth. There is one important caveat: the recipient's mouth needs be healthy. If there are cuts on the tongue or inside the mouth, or if the gums are bleeding, there is a risk of HIV infection. For that reason it is not advisable to have oral sex on the day you have dental work done nor to brush or floss your teeth before having oral sex.

There are no proven incidents the oral transmission of HIV. Believe me, if HIV were transmitted orally, there would be a much higher rate of HIV infection among gay men.

To quote the San Francisco City Clinic website: "HIV is rarely spread through oral sex and it is not spread from an HIV-infected blow-job giver to an uninfected partner. There are case reports—descriptions by doctors in scientific magazines—that suggest HIV can be spread by swallowing the cum of someone with HIV-infection during oral sex. Our experience in San Francisco supports that such spread of HIV is a very rare event. While HIV can be found in the saliva, the saliva also has special factors that block the growth of the virus. Other STDs like gonorrhea, chlamydia, syphilis and herpes can be much more easily spread through oral sex."

And lastly, here's some information about intercourse. It applies to both vaginal and anal sex.

"Several studies have been done on relationships similar to yours, where one partner is HIV-positive and the other negative (a.k.a., mixed status or HIV-discordant couples). A study published in 1994 in The New England Journal of Medicine looked at 256 heterosexual mixed status couples. Of the 124 couples that consistently used condoms, none of the HIV-negative partners were infected. Among the 121 couples that did not consistently use condoms, 12 (about 10 percent) of the HIV-negative partners became infected. Additional studies found similar results.

"Consistent and correct condom usage is the key to lowering the risk of HIV transmission in mixed status couples, whatever their sexuality. Condoms are highly effective in preventing the transmission of HIV, but sometimes fail. Those failures are most often due to incorrect usage or user error. To reduce condom failure:

  • Use water-based lubes, never oil-based ones such as petroleum jelly, cooking oil or shortening, or hand-lotion — they can weaken the latex.
  • Keep condoms away from heat or direct sunlight.
  • Check the expiration dates printed on the package. Condoms that are too old or expired, or have packaging that appears to be weathered or deflated, need to be thrown away.
  • Carefully open the condom with your fingers, trying not to tear it with your fingernails (or teeth).

And from the San Francisco City Clinic:

"There is no evidence that wearing two condoms is more effective than wearing one, and in fact, there is some hearsay evidence that the friction of the two condoms rubbing together can cause them to break, making you more susceptible to HIV and other STDs.

"As far as viral load, research has shown that the viral load in blood correlates to levels in semen and vaginal secretions. However, that correlation is only about 70% and it has not been proven what level of virus is needed for transmission. Even an undetectable viral load doesn't mean an infected person will not transmit HIV to an uninfected partner. Therefore it is very important that you continue to use condoms no matter your partner's viral load. In addition, a person's viral load can change, so that viral load a month ago may not be the viral load the day you had sex.

"In many cities, like San Francisco, after having a known exposure to HIV -- being topped by an HIV+ guy and then the condom breaks -- a guy can start PEP, or post-exposure prevention, which is a combination of anti-HIV medications. The important thing is that these medications have to be started as soon as possible, ideally within four hours, but it may be OK within 72 hours after exposure. Most emergency rooms and doctors know about PEP and can prescribe it. It's not one dose -- you have to take meds for a month and they can make you ill -- so I don't recommend it except in real emergencies. To learn more about PEP, go to the UCSF Medical Center website at and type PEP in the Search box."

After all is said and done, you have to decide what you are going to do and who you are going to do it with. I ask two things. First get the facts and make an informed decision. Secondly, no matter what you decide be honest in your decision. If you decide not to be poz friendly, at least be friendly to people who are positive.

For more complete information on HIV and AIDS visit the San Franccisco City Clinic website at

Please play safely and have a great week. Jack

You can send me email at or visit my website at You can also subscribe to my blog at Copyright 2011 by Jack Rinella, all rights reserved.

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