Question for Friday: Social Diseases

YEA! QUESTION FOR FRIDAY IS BACK! Well, sort of, I'm almost 24 hours late, but I promise he was totally worth the delay.

This week's question:

If you got a curable STD from a trick/sex partner, and you knew that both you and they had been to the doc and had it "dealt with," is it ok to sleep with them again?

I'll say this: I thought I was going to LOL a lot more than I did. Two central themes: 1) NO, and 2) did he cheat on me? That's no fun. This is a serious concern, folks. Well, not for me, for a "friend."

• Wow. I think that would be a "no" for me. -- from EdroEdro, via the blog
  
• It would have to be with Shane from The L Word, otherwise, no dice. -- from Jamie at Stuff Queer People Need to Know, via the blog
  
• Would it make me a special kind of slut if I said "yes", or just the regular kind? -- from Jeffery D., via the blog
  
• sure, why not, it's only my uterus...who needs that...j/k -- from Ansley G., via Facebook
  
• Ewww, heck no -- from Eva B., via Facebook
• Umm. Hell no. -- from Brian B., via Facebook
• only if they apologized and they REALLY meant it... or else to give them a different STD from the arsenal -- from Christopher P., via Facebook (what other STD's do you have in your "arsenal," Christopher???)
• No, I think that would kind of bring the romance to a full stop. -- from Brian R., via Facebook
  
• Which std? -- Amy C. from AmyInOhio, via Facebook (I said it was curable, does it matter from there?)
• Did 'he' know 'he' had it, before giving it to me? Did 'he' get it from cheating on me? -- from Evan of BadEvan.com, via Twitter
  
• did you have to blow him? -- also from Evan of BadEvan.com, via Twitter
  
• relationship or just one-night stand? -- from Jared of Jared's Rainbow Blog (whatever, super gay blog name :-)), via Twitter
• I think it would depend on if they cheated. I'm not cool w/ cheaters, disease or not. -- from DumbWhore, via Twitter
  

I mean, those were some serious answers. My answer in 140 characters or less: Yes. I'm not one to judge, we all fuck up. 

I got no worries if you had an STD that you gave to me -- especially if it's curable and we dealt with that. Hell, even if it's incurable, that's ok too right?

Right?

Ha. The person who proposed this question gave me this real conversation that sparked this question:

Ring, ring.

STD Guy (S): "Hey."

Friend (F): "Hey."

S: "What's up?"

F: "I think you should get yourself checked out."

S: "For what?"

F: "I'm dripping." 

S: "Oh."

*PAUSE*

S: "So, you wanna fuck around once I get it done?"

F: "Sure."

I love my slutty, slutty friends.

Question of the Week!

I was bad about following up last week's -- SO SORRY! Got really busy.

This week's question comes from an avid reader; name has been removed to protect the innocent!!!

If you got a curable STD from a trick/sex partner, and you knew that both you and they had been to the doc and had it "dealt with," is it ok to sleep with them again?

I eagerly wait your responses. :-)

Declining or Transitioning?

Thanks to @harveymilk for the heads up.

An interesting article from the journal AIDS Care that uses the changes in the gay community over the past 20 years as a way of talking about HIV prevention. 

In dry terms: 

This study sought to identify how urban gay communities are undergoing structural change, reasons for that change, and implications for HIV prevention planning. Key informants (N=29) at the AIDS Impact Conference from 17 cities in 14 countries completed surveys and participated in a facilitated structured dialog about how gay communities are changing. In all cities, the virtual gay community was identified as now larger than the offline physical community. Most cities identified that while the gay population in their cities appeared stable or growing, the gay community appeared in decline. Measures included greater integration of heterosexuals into historically gay-identified neighborhoods and movement of gay persons into suburbs, decreased number of gay bars and clubs, less attendance at gay events, less volunteerism in gay or AIDS organizations and overall identification and visibility as a gay community. Participants attributed structural change to multiple factors including gay neighborhood gentrification, achievement of civil rights, less discrimination, a vibrant virtual community and changes in drug use. Consistent with social assimilation, across cities, gay infrastructure, visibility and community identification appears to be decreasing. HIV prevention planning, interventions, treatment services, and policies need to be re-conceptualized for MSM in post-gay communities. Four recommendations for future HIV prevention and research are detailed.

There are two interesting take-aways from the article:

1) The existing gay communities and organizations are changing, and no one is quite sure where it's going, or if it's for good or for evil.

2) HIV/STI prevention in gay men is becoming more difficult due to these changes.

Anyone who works in the LGBT community or in AIDS prevention will say, in response: no duh. But it's nice that we have the research to prove what we've been saying for years. :-) 

Rectal Chlamydia!!!!

We just learned about gonoccocal urethritis in class and four things struck me: in our discussion of STDs and nursing care, we barely talked about HIV; we only talked about urethral and vaginal infections; the med class fluroquinolones (typical treatment for gonorrhea) is contraindicated in men who have sex with men with gonorrhea due to risk of resistance; and my standards are really low if I think the Christian rapper at school is hot with his awful skin.

Anyways... (via LifeLube, via AIDSMap)

Gay men should have rectal tests for chlamydia as part of their routine sexual health care, investigators recommend in an article published in the online edition of Sexually Transmitted Infections. Researchers found that more gay men had rectal infection with chlamydia than had urethral chlamydia or rectal gonorrhoea. Furthermore, the majority of rectal chlamydia infections were asymptomatic and would therefore have been missed without routine testing.

They also found that over a third of the men with rectal chlamydia were HIV-positive.

Right. So, I told you that.


What I should also tell gay men is this: you should probably have an anal pap smear done to check for carcinogenic growths related to anal HPV, and you should probably encourage the FDA to start testing the HPV vaccine on men against the above mentioned disease.


YEA! STDs!!! Aren't they fun?

A QUESTION FOR "FRIDAY"

From the depths of our sickness here at my job comes my new question...

Question: would you date someone with a long term, incurable, non-HIV STD like
herpes and/or genital warts?

And, a corollary, would you have sex with someone (let's assume short term -- maybe really short term relationship) with a long term, incurable, non-HIV STD like herpes and/or genital warts?

I'll respond with my thoughts in the next day or two.

STD Rates on the Way Up

According to a Reuters article, STD rates are on the rise. In gay and bisexual men, it's syphilis; in blacks, it's chlamydia. (For those out of the field, the two big places we tend to see changes in STD rates first are gay/bi men and black people. Sad but true. If only we could all get along over our love for unprotected sex.)

For syphilis, we are talking about the fun topic of serosorting as the reason for the spread:

Douglas said many cases are occurring in HIV-positive men who are choosing other HIV-positive men as sexual partners.

"Within that relationship, they are less concerned about the transmission of other conditions. They're not using condoms. They believe that their partner already has got the worst they can get -- they've got an HIV infection," he said.

Serosorting is this whole thought that if two men are HIV+, they can have unprotected anal sex without the risk of transmission. As a prevention effort for HIV, it works great for known HIV+s... it's probably less so for "known" HIV-s -- i.e., I think most people who are HIV- would prefer sex with someone who is HIV-, especially unprotected sex. We see now, even without the superinfection theory that, perhaps, this isn't a great policy for HIV+ men.

A CBS News story highlights the fact that a lot of this has to do with better testing protocols:

"The issue with chlamydia is the more test, the more you'll find," Zenilman said.

And I'll tell you this: these numbers are grossly underreported. Here in the Emergency Department, if you are a male, and come in saying you may have been exposed or may have symptoms of an STD, you get what's affectionately known as the love cocktail -- a dose of several drugs used to wipe out gonorrhea, chlamydia, and trichomonas. From a public health stand point, it's sketchy -- we're just adding to bacterial resistance. From an epidemiological perspective, it's sketchy -- while we're reporting the female cases (we test women because of the high risk of infertility and PID), we report almost no male cases. And I would say, in an average night shift, we will see between one and four men getting the drugs without getting tested.

HIV/AIDS: Three news stories

At work, I sometimes surf the web to find interesting news stories about HIV/AIDS to share with my coworkers. It's something I started to relieve a little boredom that can happen at 4am in the Emergency Room; but, mostly, it's to keep myself updated and provide fodder for postings for my blog.

Found three interesting little bits...

1) To start, the biggest duh story of the year (up there with "alocohol and drugs increase HIV risk behavior"): Crack users with HIV engage in unprotected sex. Thanks guys, we know. The numbers:

One-fourth of the group reported having unprotected sex in the last six months,half had not seen an HIV specialist in the last six months, and more than three-fourths were not getting important medical treatments.

*Shrug* I suppose it's a good reminder.

2) From Uganda...

Health officials and campaigners have protested proposals from Uganda to condemn
to death or severely punish people who deliberately infect others with HIV.

Uganda has become the latest in a number of countries which are considering or have enacted laws which punish people who deliberately infect others.

Let me go on record as saying: I do not support laws that criminalize sex for people eith HIV. The laws, I understand, that say it is illegal for HIV+ persons to engage in sex without first notifying their partner of their status are to provide safeguards against the almost mythical (thus, rarely true) predatorial person who is consciously and knowingly infecting people. Rather, the law is being used mainly against prostitutes and people guilty of other sex crimes -- public lewdness, solicitation, importuning, etc. -- and I don't think there has been a case where the law was used genuinely against the people that was used in propaganda to support the bill (think Welfare Queens a la Reagan for a similar example).

There are two people (or more, I suppose) in the room (or car, I suppose, or park) when sex occurs. They both make decisions and they both consent to a series of behaviors that they know may put them at risk for HIV and/or any other STD. To blame just the HIV+ person is marginalizing them, because the (supposed) HIV- person had a say in what was going on. I don't think it's right to prosecute because, as is most cases, the negative person simply did not ask if the person they were having sex with was positive.

In the case of prostitutes, I don't think it's really an issue 99% of the time because that's mainly oral (extremely low risk for HIV transmission).

A friend of mine (HIV+) once said to me a line that was disturbing at first, but I now regard as truer than anything I've heard in my years of work in HIV/AIDS: If they don't ask, they either have it or want it. It's disturbing to hear, but the reality is that most people in the world (especially in my gay world) are keenly aware that HIV exists. Most of them know that they play a part in their own protection, but, for whatever reason, depersonalize the risks and move on. So, in a way, he's right. People know they should ask, and, if they don't, they are consenting to the risks of the behavior as well as the behavior itself. (Consent, ultimately, is an agreement to knowingly accept possible outcomes of a decision -- negative and postive and, sometimes, unknown.)

Do I agree with this death sentence? No. Though my coworker brought up the point: If someone knowingly infected my daughter, I wouldn't wait for the government to do anything. I'd string him up myself.

For the record, I also don't support lynchings or vigilante justice.

3) And a good reminder that the best way to get tested is through a known source and/or provider of HIV testing services... online testing kits are not always the safest, and there are no current FDA approved HIV tests (I don't think... can someone fill me in if I'm wrong) that are "home testing." There have been in the past, but the vast majority have been pulled from the market. Besides, I don't like the idea of home testing simply because it concerns me about someone finding the result at home, alone, with no one to say "alright, this is the next step" or to help bear the emotional brunt of those feelings.

GENERAL STUFF: Random text message...

To an unnamed friend who may or may not have their first STD...

Awww... baby's first STD.

I have a better relationship with the clinic than I do with most of the men in my life.

HA! I love gay boy's first STD's.

GENERAL STUFF: Pubic Lice Going Extinct?

From the subscription of OUT magazine I believe my mother gave me, and then via digitaljournal.com .... Apparently, "A British Medical Journal" (can't find it!!!) reports that due to the popularity of waxing, the pubic louse is going extinct. And the Natuurhistorisch Museum Rotterdam is begging people to send in samples to add to their permanent collection before they are all gone!! From the digitaljournal article:

Kees Moeliker, the curator of the Natuurhistorisch Museum Rotterdam has launched his campaign to find pubic lice (Phthirus pubis) a bit more than one year ago, and so far, not a single one has been found. The museum is now going international with its search. The reason for the campaign is fear that the Brazilian may be threatening their existence. The Brazilian, essentially the practice of shaving or waxing away (nearly) all pubic hair has become so popular with women that the animal could be facing extinction.

While the Brazilian is not yet nearly as popular with men, this is not particularly important, since most men are heterosexual (as are most women) and transmission is no longer possible if the lice can't find any living space in the girls' bushes. The situation can be compared to that of the giant panda. These animals nearly met their demise because of the destruction of bamboo forests.

If you have crabs, please send them. I can't seem to find much on the Museum's site either, seeing as how it's in Dutch... or something.


Pic via the BBC