About 10% of gay men taking antiretroviral treatment have low levels of HIV detectable in their semen, according to new research. 

In the study, a low but detectable viral load (between 50 and 500 copies/ml) was associated with the presence of HIV in semen.

There is currently a lot of discussion about the effect of HIV treatment on infectiousness and the use of HIV treatment as prevention. Research conducted in heterosexual couples has shown that antiretroviral therapy that reduces viral load in the blood to undetectable levels (below 50 copies/ml) reduces the risk of sexual transmission by 96%. (PositiveLite.com editors note: the research to which this refers - HPTN 052  - measured the impact of early treatment, not undetectable viiral load, two entirely different concepts..  We have questioned aidsmap.com about the accuracy of their statement.)

But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load.

Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.

Doctors in the United States wanted to see if infection with human herpes viruses also had an impact on viral load in genital fluids.

They monitored blood and semen samples taken from 114 gay men. All were taking HIV treatment and had a blood viral load below 500 copies/ml (88% had a viral load below 50 copies/ml).

HIV was detected in the semen of 10% of the men. The average viral load in semen was low – 126 copies/ml. Whether or not this level of HIV in semen is associated with transmission is unknown.

Detection of HIV in semen was associated with the presence of two viruses of the herpes family – high semen levels of CMV (cytomegalovirus) and detectable EBV (Epstein Barr virus) in semen.

“The association between isolated HIV shedding and high-level CMV replication and EBV replication in the genital tract suggests that the presence of these viruses could play a role in HIV transmission…these findings have important implications for the development of strategies to reduce HIV transmission,” comment the researchers.

They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load.

A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.

For more detailed information on HIV transmission, visit our online resource HIV transmission and testing.

This article originally appeared in aidsmap news, May 2013. Read the full article here.

Late at night, I research and write by myself so I can avoid confronting the fact that I am alone, typically until I pass out from exhaustion. Gradually through the evening, as sources for my stories and colleagues I’m collaborating with over long-term projects go to bed themselves, I’m left alone at my computer, occasionally Googling a fact that I’m curious about; tonight, I learned about the history of Prussia.

Thoughts randomly piece themselves together until a great idea hits me, I write it down, and then my aimless reading continues. Sometimes, I’m chasing a lead and poring over ethics complaints and campaign finance disclosure forms. Other times, I’m refreshing my knowledge of American or military history. And, tonight, I purposefully watched the digital clock on my computer until 12:00 AM hit to reach another year of sobriety from alcohol; today, May 6, is the day that I decided years ago that I was finally done with drinking. 

At one point in my life, I had a good job serving my community, a good partner whose boundless compassion and understanding was remarkable, a quaint suburban home, and a good network of friends with reputable backgrounds and even more respectable jobs. Yet, during that very same period of my life, and for years prior, I had generally functioned as an alcoholic.

Somehow, I had always managed to apologize away the missteps, the rare flashes of rage, and the endless sadness, literally bouts of uncontrollable sobbing, that inevitably ensued when I became drunk. At some inexact point years ago, however, the functioning component of my alcoholism started to disintegrate and more of my work was sloppy, more dinners with my husband were missed, more hangovers caused more missed trains, and, eventually, I lost the very thing that I so desperately wanted my entire life: love.

Jung said that we do not wish to hear someone say “I love you” but, instead, “I understand you.” And, for me, this is a truth that I have found only once in my life and that was because it was coupled with love. Sometimes, I will hear someone inexperienced with long-term relationships wax poetically about the perfect nature of his newest adventure; candidly, I indulge myself in these sophomoric romps to, feel, at least for a short while, capricious and giddy. Indeed, there is a fleeting joy in being, for all intents and purposes, idiotically infatuated. But, the one thing that I rarely hear and have never uttered in years is the sincere, and quiet, appreciation of imperfection inherent in love and understanding between two human beings: the pensive tics, the bedhead cowlicks, the sometimes terrible sense of humor, the earnest goodwill found in whomever you truly love.

These imperfections are the essence of the love that we truly seek, whether we know this or not is irrelevant because it is true. And, at one point in my life, I had this love. Though, being an alcoholic, and a particularly nasty, narcissistic one at that, I threw that all away in exchange for doing whatever I wanted to do. This is, indeed, the surest way to destroy a relationship.

Let no maudlin drunk or repentant (at least today) sinner convince you otherwise: we do things as human beings not because we are compelled by nature or illness but, instead, because we choose to do these things.

We cheat on our wives because we are lustful and, for some reason, decide to not have a candid conversation about a non-monogamous yet loving relationship. We steal from public coffers because we desire greater wealth and material instead of appreciating the things we have and choosing to live within our means. We belittle others because we have the power to do so and can feel better about ourselves in the process, and there is no complexity in our motivation anymore than there is complexity in the fact that we must sleep every night as it is our biological function. Whether or not we choose to resist these motivations, to instead cultivate the noblest components we are endowed with is entirely our decision. We are not powerless nor are we weak. On the contrary, we are empowered to deliberately make decisions that have inevitable consequences, be they good or bad.

And this is the most frightening part of being human.

If we are not compelled by force to behave in a terrible way, then we have chosen to deliberately defy our ethics and the better parts of our innate characters and have opted, instead, to give in to the most repugnant and damaging aspects of our animal nature. We become drunkards, drug addicts, narcissists, mean-spirited misanthropes, or, as is typical, whiny, weak-kneed explainers who would rather use these very tools of manipulation, drink for instance, to excuse away our behavior disingenuously rather than confront the fact that our characters are, at least for some of us, inherently predisposed toward unethical acts. This predisposition is not immutable; we can change how we behave and how we cope with life in order to focus our energies in more socially acceptable and rewarding ways. Some folks call this cognitive behavioral therapy; others call it Alcoholics Anonymous. Personally, I call it ethics.

As the years go by and the length of time between the last time I was drunk and “now” continues to increase, I realize that I know very little considering I have experienced so much. Oddly, my knowledge seems to have an inverse proportional relationship to my age and experience; and, this is unnerving. For if part of getting older is recognizing that you are fully responsible for your mistakes, then you must logically realize that you are where you are because of, mostly, your own actions combined with a small number of lucky encounters.

These small chances, these opportunities presented by chance, fate, or God himself, are often hard to identify, but they exist and your actions in response propel your own trajectory down one of many different paths presented to you.

Personally, I chose an unhappy path for a very long period of time, a path that unfairly involved others to a tragic degree. And, I cannot change this, nor can I possibly ever find redemption for these actions and words. Rather, I can simply try harder and hope that those opportunities I once had will present themselves again only in a more recognizable fashion with, I assume, a different set of characters. Hopefully, I will recognize these opportunities more perceptively than I did when I was an active drunk, otherwise I am destined to repeat my mistakes and the idea of happiness, of that love, will always be the dream that I put off every evening, opting instead to read about history or write about politics until I fall asleep.

Today, I am still sober. And, I am still putting off going to bed. Even so, it is much easier being alone sober than it is drunkenly sobbing. And, for that, I am glad I made the choice to continue my sobriety today. I expect that this will continue for some time; after all, you get quite used to not drinking and, interestingly enough, are sort of puzzled after a while why people drink at all, or why you did it in the first place. Then again, there is no puzzle to it.

We do these things because we want to do them.

This article first appeared on Josh's own blog here.

“I’ve been told that I can look forward to a tremendous reduction in stress and anxiety about seroconverting. I look forward to that. We’ll see. “ 

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). I won’t deny it. I’ve been feeling very conflicted about starting PrEP.  

Why do I have access to Truvada when the majority of people who need antiretroviral medication to stay alive don’t have access? I got my hands on this bottle relatively easily. The social injustice is not lost on me. I don’t have relatively easy access to this medication because I deserve it more than anyone else.

So what HAVE I done to deserve access to PrEP? Well, a lot of it is sheer luck, actually.

•    Nearly every time I see the news, I am amazed at how lucky I am. I was born in Canada. Talk about winning the lottery. Out of 7 billion people, I am one of only 34 million people living in Canada. Trust me, it’s a great place to live!

•    I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. This provides me with ongoing access to the latest information.

•    I make a good living. I can access healthcare relatively easily and generally for free or at a cost that has little impact on my standard of living.

•    I have a doctor. He’s young (My age. That’s young. Shut up.), gay, and sees a lot of people living with HIV in his practice. So talking to him about my sex life and about PrEP was not difficult. He keeps up to date on research. After a good discussion, he agreed to prescribe PrEP.

•    Not only do I live in Canada, but I live in Québec, the only province to have a universal public drug plan. As long as the drugs my doctor prescribes are on the provincial drug formulary, I am covered for most of the cost. I pay $500 into the drug plan annually, and PrEP will cost me less than $1,000/year on top of that. And if I ever need other drugs for any reason, I will not pay for them. Because $992/year ($82.66/month to be precise) is the most I would have to pay for all my drugs combined.

I’m not trying to be disingenuous. I know that beyond being lucky and privileged, I have access to PrEP because I’ve taken some very concrete steps as well. I did lots of introspection. I tried to reduce my risk as much as possible through other means. I did a lot of research. I actively sought out access. I make sure I’m very diligent about taking my pills.

I always have been very diligent about that. I take all my antibiotics when I need them. I take vitamins daily. When I was on antidepressants, I never missed a dose in 1.5 years. I follow advice from medical professionals to the letter. Case in point: I’ve needed physiotherapy twice. Both times, the conversation during my second visit went something like this:

Physiotherapist: Wow, you’re made remarkable progress in one week. I’ve never seen anyone progress so quickly with this type of injury. Which exercises did you do?

Me: All of them, like you showed me.

PT: You did ALL the exercise I gave you?! How often?

Me: Every day, like you told me.

PT: You did ALL your exercise EVERY day?! How many times a day?

Me: Twice, like you told me.

PT: You did ALL your exercises, EVERY day, TWICE a day?! I’ve never seen this in all my years of practice! No wonder you’re doing so well!

*SLAP* You’re at risk of HIV!

I might make jokes, but I don’t take this lightly.

Every morning when I wake up it’s the first thing I think about. That might stop after a while. But two weeks into taking PrEP, it’s the same thing. I wake up, and as I ponder about whether I want to go back to sleep again for a little longer, I can’t do it. I immediately think: when I get up I have to take my Truvada pill. Because I’m at risk of HIV.

Each and every time I open the cupboard and grab the bottle, I think: how is it possible that I am so lucky to have such easy access to this medication when millions of people who need it to stay alive don’t have access?

Who needs a coffee? I get a slap in my face every morning. Two of them in fact.

*SLAP* You’re at risk of HIV and STIs!

*SLAP* You’re one of the lucky few who has access to this medication and to this prevention option!

I’ve been told that I can look forward to a tremendous reduction in stress and anxiety about seroconverting. I look forward to that. We’ll see. I’m not there yet by any stretch. But at least I get some measure of comfort from knowing that I’m putting chances on my side by reducing my risk as much as I can in my current situation. Doing my best to stay healthy seems like the right thing to do to honour those who don’t have access to this drug.

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 originally appeared on My PrEP Experience here. 

This article by Gus Cairns first appeared on aidsmap.com here.  

Data from two national sex surveys in the United States show that gay and bisexual men (men who have sex with men, MSM) reported significantly fewer sexual partners in the previous year in a survey conducted between 2006 and 2010 than they did in one conducted in 2002. This decline was consistent across most ethnicities and age groups, but was particularly marked, and statistically significant, in younger men aged under 24.

In contrast, the proportion who reported having condomless anal sex at least once in the previous year did not change between surveys. In the minority of men who also had sex with women, condom use fell markedly, but on the other hand the proportion of MSM who also had sex with women fell too.  

The proportion of men who tested for HIV or for sexually transmitted infections (STIs) in the last year did not change, although the proportion who had never tested for HIV fell.

The survey

The data come from the last two National Surveys of Family Growth (NSFGs). The NSFG is a survey of 15 to 44-year-olds; participants are contacted at random by phone but due to lower contact/response rates, people under 24, black people and Hispanic people are ‘oversampled’, i.e. a higher proportion are initially contacted than are in the general population.

NSFGs used to be conducted every three to seven years, but in 2006 a decision was taken to conduct interviews (by voice-assisted automated computer interview) continuously. This study therefore compared figures from interviews conducted in 2002 with ones conducted in 2006 to 2010.

NSFG interviewed 4928 and 10403 men in 2002 and 2006 to 2010, respectively. Of these, 197 and 272 reported having a male sexual partner in the last year – 2.7 and 2.1% respectively (this difference was not statistically significant, p = 0.1).

The results

The mean number of male sexual partners MSM reported in the previous year fell significantly from 2.9 to 2.3 between the two surveys (p = 0.035) and was more marked in men under 24 years old (mean 2.9 to 2.1 partners, p = 0.027). The number of partners also fell in men aged 35 to 44 from 3.0 to 2.2, though this was not quite statistically significant (p = 0.07).

The fall in the number of partners was statistically significant in men with incomes under 150% of the US federal poverty level (3.0 to 2.1) and in men living in suburban metropolitan areas (3.2 to 2.1) but not in city-centre areas (2.6 in both surveys). There were declines in partner numbers in white (3.0 to 2.5) and black (2.4 to 1.9) men, though these did not reach statistical significance. In general though, there was a consistent picture of fewer partners among most groups.

There were no changes in condom use for anal sex. In 2002, 57% of men had not used a condom the last time they had sex and in 2006 to 2010 the proportion was 58%. In the minority of men who also had sex with women, the proportion who had not used a condom the last time they had vaginal sex was 46% in 2002 but had become 67% by 2006 tp 2010, and this difference was statistically significant (p = 0.04). However, the proportion of MSM who had had female partners also decreased from 38 to 25% (p = 0.03).

One other notable difference was that fewer men reported transactional sex (sex for money or drugs) in the last year (down from 15 to 3%) and fewer men said they had injected drugs or had had sex with someone who had injected drugs (from 12 to 5%).

HIV and STI testing in the last year did not increase. In 2002 and 2006 to 2010, 41% of men said they had had an HIV test in the last year and in the case of STI check-ups 38% reported having one in 2002 and 39% in 2006 to 2010. The proportion of men who had never had an HIV test, however, fell from 25 to 15%.

Conclusions and comments

The researchers comment on the fact that HIV prevalence and the incidence of STIs increased in gay men during a period when numbers of partners and some other sexual risk behaviours were falling. They note that there have been previous studies in Seattle and Peru where STI incidence and/or HIV diagnoses have remained high even though sexual risk indicators in gay men have fallen. Studies of young black gay men in the US, including one recently presented at the 20th Conference on Retroviruses and Opportunistic Infections (CROI), have consistently shown that they tend to have fewer partners despite considerably higher HIV incidence.

The researchers speculate that this may be due to ‘network factors’: factors about partners that are not captured by the individual risk behaviour focus of most studies. For instance, some studies have found that black gay men tend to restrict sex to partners of their own ethnicity and are also more likely to have sex with men a number of years older or younger than themselves. Both of these would tend to concentrate HIV infection within the black gay community.  

Whether these are the main drivers of US black men’s greater vulnerability to HIV infection, another interesting aspect of this study is that gay men appear to have taken steps that could reduce their HIV risk by using a method that has received little emphasis in HIV prevention programmes for gay men – reducing their number of partners – while not increasing condom use, which has received the most emphasis.

Leichliter JS et al. Temporal trends in sexual behaviour among men who have sex with men in the United States, 2002 to 2006-10. J Acquir Immun Defic Syndr, early online publication, DOI: 10.1097/QAI.0b013e31828e0cfc, 2013. 

I think I am riding on a wave of good Karma and if that’s true, I am really enjoying the ride! It’s not a tsunami wave, it’s a simple, gentle wave with small things happening with large rewards.

Today, I went downtown for the raising of the Pride flag at City Hall. This is the first time I’ve done this, and I’ve lived here for the better part of 32 years. I went mostly because I saw a photo opportunity  - and I did get a few good ones. When I was wrapping up, I looked over my shoulder and there was a young guy watching me.

He began to tell me, “This has got to be one of the most powerful statements any city can make”, pointing to the flag. There it was, flying next to the city flag and the Canadian flag. There was another flag that he thought was some sort of British flag. I felt I had to tell him it was the Ontario Provincial flag. He went on to say, what an experience it was that I could be there taking a picture of that flag, proudly flying next to all the others, only in Canada. In other countries it wouldn’t be celebrated in the same way.

This whole experience made me think back to 2011 Toronto Pride, I had taken a photo of the Pride flag with the Canadian flag (see below) that I was so proud to have taken. It was seen by a writer who wanted to use it in a story he wrote. It was an honour to have it included in a story about Pride.  I agreed to it right away. I have since donated a copy of it for a silent auction at a local fundraiser last year.

In a true “social media experience” I saw a link on my facebook that led me to another link for a site that one of my contacts was following called Fierté Canada Pride. Right away I noticed their profile photo, I clicked on it to see a larger version of it and sure enough, it was the same photo of the two flags. I thought about other photographers I’ve met who would be upset someone used their photos without permission or compensation.  For me, if it’s for an HIV cause or to promote Pride, then please use it. I volunteer to do all photos for my local AIDS Service Organizations for most of our events. It’s a way of giving back for a lot of what they have done for me. I sent the site a private message letting them know that it was my photo and that it looked great on their site and to enjoy it.

So giving in this way is a large reward for me. Karma, what you give out, you will get back. Beautiful!

The most positive Karma experience happened about a week and a half ago.  I was out taking pictures at the local University Arboretum. I had been there for an hour or so, just sitting at the picnic table trying to catch the birds flying in and away from the feeder. I noticed a few people coming through the area. I talked to a couple of them, just a hello.

Then I noticed a couple  of guys. They looked around, then sat down on a bench to the right of me. They were around my age. I had this feeling that maybe I knew them as they fit the general description of a couple of guys I once chummed around with. One was a friend I had hoped to reconnect with, someone I hadn’t seen in about 15 years. I had made a commitment at a recent retreat back in February to try to re-connect. I had found an old phone number, but misplaced it.

So, after about 10-15 minutes, I decided to pack up and go say hello, see if it was that old friend. I turned around to see they were on their way out of the area, so I had to hurry. I managed to catch up and I called out the friend’s name. He turned around and said, “pardon me?” I said his name again and he looked at me. Then he said, “don’t tell me, give me a minute”. It was him, and like me, a little older a little more grey. He lives in another nearby city; we hadn’t seen each other in maybe 15 years and there we were, in the least of all expected places. I go to this place so often. We tried to catch up but he was in a hurry to go somewhere, said he had an appointment, he gave me his cell number and I was to call him.

This has to be the most genuine form of Karma ever, or was it “fate”? Could they be the same thing?  To move forward now I realize that I will need to do some apologizing to him. I can’t go into the reason for the separation but I wasn’t the person I am today. I didn’t know or use empathy or compassion very well then, hell most times I can’t say I had any awareness of it. I am aware that it may not be the same friendship it was before, but it could be. We can’t get into the same trouble  - or can we?

I spend a lot of time on the internet, but I am trying to get out more. Now that the weather is cooperating it’s been easier. Photography has become a social affair; I get to meet other photographers or people asking what I’m taking pictures of and they share stories of their own. One gentleman and his wife last night suggested I join the seniors’ centre, they have a photography club and I could win the photo of the week. I do qualify, you need to be 55 and over, and I am over.

So I’m trying to put a finger on what it is I’m doing and I don’t see many great things. I think a lot of it is just staying positive, avoiding the negatives. If you want things to add up in life, avoid the negatives. I have seen how people treat me by the way I treat them, I do it all so differently now. I made many bad choices in my life and tasted the bad Karma on those occasions, so yes, the good Karma is working for me now.

So I’ll sign off here and since Pride season is kicking off around the world, Happy Pride everyone.