When I first was diagnosed as HIV+, I remember being thankful for all the infrastructure in place to help me ensure that I wasn’t going to die of AIDS.  Whether it was through Philadelphia’s AIDS Activities Coordination Office or my initial visits to Philadelphia FIGHT, I received a care and attention that, just a decade or two ago, would be considered remarkable.  And, thanks to scientific advancements by pharmaceutical companies like Gilead, in part because of the United States government’s tardy, but right, confrontation of HIV/AIDS, my life expectancy is around 70, and I experience mild, if any, side effects.  Even more gratifying is the fact that these side effects have seemingly subsided now that I’ve been on medication for several months and am, happily, undetectable.  This means that, so long as I keep taking my once-a-day single pill Complera, there exists no measurable amount of HIV in my bloodstream, that I am, effectively, neutered from passing on HIV to anyone else, even if I have bareback sex, and that HIV cannot hurt me, generally. 

At the time of my diagnosis, though, I remember thinking, “Now, how am I supposed to have sex?” 

Notwithstanding all the tools, helpful professionals, and worthy mission-driven organizations here in Philadelphia, I was still at a loss as to how, exactly, I was supposed to navigate the gay sex and dating world in modern, iPhone hook up app based society.  In fact, I effectively tabled this personal discussion I was having with myself in favor of overtly sexual, overtly bareback, and thus only HIV+ majority population, sexual situations.  For example, there was a solid year where I would only go to bathhouses and sex parties for sexual gratification; after all, in an environment where everyone is barebacking, where everyone is specifically there to have sex, and where everyone, like it or not, has implicitly offered their informed consent to engage in these behaviors by their very participation in these behaviors, there is no need to say, “Excuse me, sir, but before you put your condomless penis into my anus, I’d like to show you my most recent results from Labcorp in Raritan, NJ, which detail that my CD4 count is a little low but that my HIV viral load is undetectable.”

Frankly, personal health matters are of little relevance or concern in overtly sexual, and bareback, environments, and anyone who claims anything to the contrary either doesn’t participate in these activities, and as such has no stakeholdership in the discussion, or they are complete and utter hypocrites (reformed pigs who hilariously take a “Do as I say, not as I have done” attitude in relation to HIV prevention, and who often make a living offering bad advice that won’t be used by anyone, I’m looking at you.  Many of you are HIV+ for a reason, and it isn’t because you had conservative sexual tastes.)

Even so, the longer I’ve been HIV+, the more traditional and, admittedly, boring I have become in relation to my sex and dating.  After all, at the end of the day, you can have all the piggish fun you want in a sling, but nobody who happens by your room at the bathhouse is going to want to cuddle or make dinner for you.  That isn’t to say these behaviors are bad; in fact, I routinely affirm that these exploits in bathhouses and sex parties are natural, fun, and, if done for the right reasons, perfectly healthy.  Yet, I still grapple with the best way to figure out how to easily normalize my relations with monogamy, dating, and more traditional concepts of coupling with my HIV status.  This tightrope walk of being honest with potential sex partners and boyfriends while still casting a net wide enough to actually engage in sex and dating is one that, I think, a great many of us who are HIV+ table, like I did, in favour of situations where we don’t even have to address it (like bathhouses.)  And, when we do try to be open, honest, and informative with our sex and dating partners, the results are, quite often, disheartening.

For instance, recently, I got a man’s number in a local gay bar.  We flirted relentlessly, and we both were obviously sexually attracted to each other.  So, just as our later text conversation started delving into matters that were the standard precursor to engaging in naked time together, I disclosed my HIV status.  His reaction was, at least in my insecure HIV focused insecurity based mind, predictable.  Feigning ambivalence, he, nonetheless, tellingly grew rather cool in the previously hot rapid fire text messaging conversation.  Then, he stopped messaging me altogether.  And, finally, in an attempt to salvage his politeness, said that he was tired.

Now, as I stated, I could entirely be infusing my own preconceived insecurities onto this man who very may well have been tired and entirely fine with my HIV status.  Or, as is the case with a large enough number of potential partners for me to write about it today, situations of which I have literally scores of conversation screenshots that I could chronicle in annoying detail here, he got spooked at the my mentioning of HIV and, in order to play the part of accepting, open-minded progressive, he feigned ambivalence, ran for the hills, and blamed being tired for our 180 away from having sex.  This approach, if that’s the case, while well-meaning, is annoying and compounds the difficulty those of us living with HIV already face in relation to sex and dating.  Frankly, I would much rather someone say, “Ick, gay plague,” and dismiss me summarily rather than “Oh that’s fine *oh god please no*, I’m okay with it *oh god can you get it from kissing?*”  After all, time is a premium for those of us facing death if we don’t continue to have wide, and free, access to antiretroviral medication.

This type of experience, of trying to do the right thing in disclosing and receiving little, if any, benefit to disclosing reinforces my, unfortunately relationship limiting and hostile-to-cuddling, default attraction to overtly sexual, overtly bareback outlets through which to meet men and have sex.

 Make no mistake, I am not complaining about this reality, nor am I demanding that the world do something.  Instead, I’m simply politely suggesting that we should be a little more candid with each other; I truly would never want to put anyone in a position where they were tolerating having sex with me under the ridiculous notion that they had to prove their compassionate bona fides.  Conversely, I would hope that others wouldn’t want to put me in a position where I see little benefit to disclosing my HIV status or where others blatantly lie about their status in order to have sex.  This latter group is rampant, based only my anecdotal and admittedly unscientific, personal knowledge, and while I agree with these men in that there is no statistically significant or scientifically probable chance of their transmitting HIV to sexual partners, and thus the idea of HIV status is, essentially, moot, I still cannot very well reconcile my own demands of candor and honesty along with finding sex partners and dates under false, and disrespectful, premises.

Then again, the guys who don’t talk about HIV whatsoever are also the ones who are, seemingly, having a lot more sex than I am.  So, what do I know?

This article originally appeared on Josh’s own blog here. 

This article by Roger Pebody  first appeared on aidsmap.com here.  

The majority of American gay men in relationships say they establish a ‘sexual agreement’ with their partner, both to minimise HIV risks and to maintain the quality of their relationship, according to research published online ahead of print by the Journal of Sex Research last month.

However, partners do not always agree on whether they have an agreement, on whether it was explicitly discussed, or on what sex is allowed with other people. And the agreement had been broken by one or both partners in just under half the couples studied.

The study has also found that around a quarter of the HIV-negative men who have casual sex attempt to 'serosort' or use 'strategic positioning' when doing so. However, regular HIV testing was far from universal in this group, making such practices potentially unreliable.

“From a public health perspective, we need to encourage gay couples to have more honest and explicit discussions when establishing and honouring sexual agreements,” commented Dr Jason Mitchell of the University of Michigan, who conducted the research. “Sexual agreements are not only advantageous from a prevention standpoint for couples, but the agreement can also help strengthen their relationship.”

A sexual agreement is made between two individuals, and concerns what sexual behaviour may occur within and outside their relationship. Some agreements may simply clarify that sex is not permitted with other people. Other agreements may concern the relationship being ‘open’ to a lesser or greater extent. Many couples use agreements, in part, to limit their risk of HIV infection.

A couples study

Jason Mitchell’s study recruited both partners in couples and compared their responses, rather than relying on just one partner’s perspective. Men were recruited to this cross-sectional online survey via adverts on Facebook in 2011 – the advertising was targeted to reach individuals whose profile information indicated that they might be a man in a relationship with a man. The first participants provided the email address of their partners, who were then contacted and asked to complete the survey.

The study recruited 722 men (361 couples). This was a predominantly white (77%) and relatively well-educated sample, with a mean age of 33, all living in the United States. Couples had been together for an average of an average of five years; three-quarters were living together.

One in eight men had been diagnosed with HIV. Half of them were in a relationship with another man with HIV, and half with an HIV-negative man (i.e. in a 'serodifferent' or ‘serodiscordant’ relationship).

Most men reported that they were HIV negative. (Just 3% of the sample reported that they did not know their HIV status.) However, one in five of the ‘HIV-negative’ men had not tested since the beginning of their relationship, and on average, HIV-negative men had last taken an HIV test two years ago. There was considerable diversity in the men’s HIV testing practices, with a minority testing much more frequently than others.

On average, men said that they had discussed their HIV status 12 days into the relationship, and this occurred before the couple started having unprotected sex (a mean of 81 days into the relationship). However, when the couple made a sexual agreement, this typically occurred much later – 174 days into the relationship. 

Agreements

Although seven in ten men reported having a sexual agreement, this perspective was not always shared by the man’s partner. In 57% of couples both men agreed that they had a sexual agreement, but in 25% of couples, one man thought there was an agreement, while his partner said that there wasn’t.

Amongst those couples who agreed that they had agreed, 58% said that there had been an explicit discussion, while 11% reported that their understanding was more implied or assumed. In a further 31% of cases, one partner had thought they had had an explicit discussion, while his partner thought that it was implicit.

For 56% of men who thought they had an agreement, it was that the relationship was monogamous.

For a further 41%, the agreement was to permit sex with casual partners, but with some rules or guidelines. For the last 3%, there was an open relationship, without any conditions.

Responses detailing what was permitted for those with open relationship guidelines showed that around a quarter actually permitted unprotected anal sex with casual partners. While the data shows that some couples had different rules for receptive and insertive sex, and for withdrawal before ejaculation, respondents were not asked whether there were conditions based on the partner’s HIV status and seroadaptive behaviours.

Far more couples allowed oral sex and masturbation.

Open relationship guidelines were not just about the risk of infections, but also about intimacy and context. Having sex with a casual partner on more than one occasion, physically sleeping together and dating were all permitted by half or less of couples, whereas threesomes or group sex were allowed by 81%.

Men’s motivations for making agreements were not just about minimising the risk of HIV or sexually transmitted infections, although this was the most common primary reason, cited by 23%. Other important reasons included wanting monogamy or exclusivity; fulfilling sexual desires; establishing guidelines so as to manage expectations; and building and maintaining trust.

Jason Mitchell did not analyse motivations by type of agreement, but in a separate study, another group of researchers previously found that the themes of trust, honesty and strengthening the relationship were predominant in the motivations both of men with open agreements and men with monogamy agreements.

Breaking agreements

Looking at couples, including those with an agreement to monogamy, in 46% of cases, either one or both partners had broken the rules at some point during the relationship.

But in the previous three months, 80% of couples had stuck to their rules. In 15% of the couples, one partner had broken the agreement, and in 5% both partners had.

The main reasons for breaking agreements were sexual frustration and the ‘heat of the moment’. Only a minority of men (30%) told their partner that they had broken the agreement. Reasons given for not disclosing included not giving the partner a reason not to trust the respondent and fearing that this could lead to the relationship ending.

Risk reduction strategies

In a separate article, published in AIDS & Behavior in December, Jason Mitchell has also reported on the risk-reduction strategies employed by this group of men, both inside and outside of their primary relationships.

He was interested in strategies such as serosorting, strategic positioning, 100% condom use and taking undetectable viral load into account.

This analysis is especially interesting because Mitchell actually asked respondents whether they had used strategies to reduce their risk of HIV or sexually transmitted infections. In contrast, most other studies on this topic have examined the pattern of men’s sexual practices with partners of different HIV statuses, and attempted to infer whether there was a strategy in place or not.

It therefore hasn’t been clear from previous research whether the conscious and deliberate use of strategies such as strategic positioning is something widely practiced by gay men, or just a minority pursuit.

For this couple-based analysis, those couples in which both partners had diagnosed HIV were excluded. Participants were asked about strategies used in the last previous three months – they could name more than one strategy, either because strategies were combined, or because different strategies were used in different situations.  

Always using condoms for anal sex, or always doing so with an HIV-positive partner, was reported by a minority of men. Within the main relationship, 15% of HIV-negative couples (i.e. in which both partners thought they were negative) always used condoms, rising to 38% of serodifferent couples (i.e. in which one partner had HIV and the other did not).

When having sex outside the relationship, 38% of men always used a condom for anal sex.

Only having oral sex and never anal sex was reported, for the main relationship, by 23% of HIV-negative couples and 31% of serodifferent couples. This strategy was more commonly reported for sex with casual partners – by 51% of men.

'Serosorting' (having unprotected anal intercourse [UAI] with a partner because he was thought to have the same HIV status) was reported by 66% of HIV-negative couples. Moreover, this was also reported for sex with casual partners, by 27% of men.

‘Strategic positioning’ (only having UAI with the HIV-positive partner in the receptive role) was reported, for the main relationship, by 32% of serodifferent couples. During casual sex, it was also reported by 23% of men.

Having unprotected sex because the HIV-positive partner was either taking HIV treatment or had an undetectable viral load was reported by 24% of serodifferent couples.

It was much less commonly employed as a strategy with casual partners – by 1% of men in an HIV-negative couple and 14% of men in a serodifferent couple

Finally, it’s important to note that a significant proportion of men did not have a risk-reduction strategy at all, especially with their main partner. One of the answers men could choose was ‘‘regardless of HIV-status, we never use condoms and ejaculate inside’’.

For their primary relationship, 24% of HIV-negative couples and 22% of serodifferent couples chose this answer. It was also chosen by 9% of men having sex outside the relationship.

Overall, having unprotected sex within the main relationship (in the last three months) was reported by 87% of HIV-negative couples and 69% of serodifferent couples. Moreover, for 16% of couples, there had been unprotected sex both with the main partner and at least one casual partner during the same time frame.

Improving the quality of agreements

Clearly, with a number of couples permitting unprotected anal sex outside of the relationship and with a significant minority of men breaking agreements in one way or another, there are risks that HIV can be brought into relationships.

The research highlights a number of other limitations of some men’s sexual agreements, in terms of the frequency of HIV testing, the discrepancy in partners’ perceptions of whether there is an agreement and what it entails, and the quality of communication following breaks in an agreement.

This suggests that HIV-prevention interventions which support men in strengthening their relationships and in making better agreements would be warranted.

One such approach that is being piloted is couples voluntary counselling and testing, in which couples take an HIV test and receive the results together. The focus of the counselling is not on past sexual history, but on how the couple wish to manage the risk of HIV in the future. Quantitative and qualitative research suggests that this is an intervention that many men in relationships would be interested in.

References

Mitchell JW Characteristics and Allowed Behaviors of Gay Male Couples' Sexual Agreements. Journal of Sex Research, online ahead of print, 2013. (Abstract here)

Mitchell JW, Petroll AE Patterns of HIV and sexually transmitted infection testing among men who have sex with men couples in the United States. Sexually Transmitted Diseases 39: 871-876, 2012. (Abstract here)

Mitchell JW HIV-Negative and HIV-Discordant Gay Male Couples' Use of HIV Risk-Reduction Strategies: Differences by Partner Type and Couples' HIV-Status. AIDS & Behavior, online ahead of print, 2012. (Abstract here) 

I don’t know, there is something about the French, and the French-speaking, that earns their reputation for being sexy. It’s even reflected in their gay men's sexual health websites and HIV prevention campaigns.

The latest offering from COCQ-SIDA  “Prêt pour l’action” or “Ready for Action” in English  is a case in point.  Boldly designed, with equally bold images, it’s clearly driven by the research from American Simon Rosser that says gay men like their prevention with a dose of sexy. So while not overtly graphic, this is the kind of website you want to poke around in just to see what images they’ve chosen, to go with the front page lead-ins like “to swallow or not to swallow”,  “you like group sex” or “bareback, raw or naturel”.

We’ve moved a long way, haven’t we, from prevention campaigns which were designed to scare like this one or this one. Research suggests they don’t work. Instead today’s campaigns are couched in terms that provide people with information on which they can make sound decisions. They therefore tend to be, of necessity, text-heavy but loaded with images which will hopefully draw people in. The challenge in 2013 is that now, as much as ever, we live in uncertain times. Few jurisdictions have managed to make much of dint in new infections amongst men who have sex with men and it’s become worryingly a possibility that we’ve run out of – pardon the expression – new tricks, short of turning to emerging new technologies to bolster sagging condom use.

Complicating matters is that, after all this time, we are still fumbling with the science so that some of the “facts” presented by any informational campaign like this still contain areas where we just don’t know our way. The impact of undetectable viral load on HIV transmission amongst men who have sex with men is one such instance. As a result, some men are charting their own courses, based on their understanding (sometimes sophisticated, sometimes not) of the science and perhaps more importantly their own perception of what is an acceptable risk. That latter of course varies widely.

Having said that, there undoubtedly remains a strong core of negative gay men who fervently – and commendably - wish to remain that way and look to AIDS Service Organizations for advice and information and it is this core audience to which sites like Ready for Action hold strong appeal.

So we like the fact that, underneath the pretty pictures here, there is a wealth of information both on the science and the risk associated with a variety of sexual practices, including the more exotic. We also like, mostly, the site’s approach to condom use, which recognizes they remain our first line of defence but are not always used, thus: 

“A condom and lube are extremely safe barriers against the transmission of HIV and other STBBIs. Once you decide to use condoms and get tested regularly, your risk of getting HIV and other STBBI drops considerably. When you choose to skip condoms for certain types of sexual play, the risk of HIV and STBBI infection goes up. If you use condoms inconsistently, or if you never use them, there are still things you can do to reduce the risk of HIV transmission. However, you should know that without condoms, there’s no such thing as zero-risk sex. For your peace of mind, make sure to get tested for HIV and other STBBIs regularly.”

Incidentally, there are English translation issues throughout  this site which I gather are being cleaned up. For instance, notice the use of the term “STBBIs” here (sexually transmitted blood born infections” which will be unfamiliar to those who have only just learned what “STIs” are. (The statement also errs in referring to using condoms as “zero-risk sex”.)

We do like  - a lot - the link to a testing reminder here which will alert you at intervals which you choose that it is time for another HIV test, by text message if you wish.

We like less that unless you delve deeper, the site seems to be geared towards negative guys. True, there is information on undetectable viral load here (more on that later) and there are in fact links to a separate document Living Positive (a guide for gay and bisexual men living with HIV). But the home page is poz-free.

We were a bit perplexed that the site, although being remarkably liberally minded, appears less so on oral sex. It says “To protect yourself and reduce risk .  . .  use a condom for oral sex. You can use a flavoured condom or one without lube, it’ll taste better!” Ready for Action, you just lost half your audience!

How does the rest of the information here stack up?  For us, the litmus test is how messaging like this handles the tricky subject of undetectable viral load. Few sites do this well, often favouring interpretations which seem overly conservative to some, unless you happen to be the Supreme Court of Canada. But here is what Ready For Action says:

“The risk of HIV transmission fluctuates with a person’s viral load. As the viral load goes down, so does the risk of transmission.

If a person is under treatment, with an undetectable viral load for more than six months and if none of the partners has an STBBI, the risk of transmitting HIV is very low. …..

An undetectable viral load in the blood doesn’t mean the virus is gone

The term “undetectable” refers to the fact that the tests we currently use aren’t able to detect the virus below a certain threshold. But even an undetectable viral load doesn’t mean the risk is gone; the viral load can rise quickly in an HIV-positive person when faced with infection or other factors, before falling back down to undetectable levels. Another point to take into account is that scientists can’t agree whether the viral load measured in the blood is necessarily the same as the viral load in the sperm or pre-cum (pre-ejaculatory fluid). Some studies show that the viral load in the blood is the same as that in sperm and pre-cum. Others say it’s different. At this stage, the important thing to remember is that an undetectable viral load doesn’t mean that the virus isn’t there.”

The admission that risk associated with an undetectable viral load is “very low” is certainly more realistic than most, even though this, in the case of men which have sex with men, is based on expert opinion,  rather than hard data applicable to that specific population. It is certainly more helpful than, for example the statement from Ontario’s comparable resource, thesexyouwant.ca  which says things like “We now know that (in general) an undetectable viral load lowers the risk of HIV transmission to sexual partners.”  That’s true, of course, but who doesn’t  look for more guidance than this truism provides?

Both sites incidentally err on the semen issue, the bugaboo often used to suggest to gay men that even though virus may be undetectable in their blood, their cum may well be swarming with potentially dangerous viruses. Some would argue that just isn’t borne out by the facts, particularly for those on long term ART, as Rupert Kaul’s research is finding.  In any event, with or without virus in the semen, CATIE recently reported “Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on ART, with caveats .” In the absence of hard evidence, readers may wish to make up their own mind about to what extent this applies to men who have sex with men, but some experts believe there will not be much dissimilar findings for men once better data becomes available.

Is this debate about what we know and what we don’t more meaningful to sexual health wonks than the average (GI)  Joe? Probably.  In any event who can fault those more comfortable taking a conservative approach to risk, particularly bearing in mind the risk of transmission of STIs, which in themselves complicate and exacerbate the risk of HIV transmission.

So back to Ready for Action.  While I might quibble with the details and the fine print, it’s an impressively thorough site, liberating in tone. Just as important, it’s nice to look at and feels like it is written by one of our own (or more likely a committee of our own), rather than by a public health official.  All in all this is a much better than average entry in to the gay men's sexual health sweepstakes. We like it.

Totally outRIGHT is a free leadership workshop series for young gay and bi guys in the Toronto area interested in sexual health. Sponsored by ACT, these workshops are for a cross-section of young gay and bi guys (ages 18-29). They are open to HIV-negative and HIV-positive guys, trans guys and guys from different ethnic backgrounds. 

The workshops consist of 17 modules over four days that build resilience and community. They are based on the success of the Totally outRIGHT program that was pioneered in Vancouver by Health Initiative for Men.  

Totally outRIGHT is a great way to meet other young gay and bi guys and connect with leaders in our community. It’s for guys who identify as gay or bi, want to learn about love, life, sexuality and sexual health and who want to apply that knowledge in their community. 

For more information go here.  

Want to be part of this amazing experience? Registration is now open for the workshop series being offered over four Saturdays: May 4, 11, 18 and 25, 2013. (Registration closes on Thursday, April 18, 2013 at 5:00 pm.) Register at http://www.actoronto.org/to.

Read Michael Burtch's article (My Relationship Status) - and comments - here.

I'm a gay man of a certain age. My experience with HIV in my community goes back to the beginning, even if my awareness of my own infection does not. I was there as we learned from the first reports that something was going very wrong and that – given apparent indifference on the part of many, but not all, authorities – the community had to do something about it. I have watched friends die. This long history has shaped my relationship to HIV and my attitudes about it. 

Having been diagnosed at a very advanced stage of my HIV infection in 1997, I will never be sure about when I might have been infected, but I'm pretty sure I know how, not having had a blood transfusion or injecting drugs. “Who” was a question I studiously avoided because, like others of my generation, I embrace the concept of shared responsibility and I believe that my energy is always better spent taking care of my health rather than seeking to assign blame outside of myself. 

Another reason that I have (mostly) avoided trying to identify the who and when of my infection is to avoid the distinction between the "generation which didn't know better" and those "who should have been able to avoid HIV infection", a horrible distinction that fingerpoints at a younger generation when they, like we, were just being human and pursuing our amorous interests. No human can fault another for having an occasional lapse in judgment or action that might have led to exposure to a risk of transmission. I've never met anyone who sought it out or who sought to transmit intentionally; I look on it as a hazard of our time. 

I am also an aging poz guy living with all the benefits of developments in treatment, and that is shaping some of my perceptions of HIV and my relationship to it, but these are layers added on top of my previous baggage. When I was diagnosed at 37, I didn't think I would ever be 53, as I will be later this year. I'm still banking on not making it past 65, as I have no retirement plans beyond poverty and loneliness (c'mon lottery ticket!). 

I have excellent access to health care, and that is surely the reason for my relatively good health. I am preoccupied by the fact that others don't have this access – including people living with HIV who have a more tenuous relationship with "the system," but also many of my HIV-negative friends who are part of this community that is disproportionately living with this disease. I hope that we can all decry that lack of access, and do something about it, without blaming me for taking up too much of it. Without it, I will probably die, but without it I fear that others will find themselves in my place, living with HIV. 

I've had a few of those serodiscordant situations that we seem to be talking about more these days. Of course, we now like to call them serodifferent, because we don't want to sow the seeds of discord with our terminology, but I think we all understand what it means whatever the term used. I like to think that I have lived up to my own expectations of myself in each of them, that I have avoided transmitting HIV and that I have treated my partners with the respect that I expect for myself. 

I remember a time early on, before I knew of my own infection, when I met one of my favourite bartenders outside the bar after hours (there was always a bit of a crowd milling about after the bar closed in those days). This unattainable object of my desire struck up a conversation with me and, as he seemed to be expressing some interest in taking me home with him, added the information that he had HIV. My reaction was similar to that of others in my community from my generation, at least at that time: I told him that wasn't a deal-breaker for me, that there were plenty of ways for us to enjoy ourselves without having to worry about HIV transmission. The relief that washed across his face bespoke the ravages of past negative reactions, and I felt bad for him about that. After we got to his place, he had more revelations for me, and we took more precautions to make sure that I didn't get anything else either. And we both (well, I can only speak for myself) had an excellent time. 

I spoke of another of my experiences here. A time when I knew my status and didn't disclose until asked (after the fact), but ensured for my own mental peace that I did nothing that would have possibly transmitted the virus I never wanted to someone else, even someone I knew only fleetingly. I know I didn't disclose because I feared the response would be overblown and negative, and the reaction when I responded honestly to the question asked late confirmed that for me. If I am at all disappointed in myself, it would be in not affirming my status at the outset, but in my defence that is often unrealistic in the face of expected hostility. I would note for those readers about to accuse me of being a criminal that I then satisfied all the criteria as set out by the recent Supreme Court decision to NOT be criminally responsible, so please keep your insults to yourselves. 

I had another experience that put me in the position of my bartender friend once. We were still in the bar and the "run for the exit" lights had not yet been lit, but the guy to whom I disclosed my status was straightforward and realistic in his response. We went to my place and we were able to negotiate what we both felt safe about doing. He could express his fears, even the irrational ones, and I could respect his choices and not be slighted by them. Again, we (there I go again!) had an enjoyable time. 

Let me add another one. A guy I met on the street who came to my place, who disclosed his status to me upon hearing where I worked (always a good sign that knowing I worked for an AIDS organization made him feel comfortable enough to disclose his status to me). His disclosure led to mine, and he proposed an activity (not the one you're thinking of) that ran up against my own hardwired behavioural restrictions that are part of my HIV baggage. I couldn't bring myself to do it, we discussed it (not discussion group style, but the quick exchange of words) and we adapted ourselves. I knew that what he was asking of me was not particularly risky and, considering our seroconcordance, not at all risky, but I couldn't go there and he wasn't going to take that personally. 

Somewhere in all these tales and thoughts I would like to find a lesson, for me and for others. If we could all be counted on to treat each other with respect as human beings, we might be able to end this epidemic. I should be able to disclose my status and not be faced with automatic rejection and fear. I should also be able to work with the fears and limits of my potential partners. For some, this might mean not having sex at all, or having a different kind of sex than either of us set out to have. But we should still be able to be respectful in how we express ourselves.

Or maybe we should just call me Pollyanna.

“Can I give you a hand with that?” were the first words the young man made to me in his perfect British accent.  He was tall, incredibly dark skinned, and lithe but in that athletic way only men who regularly run or play soccer can be.  His body was flawless, with that patch of hair in the middle of his chest denoting he was, in fact, a man, and when he removed his towel, the facts surrounding his being a man were decidedly and enormously to his credit. 

“And where are you from?” I responded after telling him to come into my room.  Even now, I have a habit of finding out the most banal, but eventually telling and vital to understanding, facts about men I meet under even the most anonymous and purely sexual of circumstances.

“Kenya,” he said.  I quickly started wondering whether or not I had enough personal knowledge of Kenya to validate his story.  Were they colonized by the British, which would explain his accent?  Is he just a crazy person from West Philadelphia who gets high and speaks, as I knew one young man to do, in a British accent for his own amusement or involuntary compulsion?  In a few seconds, I stopped my neurotic, thought-based assessments and was distracted by the only reason we both were seemingly in a bathhouse.  We said nothing more aside from his incredibly polite, “It was very nice to meet you,” as he left my room, leaving the door wide open and me, out of breath, on my bed.

As I write this, I am in a bathhouse.  Last night, I had an amusing and long conversation with a friend of mine at Woody’s in Philadelphia, the flagship gay bar here, and he asked me if I was willing to play wingman for his first foray into the globally popular gay male hobby of going to the bathhouse.  While he said he wanted more time before he personally dove in feet first, or up in the air rather, I had already alone decided to take advantage of half price Tuesday at Philadelphia’s only currently operating bathhouse off Rittenhouse Square.  After all, it wasn’t like I had planned on doing anything else last night, like building model airplanes, volunteering, or, most annoyingly stereotypical but factually accurate to my personal behavior, watching HGTV.  And so, when my friend and I parted ways, he went to his house, I went to the bathhouse, and I let my insecurities stay outside.  But, before we parted, he asked me some questions about the practical ins and outs of this quietly popular hobby in gay culture.

Rooms in most bathhouses in my experience are no larger than the square footage of a small storage shed in a suburban backyard.  Typically, each room has a light with a dimmer switch, no furniture or decoration aside from high gloss wall paint, tile or parquet flooring, and, more often than not, a single bed built into the floor or wall reminiscent of a submarine’s barracks.  Generally, these rooms have a television playing one or several stations of hardcore pornography or a speaker for, naturally, dance music.  These rooms usually have keys on small lanyards men can wrap around their ankles or wrists getting rid of the need of pockets and, therefore implicitly, the wearing of any clothing aside from a single towel provided upon check-in.

Originally, these businesses were started as a means to easily launder money.  After all, like all cash businesses related to the LGBT community, records were, at one time, non-existent or kept on two sets of books, and revenues somehow always found their way to Irish or Italian organized enterprises.  Today, however, these businesses, if run honestly, kept clean, and established on a premise outside of pretense or judgment, are genuinely profitable and a key, but rarely talked about, component of LGBT culture and economy.

Throughout the course of a day or night, dozens of men walk around in their towels, letting their leers and facial expressions communicate their desires, and have sex with each other.  In some cases, this sex is tender lovemaking, and in other cases, this sex is as aggressive as it is fulfilling.  In both cases, adults are consenting to engage in an activity, knowing full well the possible risks or lack thereof depending on their activity and partner of choice, and, hopefully, engaging in these acts for the right reasons.  In the overwhelming majority of bathhouses, condoms are provided at no cost to guests, and guests have every right to use them or not use them.  After all, part of being an adult is assessing risk, or lack thereof, and behaving accordingly to still enjoy life.

Often, my writing is misinterpreted, particularly in relation to sex and barebacking.  Quite literally, a reader recently implied that I was killing people by arguing against the, now obvious, ineffectual nature condom only campaigns are having on HIV transmission rates and the horrendously stigmatic approach inherent using the words “safe” or “clean” in relation to sex and HIV status.  Rather than recognize that I am simply pointing out a reality enjoyed by the overwhelming majority of LGBT folks, these readers are, instead, opting to promote their own particular agenda sustained by decades of conventional wisdom that, while once valuable to counteract a literal plague decimating the gay community, are now outdated as much as they are hurtful.  And, rather than understand that I make no point in advocating in favor of a particular activity, that I am merely pointing out the obvious reality of life, nothing more, nothing less, these readers would rather trot me out as the murderer of laughably characterized and non-existent “innocent victims.”

Last night, I engaged in mutually enjoyable and consensual sex in an overtly sexual environment.  And, the fact of the matter is that I am the rule, not the exception.  Acknowledging this does not condone or promote going to bathhouses; rather, it simply highlights that this goes on, that it is an important reality facing many gay men, and that judging this behavior or somehow insinuating that it is reckless or anything but net positive or neutral toward advancement of our loosely affiliated community is, at best, naive and, at worst, deceptive.  In both cases, such criticism is unwarranted, without merit, and, frankly, indicative of the very things that I routinely discredit, including judgmental and stigmatic practices in relation to sexual behavior.

This article first appeared in Josh’s own blog here.