Guys, this is a general message I am putting out after encountering a couple of cases in the last few months of gay or bi guys who have tested positive in circumstances when they were not expecting it. In both cases, not being prepared for this has greatly complicated the ways in which they have been able to respond to the diagnosis. All this simply underlines the need for building regular HIV testing into our lives if we have any kind of sexual life. Hopefully, perhaps even most likely, the results will come negative, but in case they do not, you might be a bit more prepared to deal with the diagnosis in the best possible way. I am just going to give a few details of these cases, but with all possible personal details that might identify them being changed. The first is a guy who found out while he was doing a routine test for a life insurance policy. He is married, with kids, and he told me that he hardly ever sex with guys, but was persuaded one day when his family was out of town and he met a guy online who assured him that he got tested himself regularly. Unfortunately, they used this assurance to go ahead and have unprotected sex, and the infection seems to have happened this way. The other guy may well have been right in saying he gets tested regularly, but it was entirely possible that the last test had taken place within the window-period when the HIV infection would not show up and so he didn't realise it. This simply shows that there is no alternative to using protection for safe sex. Since the guy who got in touch with me was also having sex with his wife, the huge concern was that he might have infected her too. He needed to find this out, but ideally without telling her since, if he was positive and she was not, he was more comfortable managing his condition without telling her until absolutely necessary (of course, he realised he would have to stop all unprotected sex with her). After a lot of problems he managed to have her tested and she was negative which was a huge relief, and he can now settle down to long term care for his condition. The second case was of a guy who was suffering from a number of ailments for about a year, for which he was being treated by his family doctor. The treatment would take care of them, but then new ones would occur - and in hindsight, one can surmise that these were opportunistic infections related to his falling immunity levels from being infected with HIV some years back. He only realised this after he went online to read up about one of his conditions, angular chelitis, which takes the form of painful cracks on the sides of the lips. He tells me that most doctors would diagnose this as a sign of vitamin deficiency, which is what he was being treated for. But on one site he read that in Africa it was considered to be a sign of weakening immunity due to AIDS, and he realised he should get it tested. He went and did the test and got a confirmation that he was HIV+ve. In his case the late diagnosis has meant he has had to go onto anti-retroviral treament immediately, while also trying to clear up the opportunistic infections. He'll be fine over time, but this was a situation that could have been avoided if he had done regular HIV testing. (One reason he told me why he didn't sounded all too common - his family doctor was not just well known to his family, but actually related to them, which made it really hard to ask for a HIV test. For years my own GP was also an uncle and I can imagine how hard I would have found it myself. A good reason for us to find independent doctors!). One other factor which he says he would like to have mentioned. He tells me that he hasn’t had that many experiences with anal sex, and he says that all of them were protected. But he also says that there were a few times when he wondered if the condom might have slipped off or torn or if the guy might have momentarily penetrated him without a condom, without his consent and before he realised it. As he says, it is natural to ask such questions, but hard to get answers. What this does underline is the need to have even protected sex with care. Please note I am NOT advocating just not having anal sex because if you really want to, you probably will. But you need to do it with care on both sides, which means someone you can trust to some extent and ideally not in a condition where you are drunk or stoned or so horny that you forget what you are doing. I know, I know, easier said than done, but just remember this story and next time you do it, you may take just that little bit more care. Let me reiterate, I am posting about these two cases NOT with the purpose of panicking people or suggesting that everyone must be forced to have HIV tests just because they are gay or bi. But it is simply common sense to acknowledge that if you have an active sexual life, whatever your sexuality, then STDs like HIV are a possibility and if you get infected it is always better to know about it soon because that can help a great deal with the treatment and with preventing you infecting others in turn. Many of us, perhaps understandably, respond to suggestions of danger by avoiding thinking about them, but this is one case where the consequences can be really complicated and easily avoided by regular testing. BTW, for fairly obvious reasons, this mail is addressed to gay and bi men. But I think there are similar issues facing women - I have several women friends, queer and straight, who have simply avoided going to gynaecologists for regular tests. At least one reason for this is understandable - too many gynaecs in India tend to take moralistic views of women who are not married and who have active sexual lives. Nobody wants to deal with patronising or hurtful comments when it deals with such sensitive issues. Yet the fact is that many conditions like ovarian cysts occur quite commonly as people grow older and left untreated can become much worse. So it is important to find doctors you are comfortable with and start going for regular checks ups. Please feel free to forward this message, or any part of it, to anyone or anywhere you think might help this message get across. Vikram
