A lot of gay guys make quick (and often irrational and incorrect) assumptions about their partner's HIV sero-status in the heat of the moment. "Oh, look, he lets me fuck him, he does not say anything about condoms, he is probably positive, just like me", thinks the horny top. The horny bottom thinks: "Oh, look, he does not grab condoms or lube, he is probably negative, like me, otherwise he would not be this irresponsible."
A few minutes later, in a dark corner of the sauna, the Human Immunodeficiency Virus has found new lebensraum.
Bingo!
In a city where 1 in 20 (Singapore, Beijing, Ho Chi Minh), 1 in 12 (Hanoi), 1 in 10 (Phnom Penh), 1 in 5 (Chiang Mai) or 1 in 3 (Yangon, Bangkok) gay men are infected with HIV, it is important to ditch such assumptions. It is important to stop ignoring HIV as 'a problem affecting others'.
Everybody who has ever had anal sex without a condom, or has had any form of condom slippage or breakage 'accident' with somebody else of whom we don't know his HIV status has, in principle, a chance to be infected.
Yes, that means YOU. Yes, it means ME. It means all of us.
One of my friends, who is a sauna and sex-party-enthusiast, sometimes gets so drunk and high on drugs that he does not really remember what happened exactly during his long passionate nights of action. When I ask him whether he has considered getting tested for HIV, he replied: "Why should I get tested? What is the point? If I am infected, I am probably infected already anyway. I will find out sooner rather than later. I prefer later, so that I can lead a normal life up until then."
Hmmm. A normal life... Meaning, in his case, that he does not need to feel guilty about having sex without condoms, as he "officially" is not aware that he might be infecting others. He reasons that if you know your status and you are HIV positive - well - it becomes much harder to justify ditching condoms, as he would feel guilty about infecting others. Another friend of mine who found out he was positive at the age of 19 refused to have any sex for nearly a year, for fear of infecting his lovers. He was depressed and could not sleep for months; any little itch or tiny cough triggered panic and alarm. Meanwhile, he kept his infection a secret from his family and most friends, leading a double life.
So why should you get tested for HIV? Why would you want to know you have a deadly disease and destroy your love life? Why face possible discrimination and stigma from friends, family and at work? Why not rather just 'let it be'?
In fact, there are several good reasons to get tested. I list a few of them below.
The first reason is perhaps partly a philosophical reason. I believe it is our duty, as the only animals on the planet who have brains that are able to reason, to get to know ourselves. Knowing ourselves and developing our personalities, talents and skills, and plan our lives based on what we learn is part of what makes life worth living. Taking stock of our lives, and taking RESPONSIBILITY for what we have done, is part of our value as human beings. Ignoring the possibility we might have HIV, which can, if untreated, be an important threat to our personal existence is, well, for lack of a more diplomatic term, rather stupid. It is also selfish versus others whom we may unwittingly infect (see below).
The second reason is biological / medical. If we are infected with HIV, our immune system is gradually destroyed. This takes, depending on each individual, between one and 20 years; fifty percent dies within 10 years. Unless we start treatment with antiretroviral medicines. These used to be terribly expensive and full of side effects, but are now quite affordable and less toxic. One used to take 6-8 pills a day in the past, but now many have been combined in convenient once- or twice-a-day doses. These pills used to have nasty side-effects, but these have decreased too, for most people at least.
Studies have shown that the earlier we find out that we have HIV and the timelier we start treatment of HIV with antiretroviral medicines, the more likely it is that our immune system will recover and the less likely it is that we will experience some of the nastier manifestations of AIDS later in life - in short, the sooner you find out, the more likely it is that you can start treatment at the right moment and live a long and healthy life.
The third reason is epidemiological. If all gay men were tested and if all of those who need treatment with antiretroviral medicines would enroll in treatment programs, the average HIV viral load in the gay community would decrease dramatically. This in itself would reduce the further transmission of HIV in our communities, even if condom use levels remained the same. Increased awareness of HIV will also likely lead to increased condom use in the community. Both of these factors - reduced viral load and increased condom use - will help turn the epidemic around.
The fourth reason is life-style related. In the 1980s and early 1990s, HIV was a death sentence. But in the days of antiretroviral drugs, there IS life after a diagnosis with HIV. Some people have been on drugs for a long time and have lived with HIV for over 20 years and are still going strong. Many friends who are positive report that they are more self-aware since becoming infected, have taken on a more healthy lifestyle, with more sports, healthier foods, more holidays and relaxation. They are more thankful to be alive, and more able to enjoy life 'day by day.' They would rather be negative, still, but the quality of their life is excellent - in some cases perhaps better than before. Most importantly, they have shaken off the lingering doubts and fears that they MIGHT be infected; the nightmares and fears - knowing their positive status was for many a relief.
The fifth reason to get tested is ethical / social. People who know they are HIV positive are probably more likely to use condoms consistently. I think it is not ethical to expose yourself, or expose others to HIV. For me it is also unethical if you infect others as a result of refusing to learn your own HIV status. I think that having sex without condoms is fine under certain circumstances, but only if we are as sure as we possibly can be that we do not aid the transmission of HIV. This means: guys who are positive should make sure they do not have unprotected anal sex with guys who are negative. Guys who are not sure if they are positive (which is, in most cities, between half and two thirds of us!) should, as a precaution, assume that they are. And if they want to have unprotected anal sex with a loved one - they should get tested first. And so should their loved one. How is that for an incentive to get tested!
In the example I used in the first paragraph of this column, both partners know their sero-status - but they do not communicate about it. This shows that no matter how well we promote HIV testing, we also need to promote communication and negotiation skills in gay communities...
Have I convinced you yet? If so, here is a little warning note! When you get tested, be sure that the clinic you go to is confidential and anonymous. You don't want the clinic to report your name and address to whatever authorities that may cause trouble. In most Asian cities there are Voluntary Counseling and Testing (VCT) clinics that are free or subsidised.
Most HIV testing centers use rapid tests, for which you can get the result within an hour. If the result is positive, a second test is done to confirm it. 'False' positive results are rare in populations with high HIV prevalence, such as MSM. If you are not sure if you can handle yourself in case you get an HIV positive result - don't get tested yet. Think about it a bit more. Or if you do decide to go but feel a bit shaky, bring a close friend, someone whom you trust.
After all, when you find out you are positive - you are not alone...
For more info and a list of clinics in Singapore, Hong Kong, Malaysia, Thailand, Philippines, Taiwan, South Korea, Indonesia and Japan, click onto fridae.asia/kys.
Jan is the moderator of MSM-Asia, an information network on men who have sex with men, HIV and human rights, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at jwdlvw@gmail.com.
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Reader's Comments
Just get tested.
No excuses.
And if you do get infected, no need to be fearful or depressed.
It is no longer a death sentence.
It is a chronic illness that can be controlled.
The longer you live, the better the chance you will live long enough for a vaccine to be discovered.
Get tested and seek treatment. Even if it means going overseas for treatment.
but i wonder how the writer get the figures
how to determine sample etc etc and concluded the figures above
i dont think the datas are reflecting the real condition
however, no matter its true or not, common sense is always play safe, responsible play...
1 in 20 in Singapore ? I think it's a lot higher than that. Sydney is around 1 in 10 amongst gay men. We know that Singapore has higher rates of unprotected sex coupled with sex jaunts to nearby epicentres like Bangkok.
I have knowingly and willingly engaged in unprotected sex in various cities throughout Asia. Part of it was simply the excitement and part of it was simply a preference on the part of the top not to use a condom when he fucked me.
So far, I have beat the statistical odds, but I know the risk.
So far any poz guy I met made me aware of his status and we were able to make a wise and informed choice to play safer
Well.. here you go... One amongst many references. And this one is a review linking to all other scientific publications on the subject:
The global epidemic of HIV infection among men who have sex with men. van Griensven F. Curr Opin HIV AIDS. 2009 Jul;4(4):300-7.
and if you want a hard copy that I am sure you will be bothered reading, get in touch.. I'll email it to you.
Denial is gay men's worst enemy...
SAFETY FIRST!!!
Errrrmmm excuse me for asking 'Ipack' but why shouldnt people demand/ask for this type of proof ?
Thought this would be just a natural reaction after reading an article of such detail that has such serious consequences for all of us.
Thanks for the 'references' 'Ipack' but maybe the article could have been referenced in the first place so those 'annoying' people wouldnt be so bold as to have to ask.
Anyways, thanks for the article Mr. Wijngaarden.
In current day Malaysia, the case is that the MSM's are actually married, having sex with guys, contracting the HIV virus and spreading it to their wives. Thus, the need to encourage total anonymity is still something that is worrying, especially since laws are in place within the Muslim community to discourage couples getting married if one of them is HIV+.
Similarly, I'd like to highlight the problem facing the Malay Muslim majority in combating the spread of HIV.
Please look up a Youtube video of 101 East discussing HIV, where the President of the Muslim Consumers Association states that married couples who have sex with condoms experience 'no feeling'.
And currently, we actually have an MP who's putting forth a silent motion to ban the sale of condoms from convenience stores in Malaysia.
and have laways said so in my profile
but the many rejections and discriminations make
mopst guys hide theire status.
all of us are responsible to accept and still have safe sex with guys
whatever their status safe sex is safe.
each time you say no to a guy because he is Positive
you force him to lie and take less care of others
fortunatly i am above that i can get free safe sex as i want
as a white gay cute man .
but most hIV+ guys have to lie to get layed
For sure give the fully researched article but also give a brief bam-bam-bam summary that everyone can read and get the message
I agree with you that there should be no question as to whether gay men should be tested. But I'd like to hear your comments on "How often". There is a widespread belief here in KL that testing in itself offers some sort of protection, so that guys are getting tested on a three monthly basis. To me that is simply the reflection of a failure to understand the topic, a lack of common sense and a waste of resources
Thank Allah who has seen fit not to publish any data on the incidence of HIV amongst Malaysian gay men. It must make Malaysian gay men feel a lot more secure than their peers elsewhere
- J.W is the Regional Aids Advisor for the Unesco (J.W@unesco.org) and is based in Bangkok. He attended, as a non-speaking participant, the ICAAP in Bali on 9-12/08/2009.
His verbose maybe debatable, however his credentials are not.
After four hours on the internet, and having consulted all available sources, I come to the conclusion that J.W. may have additional recent statistics since the complete worldwide HIV/Aids figures found are compiled up to the end of 2007. I will add that the number of HIV/Aids mentioned in the UNAIDS/WHO are those provided by each government, at least this is the case of Thailand(see below),
- On another site, I have found that for first time in 2007 more HIV cases were due to unprotected sex rather than from drug users which imply, unfortunately, a spreading of
the virus AT LARGE: J.W.'s plea for a regular and often HIV testing is fully warranted. I know for a fact that, at least in Indonesia and in Malaysia, hospital/doctor confidentiality is observed and a number is attached to the test being made. There is therefore little excuse
not to be tested. If you chose to play Russian Roulette wouldn't like to know when the last bullet is to be fired ?
- According to the UNAIDS the Asian-Pacific estimates are as follows:
"Estimated adults (15-49) HIV prevalence (%) for countries in 2007" (% = % of the country's population) -I have selected a few countries only.
-Cambodia 0.8
-Indonesia 0.2
-Malaysia 0.5
-Singapore 0.2
-Vietnam 0.5
-Thailand 1.4
As I said earlier, the HIV/Aids figures are provided by each government or para-governmental institutions. If one looks at the 2007 figure of the UNAIDS and that of www.thaigov.go.th...one would be surprised (or sceptical) of the accuracy of the same figure in both cases...
http://www.thaigov.go.th/
Summary
Population (July 2008 est.): 65,493,298
Economic Indicators (2007 est.):
GDP (PPP): US$519.4 billion
GDP per capita (PPP): US$7,900
HIV estimates:
Adults and children with HIV (2007): 610,000
Adult (15-49) Prevalence Rate (2007): 1.4%
Women (15+) with HIV (2005): 220,000
AIDS deaths (2007): 30,000
The same goes for the countries mentioned above.
When I was living in the U.S and being an active member of ACT-UP as well as a volunteer to bring food to Aids patients every evening after work, when I was in Hong-Kong and a volunteer again (bringing food and providing sex education as well as on-line counseller for disturbed young gay Chinese about their gay sexuality, etc...I was in possession -through various organisations- of statistics that were far above the median provided officially.
I would not be surprised that J.W. has access to more accurate information than those officially released...and good for him to let us have some of them.
Again, I believe it does not matter if J.W. figures for a city or another seem far fetched or not to you, the blatant facts remain: unprotected sex is on the rise, the idea that HIV+/Aids 'is for the oldies not for me' is frequent, the belief of 'super-me can't get it' prevails.
My humble advise: believe in J.W. figures, get tested, say, twice a year (even if you are in a monogamous relationship (you may be monogamous, your partner may not) and avoid dying like a moron in unbearable sufferings.
"We few, we happy few, we band of brothers" I wish to say it to all and each of you for a long long time.
JPS
Thanks for all your comments. I will soon share an overview of the epidemiology of HIV infection among men who have sex with men in the region, including all the latest figures AND sources.
33longchamps - thanks for your comments. Your points are well taken. I authored an article on the HIV epidemic in men who have sex with men which was published in the (scientific) Journal of Sexually Transmitted Diseases. I co-authored the article on the global HIV epidemic among MSM in Current Opinion, with Dr Van Griensven that Ipark mentioned in his reaction (thanks). The data I quote in my opening paragraph can be found easily on the internet.
Fridae is, to my knowledge, not a forum for academics so I try to write differently here. Pompous? Not sure. Not in line with my personality, in any case. I guess I am still finding my tone and voice. I will start putting references / sources in my columns from now on.
Cheers - Jan
Thank you for your comments which are appreciated, indeed.
I shall gladly retract 'pompous' and insert 'dwell on' instead.
'Way too long' , 'denseaus' said.
Back to the substance of your article, it is worth noting that every time statistics/numbers are cited guys tend to underestimate/question them as if to reassure themselves that they are outside 'the pack' therefore safer than the boy next door. 'Denial is gay men's worst enemy', 'Ipark' said.
I suggest that you bring a hammer in your next article for those with a thick skull.
Cheers,
JP
Thank you for your comments which are appreciated, indeed.
I shall gladly retract 'pompous' and insert 'dwell on' instead.
'Way too long' , 'denseaus' said.
Back to the substance of your article, it is worth noting that every time statistics/numbers are cited guys tend to underestimate/question them as if to reassure themselves that they are outside 'the pack' therefore safer than the boy next door. 'Denial is gay men's worst enemy', 'Ipark' said.
I suggest that you bring a hammer in your next article for those with a thick skull.
Cheers,
JP
Every time I have unsafe sex I have no unsafe sex for at least 3 or 4 months afterwards then get tested. I am sure my clinic is not surprised when all I go there for is STD tests. But it’s all a bit too late after the fact, I guess it easier to use condoms and be done with it. For the conscious of mind among us, having a test after unsafe sex is too late.
Just the other day I heard about a HIV+ guy deliberately having unsafe sex, It is criminal and he should be in jail for threatening other people’s health. If HIV+ guys are going to lie to get laid then clearly condoms are important part of keeping safe. There have been cases in Melbourne where people are jailed for having unsafe sex while HIV+.
I have had a partner who is HIV+ and there were no issues at all. I am still HIV-
All STD tests I get are free in my country so I guess it makes it easier to go and get the test. The doctor always asks why I want the test and I tell him exactly why, they often suggest other tests as well.
The down side to having STD’s is that you might find a lover who wants nothing to do with any disease for obvious reasons.
Technically even a headjob can be a high risk if your gums are unhealthy (bleed easily) and you come into contact with infected sperm.
My HIV+ X-BF was always making sure I had no cuts or skin abrasions before sex.
anyway, Jan it drives me nuts when you are apologizing all the time, if you are right and have the facts state just them, you are saving lives here
finally, I think I will renew my chapter fees from my high school abstinence club, sex isn't everything and I would rather not be one of the 20 HIV positive ones until I find my monogamous Prince to marry
Jan has given some statistics off-hand on the prevalence of HIV among MSM in the major cities in our region off-hand. We should understand that these figures are meant to be indicative only. Different research projects, with different samples, produce different results. For example, a recent research done at Singapore's largest gay sauna reveals that roughly 1 in 40 members who visited it on the day of data collection was HIV-positive. Let's not be too obsessed with the exactness of the statistics. Generally speaking, the ranking of prevalence of HIV among the cited cities is accurate. For example, Bangkok-based gays are substantially more likely to be HIV-positive than are Singapore-based ones, and gays are more likely to be HIV-positive than straight men.
However, there are a few things that I'd like to add to whatever Jan has written.
1) Jan seems to suggest that anal sex is the only source of risk. In fact, over the recent years, more and more evidence had emerged to suggest that oral sex is also a risk. Hence, I want to emphasize that both anal and oral sex performed with anyone (including your monogamous partner) be always protected.
2) Beside oral sex, being infected with other forms of STDs such as herpes also increases one's chances of being infected with HIV itself. Hence, though HIV does not have any physical symptoms, we should be educated about those STDs that do have them, and learn to avoid being infected with these via skin contact.
3) I'd also like to add a few more reasons, categorized under Community; Finance; Quality of Life; Economic; Psychology; Politics; and Sociology, for going for regular screening despite the fear for being tested positive:
(a)Community---> Eventually, any group (e.g. gays) who go for regular screening and, if tested HIV-positive, for treatment and counseling, will see a declining trend in their HIV infection rate, sooner or later. As Jan explains, those who are HIV-positive and have also been tested HIV-positive are less likely to spread the disease to others. They have been counseled to become more responsible in their sexual conduct. They undergo medical treatment that should significantly reduce their viral load. Hence, the main threat to the gay community is from those who are HIV-positive yet don't know that they are HIV-positive. Hence, for the community's sake, we should strive to reduce the absolute number of this group. If we can ensure that all HIV-positive persons be detected within 2 years of infection (by having all sexually active persons screened at an interval of 1 year), we should be able to significantly reduce the number of their victims.
(b) Finance---> Jan mentions that it's easier to treat a HIV-positive if he undergoes treatment earlier. I'd add that because it's easier, it's also more likely to be less expensive. There are many kinds of HIV medications. Doctors would usually try their best to conserve their HIV patients' financial resources by prescribing the least expensive medicines that work. If these cheaper medicines don't work, or if the HIV in a patient's body starts to show signs of resistance, the doctor may change the prescriptions. This process may be repeated, and if all the available cheaper medicines don't work, the doctor would be forced to prescribe the more expensive ones. If one can detect his HIV-positive status earlier, his immune system is more likely to be in a better shape than if he were to discover it later. This means that he stands a much higher chance of being treatable with the cheaper medications. Many HIV-positive patients who had discovered their status early spend less than S$300/month on the low-cost medications. I just spoke with a HIV-positive friend who told me that his medication costs him just around S$200/m. On top of the medication, he also has his blood tested once every 5 months. The average cost of sustaining his health is within the range of $300/month. He is healthy and holding a full-time, salaried job. He leads a normal lifestyle. However, these cheaper medicines are not suitable for all HIV patients. Some, especially those who discovered their status only when their condition worsened to AIDS (terminal stage), need to spend much more money on both medication and hospitalization (sometimes in Intensive Care Units) in order to survive. Also, these people often become too weak to work, hence their source of income may be affected when they most need it to pay for these much more expensive, life-saving treatments. If they had discovered their status much earlier, and undergone treatment at an early stage of HIV infection, they would probably be able to lead a normal life like my friend does.
(c)Quality of Life---> It's not just the money and other people. To bring the points raised above further, if a HIV-positive person needs not be hospitalized, is healthy enough to continue to work, and maintains his viral load to a safe level (meaning that his immune system can still protect him relatively well from most minor diseases such as common flu), then he can lead an almost-normal lifestyle. This means that he can enjoy those things in life that healthy people can, including going for holidays, doing voluntary work and even clubbing. It's the quality of life, that's, being fit, both mentally and physically, to do those things in life that makes it more meaningful and fun.
(d)Economic--->Singapore and all other major cities are highly dependent on human resource. Governments and parents spend hundreds of thousands of dollars to raise each child before he is expected to contribute to the workforce. If the child, like most other children, grow up as a healthy, educated adult, he starts to contribute economically to his country. Over his working life, he pays taxes, buys products and services and invests. This is how modern economies are sustained. Most HIV-positive persons who discovered their status early and undergo medical treatment can expect to lead a normal lifestyle and to survive for at least 20 years. With further medical advances this figure is likely to increase. Hence, from an economic perspective, HIV-positive people can still be contributive to their country. To use my HIV-positive friend's example again, he's contributing to the workforce, paying his taxes, investing his savings and, most importantly, not burdening others—his family and the taxpayers-- at all. He's probably going to survive for at least another 20 years, and quite possibly his entire working life. However, the same can't be said of those HIV-positive persons who had discovered their status only at the terminal stage. They had become a burden to their family and probably to the taxpayers. Their economically contributive years had been shortened. Simply because they had not been responsible to go for screening regularly, which could have led to much earlier diagnoses, and treatable conditions.
(e) Psychology---> I have an unproven hypothesis, which is, if a person goes for regular screenings, he is also more likely to practice safer sex, a virtuous cycle. If a person goes for regular testing, it tells me that he is a responsible, health-conscious, and down-to-earth person. If a person avoids going for regular screenings, there's probably some hidden fear in him. He may be a person who habitually sticks his head into the sand whenever he faces problems. He may be ignorant about STDs. He may be habitually practicing unsafe sex and is afraid of facing the verdict. Whatever it is, there is likely to be some behavioral obstacle that will continue to harm this person and his sex partners unless he overcomes it. An annual screening sends a reminder to us once a year that we need to face the verdict again the following year. It warns us that if we don't play safe, we will have to face the consequences. Hence, beside the obvious value in detecting HIV antibodies, annual screening works subtly to regulate our sexual conduct.
(f)Politics--->There has been an increase in HIV infection rates over the past years. But the statistics are not alarming. So, the government hasn't been proactive enough. Not much radical change to its stance on Comprehensive Sexuality Education, funding for HIV treatment & AFA, etc.. Among those cities cited by Jan, Bangkok's government is the most proactive. The reason is it had seen truly alarming statistics (given by Jan). To force the Singapore government to do much more than it has, I encourage more people to go for screening. Only if even more HIV infections are detected would the government start to listen more to WHO's advice, which is to reduce stigma, repeal discriminative laws, offer CSE in schools, and increase funding to NGOs like AFA. Besides, a higher number going for voluntary tests also suggests that Singapore is more mature and ready to engage important issues relating to taboos like sex and homosexuality. Whether you turn out to be HIV-positive or -negative, you win. If you are (already) HIV-positive, and detect your status earlier, you enjoy the benefits aforementioned. If you are not HIV-positive, you get a relief and a helpful reminder. Either way, you win.
(g)Sociology---> On top of the above points, I want to address the issue of social stigma on HIV-positive people. Let's ask a question: Why do you think most people are so scared of HIV? Partly because there is no cure for it. But many other viral infections (e.g. Hepatitis B) have no cure too. One major reason is, thanks to the mass media, most have seen shots of HIV-positive people suffering from tremendous pains, looking terribly skinny and feeble, and being hospitalized in ICUs waiting for their doom. It's true that many HIV-positive people are still in this plight. Particularly in Africa where quality medical services are rare and largely unaffordable. But it's no longer true of most of the HIV-positive persons in developed countries who had discovered their status early and are undergoing medical treatment. If more in our society were to see how well my HIV-positive friend is living, I guess HIV wouldn't be as feared. I am not against the HIV NGOs using fear to warn the public about the seriousness of HIV infection. HIV is a dreadful disease. But I think we also need a balancing act to encourage more people to go for regular screening. If we make HIV too intimidating, we may stimulate human's fight-or-flight response, and cause most people to opt for avoidance as a means to manage their fear for this disease. If most opt for avoidance, it would become a formidable task to persuade them to go for regular screening. Worse, there may be a spillover of stigma and discrimination against HIV-positive persons, which surmounts the difficulties in the fight against HIV. Hence, a very important strategy that I urge the NGOs to adopt is to convey a more factual picture of those who are HIV-positive, but had detected their status and started to undergo medical treatment early, and who are living well despite being HIV-positive. Most of them can continue to work and are a valuable asset to their respective employers. Let's try to reduce stigma on these people by painting something closer to reality instead of a grey effigy. Let's not scare these people's prospective employers, neighbours and even family away from them. Hence, by persuading most to go for regular screening, we can create a situation where most detected cases are of early-stage infections. This goes a long way to reducing the social stigma, because, as more people learn that being HIV-positive needs not mean a lifetime imprisonment in hospital, financial burden to family, inability to work, etc., the society would then be able to view HIV-positive people more positively. And they should. As I said, my HIV-positive friend is a good example of how a HIV-positive person can still be contributive.
4)I'd like to highlight also that, in Singapore, the Actions for Aids has been very proactive in promoting the FDA-approved rapid oral screening. In the past few years, you could do a rapid test for free during the month of December in the major gay saunas and discos. You might want to check with AFA whether this service will be offered again during Dec 2009.
So, for those guys who accuse the author for being irresponsible, what is your basis? Come on, show us some concrete proof that the author is wrong. I dare you.
By the way, Jan had worked for two major international organisations--- the the United Nations Educational, Scientific & Cultural Organisation and the United Nations Joint Programme on HIV/AIDS--- in the field of HIV/AIDS coordination. He's also academically trained in development studies and public health.
Hence, I'd be very doubtful that he's talking rubbish and plucking figures from the air.
As I explained, it's impossible to derive an exact figure for each city's rate of HIV infection, because different samples would produce different results. For example, one project may study a sample of those who frequent the gay spots like discos and clubs, while another may study a sample of all those who visit one particular gay sauna on one particular day.
It's also quite common for certain gays to seek sex partners from only one channel (e.g. saunas, clubs, public pools & toilet, parks & open public places, go-go bars, social networking websites or internet chat rooms). The level of risk exposed to each group may be different even though they may all be residents of the the same city. For example, visitors to gay saunas typically have much better access to quality condoms and lubricant, an advantageous environmental factor that promotes protected sex. On the other hand, park cruisers typically have poorer access to these, and may be tempted to practice unprotected sex.
If we were to study these sub-groups of casual sex-seekers separately, it's quite clear that each is exposed to a different level of risk of infection. Hence, there should be a statistical significance of the differences among their rates of infection. If you are interested to find out more about the figures given by Jan, it's best if you could read the original research reports, or their abstracts, which detail the research methodologies, sample sizes, and groups studied. Many of the studies are published on scholarly journals, which may be found in public or university libraries.
Could we move on to discuss about the contents and issues raised by Jan instead of wasting time to doubt his credibility. As I said, he's not just a casual volunteer without professional training and experience.
If you're in doubt, read the reference articles, and the articles those pages refer to also. The stats of infections for MSM are widely published and not difficult to find.
Doubting the figures seems to be a way to make yourself feel better about irresponsible behaviour.
Play safe.
Get tested regularly.
Get treatment early if you need it - it's best for everyone as it keeps the effects under control and can help prevent further transmission.
"This means: guys who are positive should make sure they do not have unprotected anal sex with guys who are negative."
Why only with guys who are negative? There is such a thing as overinfection.
And also: in casual sex encounters, it is rare that you can know for sure the status of your partner...
The following table was devised by a doctor/HIV specialist at Merck Pharmaceuticals. I reproduce it in answer to your question posted on Nov. 2nd 09.
"What Is the Risk of HIV Transmission During Sexual Activities?
Risk
Activity
1)None (unless sores are present):
-Dry kissing
-Body-to-body rubbing and massage
-Use of inserted sexual devices that are not shared with others
-Stimulation of the genitals by a partner if there is no contact with semen or vaginal fluids
-Bathing or showering together
Contact with feces or urine if the skin is intact
2)Theoretical (extremely low risk unless sores are present)
-Wet kissing
-Oral sex done to a male (fellatio) if ejaculation does not occur and a condom is used
-Oral sex done to a female (cunnilingus) if a barrier is used
-Oral-anal contact
-Vaginal or anal penetration by a hand with or without a glove
-Use of inserted sexual devices that are shared but are disinfected
3)Low
-Oral sex done to an infected male with or without ingestion of semen if a condom is not used or is used incorrectly (risk is less if oral sex is done to an uninfected male by an infected person)
-Oral sex done to a female if no barrier is used
-Vaginal or anal intercourse if a condom is used correctly (for example, using only water-based lubricants and not spilling any semen)
-Use of inserted sexual devices that are shared but are not disinfected
4)High
Vaginal or anal intercourse with or without ejaculation if a condom is not used or is used incorrectly "
PLEASE NOTE 'hush77': sores includes cuts or even irritation specially in the mouth, at the level of your gums or even your tongue; anywhere where the virus can enter the blood stream.
There is no % with Russian Roulette. Just mind what/where your mouth and your penis do and go.
JPS
Anyway, what i really wanted to add is that the table in Comment 38, if verified authoritatively and updated, should be an addendum to all articles here about aids, including Mr Wijngaarden's provocative, earlier article on "sucking". The "risk" information quoted by "33longchamp" is concise, to the point, and provides the raw facts, as known so far.
My only concern with the Merck list is that there are those who equate low-risk with no-risk. I mean, honestly, many of us would not voluntarily have sex of any kind, even low-risk, with someone whom we knew to be hiv-positive. Being kind and acccepting and caring, doesn't mean having sex with an infected person, or having sex at all for that matter.
Why should "hush77" (comment 37) have to ask the oral question here, Action for Aids? Maybe you should turn the Merck risk-list, once verified and perhaps with any necessary "qualifiers" added, into a poster to be put up at all saunas and bars, both straight and gay. Also, it could be included in a clickable hiv-update and info icon on websites like this, and as a link in the chatrooms, easily accessible in a practical way. But reaching the younger students who are at risk may need more careful thought and deliberation, because at that volatile age, "sex education" can be a double-edged tool. Still, those at risk need to be respected and presented with the plain facts, albeit with sensible qualifiers.
As for SL Yang and others in a similar position, may i just present an excerpt from an excerpt of a poem by Anne Porter (from Living Things) which i found in the latest newsletter of the Methodist School of Music, forgive the acronym:
"Why is it that music
at its most beautiful
opens a wound in us
an ache a desolation
deep as a homesickness
for some far-off
and half-forgotten country...
..shining at the heart of it
is the longed-for beauty
of the One who waits for us...
yet also came to live with us
and wanders where we wander...
As Gandalf said to Pippin in The Return of the King, this is not the end. Yes, there is another country, a distant shore. There is a whole world out there, the spiritual realm, and One who is Love. Dare i speak His name here? Journey mercies... :)
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