In August I found myself sitting through symposiums at the XVII International AIDS Conference in Mexico City. Over the past several years, the focus has been primarily on underserved countries like Africa, the Middle East, and Northern Europe. So imagine my surprise when United Nation’s speaker, Anthony Fauci, said we needed to redirect our attention back to the homosexual community. His speech came after statistics showed that the rates among gay men were on the rise.img_0107img_0147


This past year a Swiss Study, published results that HIV positive men with undetectable viral loads (< 48 viral copies per milliliter) for greater than six months had less of a chance of transmitting the virus to their uninfected partners. The backlash from this study, brought questions and concerns from some men who wanted to know if this gave them license to abandon condom use.


“Of course not,” was the response from the medical community, including myself. “Even if a patient is undetectable, there are ‘blips’ where their viral load can go above undetectable in the interim between testing, and what about contracting STDS like gonorrhea, Chlamydia, syphilis, HPV, herpes, and hepatitis B and C?”


The results presented from this Swiss Study did shine an optimistic light on an otherwise dreary HIV front., especially when more discouraging news followed from Merck and Co who decided to halt their long awaited vaccine trials. This Swiss Study offered hope to those uninfected men who found themselves exposed to the virus, but it was not published to promote unsafe sex. The results were especially significant for people in sero-discordant relationships – those where one is HIV positive and the other is negative – not for the sake of having unsafe sex during intercourse, but to alleviate stress associate with foreplay and oral sex.


As a doctor I often wonder how gay men interpret information such as with the Swiss Study. Enter Alex, a 25-year-old blue eyed, sandy brown haired man, who came into my office for an initial visit. After hearing his story, I interviewed again for the sake of this article.


Originally, from Los Angeles he told me that six months earlier he had met that special someone and began a serious relationship. “We never had a conversation about HIV, but I assumed that if he was he was positive, he would have told me.” Nearly three months later, Alex is taking a shower and finds a bottle of HIV medication in the bathroom. “I panicked. Working in the pharmaceutical industry, I knew what this drug was, but I kept telling myself that they weren’t his.” As the realization settled in, Alex called his best friend and asked him to accompany him to the doctor. “By then I was prepared for the worst.” Later he found out that he was indeed HIV positive and confronted his beau, who admitted that he with held the truth. Alex said, “He never apologized but he did say that he was undetectable and therefore couldn’t transmit the virus.” Soon after learning his results, Alex went on a family vacation and told them what had happened, including his father who is also gay. “My dad was so angry. He recalls the 1980’s when everyone died. I was born in 1983 so I don’t have memories like he does. Eventually he came around and now he is very supportive.” When I asked Alex how this has changed his life he is optimistic. “Sure I was upset and angry but it’s not the end.” Still Alex would choose to remain anonymous for this interview. Proof that the stigma attached to AIDS is still alive and well after over twenty-five years. The message from Alex’s story is clear; undetectable means less than 48 viral copies per milliliter. It doesn’t mean zero.


The world AIDS conference ended with appeals for further funding along with increased efforts to put an end to AIDS stigma. AIDS has killed more than 25 million people, and 33 million are infected with the virus. It has been estimated that by 2015, billions of dollars will have been spent in treating men and women infected with AIDS due to costly antiretroviral medication alone. The rising number of cases, especially in younger gay men, leaves me concerned for the future.


Then just the other day another young man comes into my office. His story is frighteningly similar to Alex except he knew his partner was HIV positive.


“Did you have unprotected sex with him” I asked.

“Yes, several times.”

“Are you prepared if the results come back positive?”

“Yes, because it was my decision. It’s like if a girl has unprotected sex. She knows that it could lead to a pregnancy.”

I think about that for a second. “Is it really the same thing?”

Leaving Mexico City on my way to the airport, I noticed the hillsides are blanketed by the colorful roofs of the small meager homes of the poverty-stricken regions of Mexico City, much like the favellas in Rio de Janeiro. It struck me as odd that the inhabitants would even bother to paint their homes in bright pretty colors, and then it was suddenly apparent. Leaving this conference after hearing so much information, I am concerned with how these facts get interpreted by our community. In light of the growing number of new cases of HIV especially among younger gay men, I would hope we could remedy this disconnection and not just ignore it by painting over it with bright shiny colors.


One Comment

  1. Posted November 5, 2008 at 8:16 pm | Permalink

    OMG! That is so scary! He understands the stigma and yet has this crazy self-serving logic. This level of apathy is shocking…and for what? So they can be “uninhibited”? Makes me crazy.

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