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Recently in HIV Category

Meds or No Meds?

Dear Dr. Dick,
I'm trying to get my boo to see a doc about getting on HIV meds. He got diagnosed in 2002, and started on HIV meds right away. He was healthy for several years, but then got on the crystal train and fell out of care (this was before I met him). He's worried about HIV drug resistance, and doesn't want to tell his provider about his crystal use. I just want him to be as healthy as possible. Any advice is much appreciated!
-Concerned in Columbia City

Dear Coco,
I know just how your boo feels. A lot of guys who have a history of crystal use feel judged and intimidated by their medical providers. I know some guys who dread having to go to the ER or to a clinic for a basic check-up. Luckily, Seattle has some top-notch providers who specialize in HIV care. If you have any friends who are poz, you might ask around to see who they'd recommend as a medical provider (with your partner's permission of course!).

Your partner's health and quality of life can be greatly improved by getting HIV care and treatment. The CDC (Centers for Disease Control & Prevention) now recommends HIV medication for ALL people living with HIV, no matter how recent the person got infected, or the person's CD4 count.

Getting people who are poz connected with care is called "TasP" (Treatment as Prevention). Research shows there are many benefits to taking HIV medications. These benefits include: a longer life and improved quality of life, reduced viral load, an increased CD4 count, a healthier immune system, and a greatly reduced likelihood of giving HIV to a partner.

It may feel awkward at first, but your partner's medical provider DOES need to know about his drug use; both medical and recreational. Otherwise, he or she could prescribe a medication or dose that doesn't mix well with other drugs. If a medical provider won't talk respectfully and openly about your boo's drug use, its ok for him to tell the provider how he feels.

Does your partner have insurance? Medicaid and many insurance plans will cover some or all of the costs related to HIV treatment. In addition, some people can get coverage assistance through Washington State's AIDS Drug Assistance Program (ADAP). Want more info? Toll Free (In Washington State): 877.376.9316.

Your partner might also be interested in the Healthy Connections program at Lifelong. This program offers free, one-on-one help for HIV-positive men and transgender individuals to get connected with care, and stay in care. Click the link for more info:

For information on taking HIV medications, including questions about drug-resistance, I recommend this page from the Resource Center on Keeping Up With Your HIV Meds:

I also recommend this article: The Silent Struggle of HIV Treatment Adherence:

I hope this helps. Thank you Coco, for your wonderful advocacy towards your partner and his health!

Take care,
Dr. Dick

Hugh Jazz: What is the Home Test Kit??

Dear Dr. Dick,

What's the deal with those big HIV box tests you can take and do yourself?
Thank you,

Hugh Jazz

Dear Hugh,

You must be referring to the HIV Home Test (also called "Self-Test"). These are kits that include everything you need to test yourself for HIV. Getting tested in a clinic is still the most accurate way to test for HIV, but the Home Test is a safe and convenient option when a clinic isn't available to you.
The Home Test Kit might be a good option for you if:
• You don't get tested at a clinic on a regular basis (it's recommended that guys who have sex with guys test every 3 months)
• You can't make it to a clinic in the near future to get tested
• You want to test between your regular clinic tests


First you swab your gums with a test stick, then put the swab in a little tube. The test looks for HIV antibodies in your saliva (spit). If your results show that antibodies were detected, this means you have likely been exposed to HIV.
When you open the test kit, take out the instruction sheet and read the instructions TWICE so you don't miss anything. Some guys like to have a friend sit with them for support. It's important not to eat or drink anything, or brush your teeth right before taking the test. Taking it when you're high isn't recommended either!

Your test results will take 20 minutes. While you wait you can clean, make dinner, chat with a friend, or even watch some porn.
If you get a positive result, it's important to get a follow-up HIV test at a clinic to confirm your results. If you do get diagnosed with HIV, connect with a medical provider right away so that you can start HIV medications. Anti-HIV meds are now recommended for all persons infected with HIV regardless of stage of infection.

The Window Period is the time between when a person first gets infected with HIV, and when an HIV test can detect the infection. The Window Period is different for each kind of HIV test.
For the home test, the Window Period can be up to 3 months. So, if you got infected with HIV on March 1, the test may not show a positive result until June 1. That means that for those three months you may be transmitting HIV to your sex partners. The home test should NOT be used to determine your HIV status right before hooking up with someone because of the high false-negative rate during the window period.
For Clinic Tests: There are a couple of different HIV tests used with different window periods. In contrast to the home tests, clinic-based HIV tests can detect HIV infection as early as 10-25 days after infection, depending on the test.

The test does NOT look for other STDs, like chlamydia, gonorrhea, and syphilis. MSM (Men who have Sex with Men), are encouraged to test every 3 months for these STDs. For a list of testing providers, visit


If you're negative for HIV, and think you might have come in contact with HIV through a condom break or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? You take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.
If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). For more info on PEP, check out my article Feelin' Peppy.

Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV. It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV. Guys who take PrEP should also do the following:
• Use condoms every time for anal and vaginal sex
• Talk to their partners about their HIV status and using protection
• Get tested regularly for STIs, and get treated if an STI pops up
• Get tested every 2-3 months for HIV
• Take their PrEP meds every day
• Use brand new needles and works every time they inject

TALK TO YOUR MEDICAL PROVIDER if you are interested in PrEP. For more info about PrEP, check out my article That Little Pill.

Thanks Hugh Jazz for your great question! Be well,

Dr. Dick

What's that coming down the chimney?

To my loyal readers,

It wouldn't be right to wish you happy holidays without imparting some safe sex advice. So before Santa slides down your chimney, take a minute and review my top ten holiday tips:

• Good things come in wrapped packages, so keep condoms close. When you give away your package, you might even tie it off with a pretty little bow.
• Whether you have one partner or four, use a new condom for every sex act. Make condoms part of foreplay, and be a smooth operator by learning to put one on with your mouth.

• Just avoid oil-based lubes like Vaseline, cooking oil, and lip balm. Use water-based lube to reduce friction that can damage tissue of the anus, penis, and rectum.
• Put some sensual lube inside the condom before you pinch the tip and roll it down. If you're having marathon crystal sex, don't be afraid to pause and add more. Even Santa needs to stop from time-to-time to grease-up his sled.

• A buildup in your chimney can make it more difficult for Santa to arrive. Test every 3 months for HIV, chlamydia, gonorrhea, and syphilis. If you test positive for an STD, connect with your medical provider right away for treatment. Find a testing provider here:

• Gracefully accepting gifts is just as important as gracefully giving them. Insertive "female" condoms, also known in NEON as "booty bags," "back packs," and "bottom bags" are a great alternative to traditional male condoms. Here's why:
• You can put one in your butt hours or minutes in advance. Since crystal can make it hard to remember to use a condom, you'll already be covered when it's time to play.
• No boner required! This means less pressure and more fun all around for you and your partners.
• You get to be in charge of your health. It's no secret that it can be difficult to talk to a partner about protection. Saying "I'm going to put a condom in," can help start an important conversation.
• Booty Bags provide extra protection against HIV and other STDs. Since the outer ring and the end of the condom bag stay outside the anus and lie against the surrounding area, you get extra coverage from fluids and sores.

• Rather than diving right in to the winter wonderland, fuel your passions with a steamy pre-hookup discussion. What are your likes and dislikes when it comes to sex? What will you use for protection? When was the last time you got tested?

• Stand, sit, or lie under the mistletoe after your holiday romp. Show your partner some holiday love rather than falling asleep right away.

• Been hearing buzz about a little something called PrEP? Guys who are HIV-negative who are at high-risk for getting HIV can take PrEP. It involves taking a pill once a day, every day, to help reduce your chances of getting infected with HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. Studies show that PrEP can reduce your chances of getting infected with HIV, however, taking PrEP does not guarantee that you won't get HIV.
• PrEP isn't meant to replace rubbers. Since PrEP doesn't protect against other STDs, condoms and regular STD tests are important. Guys on PrEP also need regular screenings for HIV, and blood tests to monitor kidney and liver function.
• Talk to your doctor or medical provider if you're interested in starting PrEP. For a list of PrEP providers in King County, please visit

• PEP: PEP can also lower your risk of getting HIV. PEP is a 28-day regimen of HIV medication that can be taken after a possible exposure to HIV. If you feel you might have been exposed to HIV, go to your doc or to the Harborview Emergency Room within 24 hours of the possible exposure. Treatment is more effective when started right away, and won't be prescribed to you after 72 hours.

• Fisting? Use elbow-length gloves and lots of water-based lube. Then, remember to wash your hands thoroughly with soap and water after your escapade.

• Sharing may not be caring in certain situations. Although it's not very likely, it is possible to spread STDs through sex toys. Put a condom on a sex toy if you're sharing or don't know if it's sparkly-clean.
• Some guys tell me they clean their toys with hand sanitizer, but, Purell simply won't remove all of the bacteria and germs. Carefully clean sex toys according to the manufacturer's instructions.

On behalf of NEON, I wish you the happiest and warmest of holiday seasons.

-Dr. Dick


Dear Dr. Dick,

I've been sprung ever since I met my partner Johnson last month----this man is off the chain! Anyway, he recently got his levels checked and the doc told him he's "undetectable." To be honest, I'm not exactly sure what "undetectable" means, but I was too shy to ask him. We used condoms at first, but haven't since we had the conversation about his viral load. Just for my info, what exactly does undetectable mean, and can you tell me how likely I am to get HIV?

- Dick in Downtown Seattle

Dear Dick,

Kudos to both of you for having these important, and sometimes difficult conversations. And hats off to Johnson: sounds like he's doing a fantastic job taking his HIV medications and caring for his health.

The CDC (Centers for Disease Control and Prevention) recommends HIV medication for ALL people living with HIV--no matter how recent the infection or a person's CD4 Count (the number of healthy white blood cells in a cubic millimeter of blood). There are many benefits to taking HIV medications, including a longer and healthier life; increased CD4 count; a healthier immune system; less chance of giving HIV to a partner, and a greatly reduced viral load.

Viral load is the number of virus particles in a milliliter of blood. These virus particles are called "copies." When a person who has HIV gets a viral load test, and the test doesn't show any HIV in their blood, the test result is "undetectable." Different tests are different, and current tests are better than the ones used years ago, so the meaning of undetectable has varied over time and can be different depending on where a person gets their medical care. Most tests that are widely used define a person as being undetectable if they have fewer than 40-50 copies of the virus per milliliter in their blood. The person still has HIV in their body, but their HIV medications have done a great job keeping the virus from replicating (making copies of itself). If someone who's undetectable stops taking their medications, the virus will reappear in their blood.

Studies show that when people take their HIV medications consistently and correctly, their chances of transmitting HIV to a partner are very small. Consistently and correctly means that a persons is taking the medication at the same time each day and is following the instructions given to them by their medical providers and pharmacist (for example, some medications should be taken on an empty stomach).

To answer your question, I can't precisely estimate your likelihood of getting infected with HIV from someone with an undetectable viral load. A study presented last year followed several hundred men who have sex with men who are in HIV discordant partnerships (one man had HIV and the other did not). In all of the partnerships, the HIV positive man was taking HIV medications, and the study found no incidences of HIV transmission. That finding is very consistent with studies of heterosexuals in Africa, which have found that taking HIV medications reduces the risk of transmitting HIV by over 90%.

With all of that said, if you are going to make important health decisions based on a partner's HIV treatment status, there are some important issues to consider.

Having an STD can increase your chances of getting infected with another STD, because your immune system is under stress. In addition, STDs that produce open sores, like syphilis and herpes, create entryways that make it easier for HIV and other STDs to get in the body.

Get regular STD tests with your partner(s), and if you test positive for an STD, connect with your medical provider right away for treatment. Treatment will help restore your immune system's infection-fighting power.

If you're going to make important health decisions based on what a partner tells you, you need to be confident that the information you're getting is right. Some people may believe they are undetectable, but actually aren't. If a person stops taking their HIV medications, they rapidly become detectable and can transmit HIV. Also, some people are not entirely truthful with their partners. I'm not saying that your partner is not being truthful or that lots of people lie about being undetectable, but some people are not entirely honest. You really need to trust someone if you're going to take a significant risk based on what they tell you. At least to me, it's one thing to trust someone you know and care about. It's quite another thing to wager your health on what someone you've never met before says on their online profile.

You may know PrEP as a hot-button subject in the gay community. PrEP is for people who don't have HIV, but are at a higher risk of getting infected. PrEP involves taking a daily HIV medication to prevent getting infected with the virus.

PrEP works best at preventing HIV infection when it's taken consistently and correctly. PrEP doesn't protect against other STDs, like chlamydia, gonorrhea, herpes, human papillomavirus and syphilis--so medical providers also recommend using condoms and getting regular STD tests. For more information on PrEP, check out my article: That Little Pill.

Crystal can add a layer of complexity when it comes to preventing HIV. Here's why:
• Prolonged, rougher crystal-sex can create tiny tears in the delicate tissue of the anus and throat. These tears create more entryways for infection to get into the body. Use lots of water-based lube during anal sex to reduce friction.
• Crystal can damage the teeth and gums, causing an increased risk of transmitting HIV and STDs during oral sex. I recommend trying out dams, oral sex condoms, and tongue condoms during oral sex. Check out Project NEON's Meth and Your Mouth Brochure for more info.
• Crystal can make it harder to take HIV medications consistently and correctly, which can lead to a higher viral load, and medication resistance. I recommend that guys who use crystal visit their primary care or HIV doc to discuss medication and their ability to take it as prescribed.


For some people, "Always use a condom" plays like a broken record. At the same time, the truth is that gay men use condoms way more than heterosexuals do. In fact, the vast majority of men who have sex with men in Seattle use condoms at least some of the time, and lots of men have successfully protected themselves for decades by consistently using condoms. Condoms are safe, cheap, easy to use, and unlike PrEP, they help protect you from all the STDs, not just from HIV. Condoms are still a very important part of protecting yourself. Even if you don't currently use condoms all they time, they might come in handy in certain situations, like if for instance, you're having rough crystal sex, or your partner stops or changes his HIV meds, or you're having sex with a guy you don't know very well.

Thank you, Dick, for your great question, and for taking charge of your health. Don't hesitate to write again if something comes up.

In health,

-Dr. Dick


Dear Dr. Dick,
As someone who just recently entered the gay dating scene, I haven't been with too many guys. Still, I was a little surprised when during my last hookup, "Mac" dropped his pants and revealed that he wasn't snipped. How is it that I've never seen an uncircumcised dick in real-life? (It was beautiful by the way). Anyway, I've heard that if you're not snipped, it's easier to get an infection in your dick, because it doesn't stay as clean. Any insight would be much appreciated.
-Snipped in Seattle

Dear Snipped
Like a circumcised dick, an uncircumcised dick is as clean as its owner wants it to be. With that said, research shows that circumcision--surgical removal of some or all of the foreskin from the penis (usually done during infancy), can provide certain protective benefits during sex. However, these benefits probably mainly affect guys who have vaginal sex.

Men who are circumcised have a reduced chance of getting HIV, HPV and herpes from FEMALE-bodied partners during vaginal sex. They are also probably less likely to spread HPV to their partners and circumcision protects their female partners from bacterial vaginosis. Circumcised men also have a reduced chance of cancer of the penis.

So what's the deal with the foreskin? Foreskin is lined with mucosa (moist tissue), that may make it easier for HIV to get in the body. Here's why:

Foreskin may be more likely to tear during sex, creating more entry-ways for infection. In addition, foreskin may be more susceptible to HIV infection than other tissues of the penis; there may be more target cells for HIV (cells that HIV invades, like T-Cells) in the mucosa of the foreskin.

Does circumcision reduce HIV transmission in guys who have sex with guys? Studies show mixed results. Most studies - including research done in Seattle - suggest that circumcision doesn't protect MSM (Men who have Sex with Men) against HIV. At least in part, this likely reflects the fact that most MSM in the U.S. are versatile, and the risk of getting HIV is highest when men bottom. Being circumcised doesn't protect you from getting HIV through your rectum. Some studies suggest that circumcision is protective in MSM who only top, but that is not certain. More research needs to be done on this important topic. Still, there are many ways to reduce the likelihood of HIV transmission during sex:

If the insertive partner is HIV-positive and taking antiretroviral therapy consistently and correctly, they are less likely to transmit HIV to a partner.

If one partner is HIV-negative and taking PrEP (Pre-Exposure Prophylaxis), they have additional protection against HIV taking hold in the body. If you decide to take PrEP, it is important to take your medication every day, to assume that the PrEP is not really effective for the first 2-4 weeks you are taking it, and to realize that PrEP is not 100% effective.


"Male condoms," insertive "female" condoms, oral sex condoms, and dams all provide a barrier against contact with genital fluids. Use water-based lube with condoms to prevent friction that could tear skin or the condom.


Test every 3 months for HIV, chlamydia, gonorrhea, and syphilis. If you test positive, connect with your medical provider right away for treatment. Getting treatment keeps you healthy and reduces your chance of transmitting an infection to a partner. Many agencies in Seattle offer FREE testing:

hygiene is especially key for uncircumcised males. Men who aren't snipped should gently pull back the foreskin during a bath or shower, and clean and dry the area well, to prevent infection.

Take care,

Dr. Dick

Feelin' PEPpy

Dear Dr. Dick,

I'm HIV-negative, and I faithfully strap on a rubber every time I ride a hottie. I feel pretty good about my safety practices, but what do I do if the condom breaks? It's happened a couple of times in my sexual tenure, but I usually notice right away and pull out. I don't have to worry about pregnancy, but what about other stuff?

-On Top Of It in Seattle

Dear Seattle Top,

Condom breakage is a fact of fact, I don't know too many guys who haven't experienced a break. It's great that you're educating yourself about risk. If a condom breaks, you might come in contact with fluids like semen or vaginal secretions, STI sores, and tiny breaks in the skin. What they all have in common is the potential to transmit sexually transmitted infections, including HIV.

If you're HIV-negative, and think you might have come in contact with HIV through a condom break or a needle stick, you might consider getting on PEP (Post-Exposure Prophylaxis). PEP can lower your chances of getting infected with HIV. How does it work? After a possible exposure to HIV, you take a 28-day course of HIV medication to decrease the chance that the virus will settle in your body.

If you feel you might have been exposed to HIV, go to the emergency room at Harborview within 24 hours of the exposure, to get a prescription for PEP. You can also see your primary care provider, if they can see you immediately. PEP works best when started right away, and will not be prescribed for you after 72 hours (3 days). If it has been more than 72 hours since possible exposure, you can still seek HIV prevention counseling around reducing your sexual risks. Keep in mind, even if you've been exposed to HIV, it doesn't mean that you will necessarily get infected with the virus. Keep calm, continue your safe sex practices, get tested, and take care of yourself.

Taking PEP does not guarantee that you won't get HIV. More research is needed to find out how effective PEP is in preventing possible HIV infection. PEP should not be used as a regular prevention tool!

NOTE: PEP is often confused with PrEP (Pre-Exposure Prophylaxis). PrEP is designed for daily use for individuals who have a high risk of getting infected with HIV (like someone in a long-term monogamous relationship with a partner who is known to be HIV-positive, particularly if the partner is off HIV treatment), while PEP is designed for use in emergencies, AFTER a possible exposure to HIV. Taking PrEP means you take a pill once a day, every day, to lower your risk of getting HIV. The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. TALK TO YOUR DOCTOR if you are interested in PrEP, and read more about it in my article That Little Pill

Things to keep in mind:
• PEP and PrEP can be costly. Check with your insurance if PEP and PrEP are covered. If not, ask if there are assistance programs to help cover the cost of the medication.
• Lube, lube, lube! Water based lube is the safest option to use with condoms.
• If you're having marathon sex, change a condom if it starts to dry out or just doesn't feel right. Don't be afraid to stop and add lube throughout your escapades.
• Make sure you're wearing the right size and shape of condom for you. There are so many options. Extra-long, snugger fit, baggy head, insertive condoms...don't be afraid to experiment, and don't let anyone shame you about your condom preferences!
• Add some lube to the tip of the condom, and pinch the tip before rolling the condom on. Both of these will reduce the chance of breakage.

Be well!
Dr. Dick

Ho! Ho! Ho! Ho! Ho! Advice for a naughty elf

Dear Dr. Dick,

Around the holidays, it's kinda hard for me to make ends meet. I'm not working right now, so you can guess how I earn my stash. Since I might be sleeping with an extra guy or three, what can I do to keep my candy cane minty fresh?


Naughty Elf

Dear Elf,

Guys trade sex for a lot of reasons---money, drug withdrawals, a couch to sleep on, or just needing a good fuck. While trading sex can be a quick (or not-so-quick) way to make ends meet, there are real safety concerns to think about. Keeping your candy cane fresh is just the beginning when it comes to safety.  

Guys who trade sex are more likely to:

  • Be victims of abuse and assault
  • Have unprotected sex
  • Feel depressed or suicidal
  • Get exposed to HIV and other STIs

You are a human being with needs, feelings, and rights. If you're trading sex, take time to take care of yourself---physically, emotionally, sexually, and mentally. Read on...


One issue you might face is a partner who doesn't want to wrap it---and if you're desperate, you might give in. Talk about protection and the types of sex you'll have before you start to play. You might say "we'll be safer and more relaxed if we use a condom," or "I'm not comfortable bare-backing." If you feel pressured into doing something you're not comfortable with, ask yourself if it's worth the price.   

When you have marathon crystal sex, your dick and anus can become raw and bleed---raising your risk of getting HIV and other STIs. Condoms and lots of lube are your best bet for protection. If you're a diehard top, you might end up a bottom when trading (or other way around). Try an insertive condom (we like to call them "Magnums for your ass"). They aren't tight on the dick and you can put one in up to eight hours before sex. For more info: Too Big to Fit in Here

Oral Sex

  • Ever put a condom on with your mouth? If you're smooth you can do it without your partner ever noticing.
  • Don't brush or floss before giving oral sex.
  • Wash your hands after sex, removing a condom, and touching sex toys. Cover a sex toy with a condom before use to shield yourself from germs.
  • Use gloves for fisting. Elbow-length gloves are the safest because they offer the most protection. Use gloves only once and wash your hands after taking gloves off
  • Make sure you're vaccinated for hepatitis A and B.
  • One study found that guys who trade sex are more likely to get STIs. Test for HIV and other STIs including syphilis, chlamydia, and gonorrhea, every 2-3 months.
  • You might also like to test yourself at home. Project NEON is giving away FREE HIV Home Test Kits. Pick one up from a peer educator or call 206.323.1768.  It's best to use the home tests as an extra test, not as a substitute for actual blood testing since the home tests are not as accurate as the testing done in a clinic or at one of our sister agencies like Gay City.
This info only skims the surface when it comes to safety. Look for part two next month, which will cover self-care and physical safety.

Be well,

Dr. Dick


Britney Speared

Dear Dr. Dick,

Is it safe to fuck with a penis piercing? My wicked Prince Albert is just about healed...

-Britney Speared

Dear BS,

There isn't much known about the safety of penis piercings and how they might affect your risk of getting HIV or other STIs. Therefore, the best way to reduce your chances of these infections is to care for your piercing and practice safer sex.  


  • A penis piercing is an open wound until it heals. An open wound is a perfect entry way for STIs like HIV. Follow your piercing aftercare instructions so the wound heals right.
  • Experts say you should wait to have sex until the wound is healed. Dried blood and other fluids can spread infection, and the piercing might also travel (move from its original position) during sex--especially rougher, longer crystal sex. Ouch!
  • Watch for signs of infection. Warning signs of infection can include bad-smelling discharge, redness, pain, swelling, and fever. Visit your doc if you think you have an infection.


Possible problems from piercing are:

  • Bacterial infection.
  • Bleeding.
  • Nerve damage.
  • A buildup of scar tissue at the site.
  • The piercing site might become hypersensitive (very sensitive).
  • Reaction to the jewelry (your body may reject the piercing).
  • Interruption of your urine flow when you pee. 
  • Hepatitis B, C, and HIV from piercing equipment that's not properly sterilized.


Oral Sex

Be careful during oral sex. A piercing can cause tissue damage if you're deep throating---and can lead to broken teeth and choking. Use a condom or avoid deep-throating altogether.

Some evidence suggests that if you're pierced, you may have a greater risk of getting HIV when someone gives you head. Protect yourself and your partner(s) by using an oral sex condom. Leave space at the tip of the condom so that it's not stretched tight over the jewelry (this could tear the condom).

Anal and Vaginal Sex

The tissue in the vagina and anus are delicate and easily damaged. Condoms and lots of lube will help reduce friction and prevent the jewelry from tearing or damaging the skin. Some guys take the piercing out for sex if it causes discomfort. Just be sure to put a condom on before you dive in, because bacteria and fluids can still get in the piercing site even when it's healed.

If crystal is in the mix, prepare ahead of time with a stash of condoms and lube. If you see or feel any signs of infection, get it checked out by a doc ASAP. Thank you for your shlong-tastic question!


-Dr. Dick 

That Little Pill

Dear Dr. Dick,

I try to use condoms when I can, but I definitely slip 'n slide. I don't want to catch the bug - ya know, HIV. I've heard there's a little pill that can prevent it. Tell me mo' 'bout it... pretty please?!

 "Pretty 'n Pink"

Dear PnP,

It sounds like & quacks like - PrEP (Pre-exposure Prophylaxis).

Guys who are HIV-negative and at high risk for getting HIV can take PrEP. How does it work? You take a pill once a day, every day, to lower your risk of getting HIV.

The pill contains HIV medicines that prevent HIV from making copies of itself when it gets in the body. Studies show that PrEP can reduce your chances of catching HIV, however, taking PrEP does not guarantee that you won't get HIV. 

The iPrEx study, which tested PrEP use in gay and bisexual men, found that participants were 44% less likely to get HIV than men who didn't take the pill. Furthermore, the guys who took PrEP everyday as prescribed (instead of missing or forgetting doses), reduced their risk of HIV infection by 90%. This year, the CDC released the results of the Bangkok Tenofovir Study--which tested PrEP in men and women who inject drugs. The study showed that participants who took PrEP every day had a 74% lower chance of getting HIV. However, some PrEP studies have found no benefit, probably because people didn't consistently take their medication.

It's important to keep in mind that PrEP alone won't stop you from getting infected with HIV. Some guys think that if they take PrEP, it's a ticket to ride bareback without the risk of HIV. PrEP should be one part of your safer sex and safer use practices.


Here are basic guidelines. GUYS WHO TAKE PrEP SHOULD:

  • Use condoms every time for anal and vaginal sex.
  • Talk to their partners about their HIV status and using protection.  
  • Get tested regularly for STIs, and get treated if an STI pops up.
  • Get tested every 2-3 months for HIV. 
  • Take their PrEP meds every day.

*If you take PrEP and use crystal, you should still use brand new needles and works every time. Don't share or reuse!

Talk to your doctor if you are interested in PrEP.

Before you can start PrEP, you'll need to test negative for HIV. Once you're on PrEP, your doctor will check-in with you regularly to talk about any side effects, your sexual safety practices, and make sure you are taking the medication as prescribed. You'll also get a blood test every 2-3 months to check for HIV and make sure the medication isn't damaging your kidneys or other organs. A common side effect of PrEP is upset stomach.

You shouldn't take someone else's PrEP drugs either. Only take it when it's prescribed for you by a doctor!


  • If you take PrEP, you have to take it every day for it to prevent HIV infection. You can't just take it the day before you plan to hook up with a hottie. Plain and simple, PrEP only works when you take it everyday. This can be hard for some guys, with all the other things going on throughout the day. Setting a phone alarm is one way to remember the medication.
  •  If you don't have insurance, PrEP can be super expensive. However, there are medication assistance programs like   


Read More:

Check out the PrEP Factsheet by Public Health Seattle King County here: PrEP Q&A: Using HIV Drugs to Prevent HIV Infection <>

Here's an editorial from OUT Magazine: Why Are We Not Talking About PrEP? <>


Yours truly,

Dr. Dick




Mouthing Off


Dear Dr. Dick,


I'm looking for a good, safe mouthwash to use--especially in orgy-situations where I tend to go down on several guys.


Thanks Doc!





Dear MO,


It's great you want to keep your mouth squeaky clean. Mouthwash can help kill bacteria and germs, prevent gingivitis (irritation of the gums), and gum disease, and freshen breath. But, mouthwash WON'T stop you from getting or spreading a sexually transmitted infection (STI) if you use it before or after you go down on a hottie. 


If you're giving head, you're going to get friendly with sexual fluids like pre-cum and cum (if you're not using a condom), and of course anything else hanging out on the dick and balls (such as sores, bumps, or tiny breaks in the skin). You can get all the same STIs through oral sex that you can get through anal or vaginal sex, including herpes, syphilis, chlamydia, gonorrhea, human papilloma virus (HPV), and HIV.  


The amount of risk linked with getting or giving head isn't known and varies with different STIs.  You can get or give herpes from oral sex, and most cases of genital herpes in gay men are now caused by herpes simplex virus 1---the type of herpes that lots of people have on their mouths.  Syphilis is pretty easily spread through oral sex, and some studies suggest that about 15% of infections are transmitted via oral sex. Gonorrhea in the throat is also common, and an estimated 25% of all cases of gonorrhea in the penis probably come from oral sex.  Chlamydia can live in the throat as well, but is less common, perhaps because it's hard for the bacteria to live there.  HPV can infect the throat, though it rarely causes throat cancer.  Finally, you can get HIV by giving head, though the risk is much lower than having unprotected anal sex.


I don't want to be a Debbie Downer, but it takes more than mouthwash to prevent getting or spreading HIV and other STIs. There isn't a lot known with certainty about how to stay safe while giving head, but read on for a couple of commonsense safety tips:


?        Avoid getting cum in your mouth

o        Getting cum in your mouth makes it easier to get an STI, especially if you have dental problems, or tiny cuts in your mouth. Finish off with your hand instead, or use an oral sex condom. 


?        Don't brush or floss before giving head

o        This can cause tiny tears in the tissue of your gums and cheeks. Tears provide a nice opening for sexual infections to enter.


o        If you want fresh breath before or after giving head, rinse or gargle with mouthwash. *Remember, mouthwash will NOT prevent you from getting or spreading an STI.


?        Don't give head after going to the dentist

o        Your dentist might be hot, but his dental tools can cause tiny tears in your mouth and lips.


?        Use an oral sex condom

o        Oral sex condoms are non-lubricated and flavored. Add some water-based or silicone-based lube inside the condom to increase sensation for your partner. Put some flavored lube on the outside of the condom to make it a juicier experience for you.  


o        Deep throating can hurt the tissue of your throat, which can make you more likely to pick up an STI. Use an oral sex condom if you are deep throating.


?        Try a dam for rimming

o        Dams are made of latex or polyurethane (for our friends who have latex allergies), and placed over the anus or vagina to shield one another from fluids, sores, and skin-to-skin contact. You can also get Hepatitis A and intestinal parasites from rimming, because you might touch feces (poop) with your mouth. Like condoms, dams should be used once, and then thrown away.


?        Get tested for STIs

o        Make testing a regular part of your healthcare, and make sure that your doctor tests you for gonorrhea or chlamydia in the throat.  If you test positive for an STI, connect with a medical provider right away for treatment. Having an STI can make it easier to get another STI.


o        Click for a list of testing sites in King County: Testing in Seattle/King County


?        Talk to your partners

o        Talk to your partners about what, if any kinds of protection you want to use, and the last time you were tested. It may seem awkward at first, but you might be surprised how well-received the conversation is.


         Get vaccinated against HPV

o        HPV is an extremely common STI.  If you are age 26 or younger, get vaccinated.



Sexual bugs just want a warm and happy home to live in. Use care when having oral sex.


-Dr. Dick




Dr. Dick on Blow Jobs: Before you lick, check the dick

Hey Doc!


I give great head and lots of it! But I hate condoms. One day I hear blow jobs are safe. The next day I hear they aren't. So what's the bottom line on giving head? Can you please settle this issue once and for all?




I. Lovedick


Well, every guy needs a hobby now doesn't he? And you're right, the issue of safety and blow jobs can be downright confusing. So let's try to make it simple.


The one who gives the blow job gets more of the risk. Your lucky recipient has less to worry about (HIV and some STIs can be transmitted to the receiver; it's not as common, but it is possible.) Today we'll just talk about giving blow jobs, not getting them.


Yes, there is clear risk for STIs. Gonorrhea, chlamydia, syphilis, and herpes can be shared when giving head. You can become infected if your mouth touches any sores, rashes, bumps, fluids, etc. So a thorough penis inspection is always smart before you begin. And play with any foreskins to check them out also. You can easily disguise it as teasing or foreplay. But inspecting a penis isn't guaranteed to make you safe! You can pick up an STI even if you don't see any symptoms! So be careful- there can be more than meets the eye!


Hepatitis is also a risk. But you can eliminate or reduce this risk by getting vaccinated for hep A and B. Even though it's not very common, it is possible to get hepatitis C through sex.


There have been reported cases of HIV transmission through oral sex. However, the number of cases is small compared to the whopping number of blow jobs that happen every day!


The experts agree on two points:


        You are less likely to get HIV from oral sex than anal sex,




        HIV risk is virtually zero if you use a condom when you give head


Your risks for any STI or HIV increase if:

        You have open sores or cuts in your mouth. These are the express lanes for infection! And since crystal is famous for causing gum problems and loose teeth, your mouth could be in serious trouble!

        You have just brushed or flossed. Scratches or tiny cuts in your gums can easily invite infection.

        You take cum in your mouth. Therefore, a lot of guys agree on this before the action begins. And many men prefer to "let it fly" anyway so it could be a win-win for you both!


 So here's my free advice to lovers of dick everywhere:


        Have an honest conversation about your STI statuses.  For example, you might say "I was negative for chlamydia, gonorrhea, etc...when I got tested last month."  

        Check your own mouth. Don't brush or floss before or just after giving head. Crystal users - take EXTRA steps to avoid gum disease and tooth decay!

        Check your partner's dick, especially under any foreskins. If you see anything unusual, play it safer. Use a condom or pass on giving head.

        Don't take cum in your mouth.

        When in doubt, use a condom. The flavored ones (and lubes) can be deliciously tasty. So why not give them a try?!

        Get vaccinated against hepatitis A and B


Well, fellatio fans, I hope this clears up the confusion.


Until next time


Dr. Dick


Edited and reposted 4/29/13

Don't Be Silly, Wrap Your Willie

Dear Dr. Dick,

I'm HIV-poz and I only sleep with poz guys. Why should I use protection?

-Ben Dover


Dear Ben,

That's a very good question, and I'm glad you asked it. You might be thinking that you already have the most serious STI (sexually transmitted infection) so why worry about protection? This seems to make sense except, when you are HIV positive, other STIs can still cause serious problems for you.


If you become infected with a viral STI like genital herpes, you can be sure that it'll put some major stress on your immune system. Viral STIs can be managed with medications, but cannot be cured; in essence, a viral STI stays in your body forever. If you are HIV positive, a virus like herpes can become harder to treat and the symptom outbreaks can be longer and more painful. The bottom line is that if you're having sex, you could become infected with another STI that is incurable.


Here's a bit more info about genital herpes:


Genital herpes is spread by direct skin-to-skin contact, (such as you and your partner's genitals rubbing together), most often during anal or vaginal sex. You can also spread herpes through oral sex (f.e., your partner has genital herpes and you give them head). Genital herpes is most contagious when the sores are open and haven't healed yet. Keep in mind that herpes can be spread even when you don't have any herpes sores. Just because you don't see any sores or bumps on your partner's dick, it doesn't mean they don't have an STI.


The first symptom of herpes is a cluster of sores that appear on the penis, vagina, cervix, anus, or butt. Rarely, sores appear on other areas of the body. They start as small pimples or blisters, and soon become open, painful sores.


Other common symptoms of herpes include:

?        Pain around the genitals, butt, or legs

?        Flu-like symptoms (fever, chills, headache or body aches)

?        Swollen lymph nodes in the groin

?        Itching or burning when you pee

?        A hard time having a bowel movement or peeing


Bacterial STIs like chlamydia, gonorrhea, or syphilis can cause very serious infections in your penis, mouth, or butt that can be harder to treat if you are HIV-positive. Bacterial STIs can be cured, but the longer you wait for treatment, the more likely are you are to end up with permanent damage or complications.


If you are HIV positive and your partner is not, (or the other way around), STIs can make it easier for you or your partner to get infected with HIV. STIs can create breaks in the skin, which make "portals of entry" for HIV (HIV will have an easier time getting into your body). Additionally, inflammation from STIs causes more of the STI-infected cells to be hanging out in your genital secretions. These cells then serve as "targets" for HIV infection. Furthermore, HIV-positive individuals who are infected with other STIs, are more likely to shed HIV in their genital secretions (semen, pre-cum, or vaginal secretions). There are also multiple strains of HIV, and you could get infected by a different strain if you don't use protection. 


The bottom line--protection is key! Unless you are in a committed, monogamous relationship where you and your partner only have sex with each other, and are sure of each other's statuses, condoms and other barriers are important.


With that said, whether or not you decide to use condoms, GET TESTED. Regular testing can catch sexual bugs early, so that you and your partner(s) can get proper treatment. Test for STIs and Hep C every 2-3 months, or based on your medical provider's recommendation.


Remember that we can care for our sexual health in many ways, by asking questions, talking to friends, protecting ourselves and our partners, and getting STI checkups.


Take care,


Dr. Dick



For more info about STIs, visit: STI Info_Public Health Seattle King County


For info about FREE testing for HIV, STIs, and Hep C, visit: Where to get tested in Seattle/King County or join NEON and Gay City for TGIF, Fridays from 3-5 p.m. at Seattle Counseling Service. Get free, confidential testing for HIV, STIs, and Hep C, eats, films and workshops, and more!


Updated and Reposted 3/7/13


Uncovered in the U District

Dear Dr. Dick,


I'm a bi guy who has a couple of intimate partners (both men and women). At this time of year when it's freezing out, it's basically a 24/7 orgy. We all tested negative two months ago, and we're good about getting tested regularly. I feel like I don't have to worry too much about getting HIV. The only thing is, I really don't like condoms. They don't feel good and I have a hard time getting off when I use them. My partners are OK with me not using them.  Two of us use crystal, but we smoke only (we don't inject or booty-bump).


How worried should I be about getting HIV? Dr. Dick, I'm not about to start covering myself up. Is there anything I can do to play it safer?




Uncovered in the U District



Dear Uncovered,


I'm glad you brought this up! While condoms can make sex a whole lot safer--it's important to acknowledge that some people just don't like them or use them. For many guys, sex without condoms just feels better---but it can come with a price (pardon the pun). If you're NOT in a monogamous relationship (where you and your partner only sleep with each other, and are sure you are both HIV/STI free) --- barebacking is risky.


Here's Why:


1) The lining of the anus and vagina are delicate. Micro tears can happen easily (especially with rougher, prolonged crystal sex), which leaves you and your partners vulnerable to HIV and other sexual bugs.


2) It's always a possibility that your partners have other partners. Even though you trust them, you should never assume you're 100% safe when it comes to sex.  Whether its oral, anal, or vaginal sex, all sex carries some risk.


3) Even though you and your partners test often, people are most infectious in the weeks right after they get infected with HIV. If one of your partners gets infected and doesn't yet know it, they could infect you.


With that said, if you're sure that you're never going to use a condom---consider the following tips for safer sex:




Douching (using an enema) damages the skin in and around your hole--making it easier to spread or get an STI. If you absolutely MUST douche before sex, use warm water only. Check out my recent article on enemas for more info.



Talk about sex before you smoke. Do you have the supplies you need? (water-based or silicone-based lube etc.). Crystal can make you forget everything when you're caught in a moment of passion.  


Try to use your own pipe only. Passing the pipe around can expose you to diseases and infections that can weaken your immune system.


3) TEST:

Test every 2-3 months

?        If you test positive for an STI--connect with a medical provider ASAP. You and your partners must all get treated. Otherwise, the bacteria/bug will continue to be spread back and forth. Your immune system will also be more compromised---which will make barebacking riskier.



Have you thought about trying an insertive condom? Insertive condoms are used in the anus or vagina, and offer protection against HIV, pregnancy, and STIs. You can put one in yourself, or ask your partner to do it. This is a great option for guys who have a difficult time staying hard with condoms on. Have fun with them by making them a part of foreplay.


For more info, see my recent article Too Big to Fit in Here.



Have fewer partners. Fewer partners = less chance of getting or spreading a sexual bug.


6) PrEP & PEP:


HIV-negative guys who are at high risk for getting HIV can take PrEP (Pre-Exposure Prophylaxis). PrEP involves taking a pill once a day, every day, to help prevent getting HIV. Guys who take PrEP should also use condoms, & get tested often for HIV and other STDs.

Talk to your medical provider if you are interested in PrEP.



(Post-Exposure Prophylaxis) can also lower your risk of getting HIV. PEP is the use of an HIV drug after a possible exposure to HIV. If you feel you might have been exposed to HIV, visit your medical provider ASAP. PEP needs to be started within a couple days of being exposed to HIV. 



It sounds like you're doing a superb job of talking with your partners. Keep it up. Talk about your HIV and STI status with your current partners--and if/when you get a new partner. You might say "I tested negative for HIV 2 months ago." If you don't talk with your partners, you don't have the chance to find out their status or sexual history.


8) LUBE:

Some guys use lube because they feel like it decreases friction and trauma to the skin. Friction can tear the lining of the anus or vagina, which makes you or a partner more likely to get a sexual bug.   


We really have no idea whether lube increases the risk of HIV and other STIs, decreases the risk, or has no effect.  More research is needed in this area. Your risk of spreading or getting HIV and other STIs may depend more on the kind of lube you use. 

Not all lubes are safe! Some lubes hurt the lining of the rectum and may increase HIV replication (the virus making copies of itself).  Here's a bit more info:


         If you are using condoms, don't use oil-based lube--which breaks down condoms. Crisco, Vaseline, and chapstick (lip balms) are oil-based and are NOT good options--even if you're desperate!!


         Stay away from lubricants that contain nonoxynol-9. Nonoxynol-9 is a spermicide that can irritate the delicate lining of the rectum and vagina, increasing the risk of HIV and other STIs.


         Some evidence suggests that lubricants containing an ingredient called polyquaternium-15 may boost HIV replication. Some of the lubricants that contain polyquaternium-15 are: Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin and Paraben-Free Liquid, and Astroglide Silken Secret.


         Some evidence suggests that certain lubricants can damage the cells in the lining of the rectum. These lubricants include: Astroglide, Elbow Grease, Gynol II, KY Jelly, Relpens, and Boy Butter.



         Some evidence points to the following lubricants as safer choices: Good Clean Love, PRE, FC 2 lubricant, and Wet Platinum.



Have you thought about how important it is to you to stay HIV-negative? What would you do if you tested positive? It's worth thinking about....



Here's to safer humping.



Dr. Dick



*For more info on PrEP and PEP visit



Go to:

& click on PrEP Q&A: Using HIV Drugs to Prevent HIV Infection.



Go to:



Hep C Positive


Dear Dr. Dick,


I was part of a study where they tested my blood for all kinds of stuff. They told me I was HIV positive. I knew this already (for six years). The woman also told me I have hepatitis C. HIV was bad enough--now this. She gave me some information but I lost it. She also told me some stuff but I wasn't too clear-headed at the time. I'm worried. What's going to happen to me? I hear a lot of different things from a couple of friends who have hepatitis C and HIV. Is there anything I can do to help keep healthier? I'm not going to stop shooting meth--at least for now--but I might in the future. I know shooters mostly get hepatitis C from sharing dirty works.


Since I switched to IV speed four years ago, I've been real careful--except for one accident, I never used anything that belonged to anybody else. It happened once when I was too geeked and mixed a hit with my ex-lover's dirty rinse water. I also used his old cotton and spoon. He was HIV positive but so am I. Did I get hepatitis C through just this one time?!! Maybe I got it through sex but I've been pretty careful on that score. I need some direction and advice.


Thank you,





Dear Anonymous,


Everybody slips up once in awhile--so don't be hard on yourself. What's done is done. It sounds like other than that you've been faithfully practicing harm reduction.


About 80% of HIV-positive people who inject drugs also have HCV--and having both infections can make HCV progress faster in the body. Make an appointment to see your doctor so you can get your questions answered and discuss your health. You'll feel a lot better when you know what's going in on your body, and can talk about treatment and care.


In the mean time, let me give you some info about the hepatitis C virus (HCV). Hepatitis simply means inflammation of the liver. HCV is a contagious liver disease (just like hepatitis A and B). It is spread mostly through contact with the blood of a person who has HCV. Common symptoms of HCV are tiredness, mild fever, nausea, loss of appetite, stomach cramps or side pain, dark yellow or brown pee, pale or white bowel movements, and jaundice (yellow eyes and skin). Unlike A and B, there is NO vaccine for HCV.


HCV infection can be acute or chronic. Acute HCV is a short-term infection that shows up within the first six months of getting HCV. 70-80% of individuals with acute hepatitis C don't have symptoms--so many don't know they're infected. About 15-25% of people will clear the acute HCV infection from their systems.


For the other 75-85% of folks infected with HCV, the acute infection leads to chronic HCV infection--meaning the virus stays in their system. Chronic HCV can lead to more serious health problems, such as scarring of the liver (cirrhosis), and liver cancer. That's why going to your doctor regularly is important if you have HCV.


A lot of injectors get HCV.  Why?? Hepatitis C can live on a surface or in a used needle anywhere from 16 hours, to four days. So, any object that has blood in it (like a cooker), or any surface that blood may have been on (like a counter top you use to prep your injections) can be a risk. While bleach can kill HIV, it is unknown if it kills HCV. That's why even if you bleach a syringe, you still run the risk of spreading or getting HCV.


It is possible to get HCV through sex. A small percentage of HCV is transmitted through sex--and it happens more among guys who have both HIV and HCV. If you have HIV and HCV, you should use condoms to prevent spreading HCV (or getting another strain from a partner). There are many strains of hepatitis C, so don't think that you're immune just because you already have the virus.


You are more likely to spread HCV when you don't use condoms and lube, have multiple sex partners; engage in rough sex; or when you or a partner has HIV or another STD. You CAN avoid getting another strain of HCV by protecting yourself!


taking care of yourself when you have HIV and HEP c:


1)     Visit your healthcare provider so they can monitor your liver health. Some people with HCV take medications to reduce the inflammation. These medications are effective, but can reduce how well HIV medications work. Seeing your provider so they can talk to you about treatment and care options is important.  

2)     Be kind to your liver! Try not to drink alcohol, as it will cause more damage to your liver.

3)     Get immunized for hepatitis A, and B, unless you have already had these infections. Getting A and/or B could cause more damage to your liver.

4)     Join an HCV support group. Be in a safe space with other folks who have HCV: HEP C Support Group.

5)     As always, take care! Rest, a healthy diet, and exercise are important ways to keep your immune system up.



Ways to reduce your risk of spreading or contracting HCV:

1)     Use condoms when you're getting some booty.

2)     Do not share personal items that may have blood on them. Razors, tooth brushes, sex toys, and nail clippers should be kept to yourself.  

3)     Cover cuts and open sores with a bandage.

4)     Use clean works, keep them to yourself, and don't share. Need clean works? Click here for the Seattle & King County Needle Exchange Schedule.



If you'd like to read more, I recommend visiting Hepatitis C Facts.


Take care.


Dr. Dick


Updated & Reposted 12/28/12







What's a freak to do?


Dear Dr. Dick,


Halloween is my favorite holiday, but I always end up with too much candy in the bowl. Any advice for how to keep my tricking in-check?


Yours truly,


Joe McFreaky



Dear Mr. McFreaky,


You'd be surprised how many people write me at this time of year, concerned about too much tricking on Halloween. Below is a sure-fire list of ways to get your freak on while reducing fright on Halloween night.


       Keep costumes to yourself. To avoid coochie critters and other fright-night cooties, keep your pants on and don't share!


       Keep condoms and lube handy. Planning to get some booty? Go trick-or-treating at Seattle Counseling Service on Friday, October 26 from 3-5 p.m., for free condoms (many sensual varieties available) and lube.


       Use the condoms and lube. Use a new condom every time you have sex. Remember, condoms may wear out before you do. Check them often during sex, when you change position, or withdraw. Worried you'll forget to use one? You can put an insertive condom in up to eight hours before sex. It could make a great addition to your costume!


*ALWAYS use LOTS of condom-safe lube (water-based) with condoms.


       Stay hydrated! Shaking your ghoul thing will make you sweat buckets. Drink plenty of water before the fun begins. It's also important to drink lots of water if injecting is on your list of plans for Halloween night.    


       Be smart about glitter. Apply it generously, but avoid your dick! Glitter has no place on your delicate flower (unless of course you dress up as a giant flower).


       Avoid biting. Wearing fangs? Avoid biting, and especially avoid drawing blood. You put yourself and your partner at risk for HIV and Hepatitis when playing Dracula.


       Don't mix crystal, boner-uppers, and poppers!  Your heart will shift into overdrive, causing changes in your heart rate and blood pressure. Read further.


       Be a smart sexual being. Get tested often. How about Tuesday? Sign-up for Health Night at Seattle Counseling Service to get free, confidential testing for STIs, Hepatitis, and HIV. Health Night happens every Tuesday from 4-6 p.m. Call 206.323.1768 to sign up. Snacks provided.


Planning on bare backing?


       Don't douche or use an enema before going out. You could damage the delicate skin around the anus, making it easier to get or spread HIV.


       Pull out before cumming. You'll lower your chances of getting or spreading HIV and other STIs.


       Avoid booty-bumping. Booty-bumping can damage your bowels and anus. It can increase your chance of getting HIV, and can also make anal sex painful. Ouch!


       Use LOTS of lube. Lube will reduce friction and lower your chance of tearing the skin around the anus.


I hope this helps reduce the trickery. Happy fright night!


Dr. Dick


Dear Dr. Dick, his profile says he's negative...

Dear Dr Dick,

Like so many other gay and bisexual men in Seattle I spend a great deal of time online looking for hookups. It seems that is where all the HOT guys hang out. When I hookup with guys from websites I practice safe sex. However, recently I met two guys online that I'm considering barebacking with. That's cool if all parties involved are HIV negative right? Both of the guys have posted the following statement in their online profiles: "HIV NEG as of November 2011."

So here's my question: is it safe to bareback with them?
Hooked on the Man Hunt

Dear Hooked on the Man Hunt,

Thank you for your question!

The short answer is, no, barebacking (intentional unprotected anal sex) is a very risky sexual practice. Barebacking can easily transmit HIV, along with several other sexually transmitted infections. These potential partners say they are HIV-negative but they were negative as of a year ago, so consider these facts:

In 2010, men who have sex with men accounted for 78% of all new HIV cases among males in the US, and 63% of all new infections in the US. Other studies have shown that recently HIV-infected guys are the most infectious, because they have very high levels of virus in their blood and semen in the first few months after being infected--before their bodies have brought the infection under some control.

Knowing your own and your partner's HIV status is an important part of maintaining one's overall health. However, just because one advertises their year-old HIV status in an online profile or in person does not necessarily mean it is accurate, and frankly you are probably taking a big chance.

Additionally, someone who is HIV negative can have another sexually transmitted infection (STI) present. Anal, oral (including rimming), and vaginal sex can spread infections such as syphilis, gonorrhea, chlamydia, and herpes. Using barriers for all types of sex can make getting-it-on a whole lot safer.

Be sure to talk more about this with your partners and even your doctor to settle on a decision that works best for all parties.


Dr. Dick

updated and reposted 1/13/14

HIV+: is my health that important?

Dear Dr. Dick,
I'm already HIV-positive and pushing 50. Do I really need to be concerned with safe sex and my overall health?
--Daddy POZ

Dear Daddy POZ,
Great question! The answer is YES!

No matter what your age, it's good to be health-conscious, especially with your sexual health and that of the local gay/bi community. If we're ever going to get HIV/AIDS under control we must care about ourselves and our communities.

In a recent study, MEN have DETECTABLE HIV in their SEMEN more often than women do in their vaginal secretions, thus making them more likely to INFECT sex partners. Also, in the same study, 70% of the men taking antiretroviral drugs had detectable HIV in their semen, compared to 82% of men NOT taking anti-HIV drugs. So, antiretroviral drugs may reduce but do not eliminate your chances of infecting others.

So, the researchers of this study conclude, "on or off antiretroviral therapy, men may be more infectious than women." (Source: POZ February 2005)

In addition, the following general health recommendations for gay and bisexual men (and really, all men) help promote health and prevent disease:

  • Not smoking and avoiding smoky places. Save the money you would have spent on smoking or buy more important things, as FOOD & CLOTHING.
  • Eating a healthy and varied diet that is low in fat and high in fiber. Fresh fruits and vegetables... can't keep still? Snack on a carrot or celery.
  • Drinking only in moderation. Two drinks a day is in moderation. But, DO drink plenty of water: 8 glasses per day is great!
  • Regular health exams and screening for STDs.
  • Regular prostate and colon cancer screening after age 50. Schedule one with your doctor, or find one in the Resource List
  • Tetanus immunization booster every 10 years. Schedule one with your doctor, or find one in the Resource List
  • 30 minutes of aerobic activity 3-4 times per week. Walking is good... watching porn is NOT aerobic exercise! (masturbation is not aerobic; for exercise to be aerobic one must do it for at least 20 min, getting the pulse up to 130-140/min. levels)
Positively yours, Dr. Dick

T-Cells and Crystal

Dear Dr. Dick:
I'm HIV+ and my doctor says crystal is bad for my HIV. But when I'm getting high, my T-cells stay up. Then when I stop using, my T-cells drop. Does this mean that crystal somehow revs up my immune system?
- Sam on Summit Avenue

Well, Sam, many guys notice the same thing. But a lot of guys see their T-cells drop when they're using speed. Some guys see no change at all.

Here's why:

There's nothing about speed that causes your body to make more T-cells. Or keep them around longer. But the stress of a high does seem to cause more T-cells to move into your blood away from other tissues in your body. And since your T-cell count comes from a blood test, it might look like you have more T-cells. But you probably don't. They may have just moved around a little.

Crystal may "rev up" other body systems, but it does NOT make your immune system work harder. In fact, speed actually makes your T-cells weaker! Crystal makes it harder for T-cells to fight off viruses, bacteria, etc and to grow new T-cells. A double whammy! And the more you use speed, the worse the damage gets.

Also, T-cells go up and down all the time. Stress easily lowers T-cells. And there's a lot of stress in not eating, sleeping, drinking enough water... or even picking up a nice case of syphilis. Sound familiar? So your T-cells may drop. But they also might bounce back again.

HIV meds are another problem. Your T-cells can also drop if you don't stick to your meds schedule. Every day, on time, exactly the way the doctor told you. Drug resistance can develop easily.

And finally, one T-cells count isn't enough. You need to look at several counts over time. And T-cells are just one small piece of your immune puzzle. You can't tell how "healthy" you are just by T-cells. You and your doctor will use many different tests to do that.

So your doctor is right- crystal really not great for HIV. But it is good to tell your doctor about your drug use so you can make the best decisions about your HIV.


Until next time, Dick

Scared sick: Get the scoop on HIV testing and special HIV+ services.

Dear Dr. Dick
I just tested HIV+. I was a little shocked but I've taken some major sexual risks lately. I wish I could go back and change things but I can't. The guy that tested me at the baths assured me the test was anonymous. But I've heard that people who test positive get their name reported to the health department. Is this true? I'm not ready to be "labeled" HIV+ but I want to make sure my health is okay. What can I do?
Scared Sick.

Dear Scared Sick,
It deeply saddens me each time that I have to tell someone that they're HIV+. It does no good to try and make people feel bad about the "risky" sex they've had. Most everyone knows they can become infected from having unprotected sex. Anal sex without a condom is the most risky, but people can get infected just from getting or giving a blow job, too. If you're still having a hard time staying safer, you may want to get some support. It's of great concern that more gay and bisexual men, including many with HIV, are getting (& giving) STDs than in the past few years.

I commend you on having the courage to get tested. This can be a really hard thing to do if you think the result may come back HIV+. Please, rest assured that the test you got at the baths was indeed anonymous. Your test was linked to the fake name you gave the tester. There is no way to track it back to the real you.

Anonymous HIV and STD testing is always available from the HIV/AIDS & STD Programs of the public health department (which provide testing in the baths), and the Seattle Gay Clinic. With an anonymous test, you will never be asked to use your real name or have to show any kind of ID. If you get tested at other places, like your doctor's office or a local clinic, you will probably get a confidential test. However, some docs do anonymous testing, too. This kind of test keeps your name private. By law, doctors and clinics must report new HIV+ cases to the local public health department when they have the patients' names. But reporting is really no big deal and is used only to keep count of case numbers and where the epidemic is headed. With "named" HIV reporting, the reported names are converted to a special unique code. Once this happens, all names are erased.
How can you check out your health without being reported as HIV+? Well, I have some good news for you - maybe the best you've heard of late. The HIV/AIDS Program, the same one that provides free & anonymous HIV/STD testing, has a program called One on One.

In One on One, you can get health services that are anonymous and free. One on One is a great way for people to check up on their health and still protect their privacy. With One on One you can get a complete medical evaluation, CD4 count, viral load, STD screening and treatment, in-depth info about HIV, emotional support, and referral to a good doctor who can follow you and advise you on your medical needs.

One on One is really helpful, especially for people who are nervous or confused about their HIV+ test result. One on One will never use your real name or ask for any kind of ID. Being told you are HIV+ can be really scary and may freak you out. You might not be ready for anyone - no matter who it is - to know about it. You can still check up on your health while you decide what you want to do next.

To make an appointment, call the HIV/STD Hotline at 205-7837 or 1-800-678-1595. Ask about the One on One program.
I wish you good luck and good health. And please, be safe.
Dr. Dick