Recently in TasP (Treatment as Prevention) Category
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
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: http://lifelongaidsalliance.org/healthyconnections
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: http://www.thebody.com/content/76250/the-silent-struggle-of-hiv-treatment-adherence.html
I hope this helps. Thank you Coco, for your wonderful advocacy towards your partner and his health!
Dear Dr. Dick,
What's the deal with those big HIV box tests you can take and do yourself?
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
HOME TEST KIT 101
HOW DOES THE TEST WORK?
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!
WHAT DO I DO WHILE I WAIT FOR THE RESULTS?
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.
WHAT IS THE WINDOW PERIOD OF THE TEST?
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.
WHAT ABOUT OTHER STDs?
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 http://www.kingcounty.gov/healthservices/health/communicable/hiv/resources/testing.aspx#test
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,
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
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.
ARE YOU CONFIDENT YOUR PARTNER IS GIVING YOU ACCURATE INFORMATION?
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.
HAVE YOU CONSIDERED PRE-EXPOSURE PROPHYLAXIS, or PrEP?
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.
IS METH IN THE MIX?
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.