EDGE San Francisco

Condom Use Advised to Reduce Exposure Risk

"Many of us would still advise condoms -- for many reasons -- in these circumstances, and HIV infection would still be one of those reasons," he said. "Because sex with a condom feels different, I encourage all my cisgender males to masturbate with condoms. Then sex can feel the same as masturbating."

And for those who want to slide along the safety curriculum, realize that two goals here with HIV infection prevention are these: reduce or eliminate the amount of the contagion and/or reduce the amount of time exposed to the contagion.

"A condom can help with both," says Garrison.

So why then are some gay men still engaging in unsafe practices?

"Some young men who are suicidal, depressed, or have a personality disorder might engage in riskier sex. Some might lack comprehensive sex education," Garrison explains. "Some might be so far removed from all the funerals we all attended back in the ’80s, that he doesn’t ’remember’ about HIV."

"And it can also be that sex feels absolutely amazing the way he enjoys it now," he said.

"My one take home message might be in all the above: think of an amazing future with you in it," continued Garrison. "Now think of all the wonderful things that you need to do, all the incredible experiences you need to have, and all the strength and health you need to possess to get there. Then find the people and the resources, the information and the encouragement to make all those things happen for yourself."

Researchers point out that a low viral load has rarely been associated with transmission in heterosexual studies, some infections have occurred and animal models suggest that HIV is five times more transmissible via anal than vaginal sex -- so a median viral load of 200 would imply a low but definite risk of transmission.

One interesting aspect of this study was the higher risk of seminal viral load associated with unprotected insertive sex. The researchers suggest that urethritis in these HIV-positive gay men could be caused by infections with fecal bacteria acquired during sex or even that the virus detected could be passively carried virus from other HIV-positive gay men. Either way, this would tend to increase the infectiousness of HIV-positive men if they have insertive sex with negative men.

"We are excited about the potential of treatment-as-prevention. Recent studies show that People Living with HIV/AIDS (PLWHA) receiving ’effective’ treatment -- meaning no detectable live virus in the blood -- are much less likely to pass their virus on than PLWHA who are not receiving ’effective’ treatment," said Frank Oldham, president and CEO, National Association of People with AIDS. "We believe that broader testing and early treatment can reduce the number of new infections and help turn the tide in the HIV/AIDS epidemic."

"But that’s for whole populations," he said. "Individuals still have to practice safe sex."

"Not only do a small minority of men in ’effective’ treatment still have live virus in their semen, but roughly three-quarters of Americans living with HIV/AIDS aren’t receiving ’effective’ treatment," he continued. "Too many don’t even know they are infected. That needs to change. We all need to get tested regularly, to protect our own health and avoid infecting others."

"And there is always the risk of other STIs, which can be devastating to people with compromised immune systems," concluded Oldham. "There is a new strain of gonorrhea, for example, that so far is resistant to all available antibiotics. So we say to all Americans: Get tested, and if you test positive, start treatment -- but continue regular, proper use of condoms."