People frequently ask whether they should "take the AIDS test," the test which shows whether you have the HIV virus in your bloodstream. Whether or not to take the test is a very personal decision best made after considering your own personal history and any possible risk factors for exposure to HIV/AIDS. It is illegal for your employer or anyone else to force you to be tested, and even your doctor may only test you with your written consent. If you are uncertain about testing, you can call any of the AIDS hotline numbers listed at the end of this article, and receive free, confidential counseling over the phone to help you decide.
Testing positive does not mean that you have AIDS. It only means that the HIV virus is in your bloodstream. It is very likely that the virus will eventually kill off many of your T-cells, which your immune system needs to function properly. If this happens, your body will gradually become more and more vulnerable to infections, tumors, and other diseases which do not usually occur in people with healthy immune systems. This condition is known as "HIV disease." Eventually, HIV disease will often progress to the point where it meets the legal definition of "AIDS".
A negative result does not guaranty that you do not have the HIV virus in your blood stream. It simply means that you have not developed the antibodies to the HIV virus. Most people, at least 90-95%, develop those antibodies within three months after they have been infected, and over 99% develop them within six months. If you have done anything recently which may have put you at risk, it is a good idea to be tested again. Some people choose to be tested every six months as part of their regular health care routine.
During the early years of the AIDS epidemic, the vast majority of people with AIDS in this country were gay and bisexual men or IV (injection ) drug users. The majority of them still are, but the demographics is gradually changing. Recent trends have shown an alarming increase among teenagers, newborn babies, heterosexual women, and People of Color. Millions of Americans are infected with the HIV virus, and many of them do not know it because they have not yet developed any symptoms and have not been tested. Many people are HIV-positive for ten years or longer before developing noticeable symptoms, and they often unknowingly continue to spread the disease to people through unsafe sex or through sharing IV needles.
The answer is simple: being tested may save your life and the lives of your loved ones. How? If you have HIV, there is no cure. The only way to stay alive and healthy is through early intervention and appropriate medications to preserve your good health. The sooner you take the test and know your HIV status, the sooner you can get the appropriate medical advice, regular blood tests, and timely medical treatment you need to stay as healthy as possible. If you do not take the test, you won't know that you have HIV until you become sick, and then it may be to late to intervene successfully.
And if you test positive for HIV, you will be less likely to have unprotected sex and infect others with the virus. On the other hand, if you test negative, you will, hopefully, be more motivated to practice safer sex in order to protect yourself from HIV and other STDs (sexually transmitted diseases).
There is no such thing as 100% safe sex, as sex always carries some risk, since no method of protection is perfect. However, you can reduce your risk of getting HIV tremendously by using condoms every time you have sexual intercourse, to prevent the exchange of semen or other bodily fluids which can transmit HIV. This includes condoms for anal sex, vaginal intercourse, and fellatio (oral) sex. It is important to put the condom on before the penis is inserted, not just before orgasm. The HIV virus is present in much higher concentrations in the male semen (cum) than in a woman's vaginal secretions, so there is a much greater risk of getting HIV from men. But as Magic Johnson proved, it is possible to get HIV from women.
Studies have shown that transmission of HIV through giving fellatio is much rarer than through anal or vaginal sex. But though it is rare, it has happened. Fellatio can also transmit other STDs such as herpes, syphilis and gonorrhea, which can then increase the risk of transmission of HIV. If you choose to give a man oral sex without a condom, you can decrease your risk by not allowing your partner to ejaculate in your mouth, not giving deep throat, not giving oral sex if there are sores, cuts, or blisters in your mouth or on your partners penis, and not brushing or flossing your teeth shortly before giving oral sex. These measures, however, still do not eliminate the risk completely. To be completely safe, it is best to use a condom for fellatio as well. Unlubricated, flavored condoms are sold specifically for this purpose.
Women who have sex only with other women are at much lower risk for sexual transmission of HIV than any other group The concentration of the HIV virus is at lower concentration in vaginal fluid that in sperm. And the mouth and hands have more layers of skin than the anus, vagina, or throat. Therefore, cunnilingus and manual vaginal sex are both considered low-risk for HIV transmission at this time. There are other STDs, such as gonorrhea, syphilis, and herpes, which can sometimes be transmitted through cunnilingus.
For those who choose to use barriers for cunnilingus, there are more options available now than in the past. Dental dams have not been very popular in the past, but they are now available in thinner, better tasting forms. The best seems to be the "Lollys", or "Glide dams." These are created specifically for cunnilingus, and are larger, thinner, better tasting, and more erotic feeling than the dams of the past. They can be purchased at erotic shops such as Good Vibrations, through catalogs, and at some pharmacies. If this is not convenient, another option is Saran Wrap, which is available in stores everywhere. Just be careful not to suck a hole in it.
If you choose to give cunnilingus without a barrier, there are ways to reduce your risk. Do not do so if you there are sores, blisters or cuts in your mouth or your partners vagina. And do not do so when your partner is menstruating, since there is a higher concentration of HIV in blood, including menstrual blood, than there is in vaginal fluid. Oral-anal sex (rimming) presents its own set of STD risks because of contact with fecal matter. Latex or plastic barriers can be used for this activity as well.
Most forms of manual stimulation are even safer than cunnilingus, but if you want to be absolutely safe, you can use a latex or vinyl glove or finger cots. STD transmission through manual stimulation is possible, and the risk increases if there is manual- anal stimulation, if there is vaginal or anal "fisting," that is, inserting an entire hand into your partner, and if there is any blood, cuts, blisters or sores in your partners vagina or rectum or on your fingers.
While many men use condoms consistently, others do not. There are a variety of reasons for this.
Some do not believe that they are at risk. They may simply need education, which you, as their partner, can help provide them.
Some say that they cannot feel anything. There are ways of dealing with this problem as well. Putting a couple of drops of water based lubricant in the head of the condom before intercourse can make it feel better. Some men have found that a condom with a larger head, such as Life Styles Xtra Pleasure, can make barriered intercourse much more enjoyable.
Another common problem is that when intercourse is interrupted to put on a condom, the man may lose his erection. Again, there are a variety of solutions. Instead of "interrupting" the sex to put on a condom, try to eroticise the process of putting it on. The partner can stimulate the man manually while putting the condom on, or can put the condom on with his or her mouth.
Men are often terrified that if they lose their erection, there partner will reject them. This fear is so great that even the possibility that this will happen may be sufficient to make him not want to experiment with condom use. A partner's reassurance that a lost erection will not end the relationship can go a long way towards making a man feel safe enough to experiment with condoms. Experiment with other ways to satisfy each other, such as manually and dildos, vibrators, and other with sex toys (condoms should be put on the toys as well). Continue to experiment with condoms regularly, but do not make intercourse the only goal. Make condoms fun.
Many men find it helpful to practice by masturbating with a condom on when alone, so that he will become familiar with the way it feels and become comfortable with the process of putting on a condom and with maintaining an erection with a condom on.
Some people prefer the "female condom" which can be used for both vaginal and anal sex. They can be inserted into the vagina or anus before sex begins, so that putting on a condom does not interrupt the flow. If the man loses his erection, he can withdraw and be restimulated without having to reapply the condom each time. Also, since it is polyurethane, it can be used with either an oil or a water based lubricant. It can also be used if either you or your partner is allergic to latex.
If none of this solves the problem, you or your partner may wish to consult a sex therapist or a urologist. A variety of treatments for impotence are available, such as sex therapy, Viagra, and many others. Only through experimentation will you find which approach is right for your partner and yourself. The more you can both relax and eroticise the exploration process, the more successful that process is likely to be.
If the problem is latex intolerance, there is, again a variety of solutions. One is the "female condom" which I have already mentioned. Another is the polyurethane condom called "Avantis", although studies indicate that these break more often than latex condoms. Lambskin condoms are not considered sufficiently safe against HIV transmission to use alone, but can be put on under a latex condom (or over it, if the receptive partner is the one who is allergic to latex).
If you are willing to do all of the above, but a male still insists on having intercourse without a condom, you might want to reconsider whether you want to be in a sexual relationship with him at all.
If you are in an abusive relationship, you may feel that you are in a situation where you can not insist on condom use, refuse to have sex, or leave your partner. In fact, there are shelters for women who are physically abused. Your partner will not be told where you are, and you will receive counseling to help you rebuild your life and regain your self-esteem. Call a battered woman's hotline in your area (listed in the Yellow Pages under Woman's organizations and services) for free, confidential counseling on your options.)
If you do not yet feel that you are ready to make this move, it is crucial that you learn everything you can about HIV transmission, and take whatever steps possible to reduce your risk.
One option is the spermacide Non Oxidal Nine. This substance has been found to kill not only sperm, but the HIV virus and many other STDs, at least in test tubes.
But not everybody should use it. Test it on your skin first. If it causes irritation, this means you are allergic to it. In this case, if you use it during sex it will create sores in your genitals, which could actually increase the risk of HIV transmission. If you and your partner are not allergic to non-oxidol nine, you can put spermicidal foam, jelly, or a contraceptive sponge in your vagina or rectum before sexual activity. Non-Oxidol nine is also found in many lubricants and on many condoms.
Another option is to use a female condom, which you can insert without your partners cooperation before you expect sex to begin.
Another option is to give you partner oral sex. This puts you at significantly less risk than anal or vaginal sex, and many men consider it to be a satisfying substitute. And some people have learned to put a condom on their partner during oral sex without him ever even knowing.
There are also many support groups and hotlines available for people to receive support to empower themselves and be more assertive about safer sex.
It is important to be tested because you could have been infected with the HIV virus by any sexual partner you may have been with in the past. Any partner in your past may have had other sexual partners who may have been infected, and your partner could have unknowingly infected you. And many people have a past history of some IV drug use, and you may have been exposed through drug use. In addition, many men who appear to be heterosexual have had a history of some sexual relationship with men, and may have been exposed to HIV, but they may not choose to share this information with their female partners. Getting tested lets you know where you stand, instead of making lots of guesses and assumptions about your partners, their past partners, and their possible risk factors.
Marriage is not protection against HIV, and many married men have contracted HIV from their husbands. How so? At least 60%-70 of married men have had sexual relationships with other women, and some contract HIV and pass it on to their wives. While approximately 30%-40% of married woman also have sex with others while they are married, it is more difficult for a woman to transmit the virus to her husband than vice-versa. So being married is no guarantee that your spouse will be faithful or will be honest about extramarital affairs, and many committed and devoted spouses have affairs and can bring home diseases. Even if both husband and wife are completely monogamous during the marriage, most have had other sexual partners before marriage and may have been exposed to HIV by a former lover.
It is highly recommended that couples considering marriage take and HIV test before making this commitment. Taking the test does not imply that you don't trust your fiance, it shows that you both care enough to learn the truth and start off your marriage with all cards on the table. If one partner tests positive for HIV, they will have the chance to seek medical care to stay healthy, and the negative partner can be protected from contracting HIV by practicing safer sex.
For some people, non-monogamy is a way to achieve sexual satisfaction until they find a person whom they want to be in a committed, monogamous relationship with.
But for others, non-monogamy is a lifestyle they choose to be in even if the already have a committed relationship. This choice presents disease control challenges which people have dealt with in a variety of ways.
The safest way is to practice safer sex with all partners all the time. If you are in the habit of using condoms with one person, you are more likely to use them with others.
If you are an experienced condom user, it will be easier to use them. None of your partners will have to feel like they are discriminated against while another person gets special privileges. And there will be less pressure to feel that you have to report every detail about what you did in bed with each partner to the others, in order for them to feel safe from HIV and STD transmission.
Some people, however, choose to be what is called "fluid bonded." This means that they have unbarriered sex (sex without condoms or other latex or plastic barriers) with one partner, usually the "primary", while having safer sex with any others. For some people this works, but it requires a high degree of honesty, self discipline, and good communication.
Do not assume that because you had unbarriered, or "fluid", sex with somebody, this means that you are fluid bonded. If a person does it with you, there is a good chance that that person will do it with somebody else. Do not try to pressure somebody into being fluid bonded before he or she is ready. This will just encourage deception. If you are practicing safer sex, you won't have to worry as much about what your partners are doing with other people.
If you are sexual with somebody who is fluid bonded to somebody else, do not try to persuade him or her to have unprotected sex with you. This endangers everybody involved, and will undermine not only the persons relationship with their primary partner, but their relationship with you as well.
If you are fluid bonded, it is important to agree to tell each other if one of you "slips" and has unbarriered sex. This should be done before you and your partner have sex again. In this case, it is best to return to using condoms for another six months, and then be retested. Make it clear, however, that you are doing this for safety, not as a punishment. Do not punish your partner for being honest, even if you are angry. Be a "tellable person".
Some people are part of a group of people who agree to have unbarriered sex within the group, and no sex or safer sex outside the group. This is know as "Polifidelity." Of course, the more people you have in the group, the greater the odds that one of them will "slip" and bring an STD into the group. Remember that you are trusting these people with your life. In an arrangement like this, it is particularly important that all members of the group be tested before they become "fluid" with the others, and again every six months, for the protection of all concerned.
If you decide to take the test, it is best to go to one of the Alternative Test Sites, which are located in every county in California. These clinics do anonymous testing--you do not give your name, instead you are assigned a number which corresponds to your test results. You can only receive your results by bringing your number back to the clinic--this way no one else can get your results. You can decide whether to tell anyone your results, and your privacy is protected, so you will not face discrimination in housing, employment, or health insurance. If you are tested at your doctors office or a hospital your name will be used so it is harder to keep results private. As a result, most people feel safer going to an Alternative Test Site. Any of the organizations below can refer you to locations of alternative test sites in your county, or you can call your County Health Department for addresses.
There are now home HIV tests that you can buy in a pharmacy. You prick your finger, mail in the blood sample, and receive your test results over the phone. But if you test negative, you will receive no counseling, and if you test positive, you will probably receive inadequate counseling. Therefore, I do not recommend the home test, exept as a last resort if you live in an area where there is no other form of anonymous testing available.
If you test HIV positive, you will be offered free counseling explaining what these results mean and what you can do to stay healthy. You will be urged to practice safer sex to avoid spreading HIV to anyone else.
If you test positive, don't face HIV by yourself. Having HIV is very stressful, and having the right information and emotional supports is crucial both to your physical health and your emotional well being. Many free services are available to help you handle this very difficult situation, such as counseling, support groups, medical care, free meals and groceries, affordable housing, and other services. Individual counseling and support groups can be very helpful in coping with stress, confusion, and decision-making. New medications have become available recently which, while certainly not a cure for HIV, have enhanced the quality and increased the duration of life for many HIV positive people. For more information, call the organizations listed on the next page.
1307 University Avenue
Berkeley, CA 94702
HIV/STD Counselor, Educator