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August 6, 2009

HIV Panic, Redux
FILED UNDER: "Gay Men's Health & Culture"
TAGS: gay men's healthhealth careHIV / AIDSHIV Panicimmigrationpublic health
By Trevor

hiv_panix_redux.jpg

I started feeling like crap on Saturday. The boys and I had just arrived home from the Russian River, where we spent the weekend with the bears for the annual "Lazy Bear" festivities. As soon as my friend dropped me off at my friend's house, I started to feel vaguely chilly and achy -- the kind of feeling you get when a bad cold or flu is just around the corner. I didn't think too much of it: All my friends had been sick the past week with strep throat that they kept passing around. Perhaps my turn was up. So after an episode of the Golden Girls, I passed out.

I'm not sure what time I woke up, but I immediately knew something was up. I felt feverish, with chills all over my body, and my muscles felt sore and stiff. I knew I had to get up and take some Ibuprofen to help check the fever, but getting out of my warm bed to venture into the chilly house seemed a challenge. After some procrastination, I managed the trek to the bathroom and downed some pills. And then back to sleep. When I woke up again in the afternoon I knew something was definitely the matter. I spent the day feeling terribly fatigued, feverish, and generally pretty gross.

My mind began to reel: What ailed my body? My friends had been sick with strep -- and this was definitely not strep. No sore throat. Perhaps the flu? Not likely -- I didn't have any nasal congestion of chest-cold symptoms. In the back of my mind, I knew that the last two times I had gay male friends who were struggling with flu-like symptoms in the summer months wasn't because of an unseasonable flu infection -- it was their seroconversion sickness. Essentially, it was their body sending them a memo that something was very wrong.

I began texting my friend who does HIV testing in the city, freaking out about how I needed him to bring an HIV test over immediately because I was sick and having seroconversion anxiety. He was in the East Bay, but luckily said he would try to bring one over a bit later. I tried to focus on the Golden Girls in the interim, but mostly spent my time recalling the past three months of my sexual life, detailing all the possible moments where HIV might have found its way into my body. The more time I spent crunching the possibilities, the more red flags I remembered / imagined.

Remembering -- of course -- is a process fraught with imagination, and in times like these our imaginations runs wild. Usually I reconstruct hookups' faces into some frail-like memory, focusing on a zit that could have been a sore, or a skinny waistline that at the time I thought was the result of cardio, but perhaps was a sign of a disease-ravaged body. This time, however, I was mostly focused on a passionate but short-lived affair I had with a wonderful guy I found out later had a long expired work visa and was living the US without government sanction. "His access to health care was probably zilch," I worriedly rambled to my friend who arrived with the test. "Did he get tested anytime in the last year?" I kept thinking about our sexual encounters -- mostly about how we didn't use condoms.

~~

What I was feeling wasn't regret, per se. To say that I regret our having sex without condoms would perhaps be to indicate that I expect to act differently in the future under similar conditions. Don't get me wrong: I have sex with condoms most of the time. But it's of course the "most" in that sentence that is most operative. What separates who falls in the percentile of scrutiny is a mushy calculus that I won't attempt to describe as rational or even reasonable. To say that there is some formula that we might apply to decide such matters is of course downright silly. There are a dozen kinds of reasons Public Health research might demonstrate in action for some set of guys or another, but they're not ubiquitous nor are they likely to stay static for one guy.

You might be thinking here that I've written all of this before. And you'd be exactly right. And this is where I get so frustrated with myself -- because this anxiety is like goddamn clockwork. Is this what it's like to be a sexually active, HIV-negative gay man? A three-to-six month cycle of negative tests and a hodgepodge of sexual encounters, followed up with a fresh batch of Paxil-deserving anxiety while painstakingly reconstructing every possible "mistake" you made since you last tested negative?

It seems to me that there are two possible ways to get out of this unhappy cycle. One -- testing positive -- is obvious. The other, I guess, is to be the perfect Public Health princess and manage to reduce your risk of contracting HIV to absolute zero. I shouldn't be so flip; this actually is feasible for many HIV-negative gay men and I know many guys who do in fact use a condom every time. I applaud their commitment! But -- for probably hundreds or maybe even thousands of reasons -- this goal has eluded some of us. Some wish they could achieve it, but for whatever reason find it difficult or impossible to do so. Others never shared this goal at all, and instead prioritize pleasure over risk (and I mean that in the most literal, non-judgmental of ways).

I guess I'm just frustrated to find that in the five years since I wrote a piece strikingly similar to the one you're reading, I still find myself in the same cycle of fear. Perhaps this is just the cost of being promiscuous in the face of a sexually transmitted disease. Perhaps it is just a reality of this thing we call risk. But I can't help but think that I have no similar anxiety about getting in my car to drive home at 2:00 AM, despite the fact that I'm taking a risk that I will be injured or perhaps even die in a car crash. I don't think I'm naive about the risks of driving at night, just like I don't think I'm reckless when it comes to HIV. All I know that of all the many risks I'm bound to incur in my life (driving, jaywalking, checking my luggage on a domestic airline, etc), only one seems to sit so close to home at the intersection of identity, health, and sexuality. And that is one messy fucking intersection.

~~

Saturday I spent a lot of time thinking about what I would do if I tested positive. Who would I tell? Would I blog about it? I felt frustrated not by the immediate reality of the health of my body, but rather by the possibility of having to disclose that seropositivity to potential sexual partners in the not-so-Poz-friendly state of Michigan. Or better yet, of being branded HIV-positive and how that might inflect / affect my future identity, research, activism, or employment.

After another negative test, I find myself back at square one. What I want is a sexuality without this kind of maddening, cyclic anxiety. A way to live my life, have great sex, and quit spending days or even weeks freaking out about seroconverting. Perhaps that's too much to ask.

PERMALINK | Posted at 4:42 PM | Post a Comment (6)

6 Comments

Since the end of my first relationship, and with one whopping great exception, I've used a condom or done the 4T "bareback boyfriend" routine every time. It's not a commitment to me, it's habitus, just how I have sex, and testing has never been especially stressful for me -- except for that one occasion after the guy took a condom off and I had to take PEP. If I get fluey, I assume it's just the flu. That boom and bust cycle of confidence and terror must be exhausting, and I wonder if at some point you might not end up thinking "Okay, fuck it, if it happens it happens, and at least then I'll know?"

Author Profile Page Daniel Reeders User Profile | August 7, 2009 12:06 AM

Oops -- a quick PS: most people who experience seroconversion illness (about 50%) will experience it immediately following exposure, give or take a couple of days, for about two weeks. It might be possible but I've never heard of a delayed reaction.

For any readers who think they might be experiencing seroconversion illness, you can ask a doctor at a specialist sexual health clinic for what's called an Incident Infection test, which is a test protocol looking for antigens to certain proteins like p24, which are produced directly by the virus from about 12 days onwards after exposure. It's a way of narrowing the window period and getting that extra peace of mind.

Author Profile Page Daniel Reeders User Profile | August 7, 2009 12:12 AM

Girl I feel you. Thanks for this Trevor, it was beautifully written.

Author Profile Page Scott User Profile | August 7, 2009 1:53 PM

What happened to your forehead.

Author Profile Page Scott User Profile | August 7, 2009 1:54 PM

I agree, Trevor....wonderfully written. As someone who DID experience and recognize my own sero-conversion illness (and had the knowledge and resources to do immediate follow up and get an early and immediate diagnosis), I am particularly attuned to the issue.

....and I'm glad Scott asked about your forehead because I noticed that right away, too!!

Author Profile Page Erik L. User Profile | August 7, 2009 2:07 PM

The feelings you describe are poignant. The book by Eric E. Rofes, "Dry bones breathe: gay men creating post-AIDS identities and cultures," Routledge, 1998, p. 83 discusses two good books on the anxiety of being HIV-negative:

  • William I. Johnston, Foreword by Eric E. Rofes, "HIV-Negative: How the Uninfected Are Affected by AIDS," Insight Books-Plenum Press, New York, 1995 (HTML online version at --world.std.com/~wij/hiv-neg ) -- The author makes the still valid point that all attention has been placed on the real needs of HIV-positive men and as a result HIV-negative men feel guilty about expressing their own "victimhood" status by having a panic attack about becoming positive. Johnston hypothesizes that this psychological stress contributes to more HIV infections. (Psychosomatic medical psychology has lots to say about the relationships between anxiety and somatization disorders that lead people to anxiety over being sick with a medical disorder when they are not sick. These same factors can lead a person to take more risks.)
  • Walt Odets, "In the shadow of the epidemic: being HIV-negative in the age of AIDS," Duke University Press, 1995 -- The advice in this book is more dated than the advice in the above book.
  • William I. Johnston discusses the common psychological reactions gay men have after testing negative for HIV:

    • Guilt -- Why was I spared? Do I deserve it because I had bareback sex?
    • Worried about the accuracy of the test and don't believe result.
    • I must be immune and can bareback without worry.
    • Worried that if I get infected in the future, it will be my fault.
    • Reluctant to let others know I'm HIV negative.
    • Separated from HIV positive friends.
    • Worried that other people are lying about their HIV status.
    • Elated, but unable to celebrate out of respect to others.
    • Depressed and disappointed I did not test positive to "get it over with."
    • Accepting of the results and I am committed to practicing safe sex in the future.

    • I can tell by your writing that not much has changed since the 1990s for HIV-negative gay men other than the fact that they are no longer seeing their friends die from AIDS. Of course, this has not eliminated the many other reasons to worry about being infected with HIV.

      It is not your fault that the strategy of using condoms and having periodic HIV tests is the only prevention method being offered to gay men today. Many gay men have adopted other strategies based partially on science and largely on folklore (which has been more accurate than science in some cases, such as folklore saying HIV is rarely passed via oral sex).

      As a result, the annual HIV infection rate (i.e. the number of new gay men infected with HIV each year) in America has been virtually constant over the last ten years because there has been no change in how HIV infections are prevented. Decades of public health experience has shown that the only way to reduce an infection rate that has remained constant for years (for any infectious disease) is to provide a new and better prevention program. For HIV this might include inventing an HIV vaccine (which hasn't happened yet), developing a rectal micobicide lube to allow bareback anal sex (still in development), or providing intensive psychological counseling and community support groups for gay men (this is something that proved to work in the 1990s, but has lacked continued funding).

      Clearly, a technological solution (e.g. HIV vaccine) is much easier than providing community support groups and psychological counseling, which is unfunded in most parts of the U.S. Given there is no technological solution, most gay men are left on their own to develop a community support group to help them stay uninfected.

      Do you feel like you have such a community support group to help you stay HIV-negative?

      P.S.

      I noticed Professor David Halperin from the University of Michigan had previously helped you write Trevor Hoppe, "HIV Panic, Part One: Demystifying the Epidemic," UNC-Chapel Hill Lambda, Vol. 28, Issue 1 and 2, Fall 2004 and Trevor Hoppe, "HIV Panic, Part Two: Sexual Transmission and Public Health," UNC-Chapel Hill Lambda, Vol. 28, Issue 3 and 4, Feb.-Mar. 2005.

      Author Profile Page Thomas Kraemer User Profile | August 8, 2009 6:28 PM


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