As gay and bisexual men, it can be overwhelming -- and in some cases, downright exhausting -- to keep HIV at the front of our minds and on the tip of our tongues. But talking about it, with a friend, a doctor or a potential partner, can ease our anxieties and potentially change our thinking and our actions for the better.
Starting the conversation is often easier said than done, which is why I've listed four conversation-starters for gay and bisexual men, developed by gay and bisexual men**:
1. With a Partner: "Have you ever been treated for a sexually transmitted infection (STI)?"
Much has been written about the harm in asking a potential partner if they're "clean," when what you really want to know is whether they have an STI. Not only does the "clean" question stigmatize those living with HIV (or some other viral infection), it may not yield particularly helpful information for managing your sexual risk. Many STIs, including HIV, may not show discernible signs or symptoms, which might cause someone to answer your question earnestly, but incorrectly. Additionally, we now know that people living with HIV who consistently take their medication can significantly reduce their risk of transmission by as much as much 96 percent. This means there's no need to call it quits simply because someone you like may have HIV. Instead of declining that second date, you might ask the person about their HIV treatment instead. It will show that you've done your homework and that you are willing to take the conversation to a place beyond "drug and disease free."
2. With a Provider: "Do you feel comfortable talking to me about PrEP?"
Recently, it seems not a day goes by without someone saying something about PrEP, the once-daily pill meant to reduce risk of HIV infection. PrEP may not be for everyone, but it very well could be for you. And the only way to know for sure is by talking to a knowledgeable health care provider who can help you make that decision. Unfortunately, many practitioners still don't know all that much about gay and bisexual men's health -- let alone PrEP. While some efforts have recently been made to rectify this problem, it does not appear to be going away anytime soon. Therefore, you might consider asking your provider what they know about PrEP before delving into a conversation about whether it might be right for you. The San Francisco AIDS Foundation offers this helpful piece of advice: "If your doctor simply doesn't know what [PrEP] is and is uncomfortable prescribing it, ask them for a referral to someone who might be better able to meet your needs...If they say they don't know anyone to refer you to, ask whether it might be possible to be referred to an HIV specialist."
3. With a Partner: "Do you think it might be time for us to start getting tested together?"
Many gay and bisexual men continue to believe that the only people who contract HIV are those with multiple sexual partners. While number of sexual partners is certainly one risk factor for transmission, an increasing number of gay and bisexual men are acquiring the virus from their primary partner. In fact, recent estimates put the number around 68 percent. With more and more same-sex couples choosing to be "monogamish," it is essential for gay and bisexual men to to talk openly and honestly with partners about their sexual risk-taking. Testing together is better than not testing all, especially if you and your partner have chosen to stop using condoms. Talking to your partner about routine HIV testing isn't a measure of sexual infidelity, but emotional maturity.
4. With a Provider/Test Counselor: "What happens if the test comes back positive for HIV?"
Sitting down for an HIV test can be a nerve-wracking experience, especially if you try to recall every sexual encounter you've had in the months or years leading up to it. Rather than fixate on the number of times you might've been exposed to the virus, you could turn the experience into an important learning opportunity. Scientists know far more about HIV today than they did 10 or 15 years ago, but often that information does not trickle down to the average gay or bisexual man. For example, the medicines used to treat HIV are safer and more effective than they've ever been before. Nowadays, it's entirely possible for someone newly diagnosed with HIV to lead a long, healthy life. The trick is knowing where to go and who to talk to in the event you do test positive, so you can immediately connect to care. Talking to a health care provider or counselor about HIV before there's cause for concern will prepare you for living a sexually fulfilling life no matter the outcome.
These are just are just four of the many conversations gay and bisexual men can -- and should -- be having about their sexual health broadly, and HIV, specifically. How these conversations unfold will depend largely on race, class, gender, age and other core aspects of identity. Perhaps the one thing we can all agree on is that talking about HIV with honesty and integrity is essential for the collective well being of gay and bisexual men everywhere.
Check out the Human Rights Campaign's"HIV/AIDS" topic page, where you can get answers to Frequently Asked Questions about HIV, debunk common myths, gain helpful information about PrEP and PEP, and learn more about the impact of HIV on the LGBT community. Join the conversation around National Gay Men's HIV/AIDS Awareness Day by using #NGMHAAD.
**I'd like to thank Renato Barucco, Adam Eickmeyer, Kevin Henry, James Hinson, Marcos Garcia, Jeff Krehely, Michael Toumayan and the other gay and bisexual men who contributed to this piece.