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Timothy Frasca Headshot

Open Wide -- HIV Testing in the Bedroom

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I heard from Diego this week, unexpectedly.

Diego was a 16-year-old kid when he walked into our Santiago-based HIV/AIDS prevention storefront outfit in the mid-1990s. He was typical of the hundreds of gay Chilean adolescents and young adults who wandered through our doors out of curiosity after hearing through the grapevine that a gay organization had sprung up their city. As in so many countries in Asia, Africa and South America, AIDS generated gay activism where none had previously existed.
Diego was smart and articulate. He signed up for one of the newcomers' safe-sex workshops, the structured sessions imported from the U.S. for young gay kids to joke and flirt their way through basic HIV101 and pick up some insights into their own and others' sex lives, the lives that we workshop facilitators were trying to get them to modify for their own good.

Then Diego decided he wanted to be a peer educator, too, took all the training courses, read the background materials, and attended our network meetings with other city health and human rights organizations. I had my eye on him from the beginning because he had such command of himself even as a teenager, spoke confidently and picked up everything quickly. He also knew the gay scene and had a million friends to join him in exploring the city's cruising spots and faking IDs to get into the city's three gay bars. He recruited dozens of them to fill out our first big survey of gay Santiago and later co-wrote with me a short piece on the downtown hustlers.

I helped start the Chile AIDS Prevention Council during the Pinochet dictatorship and served as its executive director from 1993 to 2000. I always encouraged Diego to pursue his studies and applauded him when he pursued his studies and landed a good job. But the news this week was a sad reminder of the limitations of our two decades of HIV prevention work: Diego wrote me from the emergency room in the middle of a painful attack of herpes zoster (shingles), a sign that his T-cells were dropping and his immune system seriously undermined.

Yes, Diego became HIV-positive about six years ago. All that education, all those courses, all those careful counseling sessions went out the window when he fell in love and moved in with his first serious partner. Six months into the romance, they decided to get an HIV test, and both came home with bad news.

After leaving Chile in 2004, I have worked in HIV prevention research and just finished collaborating on a New York-based study that might have kept Diego from joining the depressing statistics.

We gave study participants a bag of rapid HIV test kits, the oral swabs that produce a preliminary result in 20 minutes and were just authorized for over-the-counter sale by the Food & Drug Administration in July. (They will be in drugstores in October.)

Our study participants tested themselves but also screened over 100 potential sex partners before jumping into the sack. Six of the partners turned out to be HIV-positive, unknown to themselves, not at all a surprising figure given the high prevalence rates among gay men in urban centers worldwide.

Asking a casual or an ongoing partner to take an HIV test right in the bedroom may sound shocking, and our participants' partners were often taken aback, to say the least. But for the most part, they understood the logic of the request, and some were enthusiastic about the innovation.

A few were indignant, and about one-fifth refused. Depending on how the refusal sounded, our study participants sometimes reevaluated the sexual activity they were willing to engage in with them. Sometimes the encounter ended right there.

Testing a partner HIV-positive was always a tough moment, but some of the partners newly informed of their status promptly sought medical care, and their prognosis is better than if they had waited to fall ill.

Would Diego have pulled out an oral swab and asked his new boyfriend to check his HIV status before their first overnight date? We'll never know. But I do know that all the behavioral coaching in the world won't eliminate that blinding ecstasy of one's first love, that wonderful moment when everything feels brighter and rosier and the idea that something could go wrong feels like it's coming from a parallel universe. If Chileans could buy rapid HIV tests like pregnancy screens, Diego might not be in the hospital today.