This is an interview conducted with a prominent nyc physician and leader in the field of HIV/AIDS treatment and prevention. Although he's turned down large amounts of money for interviews with major media, he agreed to give this interview as a service to our local gay community. He is a dear friend of mine. He is also very cute! (sorry boys, he's taken....)
Where is HIV spreading most quickly in nyc's gay community?
Okay, i can talk in reference to my practice, primarily male homosexuals from the village, east village and chelsea, the trendier gay crowds. My patients are a skewed population in comparison to gay communities elsewhere in the country. Here, HIV is spreading most quickly among the younger populations, men in their 20s and early 30s. One problem with treating that age is group is that they weren't exposed to the overwhelming death-rate that the the rest of us witnessed at the beginning of the epidemic, so they're not as fearful regarding the consequences of infection. They're not carrying the trauma older gay men still live with.
So what percentage of gay men in that age group would you say are HIV+?
Based on the numbers i see in my practice, I would say 40-45% of gay men in lower manhattan under 40 are poz.
You're kidding! That's almost half! Of those people who carry the virus, how many would you say are infected with HIV without knowing it?
Probably about a third of those don't realize they are positive. A big part of the problem is crystal meth abuse, because the drug effects memory and lowers inhibitions, people may engage in high-risk activity while they're partying and then when the drug wears off they put it out of their minds, forget there were risks involved or forget the encounter entirely.
Ok math isn't my strong suit but according to the statistics you're giving me, approximately 2 or 3 men out of 6 that you would meet at The Roxy, The Monster or The Cock are HIV+ and at least one of them doesn't know it.
That sounds about right.
Okay, but if nobody's dying anymore thanks to all these new treatments, and your health is okay, then why SHOULD you worry about HIV? What are the benefits of knowing your status if you're not even sick?
The benefit is that if you are negative we can help you stay that way, and if the patient is positive some doctors like to start antiviral treatment early and encourage behavior modification because the partying and the drugs probably weaken the immune system and make the disease more difficult to treat. And of course, we'd like to teach you how to protect your partners as well.
So what would you say to someone who's avoiding being tested because they don't want to know they have the virus?
You're delusional.
I saw something about a vaccine on the news last night that sounded encouraging, what's going on with that?
There are several types of vaccines being tested, some for prevention and some for immune enhancement. But the are mostly in the development stage and so far we haven't hit on one that works.
So what you're telling me is there's no miracle cure waiting around the corner.
Right.
Bummer.
Yes.
So if you're already HIV+ and your partners are also poz, then what's the point of using condoms?
The point is that there are many other STDs besides HIV that can dramatically weaken or damage the immune system and make treament more difficult.
So even if you're already poz, there are a lot of good reasons to keep protecting yourself.
Yes, many!
Let's talk about something that happened to me personally; I'm HIV+, I was fucking this hot kid with a really tight ass and the condom broke without me realizing it. I called you and you told me to send him over to your office for for immediate treatment; a year later he's still negative, thank god. I think a lot of people still don't realize that if you've been exposed to the virus there's a 72 hour window of opportunity for treatment that will prevent seroconversion.
I make sure all my own patients are well-informed on this subject. With that particular patient, we first discussed his sexual history and determined, based on his answers, that this was probably his first exposure. He was treated with a combination of protease inhibitors.
Well, it worked. If a kid without health insurance finds himself in a similar situation where should he go for treatment?
He should go directly to the emergency room at any local hospital.
I wanted to ask you about my friend who's exclusively an oral top and contracted the virus through oral sex. I was really surprised because I thought it was safe to get your dick sucked, but you told me you've seen several similar incidents of this type of transmission in your practice.
Yes, it does happen. Oral sex is considered low-risk behavior, but if there is blood in the gums from recent flossing or some kind of oral infection, blood can actually enter the urethra even if the top doesn't ejaculate. And the bottom can also contact HIV from the pre-ejaculate if there is bleeding in the mouth.
Gee, doc, that didn't stop you from going down on me ten years ago when i met you in the steam room at the YMCA!
(laughs) Like I said, it's considered low-risk behavior, but if you're asking me if HIV is transmittable through oral sex, the answer is yes and it happens more frequently than most people realize.
That sucks. So good oral hygiene is critical to safe oral sex but you shouldn't floss before sucking dick. What about Hepatitis C, is that sexually transmittable too?
It happens, but it's not as easy to contract through sexual contact. It happens most frequently from sharing needles or blood transfusions.
So is Pamela Anderson lying when she said she got it from having sex with Tommy Lee?
(laughing) She's not one of my patients, thank god.
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