#the power dynamic can become so toxic so fast when there's a big age gap

[absolutelygenderfluidcrow]

"I think I need someone older" no I need to BE that older someone.

[ellenlucasonlinedatingblog]

A Future Without HIV: Are We There Yet?

Jennifer Waugh

The findings of a major eight-year-long HIV study known as the PARTNER2 study have shown that so long as HIV+ partners are being fully treated, there is no chance of passing on HIV to a sexual partner, even with unprotected sex. What does that mean, and where do we stand now that we know this?

Last weekend was huge for HIV research. Literally epic.

The Guardian, CNN and other major news sources reported on the findings of a major eight-year-long HIV study known as the PARTNER2 study. This landmark study followed 1000 male couples where one partner was HIV positive and on antiretroviral (ARV) medication, and one partner was negative for the disease, across fourteen different countries in the United Kingdom.

The study findings showed that when men were adherent to their ARVs (when they took their meds daily and as directed), they became virally suppressed, and had no chance of passing on HIV to their sexual partner, even with unprotected sex. These couples reported engaging in unprotected sex more than 77,000 times collectively without any transmission of the virus.

You heard that right: so long as the HIV+ partners were being fully treated, it was found that there was no chance - zero — of passing on HIV to their sexual partner, even with unprotected sex.

The findings of this study were published in 2018, but the CDC recognized the fact that undetectable viral loads lead to zero HIV transmission in 2017, showing support of the Prevention Access Campaign’s “Undetectable = Untransmittable,” or “U=U." More than eight hundred organizations across one hundred countries have now joined together in support of the U=U campaign. HIV/AIDS has claimed the lives of millions since it was first discovered in 1983, but it seems things may finally be looking up.

This is obviously amazing news. This is also a lot to unpack, though, so let’s talk basics, filling in gaps you might have about HIV or AIDS, treatment, and their history, then let's take a look at the view from here.

What are HIV and AIDS, anyway?

HIV (Human Immunodeficiency Virus) is a disease that attacks the immune system, and which makes anyone who has it more susceptible to other infections that can then cause AIDS (Acquired Immune Deficiency Syndrome). A person living with HIV is considered to have AIDS when their CD4 count — the amount of white blood cells in the body — drops below 200 (the normal range is 500-1,500), and they have been diagnosed with what's called an opportunistic infection. Some of the most common opportunistic infections are recurrent pneumonia, toxoplasmosis, hepatitis B and C, and candidiasis (yeast infections or thrush) - though there are many. Basically, because HIV attacks the immune system, which makes it easier to fall seriously ill by another serious infection, and greatly inhibits the body’s ability to fight back. Good CD4 cells are destroyed, and HIV begins creating new copies of the virus.

One big misconception that still exists, thanks in part to stigma and lack of accurate education, is that HIV = AIDS, or even that HIV always leads to AIDS. That’s not true. With advances in research and treatment options, many people with HIV in developed nations now never experience AIDS.

HIV was initially found in 1981 and first called GRID -- Gay-Related Immunodeficiency -- because it was first seen in gay men. This framing unfortunately perpetuated stigma (negative, oftentimes shameful, perception) that still surrounds both gay men and HIV to this day. HIV isn’t just about gay men. It can be transmitted (passed from one person to another) through bodily fluids including blood, semen, vaginal fluids, and breastmilk. Though the virus passes most easily during anal sex (due to the ease with which anal tissue tears, making the act more “risky” for the receptive, or bottom, partner) HIV does not discriminate based on sexuality, gender, or skin color. Contrary to historical stereotypes, statistics show that globally heterosexual women are who experience the highest rates of HIV infection.

In the 1980s and 1990s when treatments were not yet readily available or affordable, hundreds of thousands of gay men had died from AIDS, largely due to homophobia.  In the USA alone, "By 1995, one gay man in nine had been diagnosed with AIDS, one in fifteen had died, and 10% of the 1,600,000 men aged 25-44 who identified as gay had died." Gay men have accounted for more than half (55 percent) of all AIDS deaths since the epidemic’s beginning.

Sensationalized news articles and headlines across the world played a great part in this by demonizing gay men, using terms like “gay plague,” “gay cancer,” and displayed images of tombstones and the Grim Reaper. Heartlessly, HIV and AIDS were viewed by many as a punishment for what they or others considered “amoral behavior,” like sex between men, IV drug use, or sex work. This, combined with existing intense bias against these groups, led to a mass amount of fear, and tremendous silence surrounding the disease. At the height of the AIDS epidemic in the US and beyond, gay men led activist movements criticizing the government’s blind eye and lack of action at such a crucial time, fighting for the Reagan administration to pay attention and to fund research and treatment. It wasn’t until 1986 that President Reagan even mentioned the word AIDS publicly. During this time, HIV was still considered by many to be a death sentence, as affected populations continued to be further marginalized.

Ian Green, Chief Executive of Terrence Higgins Trust, a British charity that provides services relating to sexual health and HIV, was diagnosed with HIV 23 years ago. In a recent interview, Ian, now undetectable, disclosed fears he had when he was diagnosed that many still have today when they test positive for HIV. “The most significant [emotion] at that point in time was how long did I have to live. The other thing that really concerned me for a very long time is am I a risk to other people?” I can only imagine the immense relief that might now be felt by a person living with HIV to learn they are unable to pass it on to anyone else – to not feel as though they are any sort of danger to other people, so contrary to perceptions and experiences of the past.

In the United States, specifically, the population most affected by HIV is still men who have sex with men, accounting for 26,000 new infections each year. Worldwide, though, women represent the majority — 52% — of all adults living with HIV. Though we know anal sex poses the greatest risk of transmission, penis-vaginal intercourse is also a leading cause of transmission worldwide. Similar to the anus, it's easy for the vaginal wall to experience small (usually unnoticeable) tears during intercourse, providing a route for HIV transmission. Vaginal tissue is highly susceptible to any type of infection. Beyond basic physiology, women (including those who don't have vaginas) also remain disproportionately affected by the virus due to vulnerabilities created by social, economic, and cultural status. Gender inequality, as well as intimate partner violence, reinforce harmful power dynamics, both on a personal and systemic scale. In many countries, women face significant barriers to education and healthcare, contributing to a known lack of understanding around pregnancy and HIV.

What about treatment?

HIV treatment medications (ARVs) became available in the late 1980s, starting with the first licensed drug, AZT (of the drug class Nucleoside Analogs), which was initially highly toxic.

Fast forward to the 1990s and a new era of ARVs. Researchers began to realize that one class of drugs was not enough to control CD4 counts, and eventually introduced HAARTs – highly active antiretroviral therapies – made up of combinations of Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Protease Inhibitors, Fusion Inhibitors, CCR5 Antagonists, and Integrase Inhibitors. Not only were these treatments (called “cocktails” in early years) numerous - sometimes 20 or more pills a day - but many doctors refused to even treat people living with HIV. Then there’s the fact that even seeing a doctor and paying for these incredibly costly meds meant having health insurance (something many, many people didn’t have), and a plan that would potentially pay thousands upon thousands monthly for treatment.

Through years of advocacy and research, ARVs became more effective in treating the virus, and HIV resource agencies began growing around the world, making it easier for more people to access these medications. Drug trials continued, and researchers found the right combination of these different classes of drugs.

Today, people living with HIV who are connected to treatment can now take as little as one single pill per day as their full treatment. (That one pill contains at least three types of medications, though.) By finding these effective combinations, remaining adherent to one’s ARVs has become much easier than not only remembering to take, but having to swallow, handfuls of pills per day.

This brings us back to the results of the PARTNER2 study and what life looks like for people who receive HIV treatment today.

UNAIDS data from 2018 reported that 21.7 million of the 36.9 million people living with HIV worldwide were receiving treatment in 2017. Their current initiative and goal is 90/90/90: that 90% of people living with HIV will know their status, 90% of those people will be on treatment, and 90% will be virally suppressed. Adherence to treatment is key to suppression of the virus.

Current standards of treatment include taking daily medication and having lab work done every six months prior to checking up with a healthcare provider. Today there are many ARV medications, and doctors choose the best regimen for each individual patient. Typically, after a few months of taking medication (and depending on how long they have been living with the disease untreated), people diagnosed with HIV will have such a small amount of copies of HIV in their blood that they are considered “undetectable.” People achieve viral suppression (a controlled, lowered amount of the virus) when the copies of HIV are less than 200 per milliliter (mL) of blood. This doesn’t mean that a person with an undetectable viral load will test negative for HIV, but during routine labs (which check the CD4 – the level of good white blood cells, and the amount of HIV copies in the blood) their amount is so small that it will not show up on that particular test.

It’s important to note that just because a person achieves undetectable status does not mean they can stop taking medication. If a person begins missing more than 3-4 doses of their ARV per month regularly, their viral load can climb to a detectable value, and they may need to switch medications to get that number back under control.

So, what does this news mean for everyone?

Obviously, the fact that HIV treatment has now been proven to prevent transmission when taken properly is incredible news, and is potentially momentous both for people living with HIV and those of us who have worked or are currently working to prevent it. Researchers have been working hard for decades on the science behind HIV and developing and administering effective treatment.

But what about the people who don’t have access to these medications? In developing nations, poor economy contributes to a lack of healthcare, and the availability of medication to fight HIV. UNAIDS estimates that more than $26.2 billion will be required to combat HIV/AIDS in the year 2020. Treatment is expensive.

Stigma plays — as it always has — another huge role in the ability to receive treatment. Even just being tested for HIV is scary because of fear of judgment and discrimination. In terms of HIV, however, ignorance is not bliss. It is crucial to know one’s status so that treatment can be initiated, and more people will not come in contact with the virus. 73 countries worldwide still consider homosexuality to be a prosecutable offense, sometimes punishable by death: these attitudes and policies obviously keep many people from even getting tested. A key proponent to HIV prevention is education and counseling, but for many, the idea still exists that HIV = gay, and it can be dangerous to discuss either.

There are many other barriers that exist that prevent people from receiving HIV treatment. People of color and those who are low-income are incredibly underserved. Many people do not have access to health insurance or appropriate healthcare. ARVs cost upwards of $3,000 per month without insurance. Even with insurance, lack of education often leads to the inability to understand a diagnosis and other parts of health, and makes it difficult for many marginalized people to communicate their needs with a doctor. What about transportation? Just getting to a doctor’s office or pharmacy is often a task on its own, especially in rural areas or healthcare deserts (areas with no clinics or hospitals). Additionally, housing and food security play their own roles in creating barriers to optimal HIV health. Without a safe place to live, many people lack a safe place to store their medications even if they can get them. Most ARVs need to be taken with food to be absorbed properly: not knowing where your next meal will come from adds another layer to the struggle with adherence.

Luckily, there are many HIV resource agencies to assist people with some of these barriers and help to make access to HIV healthcare easier. In the United States, the AIDS Drug Assistance Program (ADAP - though the name varies by state; for example, this resource is called MIDAP in Michigan) provides free HIV healthcare and HIV medications for people enrolled in the program. This organization even covers undocumented citizens. HIV resource agencies often provide testing, education, counseling, and HIV health management services (including social work, and food, housing, and insurance assistance) for people who are lucky enough to have an organization in their area.

There are also other recent HIV advancements to be excited about. Pre-Exposure Prophylaxis (PrEP) was initially approved by the FDA as a preventative medication from MeetPositives SM Feed 4 http://bit.ly/30bb2qr via IFTTT

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A Conversation with My “Rapist” - Part 1, A History

Two days ago, I had a very interesting experience. TW: abuse, trauma and rape

I want to share it with you all and process it - brace yourself for a long, very personal, pretty heavy read... in multiple parts 

 I came to uni  3 years ago, at age 19,  with an open heart and open mind, thankful to have escaped from the home town where I suffered a great deal of abuse, neglect, bullying and harassment. I was feeling hopeful - I could use this fresh start and change of environment and pace to change things and myself. I was also very vulnerable - having missed out on so much development and many of the experiences that a normal child growing into an adult would face. 

I knew I was damaged from my past, I was scared of simple things - like being hugged. This held me back in connecting to people  (and still does now in more complex ways) - the thing I wanted most, and I tried to work on this everyday. I attempted to slowly confront my fears and relearn how people are.(As it stands, I can now hug people without being scared so yay me!) 

During this time, I find someone who I really like and am immediately intensely attracted to. They are charming, fun and somewhat mysterious. Truth be told, I could still write a thousand sonnets about the experience of “falling in love�� (albeit superficially) with them. This was maybe the 3rd time in my life I’d had a real life (as opposed to online) crush return the interest - the first and only genuinely wholesome time being when I was 14. (side bar: Dear Penguin Boy, you will always hold a special place in my heart, you adorable nerd. I am so sorry I dumped you out of the blue, I wasn’t aware of splitting back then or my shitty disordered attachment style. PS. How’s your egg doing? ) The second was when I was 18, and in retrospect was probably (read: definitely) being manipulated by this older Dutch man who had a thing for taking advantage of inexperienced younger girls. (Which my virgin ass surely was.) The trauma of that experience is a story for another time. 

This was only made better by the fact this time it was a fucking girl. A fellow woman? Showing interest in ME? LORD BE PRAISED - MY GAY DREAMS ARE COMING TRUE. I could barely believe it was even happening. 

We hook up and eventually begin to date. The relationship is incredibly tumultuous - our flaws and unresolved past baggage ravage the other’s. We both like each other, but over the year and a half of stop and starts we hurt each other frequently. 

I know I’ve made mistakes in the relationship - applying pressure for it to be more serious than she wanted (FWB to actually dating) being the main one. And beyond that, pushing for things to go to fast and trying to rush the emotional connection that I was craving. We start on poor footing due to this, but she doesn’t protest strongly or make it clear when things progress further that we’ve gone beyond what she wants. In retrospect, it was still wrong of me to pursue to relationship in the first place.

 I  wish we’d just dated super casually instead - less sex and private hang outs (where if you don’t talk, there’s not much to do but fuck) and more public dates until we knew each other better or didn’t want to pursue it further. I also wish we’d deeply and bluntly discussed our understanding of what was happening, where things were going and relationships in general. Pro-tip: always confirm definitions - people mean totally different things with the same words.  It would have made things a whole lot less confusing. 

As we date, certain things become clear.

She doesn’t understand consent. She knows that if someone says no you stop - but beyond this, she cannot see the grey areas that exist and that it’s most important to get a yes.

I live in the grey areas, unwillingly, which is why I try to communicate so bluntly and be so straight forward. I’m already so complex - I don’t need or want to add any extra grey. Being complicated isn’t something fun I chose to do to be mysterious - it’s something I had forced upon me by circumstance - fighting to survive and get my needs met as a child. How I’ve adapted to cope with that. It’s something I’ve spent and will spend years in therapy trying to rectify. 

When I try to talk to her about this - she wants me to teach her about BDSM, so I try to start with the most important part, the foundation, consent and communication - she gets angry with me. She considers herself the victim and does not take criticism or questioning well - but it takes me years to realise this. 

I try desperately to understand her, but with no communication to go on, I am lost. She hates when I probe and needs to open up in her own time. She doesn’t share much of anything at all  -  from the small details about her day up to how she feels in the moment. I am sometimes given stories from her past, and left to extrapolate the rest. I hate the unknown - I am scared, so I push- for anything.

I have idolised her and refuse to blame her for her flaws. I buy into the victim narrative she believes not realising it. I am unable to explain her behaviour through insight into her past or present emotional state/experiences due to lack of data, but I try desperately anyway. Lacking context, I settle on believing her actions are always my fault, a lie I’ve been fed by abusers in the past. She’ll give me what I want and need when I deserve it by being perfect.

I become increasingly scared, self-loathing and insecure. I berate myself for every small thing I see as being done wrong, and whenever I take issue or am hurt by something she does or doesn’t do (usually communicate with me more), I find a way to make it my fault. I waste hours of my alone time on this, tearing myself down. 

I believe I am abusive and toxic, I am the perpetrator and she believes she is the victim of things in life and I suppose that she rarely does anything wrong. I deny my own reality and accept hers. She doesn’t need to manipulate me, no one would, I do it to myself.

 In my defence, my reality was/is pretty fucking abysmal and you might want to deny it in my place too. Despite the misplaced shame and guilt, it’s easier to be an abusive person than admit you’ve been so chronically abused and continue to relive it. One is a position of power... and the other is a complete lack of it. If I’m being abusive, then I can change. If I’m being mistreated, there’s not much I can do, it’s in the other person’s hands to cut it out or step up. And if there is anything that will trigger a victim of childhood neglect and abuse it's feeling helpless / powerless. 

To others, it looks like she is manipulating me to believe this about myself, but in fact I am filling  the gaps in our relationship with past experiences. I am reliving and recreating the trauma of my past abuse. She shares the victim mentality (and unfortunately enough, the height and build and gender expression of, priming me for this response) with a past online lover of mine who I was emotionally abused by and sexually pressured by for a year at 17.

It is easy to see how rape occurs within this dynamic. And, as a big surprise to no one, it did

 In a way, it was predestined by the circumstance and flaws of each of us. It was almost inevitable, unless either I realised what was happening and dealt with my past trauma or she worked through her issues with the victim mentality and then went on the learn more about consent and communication. We were both 19. This wasn’t going to happen without some outside intervention. 

Here’s the interesting part though - the level of insight, understanding and processing I have now would not have been reached had I not sat down to talk with her multiple times. It wasn’t easy and it definitely wasn’t pleasant for either of us - but I know it was ultimately beneficial. Or, at least... the most recent go at it (only a few days ago) was. And that’s what I would like to explore next.