In the United States, the life expectancy of a person without HIV is 79 years. The life expectancy of a person with HIV, diagnosed at age 20, who has access to modern HIV medication and takes it faithfully for the rest of their life, is 71 years.
Now, eight years of life lost is a serious thing. And having HIV is not exactly pleasant: there’s stigma, the medication has serious side effects, and even during clinical latency HIV can affect your health. It is best to avoid getting HIV. But with modern treatment you can live long enough to die of something else.
But without treatment the life expectancy of a person diagnosed with HIV at age 20 is not 71. It’s 32. Appropriate HIV treatment buys you literally decades of life.
Being treated for HIV also increases your chance of having an undetectable viral load. If you have had an undetectable viral load for the past six months, evidence suggests, your chance of transmitting HIV to a partner is negligible to nonexistent. That’s right: we can actually eliminate an HIV-positive person’s chance of transmitting HIV.
The problem is that only thirty percent of people with HIV have an undetectable viral load. The biggest cause of this is that many diagnosed people are not in treatment: nearly half of people diagnosed with HIV are not engaged in care. That I can’t do much about. However, the second biggest cause is people with HIV not getting diagnosed, and that I can do something about.
If you are reading this and you are at risk of getting HIV, get tested for HIV every six months.
That means:
- Trans people and/or men who have PIV or anal sex with trans people and/or men.
- People who inject drugs.
- Poly people.
- Full-service sex workers.
- People who have vaginal or anal sex and do not use condoms correctly and consistently outside of a committed, long-term relationship with a person (or small number of people in the case of quads and triads) who has been tested and either doesn’t have sex with anyone else or uses condoms correctly and consistently.
- Anyone who has PIV or anal sex with people in the above groups.
About “correctly and consistently”: perfect use of condoms is not hard. You have to use the condom every single time you have sex for the entire time you have sex, you have to use a condom that isn’t expired or already used or likely to break due to excessive heat exposure, you have to use non-oil-based lube if you use lube, and you have to get a new condom if you put it on backwards first. The most important thing is using the condom EVERY TIME. Condoms do not work if left in the nightstand. However, some of you people are the ones making condoms’ typical use effectiveness rate so much lower than its perfect use effectiveness rate, and if that’s you you need to acknowledge that about yourself and get tested.
Look, I get it. Getting tested is an enormous pain. You have to make a doctors’ appointment or wait in line at a free clinic; I myself have skipped my HIV tests for over a year because I was too flaky to make an appointment. Getting your blood drawn hurts. And lots of people don’t want to admit– even to themselves– that they’re the sort of people who can get HIV, because that’s for other people. People who are dirty or slutty or make stupid mistakes. Lots of other people are afraid to hear the news. If you think something might ruin your life, it’s only natural to try to push it away as long as possible.
But shame, stigma, and denial are not acceptable or evidence-based ways of preventing HIV. They are not worth sacrificing potentially years of your life. They are not worth infecting people you know, perhaps people you love, with a chronic illness. HIV is manageable and survivable but only if you know you have it so please for the love of fucking god get tested.
watsonbladd said:
There is a new OTC HIV test. However, it is not as sensitive (ELISA vs PCR).
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Sophia Kovaleva said:
I’m like, sooo confused by that. People don’t get tested for STIs? People get tested, but only get their urine tested, and not blood?? People refuse to get tested because tests are for sluts??? How does that happen? I just go to a doctor twice a year, ask for full STD panel, and get it. I don’t feel comfortable asking people to have sex with me if I don’t have fresh test results, and I woulnd’t feel comfortable having sex without known STI status. And apparently in a parallel universe, people don’t get tested, but do engage in unprotected penetration with strangers. HOW?!
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gazeboist said:
I’d imagine it’s less “people refuse to get tested” than “people assume they don’t need to get tested”.
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sniffnoy said:
Plenty of people don’t even go to the dentist twice a year, and the dentist sends you reminders.
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tcheasdfjkl said:
I think part of the problem is that you generally have to proactively ask to be tested, and people are embarrassed to do that because of internalized sex negativity or because of a lot of experience with other people being judgmental and a sometimes justified belief that the doctor will be judgmental. (Dealing with a judgmental doctor is almost certainly less bad than having undiagnosed HIV, but it can be hard to prioritize far-term concerns over near-term ones.)
It’s also hard to consider bad and especially stigmatized outcomes to be within the space of possibility. “What is true is already so” is a really important but difficult lesson to learn for health stuff in particular.
I get tested regularly now, but (a) I’m lucky to have very nonjudgmental doctors, (b) I still feel a little embarrassed when the doctor asks “do you need to be tested for syphilis also in addition to the other stuff” and I have to be like “yes please test for all the things just in case” (c) even a couple years ago it would have been really hard for me to ask without feeling too embarrassed. I’m really sensitive to the possibility of someone judging me, which has gotten in the way of other types of healthcare interaction too, and I’m lucky that I didn’t ever have much of a need for STI testing until I started learning to somewhat get over that.
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gazeboist said:
Why is syphilis special cased?
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tcheasdfjkl said:
@gazeboist
I am not completely sure but I think there’s a sense that it’s only really necessary to test for it in higher-risk populations (similar to the categories Ozy set out in the post) so I need to be like, yes I am sort of in a higher-risk population, which feels weird.
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Stop judging me, Sophia Kovaleva said:
In my country, there are three ways to get tested.
You can go to a free clinic. You wait all day, and they might not have time to see you at all that day. Then you come back a week later for results.
You can go to a doctor for a prescription, then go to a lab for the blood draw.
You can go to a lab without a prescription, but I can’t afford that, and many labs refuse.
Is there a way to get tested that doesn’t require me to take two days off work? Or am I supposed to pick days off from the vacation tree?
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Evan Þ said:
Not sure about your country or your doctor, but here in the US, my doctor has a place on site where they can draw my blood right after my appointment; they call me next week to tell me the results. I’m sure other doctors are different, but hopefully you can find one who has that?
Or, I hear that if you donate blood and they detect HIV, they’ll let you know.
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tcheasdfjkl said:
The logistical burden is a real thing and it sucks, but I’m confused about why you’re saying it’s necessary to take two full days off work – does a doctor’s appointment or a blood draw take a whole day?
Where I am, some doctors have labs onsite where they can do the blood draw right after the appointment, but even if that’s not the case, there are labs where you can go without an appointment, so you could go there right after your doctor’s appointment. Though wait times are sometimes terrible, so yeah, that does require having time flexibility for that day. Still, that should be one day.
Of course even one day is more than you might have available, which is terrible for this reason and many others 😦 and as someone who is awful at logistical things, I don’t want to shame people who have trouble making time for stuff, whether for work reasons or brain reasons or other reasons. I am just confused about that point of fact.
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Lambert said:
Does ToT have a readership that’s all that uninformed on HIV testing?
Conversely, where is the most optimal place to signal-boost this message?
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ozymandias said:
Grindr? 😛
But seriously: there are teenagers and other sexually inexperienced people who read my blog, and even a lot of sexually experienced people don’t know how much proper HIV treatment can extend your life and that people with an undetectable viral load can’t transmit HIV. So I think it’s important to tell people these things.
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Treblato said:
Become a human lab rat, get a free diagnosis and earn some cash at the same time.
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