This is Sitting Queerly, a newsletter focused on the late blooming queer experience, the lofty goal of opening up conversations and celebrating those who embrace their full selves.
When I last visited the healthcare provider who provides my PrEP prescription, my HIV test came back inconclusive.
The doctor came in and explained that I could either sit for another pinprick test or have them take a full blood sample and send it out for testing. She noted that inconclusive results are not uncommon and can be caused by a variety of factors, many of which have nothing to do with whether someone has HIV or not.
I like to think I was calm on my exterior as I said I wanted the full blood sample taken.
It would take several days for the results to be available, she said. They’d call if it came back positive.
Beginning in the 1970s, many in the queer community, especially gay men, watched as friend after friend died from a mysterious illness. Many of those dying did so alone because so many wrongly believed they would get sick just by being in the presence of the infected. Families either outright refused to be part of their dying relative’s final days out of shame for their condition if not their sexual orientation, or, if they did provide some form of final rites, wouldn’t allow the deceased’s chosen family to be part of it. The U.S. government ignored the epidemic and let it run unchecked, putting untold numbers of people at risk.1
Now many aspects of how queer folk engage and view the world, from a predominant fixation on physical fitness to a propensity for social activism, are motivated by how truly devastating HIV/AIDS was for the first several decades after it entered the public consciousness. It has served as the inspiration or backdrop to numerous books, stage productions and other creative outlets.
Not that I was paying much attention to anything about HIV/AIDS when I was a teenager or young adult in the late 1980s and through the beginning of the millennium. That was a disease that affected only gay men and I wasn’t gay, obviously.2 But stories about Ryan White, a teenager who contracted HIV via contaminated blood as part of his hemophilia treatment, or urban legends of people sitting on needles embedded in the seat cushions at movie theaters with a terse note congratulating the individual they now had AIDS, still made it something to know and fear.
Sexually-transmitted infections (STIs) were something I worried about to some degree as I grew into a horny teenager and 20-something. By this time universities and health agencies were catching on that an ounce of prevention was worth a pound of cure so free condoms could be available at student health centers or other entities. I didn’t have penetrative sex until after I’d graduated from college but I did use condoms regularly for something akin to intercrural sex, though the consideration there was more ease of cleanup than anything else. But given that I didn’t do one-night stands and all those interactions were with individuals who I had some familiarity with, I felt pretty safe from any possibility of contracting an STI, especially HIV/AIDS.
Antiretrovirals have since made HIV/AIDS a more chronic instead of terminal illness, especially if treatment begins before the condition becomes full-blown AIDS.3 PrEP (pre-exposure prophylaxis) has been around for more than a decade and has made it increasingly unlikely for those taking it consistently to become infected through sexual contact with those with HIV/AIDS. Regular STI testing is now increasingly considered part and parcel of being queer and the responsible thing to do, as is a frank openness about talking about one’s sexual health with other queer folk.
It still boggles my mind how a disease considered a virtual death sentence, physically and socially, when I was a kid is now able to be managed and prevented. It’s begun to affect sexual habits, such as the near disappearance of stigma around men engaging in bareback anal sex. In fact, treatment of infected folk is so effective that being “poz,” while still having some stigma, is no longer the ostracizing or shaming designation it once was. If anything, there is a growing effort to shame those in the queer community who are prejudiced against those who are positive but are undetectable and thus unable to transmit the virus.
But sex, no matter your orientation, partner(s), or practices, always comes with risk. HIV/AIDS may have only been around for about 100 years—with only about half that time at a pandemic level—but plenty of other STIs have been around for centuries and possibly millennia. According to Wikipedia, gonnorhea was first recorded 700 years ago as occurring in a part of Paris populated by sex workers4 and known as “Le Clapiers,” hence “the clap.” In a potentially karmic reverberation, syphilis originated in South America and was only brought to Europe because of pillaging sailors and soldiers who contracted it while simultaneously passing on devastating infections such as smallpox to the indigenous communities they ravaged. And being monogamous and/or married is as effective an inoculation as the rhythm method is as birth control, if the history of human behavior is an indicator. And no safe sex practice can prevent transmission of any STI with 100 percent efficacy.
Devon Price recently wrote at length about the unavoidability of risk, be it in the bedroom or in fighting for the revolution. I particularly appreciated how they advocated for a mindset of risk admission rather than risk acceptance or risk tolerance:
When we acknowledge that we must always choose between risks rather than avoid all of them, we can be more clear-headed about the likely consequences of our actions. Risk admission means making peace with the losses we are most willing to endure before they even happen, and saying to ourselves, “I chose this, and I wanted it, and I know how to deal with what might happen.”
They spoke about how when they recently were diagnosed and treated for gonnorhea there were responsible steps they had to take, such as taking antibiotics, abstaining from sex until the infection cleared and notifying their sexual partners. Those are possible steps they knew they may need to take given their choices, Devon said, and hopefully their partners understand that as well.
When I approached my wife about opening our marriage so I could explore the queerness I had long denied myself, there was no debate about taking precautions. PrEP and condoms were immediate conditions I offered and that satisfied her. She also preferred I not have hookups and the like but did not make it something she expected of me. For my part, I need some level of emotional and intellectual connection with an individual before doing anything intimate, so hookups weren’t something I planned to do.
I started PrEP immediately and, while I missed a dose or two during the first six months5, was otherwise consistent. I only had two other sexual partners beside her in that time and know them well and stay in contact with them. We even let each other know whenever we’re sick (though it’s never been a result of an STI to date). Quarterly testing is a requirement for me to maintain my PrEP prescription and I also have doxycycline on hand if I feel it necessary to take something the day after sleeping with someone. I wanted to be more conscientious than what study after study had found when it came to bisexual men and their adherence (or lack therof) to safer sex practices.
You are responsible, I told myself. You are being responsible, I told myself. You are doing what you need to do, I told myself. You are doing what you need to do and you are doing it transparently, I told myself.
And yet, when I was told that HIV test was inconclusive, I forgot all of that.
Instead, I thought about how my selfishness had potentially exposed my wife to a serious health risk. How my recklessness could endanger her life as well as mine. How my indiscretion could destroy our marriage if not each other’s lives.
Intellectually, I recognize this mindset is not helpful. My wife knows of my activities and the precautions I take. She is free to make her own choices accordingly. She could get on PrEP herself. She could abstain from sex with me or limit us to less-risky forms of physical intimacy. She could ask I test more frequently, which I would be amenable to. She could seek to end our relationship. Or, as she has done to date, she could accept my precautions as sufficient for her protection.
Just as I have made choices, so has she, and I should accept that.
But that guilt and shame, that ingrained rut of seeking to please and serve others over myself, is still there. I chose this risk, but I feel I forced it upon her. She has chosen to not pursue any relationships outside of our marriage, but because I had, she was now forced to take that same risk. If I wasn’t so needy in seeking physical intimacy with men, I wouldn’t need to worry about any of this to begin with.
The clinic never called. I wasn’t satisfied with a non-answer, so I called and left a message saying I wanted verbal confirmation of the result.
I missed their return call but they left a voicemail. The transcription said the test came back negative. I’ve told my wife about the whole situation and, after a brief discussion of how an inconclusive result can occur, seemed satisfied.
I was more than 99 percent certain that the second test would come back negative, just as PrEP is considered 99 percent effective at preventing transmission of HIV.
That isn’t 100 percent certainty. And I need to be OK with that.
Final Note…
This is where I make a PSA to do everything you can to protect yourself (and your sexual partners) from STIs.
Use condoms. Properly.
Make sure you’re vaccinated against those STIs that can be prevented (hepatitis A + B, HPV, monkeypox).
Take PrEP.
Take doxycycline the day after sexual activity, especially if you’ve engaged in high risk behavior, such as having multiple partners in a short period of time or not using condoms.
Get tested regularly (at least every three months).
If you’re sick, go to a healthcare provider for a diagnosis.
If you get an STI, tell your partners.
I appreciate there are potential barriers to some or all of these precautions for some folk, depending on their financial status, access to quality health care, and sense of personal safety. Do what you can.
We need to admit that risk is unavoidable. That doesn’t mean we should be reckless.
I hope this statement sounds as dripping with sarcasm as I intended it.
So long as you stick to your medication regimen, and thus can afford your medication, which means you have a job that provides decent health insurance.
They would have been called prostitutes, but that’s a dated and sexist term we should get away from.
Alongside with my daily psych and allergy meds due to a disruption of routine.
This really is an important subject, now as ever - there's been an avalanche of STIs in the wake of PrEP, and there are real health consequences from taking antibiotics as a prophylactic. Thanks to Ty for shining a light on the choices we make, and our responsibilities to ourselves and others.
The guilt and shame that comes with having an open relationship and "trying" to be responsible while also getting your own needs and desires met is real! thanks for sharing this so openly, Ty. Appreciate the candor and inspiration