Status Misrepresentation

[+ SirBillybob]

In U=U MSM PARTNER1/2 research combined, 1500+ individuals in some 750 serodifferent couples were completely aware of their own and their partner’s HIV status. The intention was to maintain non-transmission via sustained viral suppression throughout follow-up periods of condomless and pre-exposure drug prophylaxis-less anal intercourse. Otherwise, behavioural adjustments on the part of the seronegative partner, such as being lower-risk insertive in anal (a seronegative cohort majority), and receptive anal but without poz partner ejaculation (almost half) were clearly optional. In contrast, there would have been no strong argument for the seronegative partner to refrain from coital ejaculation.

It goes without saying that the knowable was normative and influenced the risk hierarchy. It doesn’t matter that there was non-incidence of infection in both subsample categories, stratified according to whether within-anal ejaculation by the HIV-positive partner reportedly occurred. If one wants to be aligned with U=U research in one’s own risk management there is little daylight between the norm of status awareness and the imperative of awareness, the necessity of awareness and the right to know. However, the real world outside of prevention research is not so simple. A seroconversion due to viral breakthrough in a TasP study is censored data and disqualified as posing cohort incidence greater than zero. Otherwise, all components of overall not knowing in the real world call for judicious, context specific, use of various prophylaxis options.

A limit to knowing when the information exists but is not accessible, for whatever reason, is more inclined to get hackles up irrespective of downstream health outcome. Although rights and responsibilities are ideally complementary rather than contradictory, tension arises when emphasizing one is mistaken for diminishing the other. 

As you say, Phil, information governing behavioural decisions at point of intercourse may be scientifically flawed for reasons already mentioned and beyond the scope of the truth vs mendacity consideration. Jurisprudence is not caught up with that unless it has material value in individual case adjudication. 

Edited 15 hours ago by SirBillybob

[pubic_assistance]

On 6/29/2026 at 7:16 AM, PhileasFogg said:

IF they are sticking to the treatment protocol, there’s little difference

THAT is not always true. 

The degree of failure in today's HIV medication is limited but not ZERO. So ..although its not a traditional game of Russian Roulette with a one in six chance of losing. Failure in HIV medications is currently estimated at 2% to 3% even with consistent adherence . Do you still want to play ? 

Edited 11 hours ago by pubic_assistance
spelling

[+ PhileasFogg]

36 minutes ago, pubic_assistance said:

THAT is not always true. 

I did not know that.  Thank you!

To clarify - you’re referring to ART effectiveness?

If so, like birth control, cited effectiveness rates have to do with proper use (on time, daily, no antibiotics, etc).  Might the lowered effectiveness of ART be based on similar careless administration by the patient?   If so, I’d argue my stated concern is valid…if not, I need to research more to enhance my understanding. 

[DMonDude]

22 hours ago, SecretProvider said:

FYI - A doctor client told me that 90% of his gay patients that test positive were in monogamous relationships, and so were not using protection be it condoms or prep. 

This is what I've heard from a doctor friend as well.

Being on PrEP is something i feel everyone should do if they can. Even if in a monogamous relationship.

 

Side tangent: I personally see it as being similar to having a pre-nup for a marriage (which i also think anyone getting married should do). People should never let their romanticized notion of a relationship/monogamy/marriage lasting forever or being guaranteed to be faithful stop them from protecting themself.

If something as medically life altering as serious STI infection from a cheating partner or as financially life altering as a divorce is a possibility, everyone should still protect themself regardless of how much you love and trust your partner in the present. Doing so does not inherently mean your relationship isn't sound or is less than or that you lack faith in the relationship's long term success. You're simply protecting yourself from the possible consequences of things that aren't fully in your control.

Edited 10 hours ago by DMonDude

[+ PhileasFogg]

As I think we’ve established, this post isn’t about relationship fidelity but rather provider honesty/integrity and the implication to clients who accept their representations at face value 

[DMonDude]

33 minutes ago, PhileasFogg said:

As I think we’ve established, this post isn’t about relationship fidelity but rather provider honesty/integrity and the implication to clients who accept their representations at face value 

Most of the replies have established this all really boils down to "our safety is in our own hands". Fidelity or provider honesty/integrity and whether clients accept provider representation at face value or not all kinda don't matter.

[pubic_assistance]

5 hours ago, PhileasFogg said:

cited effectiveness rates have to do with proper use

I was quoting the percentage of drug failure even when consistently administered.

The failure rate in the general population where you find a varying consistency of administering the dosage is FAR higher. Somewhere around 15% in most communities and up to 30% in others. 

So to be completely reliant on SOMEONE ELSE taking their medication is INSANE

Being consistent in taking your meds yourself is a low risk but never a NO risk situation.

Personally I rarely bareback and I would NEVER in a million years let anyone top me bareback.(Not that I bottom anymore)..but when I WAS still taking it up the ass I never got fucked without a condom. (Yes I know a condom CAN tear...but in all my years of fucking I am unaware of that ever happening). 

 

 

 

 

[Muscle_Admirer]

I liken the HIV status disclosure of providers to an article I read a few years ago about the rather frighteningly high estimated number of commercial airline pilots in the US and globally  struggling with mental health and not seeking treatment for fear of losing their jobs.  I think regardless of one’s generosity emotionally and socially with persons who have seroconverted, the fact remains most people would think twice about hiring someone who is disclosed HIV+ than someone who is HIV+ and feigns that they are HIV-.  Simple economics make provider disclosure of HIV-, unreliable.  I am the master of my own health and wellbeing and take precautions as such.

[jonasfoleson]

what's to whine about? safety is important. odd to complain about something that is there to promote safety.