The online diary of a gay courtesan.

Part 9 of 13: STDs

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Let’s get something very clear up front: I am not a doctor. Also, I’m not telling you to have sex for money. I’m not even assuming that you’ll have sex with your clients/club patrons/phone callers/Skype watchers/etc. (though it’s a given, if you choose to shoot videos that involve other people being in the scene with you). What I propose to do here is supply you with some no-nonsense advice. That’s all I’m able to do. Educate yourself. Make informed choices.

Risk Management. There’s no way around this: You have to get used to tolerating risk (more on this in “Part 10: Legalities”). Adult entertainers are marginalized in practically every way imaginable. The best way to survive is to understand risk. Respect risk without fearing it. Understand how to minimize it, and accept that you can never truly eliminate it (N.B. This is true about life in general.). If you cannot tolerate risk, then this isn’t the career for you.

Compatible Primary Care Physicians. It’s vital that you find a Primary Care Physician (PCP) who’ll work with you without judgment, regardless of your profession. This becomes even more important if your private or work life is unconventional. You’ll need to speak frankly with this person, so it’s crucial that you see someone who doesn’t have prejudices that will interfere with your care. Seek out references for PCPs who are known to be sensitive to your needs.

PrEP. HIV is now manageable to a degree that was only imagined not long ago. This is excellent, of course; however, it’s also become common lately for people to be “Neg and on PrEP.” Frankly, that is a red flag: It’s essentially saying, “I want to fuck bareback.” PrEP is intended to be part of a regimen of risk reduction, not the sole shield against infections. I don’t use it, but I don’t feel I need it. PrEP is supposed to be the back up, in case a condom breaks. PrEP provides zero protection against anything except HIV transmission. Forgoing condoms will elevate your risk for everything that’s mitigated by using them. You should be simultaneously using a variety of strategies to reduce risk of exposure to STIs. If you feel PrEP is helpful to you, by all means take it; however, don’t be deluded into thinking it’s the only tool you should be pulling out of the toolbox. My line of reasoning is this: If I use condoms, I won’t need PrEP; however, if I use PrEP, I’ll still need condoms.

STIsAtAGlance_ChartImmunizations. I’ve chosen to be immunized for those infections that can be largely prevented. Some people have criticized me for “overkill,” but I think they’re idiots. End of story. If there isn’t a contraindication preventing immunization, they’re an excellent way to reduce risk. Ask your PCP about vaccinations, and explain why you’re at elevated risk. If you don’t tell your PCP bluntly why you’re interested in these shots, you may be advised you don’t need them. My PCP knows my situation. In 2013, he brought up immunizations when there were deadly outbreaks of bacterial meningitis amongst gay men in New York City and Los Angeles. He encouraged me to get the shot, and I said yes. Airports have made the world a very small place… Your PCP may not think of this, so be sure to ask.

Frequent screening. Your situation will define “frequent.” For me, I get screened and tested every six months. Your PCP might suggest a more frequent schedule; however, my PCP has told me that monthly visits are ineffective and expensive. But perhaps you need to go that often? Some people go quarterly. You have to evaluate this with your PCP. But you definitely should stay current on all the facets of your health and wellness.

Do you post your status or not? One of the methods by which people can reduce risk is to sero-sort (to have sex only with people of the same HIV/STD status). I’ve chosen to keep my HIV status publicly posted and updated over the years for a few reasons: 1) People would notice if I went past the six-month mark, so it obliges me to stay on top of my health monitoring; 2) I want to encourage people to know their own status; 3) most people are HIV/STI-negative, and they want to sero-sort. There’ll be people who’ll criticize this choice for their own post-modern rationalizations concerning HIV stigma. That’s fine. I know HIV is now manageable (by taking a pill every day for the rest of your life that costs +$1,000/month). Politically correct messaging aside: HIV is not yet curable, and infections shouldn’t be so cavalierly dismissed. If you’re Poz, you’ll likely know firsthand that managed HIV is still HIV+. I know plenty of people who are Poz, and not a single one of them has ever said, “My life is so much better now that I live with HIV.” If you can avoid getting it in the first place, do so. This isn’t an endorsement to be rude, dismissive, mean, or hateful toward people who are Poz. This is an endorsement to mitigate risk, so that when you have Poz partners (known to you or not), you’ll be less likely to seroconvert. Something else to consider are laws in your area that require you to inform your partner(s) about your positive HIV/STD/STI status. Knowingly exposing people to HIV without informing them in advance is a felony in many places.

Symptoms & Communication. So, what do you do when you’re exposed to an STD/STI? Get treated immediately! As soon as possible after/Simultaneously to this, discreetly alert the people you’ve seen within the timeframe of your exposure until the present. Don’t have sex until you’ve completed the prescribed treatment. People may be upset with you after you tell them, but most will likely be glad you told them. People have to accept their own part in exposing themselves to risk, but you have a responsibility to inform them, so that they can take necessary action. Also, if you don’t alert your partners, and they don’t get treated, you’ll be re-exposed if you see them again. If you think they’ll be mad when you DO tell them about cooties, what do you think they’ll be when they find out you knew and didn’t tell them?

Resources.

Centers for Disease Control: 2015 Sexually Transmitted Diseases Treatment Guidelines

Centers for Disease Control: PrEP

So They Can Know: STD Info

Talking to Teens: What Parents Need to Know about Sexually Transmitted Diseases

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