Bryce Furness: The chance of you having sex with somebody who has an STI or HIV is much higher than you would be in wards one or two, simply because the rates are higher in those wards.
Malachi Stewart: Hey, welcome everybody to another episode of Positive Voices. I'm your host, Malachi Stewart.
Tei Pearson-Hall: I'm Tei Pearson-Hall.
Malachi Stewart: And today we have a very special guest to talk about something that I know you all are curious about. Myths.
Tei Pearson-Hall: Yes.
Malachi Stewart: Listen, in the world of HIV, there is so much myths. There's a lot of myths in the world of healthcare, sexually transmitted infections/diseases. And here we have our guest Bryce with us. Bryce, introduce yourself, let people know who you are and what you do.
Bryce Furness: Hey, my name is Bryce Furness. I am a physician. I work for the division of STD Prevention at the Centers for Disease Control and Prevention. But I have been embedded in the Department of Health in Washington DC since 2002.
Malachi Stewart: Yeah. So you're not new to this. You're true to this.
Bryce Furness: I'm not new to this.
Malachi Stewart: You true to this. Tei, we worked together at a few clinics before, so I definitely have experience with you professionally and you're definitely one of the best. So I'm interested, before we even get into some of the questions people had like on the streets and in the community, what are some things that you would like to address, just myths that you hear or miseducation? And if I could start with one, what does it mean, for example, to be clean?
Bryce Furness: It's a good one because I hate that word. And it's used. The way that it's used, at least in the clinical setting is in a very derogatory form. And so it tends to be patients that are having symptoms. So they probably have a sexually transmitted infection. And they're talking about their partners in that, "Well, I thought they were clean." And I don't think it comes from a place of self-awareness where you know saying that means that you right now are unclean. You are here for an unclean reason. And so to me there's the discordance between how we use that word and what we think it means. It's always somebody else that that's clean or unclean. It's never us.
Malachi Stewart: Yeah, that makes a lot of sense. What are some other things?
Bryce Furness: I'm very proud of the fact that the DC Health and Wellness Center, our pre-exposure prophylaxis clinic for HIV, more than 75% of our patients are brown and Black MSM and transgender females on the medicine to prevent HIV. That is the way to end the HIV epidemic. That and U = U equals you are the two steps that are going to make HIV a completely different animal in a couple years. And for someone who's been in this for a long time, who was actually in HIV before highly active antiretroviral therapy started, this is all a game changer. So I'm very proud of the fact that most of the patients that we see at the clinic that are getting the pills to prevent HIV are MSM and trans of color.
What I want everybody to know is that there are no barriers. You do not have to have insurance, you do not have to have a medical home. DC and the DMV has safety nets upon safety nets for HIV prevention and HIV treatment. There is no reason for anybody who's HIV positive to not be on treatment. There is no reason for anybody who's HIV negative who has had a bacterial STI or multiple partners or engages in unprotected receptive anal intercourse to be on pre-exposure prophylaxis. None. So that's the one myth that I just want to put out there upfront. There are no barriers. And DC and the DMV has safety net upon safety net. So there's no reason if you want it to not be on it.
Tei Pearson-Hall: Wow, good one.
Malachi Stewart: That's good.
Tei Pearson-Hall: Yeah. Another question for you, why aren't lesbians at the table for these conversations?
Bryce Furness: That's a very good question. It's sad, but I think that when we think about lesbians in the world of sexual health, we think about women who have sex with only women. And women who have sex with only women are at lowest risk for STIs, including HIV.
Tei Pearson-Hall: Oh, wow. Okay.
Bryce Furness: But women who have sex with men and women tend to choose higher risk men. And so women who have sex with men and women are at higher risk for HIV and other STIs than women who have sex with men only.
Tei Pearson-Hall: Wow.
Malachi Stewart: I didn't know that, that it tends to be higher risk men. That's information to me and I've been doing this for a while.
Bryce Furness: We just published a study based on the parish health units in Louisiana where we were looking at extra genital screening. And the numbers weren't high enough, but it appears that women who have sex with both men and women have a higher incidence of bacterial sexually transmitted infections in the rectum and the throat versus women who have sex with men only and women who have sex with women only.
Malachi Stewart: What kind of infections are bacterial?
Bryce Furness: Bacterial infections are gonorrhea, chlamydia, syphilis.
Malachi Stewart: Okay, that makes sense.
Bryce Furness: Viral are things like HIV, human papilloma virus, which causes warts and cancers. HPV, HIV, herpes
Malachi Stewart: And herpes. Got it. So you talked about, and you brought up wisely, that lesbian women are a part of the conversation. Can I ask you what assumptions are made about men who have sex with men? Because it seems like sometimes there are a lot of assumptions that men who have sex with men only have sex with men. Is that true? And how does that look?
Bryce Furness: Well, we could spend an entire episode talking about that. So I'll tell a story. You know through Whitman Walker Health we are in the Crew Club, which is the only real bathhouse in Washington DC, and we do STD screenings. And we typically do that Tuesday evenings and Tuesday nights. And part of the process of enrolling to get tested for HIV and STIs is demographic questions. So we have men who are in a towel in a club that does not allow women, and the only reason they're there is to find and have sex with other men. When you ask them what their sexual identity is, they'll say heterosexual.
Tei Pearson-Hall: Wow.
Bryce Furness: So that's one end of the spectrum. The other end of the spectrum is there are a lot of young clients in our clinic who consider themselves bisexual, but haven't had female partners in years. Specifically, I ask about partners in the last three months, in the last year. And they consider themselves bisexual, but it's been years. I've known them for a long time. It's been years since they've had a female partner. It's identity and an identity and behavior often don't jive. And then you have men who have sex with men, which is a behavior, it's not an identity. You have gay men. And then within gay men you have a whole bunch of different types of gay men. Do you have platinum gay men-
Malachi Stewart: Yes, you do.
Bryce Furness: ... and gold gay men and silver gay men. And the joke is whether or not they've been through a vagina or ever seen a vagina. So platinum gays basically were born by C-section and have never been with a woman.
Malachi Stewart: I've never platinum before.
Tei Pearson-Hall: I've never heard these.
Bryce Furness: They have never ever seen a vagina, been through a vagina, nothing.
Tei Pearson-Hall: Platinum.
Bryce Furness: Then you have gold that are basically, they were born through the vagina, but they've never been to one since then. And then you have the silvers and the bronzes. And it's also, temporally, there's an evolution. And that's why oftentimes people just ask about sexual orientation and gender identity once. But that evolves. And a good example of that is when I ran the transgender health clinic at Whitman Walker Health, there was a man who was in the military who was married to a woman. This man realized that he was a transgender female. And so we started the process. He froze some sperm before the process started. His wife was 100% heterosexual. They're now still together. They have two kids and she's now 100% lesbian because she was in love with the same person who was initially a male transitioned to a female. They're still together. They have two kids together. And so if you would've asked her when she first met this man, "What's your sexual identity?" "I'm 100% heterosexual."
Tei Pearson-Hall: Heterosexual.
Bryce Furness: Go talk to her now. She's like, "I'm 100% homosexual."
Tei Pearson-Hall: Yeah. It's an evolution.
Bryce Furness: It's a spectrum and it changes over time, especially with youth.
Malachi Stewart: And thankfully that we live in times where people are able to be who they are. But I really appreciate you clearing up the difference between behavior, that people assume an identity. Identity and behavior, like you said, doesn't always mesh. One thing I want you just to clear up and say I guess in a way that people can understand, we talk about U = U a lot here on the show. We talk about what it means to be undetectable. Can you kind of just explain what that means. And let people know, can they trust that?
Bryce Furness: Yes. Yes, they can trust it. It is science. And I'm a scientist and the science behind that is amazing. What U = U means is that HIV positive individuals that take medication to get their viral loads "undetectable" have a very, very low risk approaching zero of transmitting that virus to somebody sexually. So when you're talking about U = U and you're talking about viral loads, you're measuring what the viral load is in the blood. So when it's undetectable in the blood, it's even less detectable in body fluids, ejaculate, pre-ejaculate, vaginal fluids. So it's even less likely to be there and be able to be transmitted. So that's really what they're talking about. They're basically saying that when you can identify it in your blood, you can't transmit it to other people. And when they can identify it in their blood, it's even less likely to be in the other body fluids.
Tei Pearson-Hall: Good. Thank you for that. So I've kind of heard PrEP kind of mentioned quite a bit. Can you talk a little bit about what that is?
Bryce Furness: Yeah. PrEP is, it's going to be one of the two pillars of the end of the HIV epidemic. It is basically a pill or a shot that individuals get in order to prevent HIV. And there are criteria. Typically CDC, the Center for Disease Control and Prevention has criteria for who should be educated about PrEP, who should be started on PrEP, who should be offered PrEP. And often those revolve around things like number of sexual partners, whether or not they've had a bacterial STI, gonorrhea, chlamydia or syphilis within a certain window period, whether or not they have drugs while they're drunk or high. There's certain criteria. The reality is at the DC Health and Wellness Center that we will put anybody on PrEP who wants it.
And I was forced to deal with one of my own internal biases because I had a 65-year-old heterosexual man in a wheelchair come to clinic and wanted PrEP. And I at first was like, "He's in the wrong clinic. He's here for tuberculosis or he's here for something else." I was wrong and I learned a valuable lesson. And he knew. He was very smart. Basically, he often paid for sex. And so he was heterosexual. He was in a wheelchair because he'd been hit by a car. So it was a temporary thing. He's ambulating now with a cane. But he identified his own risk. He knew that basically, "I pay for sex. I have transactional sex all the time, and being on PrEP would give me an added sense of security." That's not one of CDC's inclusion criteria.
Tei Pearson-Hall: Okay, got you. Thank you.
Bryce Furness: We will start anybody on it that wants it.
Malachi Stewart: Even if they have no money.
Bryce Furness: Even if they have no money.
Malachi Stewart: We got to keep saying it-
Bryce Furness: Yeah. We do.
Malachi Stewart: ... because I've been out to so many restaurants, I've had so many waiters, mostly college students who are like, "Hey, I'm not on PrEP." They find out what we do, they hear the conversation at the table. They're like, "Hey, I'm not on PrEP because I can't afford it, or I don't want my mom to find out. I don't want her to see that I'm being tested every three months," and ask me why. And so I'm like, "Oh, there's ways around that? We do this." And at the time, me and the PrEP coordinator had each other's number. So I was sending them on Monday. By the end of the day, they were walking out with PrEP and having had their first test. But I love that you're letting people know that.
Tei Pearson-Hall: There's no barriers. Yeah.
Malachi Stewart: What about Doxy or Doxycycline, PEP? What is that? Talk to us about that.
Bryce Furness: That. So Doxy PEP is newer and controversial. And it's controversial within the lens of antibiotic resistance or a growing antibiotic resistance. But Doxy PEP is basically a way that gay men, and it's really been only shown to be efficacious or really work with gay men, where they can have high risk events and take 200 milligram doxycycline pills, so 200 milligrams of doxycycline once hopefully within 24 hours of the event, but definitely within 72 hours of the event. And if they do that over time for these high risk events, they're much less likely to have chlamydia. They're much less likely to be diagnosed with syphilis because doxycycline can be used to treat both chlamydia and syphilis. But interestingly enough, in a couple of the studies, they're also less likely to have gonorrhea.
So it seems like this Doxy PEP, post-exposure prophylaxis is what PEP stands for. When you have an incident and you take this medicine within 72 hours, but hopefully within 24 hours afterwards, you're much less likely to be diagnosed with some of the more common STIs, gonorrhea, chlamydia. And it's interesting to me because there is pushback from the antibiotic resistant crowd that we're going to be using doxycycline too much, all these other types of things. The reality for me in our clinic is we've been offering it for a long time way before there was a name on it, like you were familiar with U = U before they named it U = U for sure. I was very familiar with Doxy PEP before they named it Doxy PEP. And when we give guys in our PrEP clinic or HIV positive guys in our ART clinic a certain number of doxycycline pills and then check to see how much they've used over, it's usually a three month period between appointments, I just had a patient I saw yesterday who was given 30 three months ago and hasn't used any.
And we have starter packs. We gave out starter packs at Capital Pride. They were very popular. And in those starter packs basically are six pills. So it's three different Doxy PEP. And what I tell, what I counsel my patients is that it's not for your regular partners or your partners you're comfortable with. This is not for your partners who you talk about sexual health. You talk about HIV testing. You know they're HIV negative and you know that they were tested within the last three months. You know that they get regularly screened for STIs and that they don't have STIs. That's not who you use Doxy PEP with. We all have hooked up with someone where the next day our gut was just telling us that we shouldn't have done that. That's when you pop the two doxy [inaudible 00:13:18].
Malachi Stewart: This is the Grinder, the jack up, the A9, the I went to the glory hole and didn't see who the person was. These are those kind of hookups.
Bryce Furness: Or the hookup where you try to have conversations about sexual health and you know by no eye contact and other things that they're probably not telling you the truth.
Malachi Stewart: People out here shifty. I know we have a lot of questions that we have from the community. But the last thing I just want you to clear up, because I get this all the time, safe sex. Does that mean condoms?
Bryce Furness: I think safe sex is one of the terms. There are several terms that just need to go away. Safe sex is one of them, clean is another one. High risk is another one, risky, high risk. All of those terms for me, and this is where safe sex depends on the person in the situation. So we know one of the criteria for inclusion for pre-exposure HIV prophylaxis is number of sex partners. But to me, a guy who has three partners and never uses condom for receptive anal intercourse is much less safe, much riskier, all those terms we don't want to use, than a guy who's had 20 partners but uses condoms 100% of the time with both receptive and insertive anal intercourse. So it's a lot more about the quality of the partners than it is the quantity of the partners. And so that's why I have issues with things like clean and issues with risky and things with safe sex because it depends.
You also have situations, you have sero sorting. And so if you're an HIV positive individual and you're having sex with another HIV positive individual, you are going to be less likely to, "have safe sex," than you would otherwise. And so that for them is safe sex. Sero sorting is a version of safe sex. Another instance could be HIV negative men are more likely to be insertive partner with an HIV positive partner because it's less likely to be-
Malachi Stewart: It's less risk.
Bryce Furness: So for them, that's safe sex. They're thinking about this, they're trying to minimize risk. And it's all about harm reduction. And I think when we talk about safe sex, it's a one glove fits all when the reality is it's steps for everyone. And everyone's got to figure out how they are going to reduce their own risk and feel better about the sex they're having, the people they're with and always focus on pleasure.
Tei Pearson-Hall: Thank you for that. One more question before I kick it to the streets because we have folks outside that wanted to answer some questions. Can you explain to us a little bit about why the Black and brown community numbers are so much higher when it comes to STIs and HIV?
Bryce Furness: Yeah, that's a tough question. If I knew the answer to that, I'd probably be a very wealthy man. But I think in my experience-
Tei Pearson-Hall: Me too, right?
Bryce Furness: Yeah. I think in my experience it's multifaceted and there are multiple things. I think one of them is something that we call prevalence pools. So unfortunately, if you live in ward seven and eight in the city and you're having sex with somebody from ward seven and eight in the city, the chance of you having sex with somebody who has an STI or HIV is much higher than you would be in wards one or two simply because the rates are higher in those wards. So the prevalence pools definitely play a role.
I think that unfortunately access, so access to care is a big one. Obviously you're less likely to have an STI, especially a sexually transmitted infection that doesn't cause symptoms if you're able to get screened and treated more frequently. If you're in the southeast of the city, you don't have a lot of options. So you're less likely to be screened if you're not having symptoms. And we can pass on sexually transmitted infections including HIV without having any symptoms. So I think prevalence pool is big. I think access to healthcare is a big issue.
And then I think stigma and shame are a big issue. I think that within certain communities, especially communities that are very faith-based driven, people aren't honest and transparent about sex. And that leads to everything from young folks not being educated about how to prevent pregnancy or how to prevent STIs. It leads to this whole issue of young folks not knowing that they could go get tested and treated for STIs, vaccinated for STIs without parental consent, without having to pay anything. That's all part of the process because it's not talked about. It's not something that's passed on.
And then I think the other end of that is that you have older males who are HIV positive that do not disclose their status to their younger partners because of shame, because of stigma. And even to this day, I have patients in my clinic that sometimes when they travel, they don't take their PrEP. They don't take their pre-exposure prophylaxis because they don't want their friends to know they're on it because there's still a little bit of shame.
Tei Pearson-Hall: Wow. Okay.
Bryce Furness: And so to me, those are probably the three biggest things that contribute to it. Yeah.
Tei Pearson-Hall: Thank you for that.
Malachi Stewart: Yes. So knowledgeable. I want to know what the street's talking about, Tei.
Tei Pearson-Hall: So listen, we got our good girl Joy outside. Joy is outside down on U Street in the rain. Thank you, Joy. Because god, I wasn't trying to be it.
Malachi Stewart: Wouldn't have been my hair.
Tei Pearson-Hall: Hello, mine neither. But listen, let's see what the streets are talking about. Let's see what myths are out there so we'll come back and our guests will be able to answer those for us. Be right back.
Joy: So Anthony, welcome to the Positive Voices podcast. Thank you. So we are here on the streets to ask you about what you know about HIV and dating in the DMV. So my first question to you is, can HIV or AIDS be cured? Yes or no?
Speaker 5: No.
Malachi Stewart: Bryce, what you think? Because the girls out here saying Magic Johnson be cured for years.
Tei Pearson-Hall: Hello.
Bryce Furness: My gut feeling is to say no, HIV cannot be cured. I've been dealing with HIV for a very, very long time and it's not something that I would say is curable. But I will say that there are, I think it's been the third or fourth case of HIV that has been eradicated from a person living with HIV through bone marrow transplant and some other things going on. I think this was first discovered for someone who was living with HIV, but also was diagnosed with a bone cancer or a blood cancer. They got a bone marrow transplant and then it seems like they couldn't find the virus in the body anywhere. So that was patient zero. I think there's been the Pittsburgh patient and then there's one from Europe.
But in general, when we talk about the cost and the hassle that went into them being unquote cured, it's not feasible to say that HIV is curable. And I also know that there have been instances where people have been deemed cured of HIV, not living with HIV anymore, and then the virus was found. And I think that's one of the things, what makes vaccination for HIV and what makes U = U so important is that the virus can hang out in organs. So even when you completely change the bone marrow and the blood and it looks like it's gone, it doesn't always necessarily mean that it's gone. So in general, I'd have to say no. HIV is not curable. But there are instances where people living with HIV have had some extraordinary medical procedures that have made them HIV negative for the time being. That's going to be my answer.
Tei Pearson-Hall: Thank you.
Malachi Stewart: Fair.
Joy: All right. So who is the largest group of people diagnosed and living with HIV in DC?
Speaker 5: I would say African-American Black men.
Tei Pearson-Hall: What you think?
Bryce Furness: He's right. He's exactly right. But I would put age and gender of sex partner in there. So it's basically young Black men who have sex with men are where we're seeing the most number of new cases. And it's sad, but I work with the DC Department of Health. We provided HIV screening at both Black Pride and Capital Pride, and we identified three new HIV infections all in young Black men who had sex with men, gay guys that were less than 21 years of age who had never tested for HIV before.
Tei Pearson-Hall: Wow.
Bryce Furness: So that really is where we need to be getting the medicine to prevent HIV. That's really where we need some education. That's really where we need honesty and transparency within families, within faith-based networks, whatever it happens to be. They need to be talking about this because one of them was 18 years of age. It breaks my heart.
Malachi Stewart: Who would the second largest group be?
Bryce Furness: It's a good question. And I'm going to say I think without knowing, because I did not look at this before I came, I think that it's Black women.
Malachi Stewart: You're correct. You're correct.
Tei Pearson-Hall: Ding, ding, ding. Right.
Bryce Furness: And I want to say that that's a huge issue. And so I'm glad I got it right and I'm glad we're talking about it because we run the PrEP clinic, we have the PrEP clinic, the publicly funded PrEP clinic. We have a very difficult time getting Black women to start PrEP and stay on PrEP. If they happen to be in a discordant relationship, if they happen to be with a man, a husband, a partner who's HIV positive, then they get it. They need to be taking the medicine. But outside of that, they don't seem to think that they're at risk. Even if they've had gonorrhea or chlamydia or syphilis, even if they've had other sexually transmitted infections, they don't seem to think that they could get a sexually transmitted infection which happens to be HIV. So I think that it's good to be letting people know that.
Tei Pearson-Hall: Now, I'm going to throw you with a wild question. Why do you think that is? Why do you think that Black women don't do preventive rather?
Bryce Furness: I think part of it is defense mechanism. So I have been sexually active since the late eighties. I have never had sex in a time where HIV wasn't an issue. And I think anything we can do to minimize the threat of that is going to help us be sexually healthy. And so I think part of it is that they don't want to consider themselves to be a high risk group. The women who I have taken care of in the PrEP clinic who have been on PrEP because of their discordant partnerships, when that ended, they're like, "I'm no longer at risk. I don't think I'm at risk." And data doesn't seem to convince them. It's a personal decision.
Tei Pearson-Hall: Thank you.
Bryce Furness: So saying that black women in Washington DC are at the second highest risk of HIV doesn't seem to resonate with them.
Malachi Stewart: Yeah. They're like, "Not me, girl."
Tei Pearson-Hall: "Not me."
Malachi Stewart: "Not me."
Tei Pearson-Hall: Somebody else.
Malachi Stewart: Yeah. But then you as a person who was formerly DIS, I'm calling you as a disease investigator to tell you, "No. You, girl. You."
Tei Pearson-Hall: Let's see what else we have on the street. Joy, what's your next question?
Joy: Okay. Welcome to Positive Voices, Nay and Amaya. Do y'all know what PrEP is?
Speaker 6: Yeah.
Joy: Okay. What is PrEP?
Speaker 6: It's like after you've exposed to HIV, take it afterwards or prevent it or something like that.
Tei Pearson-Hall: So was she right?
Bryce Furness: She's so close.
Tei Pearson-Hall: She's so close.
Bryce Furness: So close. I'm rooting for her. So she's close. The way that she described it, there are two ways to prevent HIV. There is pre-exposure prophylaxis, which is where you take a pill on a regular basis to prevent getting HIV in case you happen to be exposed. So we were initially rolling out pre-exposure prophylaxis or PrEP among individuals that are, "high risk." And I hate that term, but high risk. And there are several ways you can be considered high risk. You've had a bacterial STI recently, gonorrhea, chlamydia or syphilis. You have unprotected anal intercourse with people that you don't know that well. You have multiple partners. You have sex while you're drunk or you're high. You engage in commercial sex work. You've been incarcerated. There are a lot of different criteria.
So that's where you take a pill like you haven't been exposed, the risk hasn't happened yet. You just take a pill because it may happen. And if it does happen, you don't have to worry about it because you're taking the pill to prevent HIV. What she described as post-exposure prophylaxis. So post-exposure prophylaxis has its roots in healthcare because ever since we've been dealing with HIV or Hepatitis or other bloodborne pathogens, we have had needle sticks or incidences where healthcare providers have been exposed to the virus and run the risk of becoming infected with that virus.
For example, working in a Kaposi sarcoma clinic at AIDS Health Foundation in the mid nineties. You are working with a man who's got KS in his brain and is a little demented. So he basically behaves in a way that leads somebody who's taking care of them to get stuck with a needle that just came out of his arm that was giving him medicine for his KS. So that person, that healthcare provider now has a large bore inoculation through their skin into their system basically that has HIV in it. So it's an incident that could lead to HIV infection. And so you take a medicine afterwards to prevent it from happening.
Right now, post-exposure prophylaxis, we have a PEP hotline in Washington DC. We are very much ahead of the game in the DMV. But that requires taking two pills once a day for 28 days. So post-exposure prophylaxis, what she's describing is taking two different HIV medicines once a day for 28 days. That works at preventing HIV if you have a high risk sexual event where you may have been exposed. Pre-exposure prophylaxis is either taking one pill every day, just one pill every day, or now we have injectable PrEP. It's coming around where you would get an injection every two months.
Tei Pearson-Hall: I have another question to follow up for that. So the two pills a day for 28 days, what if you have another incident within those 28 days? Do you start over?
Bryce Furness: It's a very good question. And we actually, we encourage people to remain abstinent for those 28 days because they don't know ultimately how this is going to unfold. So we do rapid HIV testing and we do fourth generation HIV testing when we start the post-exposure prophylaxis. But there's still a very, very small possibility that they could sero convert, could become HIV positive during the duration of this therapy. And it could be because of an exposure before what they actually think is their high risk exposure. So we encourage people on post-exposure prophylaxis to try and remain abstinent during the course of their therapy because then they come in at 28 days when they're done and we do the HIV testing again. And then if they're negative, we know that they're negative for sure. And at that 28 day visit, we try to start them on pre-exposure prophylactics so that it doesn't happen again.
Tei Pearson-Hall: Got you. Thank you for that. Joy, what you got?
Joy: True or false, is it okay for you to have unprotected sex with your partner if y'all both have HIV?
Tei Pearson-Hall: No.
Bryce Furness: I'm going to be very honest about this question. There's no right or wrong answer and it's a personal decision. And what I mean by that is that two HIV positive individuals who don't want to use condoms and are in a loving relationship, there's no reason why they can't have unprotected sex or condomless sex. That's my opinion, basically. And I think that it's a personal decision. And I'll give you an example. In the pre-exposure prophylaxis clinic that I run, I have a patient who's been on daily PrEP for three or four years. He has taken a pill, he's had lots of boyfriends. He's been diagnosed with gonorrhea, chlamydia or syphilis multiple times. He's now in a relationship with an HIV positive individual who's on medication and undetectable. So he wants to stop PrEP. His decision is, "I know this man's HIV positive, I know he's undetectable. My risk of getting HIV from him is zero. We're monogamous. I don't want to take PrEP anymore." So that's a personal decision for him.
Malachi Stewart: That is personal, yeah.
Bryce Furness: And so I don't think that there's a right or wrong answer to this question. I think it depends on the person. It depends on what your comfort zone is. And the other thing, sorry, but you are probably going to say this, is that is a form of safer sex for some people is what's called sero sorting. And so not only searching out partners that are known to be HIV negative or HIV positive based on what you are, what your status is, but also having sex in ways that minimize risks. So the HIV positive partner would be the receptive or bottom partner and the HIV negative would be the top or insertive partner. So it's a personal matter.
Tei Pearson-Hall: And you're saying serial sorter?
Bryce Furness: Sero sorting.
Tei Pearson-Hall: Okay. Sero sorting.
Bryce Furness: The sero is S-E-R-O and the sero is based on your serology as to whether you're HIV positive or HIV negative.
Tei Pearson-Hall: Got you. Thank you. Joy, what else you have out there?
Joy: Since I only have had oral sex, I am not at risk for HIV. True or false?
Speaker 7: False.
Speaker 8: False.
Joy: That is false. Yeah. Okay.
Speaker 8: Don't be putting random stuff in your mouth.
Bryce Furness: I love how quickly they answered that.
Malachi Stewart: Yeah. So if you just a munch, what is the risk?
Tei Pearson-Hall: Yeah.
Bryce Furness: So I will say that there is definitely risk associated. But when you talk about all of the behaviors, it's probably the least risky that involves touching or engaging with another person. Obviously things like masturbation and mutual masturbation where there's no touching or frottage where there's touching, but there's no exchange of body fluids. Probably less risky. But when you're talking about the strata of risk for HIV acquisition or transmission, it is the low hanging fruit.
And I know that one of the many successes of the quote safe sex campaign of the eighties and nineties was that people knew that of all the types of sex you could have, oral sex was low risk for HIV. And that was even before U = U or undetectable means untransmissable. So I love how quickly they answered. There is some risk there. And of course that risk depends on things like the viral load of the person who happens to be inserting their penis into their mouth, has to do with whether or not the gum disease and the oral health of the person who's receiving the penis.
Malachi Stewart: And if you swallow.
Tei Pearson-Hall: Hello.
Malachi Stewart: I mean, call a thing a thing. Because I ain't doing it, you got to be my man. But I can't be out here just doing it. I'm be like up, "Did it erupt? Take it away."
Tei Pearson-Hall: "Now take it back."
Malachi Stewart: But that does change the risk factor, right?
Bryce Furness: Yeah. Totally.
Malachi Stewart: Yeah.
Tei Pearson-Hall: Joy, what else you got outside?
Joy: True or false, STIs can only be transmitted when symptoms are present?
Speaker 9: False. The biggest symptom is no symptom.
Malachi Stewart: Oh, first of all, he's fabulous.
Tei Pearson-Hall: Hello. He showed up.
Bryce Furness: I love everything about that person.
Malachi Stewart: Yes. Fabulous.
Tei Pearson-Hall: Yes.
Bryce Furness: Let's bring that person in.
Tei Pearson-Hall: So was they right?
Bryce Furness: They are right. And I think it's interesting because Joy, she's bouncing back and forth between STD and STI. And I appreciate that because I'm old school and I'm just ingrained with STD, but the preferable term is STI.
Tei Pearson-Hall: Is that the same?
Bryce Furness: No. So STD is sexually transmitted diseases. STI are sexually transmitted infections. And the reason why we prefer STI infections now is because chlamydia is known as the silent infection. A lot of us have chlamydia and we don't know that we have it. So we can have chlamydia and not know we have it, and we're still at higher risk of acquiring HIV if we're exposed. We can have chlamydia and not know it and still have infertility or other problems with our uterus or our fallopian tubes or those types of things. So it's the silent infection that can lead to disease.
HIV is a perfect example. You get HIV, you don't immediately know you have it. And before we had treatment, it could be 10 years, it could be 20 years before you started getting a disease, before you started getting any symptoms. So infection is a much preferred term and it's because a lot of these bacterial and viral infections don't cause symptoms. And you need symptoms in order to classify it as a disease.
Tei Pearson-Hall: Good stuff. Thank you. What else you got, Joy?
Joy: All right. So welcome to Positive Voices, Tycory and Mary. When you're on HIV therapy, you can't transmit the virus to anyone else. True or false?
Tycory: It depends. True if you're undetectable, undetectable = untransmittable.
Tei Pearson-Hall: Hey.
Malachi Stewart: We out here doing the work because the people know.
Tei Pearson-Hall: Yes, U = U.
Malachi Stewart: They must've been reading my shirt.
Tei Pearson-Hall: They was outside. U = U.
Bryce Furness: There's nothing I could add to that response-
Malachi Stewart: It was perfect.
Bryce Furness: ... because the question, it could have been gone either way. It's not taking the medicine that's going to prevent the HIV. It's having an undetectable viral load that's going to prevent the HIV transmission. So that dude did perfect.
Malachi Stewart: Well, speaking of preventing HIV, because a lot of these questions were centered around what it meant to be negative or positive and if people were able to contract HIV or sero convert, what does it even mean to be HIV negative?
Bryce Furness: Oh, that's an excellent question. I'm glad you asked it. So I don't know what it means. And I think that that's a big issue. I think that when you go on dating apps or sex apps and you see HIV negative, we kind of put a lot of weight on that and there's a lot of people that put maybe undue emphasis on that unfortunately. But there's no standard meaning to what that means. And what I mean by that, Malachi, is that you have people who have never tested for HIV that call themselves HIV negative because they've never tested positive. The other end of that spectrum are people who are taking medicine to prevent HIV who get screened for HIV and other STIs every three months. So they're HIV negative and they know they've been screened a month ago. So they have a recent test versus the person who's never tested in their HIV negative because they've never had a positive test. And then you have everything in between.
I think personally, when I talk about being HIV negative, the way that ending the HIV epidemic is set up and the way that healthcare and prevention for HIV and treatment for HIV is right now, to me, what I'm hoping that means is that I get tested regularly and I've tested HIV negative within the last month or two.
Malachi Stewart: Yeah. That's a great point because I know a lot of people, especially a lot of my straight friends who don't ever really get tested for HIV and they are proudly like, "Well, I'm negative." And I'm like, "Are you, [inaudible 00:35:12]? Do you know that for sure?"
Tei Pearson-Hall: You say when you haven't even been tested.
Malachi Stewart: Right, right. For sure. For sure.
Bryce Furness: When somebody says they're HIV negative, that should open up a whole other conversation basically is like, when were you last tested?
Tei Pearson-Hall: How do you know?
Bryce Furness: How frequently do you get tested? What have you done since your last test? Have you injected drugs since your last test? And if you did, did you share needles? Have you had unreceptive anal intercourse since your last HIV test with people whose HIV status you don't know? Because then they can't be saying they're HIV negative because they put themselves in situations where that HIV negative test that was done a month or two ago means nothing.
Malachi Stewart: Can I ask why anal sex is more risky?
Bryce Furness: Anal sex?
Malachi Stewart: Or so risky rather?
Bryce Furness: So there's probably two main reasons. The first is that the rectum tends to be more sensitive. It basically tends to be more sensitive. There tend to be cells in the rectum that are more likely to be infected with HIV if exposed than the mouth or the vagina or some of the other holes we stick our penises in. And then oftentimes, or not oftentimes, depending on the person who's receiving the penis and how big the penis is and other things, it could be traumatic, which means there could be tearing, there could be bleeding.
And then I'm going to add a third that I just thought of is it depends on rectal prep. And so you have a lot of people that prepare their rectums for receptive anal intercourse. And in doing so, they cause micro damage or they cause damage to the rectum in the area that then makes it more likely for them to become infected if they're exposed to the virus.
Malachi Stewart: Wow. And by prep, you mean cleaning out?
Bryce Furness: I mean, yeah.
Malachi Stewart: Yeah. By cleaning out, because I don't know if everybody knows-
Bryce Furness: It's preparation, not prevention.
Malachi Stewart: It's preparation, right, right. Because there's another type of... So for example, I prefer lube injectors to prevent tearing. So I'm like silicone lube, lube injector. Get that silicone lube up there because what you're not going to do is tear up the house. You ain't going come in like a wrecking ball. Okay? You are not Miley Cyrus. Thank you for that.
Tei Pearson-Hall: Question for you. So do condoms prevent STIs?
Bryce Furness: Condoms prevent some STIs? And it's a really good question. I think that in general, condoms are very good at preventing the transmission of sexually transmitted infections, including HIV that are transmitted through body fluids, so ejaculate, pre-ejaculate, vaginal fluids. So it prevents gonorrhea. It's very good at preventing gonorrhea, very good at preventing chlamydia, very good at preventing HIV because those are the three STIs, two bacterial and one viral that are primarily transmitted through body fluids.
It's not so good at protecting against sexually transmitted infections that are transmitted through skin to skin contact. So here you're talking about things like the bacteria syphilis, you're talking about things like the viral HPV for human papillomavirus, which causes warts and cancers. And you're also talking about herpes simplex, HSV one or two. One cause cold sores two can cause general lesions, but two can cause cold sores and one can cause general lesions as well. But they're transmitted through skin to skin contact.
So a perfect example is during syphilis, several stages of syphilis, you can have a sore on your penis or your vagina, but then you can also have lesions in your mouth. So you can have a condom down there, and if you're making out with a person, those lesions in the mouth are filled with the bacteria that transmit the disease.
Malachi Stewart: Or have oral sex without the condom.
Bryce Furness: Yeah, or having moral sex. You know what? I do a presentation. And in the presentation, syphilis is characterized by sores and rashes, and one of the slides of syphilis case is a man with a big chancre on his lip. And so I put that slide in there specifically to address this point that if that man wears a condom and has sex with a woman, that woman's still going to get syphilis because the infection, the transmission's occurring from the chancre on his lip, not from anything on his penis. So great question. And it depends on the sexually transmitted infection.
Malachi Stewart: Excellent, excellent. So I have a final question. We talked this season to women around HIV and the connection between that and pregnancy. In your professional opinion, can women who are HIV positive have babies?
Bryce Furness: Absolutely. Actually in all honesty, it's a little disheartening to me that in 2023 we're still asking that question.
Malachi Stewart: Same.
Bryce Furness: So that's my gut feeling. I've worked in Africa, I've done a lot of stuff in Africa usually around sexually transmitted infections. But I actually did polio eradication and measles morbidity eradication in Botswana in 2004. And one of the big pushes over there was the prevention of mother to child transmission of HIV. So these were HIV women living with HIV who were having babies and they were doing everything they could to prevent the virus from being transmitted from the mother to the baby. So it's been going on for a very long time and it's definitely doable. So yes, you can have a baby if you're HIV positive, especially if you're in care and you're have an undetectable viral load.
Malachi Stewart: Bryce, I can't let you leave without addressing how people get connected to these resources. They're listening to you talk about PrEP, they're listening to you talk about Doxy PEP. How do people get connected to these resources and what barriers are there to prevent people from getting access to them?
Bryce Furness: So it's a great question, Malachi, and I appreciate the opportunity to talk about this. But there should be no barriers in the DMV. And so I want to be very clear that if you're interested in pre-exposure prophylaxis or preventing HIV or you're interested in HIV comprehensive care, taking medicine to treat your HIV, come to the DC Health and Wellness Center. And it doesn't matter as far as I'm concerned whether you're a DC resident or not when we're talking about HIV, either in the context of prevention or diagnosis and treatment. We take care of Maryland, Virginia, and DC residents.
Malachi Stewart: Awesome. And where can they go to access to DC Health and Wellness Center?
Bryce Furness: It is at 77 P Street Northeast. And so it's kind of like that area where New York Avenue and Florida Avenue all come together. We are in the back of the People's Building. Okay. So where the Wendy's used to be and the McDonald's is, I think the McDonald's is on the corner of New York and First. People's Building is right across the street, and then we're on the backside of that. So the actual address is 77 P Street Northeast, right off of North Capitol, right off of Florida.
Malachi Stewart: Thank you, Bryce. And he's going to be there if y'all get there. So he'll meet you there. You can get all this wealth of information right there on 77 P Street at the DC Health of Wellness Center.
Tei Pearson-Hall: There you have it. Listen, thank you so much to our guest for being here today. Another great episode of Positive Voices. I was your host, Tei Pearson Hall.
Malachi Stewart: I'm Malachi Stewart.
Tei Pearson-Hall: And we want to just thank Bryce for being here today to talk about all of the myths that go on in the community as it relates to STIs, STDs, HIV, and AIDS. So listen, if you want to get connected, you want some resources, we have you covered. Head on over to linkudmv.org. You put your zip code in, you'll be able to find all kinds of resources. As Malachi said, if you need a ride, they might be able to help you out. If you need some rental assistance, they can help you out. If you need some clinics, they have you covered there as well.
Also, you may want to say, "Hmm, we need some more information. We want some statistics. We want to hear more about what Bryce was talking about." Head on over to dcendshiv.org. You'll be able to get all of the things that you want there. If you want to check out Malachi and I a little more for season two, click the podcast button at the top. You'll be able to find more of Malachi and I as well as season one. We'll catch you guys next time. Positive Voices season two.