What are routine questions regarding gay men's health that I should be asking my physician during a regular examination?

We recommend that sexually active gay men and other men who have sex with men be tested for HIV and STIs (gonorrhea, chlamydia, and syphilis) every three months. Testing for syphilis usually involves a quick physical exam and a blood test. Testing for gonorrhea and chlamydia involves a urine sample if you perform insertive oral sex or anal sex (i.e. if you “top”), a swab of your throat if you perform oral sex on other guys, and a rectal swab if you practice receptive anal sex (i.e. if you “bottom”).  If you are not getting tested every three months ask your provider if you can be.

The last time I had unsafe sex was 8 months ago, I just had an HIV test and it was negative. Do I have to worry?

There is a period of time (commonly referred to as a “window period”) between infection and a positive HIV test, but with the type of HIV tests used today, this period is generally only about 3 weeks (and no more than 6 weeks). If you have not had any possible exposures in the last 8 months (i.e you either used a condom, were protected by PrEP, or your partner was undetectable), than you can be extremely confident that you are HIV negative. We recommend that sexually active gay men and other men who have sex with men get tested for HIV and STIs every 3 months.

How long does it take for HIV to show up in a blood test?

This really depends on what type of HIV test is done. Most labs now use what's called a ""4th generation"" HIV test. This type of HIV test detects antibodies against HIV - which your body produces in response to the virus, as well as HIV antigens which are part of the virus itself. It usually turns positive about 3 weeks after infection, and should definitely be positive by about 6 weeks after infection. If you are worried about an exposure to HIV that occurred more recently than 3 weeks ago, ask for an HIV viral load test (also called an HIV RNA test).

I bottomed without a condom about 3 weeks ago. I used to be on PrEP but have been off for about 6 months. Over the last few days, I've been having fevers and feel really tired, could this be HIV?

Your story is concerning for acute HIV. This is the earliest stage of HIV infection and occurs about 2-3 weeks after someone gets infected with the virus. Not everyone gets symptoms during acute HIV, but most people have some combination of fever, tiredness (fatigue), sore throat, rash, swollen glands, diarrhea, and general weakness. Some say it's like the worst flu of their life. We strongly recommend that you see a provider and be sure to let them know you're worried about acute/early HIV infection.

I was diagnosed with HIV about a year ago. I started on meds right away and have been undetectable for the last 9 months. If I top someone without a condom, what are the chances of me transmitting HIV?

If you take HIV medications correctly and maintain an undetectable viral load (meaning, the amount of HIV in your blood is so low that it can’t be detected with tests) for at least six months there is no risk of sexually transmitting the virus to an HIV-negative partner. This concept is called U=U (Undetectable = Untransmittable). It is important that you continue to take the medications correctly, every day.

How often should I be tested for HIV?

The CDC recommends that all adults > 18 years old are tested for HIV at least once in their lifetime. Men who have sex with men, trans people who have sex with men and people who inject drugs should be tested more frequently. In San Francisco, we recommend that folks in these groups get tested for HIV every 3 months. People on PrEP should also get tested for HIV every 3 months.

I had sex without a condom and I'm worried I might have HIV, what should I do?

The only sure way to know your status is to get an HIV test. You can buy an HIV home test kit at a pharmacy, go see your regular medical provider, or drop into a local HIV testing site: https://gettested.cdc.gov/ HIV antibody tests take 3-6 weeks to turn positive after someone gets infected with HIV. If the sex without a condom was less than 3-6 weeks ago, you can talk to your provider about getting an HIV RNA test instead of an HIV antibody test. The HIV RNA test becomes positive 10-14 days after someone gets infected with HIV.
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