Newly dating and slightly anxious, two men bared their arms for blood tests and pondered the possibility that one of them, or both, could be infected with HIV. An innovative programme - called Testing Together -would allow them to hear their test results minutes later, while sitting side by side.
Eric Zemanovic, a dental hygienist, and Dominic Poteste, a restaurant server, had been dating two months after a yearlong friendship. In the past, both had practiced safe sex and got regular HIV tests. Both are in their early 30s. They had grown up when AIDS meant an early, horrible death. So, whenever they heard about friends testing positive, they felt pangs of fear.
Poteste explained: "There's always an anxiety that comes with getting tested, even though 99% of the time I've been safe and been careful, there still is always ..." His voice trailed off.
"A slight possibility," Zemanovic completed the sentence.
"A slight possibility," Poteste agreed.
An encouragement for gay male
Testing together, now under way in Chicago and Atlanta, Georgia, takes an unusual approach: It encourages gay male couples to get tested together and hear their results together. After delivering the results, counsellor talks with the couple about what to do next, including agreements they may want to make with each other about sex and health.
Are we agreeing to be monogamous? Is any sexual activity outside the relationship OK? How are we going to protect each other from infection? Couples address these questions and more.
The idea is to bring honesty to sexual relationships, said one of the researchers behind the programme, Rob Stephenson of the Rollins School of Public Health at Emory University in suburban Atlanta.
Relationships offer only "mythical protection" from HIV, Stephenson said. Some couples may have avoided talking about each other's HIV status, thinking, "If he were HIV positive he would have told me," or "If he wanted to know, he would have asked."
Testing together could build trust
Poteste and Zemanovic, the newly dating Chicago couple, differed in their past approaches. Zemanovic was in the habit of asking his sex partners about their HIV status; he was neurotic about it, he said. Poteste had not been as sexually active as his new boyfriend, but he had not always asked the questions: Have you been tested? What's your status?
"You have an assumption that if there's something this person could do to potentially hurt me, they would tell me," he said.
Zemanovic hoped getting tested together and discussing results with a counsellor would build trust between them.
Poteste hoped the counsellor could help them start a conversation so they could ask and answer difficult questions.
Testing together started in Africa
It started in Africa more than 20 years ago. Researchers believe couples testing have successfully reduced the spread of Aids among married, heterosexual couples in some African regions. One study that looked at couples where one spouse is HIV positive and the other is HIV negative estimated that couples testing were cutting the rate of transmission by more than half.
In Washington, DC, where the rate of HIV infection rivals that of some African nations, some community agencies allow couples to test together. Family and Medical Counselling Service Inc. have been testing about 145 couples together annually since 2008. Most are heterosexual couples.
In Chicago and Atlanta, Testing Together, financed by the MAC Aids Fund, hopes to test 400 couples by the end of the year.
Each participant in Testing Together signs a consent form that addresses receiving counselling, testing and results with a partner in the same room at the same time with a trained counsellor: "I hereby consent to allow my partner to know the results of my HIV test," it begins.
Main sex partners forgo condoms
The programme challenges conventional practices in the United States, where HIV testing is usually private and for individuals only. At most other clinics, a man who asks if his partner can be there when he hears his test result is denied because of patient confidentiality concerns.
Two trends are fuelling Testing Together. One, the number of gay Americans telling the US Census they are living with same-sex partners nearly doubled in the past decade, to about 650,000 couples. About half those same-sex partnerships are gay men.
What is more, a new line of research suggests that up to 68% of new HIV infections in gay men come from a main sex partner, not from casual sex, in part because main sex partners are more likely to forgo condoms.
Counsellors are trained in how to deliver test results, with particular emphasis on how to tell partners the most difficult news: one partner has the virus and the other does not. With these so-called "HIV discordant" couples, counsellors have a great opportunity to reduce the spread of the virus by helping the couple learn ways to protect the uninfected partner, primarily through correct and consistent condom use.
HIV transmitted even when there are no symptoms
Counsellors are trained to dispel myths. If the couple thinks the test result means one partner has been unfaithful, the counsellor might point out that the infected partner could have acquired HIV before the partner became a couple. If the couple believes the virus is sleeping and can't be transmitted, the counsellor might explain that HIV can be transmitted even if there are no signs or symptoms. If the couple believes their status is proof that precautions are not needed, the counsellor might explain that HIV could be transmitted in the future as the infected partner's virus levels rise.
Sam Hoehnle is a counsellor in the Chicago programme. "It never becomes easier emotionally" to deliver the news to an HIV discordant couple, Hoehnle said. He tells the HIV negative partner his results first, and then spends more time and attention on the HIV positive partner. He has seen partners support each other, but he acknowledges he cannot read minds. A show of compassion could mask anger or fear.
"You don't know what's happening internally, in their heads, about how they're feeling about each other," he said.
Poteste and Zemanovic got the best news possible: They were both HIV negative.
A movie ticket for participating
They both laughed with the sheer relief of it. The counsellor had been nonjudgmental and had not wanted to talk about the past, only the future, pressing them to talk specifically and directly about their agreement on sex outside the relationship.
Zemanovic: "We both agreed on monogamy. And if we do need to go outside the relationship we agreed to talk to each other and find out, 'OK, what do we need to do here?'"
Poteste: "This was a full exploration of monogamy, whereas before, it was a casual statement or a passing joke that was maybe passive-aggressive.... We need to be much more direct in communications than we have been."
As a thank-you gift for participating in the programme, they received two movie passes and a gift certificate for drinks and popcorn.
After the other decisions they'd made that day, deciding on which movie to see would be a snap.
(Carla K Johnson, Sapa/AP, January 2012)
Gay couples vulnerable to HIV