I know that this is kind of late to be posting a reply, but I couldn't help but add in some information that is commonly overlooked.
At this day and age, HIV is not at all what it once was… so the concept of HIV being "not all that bad" isn't entirely a myth. I myself have been living with it for over 5 years and counting now. That being said however, there are also some dangers that need to be taken into acount when assessing the risk factors and the extent of the risk you're willing to take. Too many people do not realize that such risks exist. So in short.... Yes... On one hand, HIV isn't so bad, but on the other hand, it opens the door for a number of potentially serious (if not fatal) issues. I will summarize the more critical ones below....
1) Toxoplasmosis: Toxoplasmosis is a bacteria that is most commonly found in kitty liter and bird droppings. It's main source comes from the consumption of meat (including fish) that has not been fully cooked or frozen. For the average person with a normal immune system, exposure to Toxoplasmosis will resolve itself on its own. That being said however, when Toxoplasmosis bacteria is introduced to HIV, a whole new world of trouble begins. There's an interaction that takes place over time (usually wihin a few months) between Toxoplasmosis and HIV that becomes quite problematic… namely, that it forms a bond with the cells infected with HIV in the blood stream, which are then passed to the brain for the final stages of exposure to begin. Simply put, over time, the combination of the two will literally eat away at the brian, causing regular bodily functions to become quite challenging over time, until it finally eats away at the brain slowly enough to slowly cause a cerebral hemorrhage. During this process, headaches, body ache, fatigue, and chronic pain become more and more of a problem until it literally kills you very slowly. It's actually quite a slow and horrible death. So... Unless you're willing to freeze your steaks or sushi (as two examples) before preparing them, when you're HIV+, eating such foods is quite literally gambling with your own life.
2) Pneumocystis Pneumonia: This is a particularly nasty form of pneumonia as it is, which if untreated has great potential to become fatal. When mixed with HIV, makes the severity of it even worse. More often than not, when this form of Pneumonia is mixed with HIV, it's fatal, and not a pleasant way to die. As it attacks the lungs, it becomes harder and harder to get rid of and can cause some serious and often painfully fatal respritory issues. With a compromised immune system, the mix of the two can cause a complete depletion of the body's CD4 cells, which are most critical to fighting off any kind of virus or bacteria forign to the human body. Once this happens, you then open the door to just about anything to add to the mix, which is part of what makes this combination fatal in most cases.
3) Liver Failure: Sadly, while most of the newer HIV meds on the market are quite effective at surpressing the HIV virus itself as to lead a normal and healthy life, they also are quite hard on the liver. As such, liver failure is a constant concern to anyone living with HIV on the meds. This is part of why blood work is taken so frequently to keep track of what is going on within your body chemistry. One of the worst offenders for this potential threat believe it or not is a drug called Truvada, which is a combination drug that includes both Emtricitabine (200mg) and Tenofovir (300mg). This is just one of many potential problems that these kinds of drugs present. In short, if you're on the HIV meds, you pretty well have to be worried about this possible complication. This obviously can be worsened if you add alcohol to the equation.
4) Chronic Diarrhea: Most people do not realize just how common of a side-effect that this is when using a lot of HIV drugs. As I mentioned in reason 3, Truvada one of the biggest offenders for this. I know this all to well from personal experience. The problem with this comes in whereas the strongest medication for such things available is Lomotil, which is stronger than Immodium. In most cases (such as mine), Lomotil alone is just not enogh to combat this side-effect. In some cases, this can result in moments of incontinence where you're fine one moment, and the next, your ass just explodes out of nowhere. This can be particularly embareassing if you're out in a public place when this happens. Again, I know this from experience too. Other issues can also stem from this problem as diarrhea is known for causing an excess amount of liquid (water) from the body to pass through the digestiv system, instead of absorbing into the body as it should. This can open the door potentially to having side-issues with dehydration at the same time as you're dealing with an explosive mess.
5) Cost of Meds: While it is true that most of the newer HIV meds on the market are effective at surpressing the HIV virus, if you live in an area that does not have any kind of medical funding assistance, you're suddenly faced with another problem… the cost of the medication itself. For example, the Prezista, Norvir, and Truvada (that keep me alive) alone run over $3000 for a 30-day supply. Unless you're rich like Bill Gates or if you have some kind of awesome drug care coverage, this can suddenly make your cost of living very expensive. To this day, there are still many people (even in North America) who have to go without these life saving meds, simply because they cannot afford to pay for them. This is the reality that you must face when you are diagnosed with HIV and must go on the meds.
Once you get past these issues (among a few others that I haven't listed), sure.... HIV isn't all that bad. There are a few other points that I would like to touch on as well....
@FlammeRouge:
Poor education / awareness is a more serious culprit. I've heard from a public health sex worker, whom I had a talk with very recently, is that gay teenagers think it's okay to have unprotected sex and actually getting infected with HIV isn't that serious. If you're already infected you don't have to use condoms, inside condoms, dental dams, gloves and the like, and that would be completely fine, and that there would be little to no reason for concern whatsoever, it's just that once you're not seropositive anymore you'll have to use medication. So these teens try to get infected with HIV purposefully. One of these methods is bareback sex, but oral sex and any other activity which causes exchange of bodily fluids also transmit HIV.
There are a few problems I have with this… The first is that I have learned the hard way that any Public Health organization will tend to help promote the stigma, and in some cases, actually gives outright wrong information with respect to prevention methods and risk factors for reasons that I have never quite understood. That being said though, the whole topic of condoms isn't as cut and dry as it may seem. Just being HIV+ alone doesn't actually mean all that much to the risk factor involved. If you're HIV+ and have an undetectable viral load, it is virtually impossible to infect someone, which means that the whole concept of bareback sex being a huge risk is flawed. While this is true with someone who is HIV+ with a high viral load engaging in unprotected sex is like playing with fire, this does not hold true with an undetecable viral load. This is one of the biggest things to take into accout when assessing risk factor.
Also, Truvada is also used as a PrEP drug, which can help substantially reduce the risk of contracting HIV. This kind of thing also plays a large factor when assessing your risk.... So.... In answering the original quetion, while it may be true that bareback porn has resulted in some HIV infections, it's just not realistic to go so far as branding it a "culprit" for HIV/AIDS.
@cwilbur:
Bareback sex is OK in the real world: when you're in a long-term monogamous relationship with a partner of the same sero-status, or a long-term closed relationship with two or more partners of the same zero-status.
Beyond that, the chances of a guy who's poz and successfully medicated transmitting HIV though unprotected sex are less than the chances of a guy who doesn't know his status transmitting HIV while using a condom – because guys who are actually poz but don't know their status have insanely high viral loads; combine that with the slightest bit of error in using a condom, and you've got a public health problem.
Even with one partner who is HIV+ and one who is not, bareback sex is not necessarily out of the question. As I mentioned, the viral load plays a large part in assessing the risk factor. You are also correct with respect to the risk factor being lower with someone who is medicated. This is both because generally speaking, people who are taking the HIV meds most often have an undetectable viral load. It also holds true in that while there may be exposure to HIV through uprotected sex, there's also a certain amount of exposure to the anti-bodies as well when they're on the medication, which also plays a part in reducing the risk. In short, calculating the risk factors can get quite complicated.
