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LIVING WITH HIV/AIDS
 Injected or Topical Testosterone: Which Works Best?
I've heard that the topical gel form of testosterone is a safer and more efficient delivery system, but injections seem easier to use on some level because they're applied every week or two rather than every day. What do you think?
Nelson Vergel responds in the "Nutrition and Exercise" forum
Dealing With Post-Diagnosis Stress: Can I Smoke Occasionally if It Helps?
After being diagnosed with HIV in the fall, I quit smoking by using a nicotine patch. I was doing well until a few weeks ago when the cravings began to reemerge. My infectious disease doctor is great and my HIV med regimen is working well, but I'm still adjusting emotionally to being an HIV-positive person. The thought of never smoking another cigarette is depressing me. Considering the amount of stress I'm dealing with, would light smoking be OK if it allows me to keep my sanity?
David Fawcett, Ph.D., L.C.S.W., responds in the "Mental Health and HIV" forum
MIXED-STATUS COUPLES
How Can Sex Be Even Safer in a Mixed-Status Partnership?
I'm in a very committed relationship with a wonderful guy who happens to be living with HIV now. His viral load is still low and his CD4 count is close to 500, so his doctor hasn't advised him to start treatment yet. We have as safe sex as we can -- never penetrating without a condom and usually just jerking off or coming on unbroken skin. We also either use a condom during oral sex or are careful there's no pre-cum present. I've consistently tested HIV negative. What else can we do to protect one other's health?
Robert J. Frascino, M.D., responds in the "Safe Sex and HIV Prevention" forum
 Are you a Black or White man in a relationship with another man? Then you might want to know about a study out of Columbia University called the You & Me Study.
Men who have sex with men (MSM) account for the majority of HIV/AIDS cases in the U.S.; and while about half of all MSM are in steady relationships, little health research has focused on same-sex couples -- especially Black and interracial couples. The You & Me Study is part of changing that.
Couples are the experts on their own relationships; by reflecting on your experiences in your relationship, you could take an active role in a project that will benefit your community. Find out more about the study; and if you're in New York or San Francisco, you might be eligible to participate!
HIV/AIDS TREATMENT
Resistant to Sustiva and Viramune: Will I Be Able to Take "B-Tripla"?
Dear Dr. Bob: I just read your recent blog entry about the new HIV drug expected to come to market in the near future, which you nicknamed "B-tripla" (rilpivirine/tenofovir/FTC). Since this new drug will have a component that's in the same class of HIV meds as Sustiva (efavirenz, Stocrin) and Viramune (nevirapine), if someone's virus showed resistance to those two drugs, would B-tripla be out for that person as well?
Robert J. Frascino, M.D., responds in the "Fatigue and Anemia" forum
Off HIV Meds Due to an Allergic Reaction: Should I Be Concerned?
My mail-order pharmacy delayed shipment of my HIV meds, causing me to be a week late taking them. My first day taking them after the delay, I had a severe allergic reaction and had to go to the emergency room. My specialist took me off my meds at that point, and I haven't taken them in close to four weeks. How concerned should I be?
Benjamin Young, M.D., Ph.D., responds in the "Choosing Your Meds" forum
Why Do I Get Sick When I Drink Now That I'm on HIV Meds?
I'm a 39-year-old man and I've been HIV positive for nine years. My viral load is undetectable and my CD4 count is 945. I started treatment for the first time just over a month ago -- I now take Isentress (raltegravir) and Truvada (tenofovir/FTC). I used to enjoy hanging out with my friends and having a couple of drinks, but since I started HIV meds I can't seem to hold my liquor. If I have even two drinks, I get very nauseous and sometimes vomit. Is my life over? Should I just stay home, take up knitting and drink iced tea?
David Fawcett, Ph.D., L.C.S.W., responds in the "Substance Use and HIV" forum
More Questions About HIV/AIDS Treatment:
OTHER HEALTH ISSUES & HIV/AIDS
How Can I Get a Surgeon to Treat My Male Breast Enlargement?
My HIV viral load has been undetectable for many years, I have a high CD4 count and I've never been sick with anything HIV related. However, I have severe gynecomastia (male breast enlargement) that's causing me great emotional pain. I'm a public school teacher and my students have made remarks. Even adults stare at my chest, no matter how binding my clothes are. I've checked with insurance companies; none will pay for the procedure to get rid of this problem, because it's considered cosmetic surgery, and I can't afford it myself. What can I do?
Keith Henry, M.D., responds in the "Managing Side Effects of HIV Treatment" forum
What Can I Do About Loose Stools?
I've been extremely healthy all my life, including since I became HIV positive. I never had a problem with diarrhea until I started taking Atripla (efavirenz/tenofovir/FTC, also known as Trustiva). I take the meds at night, and every morning I have pretty loose stools. Do you have any suggestions for what to do about this?
Nelson Vergel responds in the "Nutrition and Exercise" forum
More Questions About Other Health Issues & HIV/AIDS:
 I've Told Everyone Important About My Diagnosis; Now How Do I Tell My Parents?
(A recent post from the "I Just Tested Positive" board)
I was recently diagnosed on April 14, 2011. I have since told my best friend, my partner, my sister and brother-in-law. Besides my parents ... these are the closest people to me in the world. ... I am terrified about how to tell my parents. When I came out to my mother, her reaction was one of denial! Her fears were that THIS exact situation would happen ... I want to tell my parents so that they know what is going on, but I live so far away from both of them that I don't want to do it over the phone, and I want them to see that I am still OK. But I am also terrified of the rejection I could possibly receive from them. I just don't know what to do ... Please help!!!!!! -- workaholic
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UNDERSTANDING HIV/AIDS LABS
What's the Normal Range for Vitamin D Blood Levels?
I've been paying attention to the recent focus on connections between low vitamin D blood levels and conditions such as decreased bone density. What's considered the normal range for vitamin D levels? What's the relationship between blood levels of vitamin D and calcium?
Mark Holodniy, M.D., F.A.C.P., C.I.C., responds in the "Understanding Your Labs" forum
HIV TRANSMISSION
Does Frottage Become a Risky Activity if There's Pre-Cum Involved?
Last night I was fooling around with a guy and he was pressing his penis against the area between my anus and genitals. He didn't ejaculate and the contact was brief, but there could have been pre-cum present. I also have a history of hemorrhoids. Should I be worried? Does this episode warrant HIV post-exposure prophylaxis (PEP) or testing?
Robert J. Frascino, M.D., responds in the "Safe Sex and HIV Prevention" forum
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