Let’s Clarify The Meaning Of ‘Undetectable’
An undetectable status guarantees one can’t pass on HIV, so why does the stigma persist?…
In October 2017, the US Centers for Disease Control and Prevention (CDC) recognized National Gay Men’s HIV/AIDS Awareness Day by acknowledging that people living with HIV, whose treatment has brought their ‘viral load’ to an undetectable level, do not transmit HIV to any other person. In the official memo, the CDC noted that the HIV virus continues to disproportionately affect men who are sexually active with other men. As of the announcement, more than 26,000 gay and bisexual men had been diagnosed since 2015, representing two-thirds of new diagnoses in the United States. In Canada, one in five HIV-positive individuals don’t know their status.
The announcement has been vindicated after three different studies – which, together, included thousands of couples and sexual acts without a condom or pre-exposure prophylaxis (PrEP) – detected absolutely zero HIV transmissions to HIV-negative partners when the HIV-positive person was virally suppressed via medication. This status is regarded as “undetectable.” It means people who take their HIV medication daily and as prescribed maintain an undetectable viral load and have no risk of sexually transmitting the virus to a partner. These results are as official as they come, and were endorsed by the world’s leading HIV scientists.
It’s important to note that being undetectable doesn’t mean you’re forever free of the virus. If the individual stops taking their medication as prescribed, the virus will build in the blood and the viral load will hit a transmittable level. It is fairly common for viral loads to fluctuate, though this is often only the case when a patient begins a new treatment.
A very, very small percentage of HIV strains are resistant to Truvada (the Health Canada-approved drug, known as PrEP). A study of people in Kings County in Seattle, WA, found that only 0.03 per cent of the local HIV-positive population had both viral loads and a high-level resistance to the drug. In a decade, there have been only four cases of primary Truvada-resistant HIV transmissions to those adhering to their PrEP regimens.
Obviously, other sexually transmitted infections (STIs) are out there, so individuals who are having a lot of condom-less sex would be wise to visit their doctor frequently to get tested for other STIs. Being tested every one to three months (depending on the number of partners) is what’s normally recommended.
“The first generation of the antiretroviral therapies we know today became available in 1996,” Grant Roth, an HIV prevention specialist, tells IN. In other words, medication of this sort has been around for a while – we’re just finally paying attention. According to Roth, there are a slew of drugs people can take to ensure an undetectable load, the most common being a one- or two-pill regimen that consists of three to four different drugs taken once or twice daily.
However, despite being completely undetectable, the HIV stigma still exists to a harrowing level. We know that someone who is undetectable cannot transmit HIV to someone who is HIV-negative, even without PrEP and/or condoms. However, not everyone is aware of this (due to a lack of education or general ignorance), and some do still worry about contracting HIV.
“There is a fear around HIV that has been perpetuated since the very beginning of the HIV/AIDS epidemic, so there are people who are incredibly fearful around sleeping with someone who is HIV-positive, regardless of their undetectable status,” Roth explains. “This can make it difficult for some folks who are undetectable to have an open and frank conversation with their sexual partners around them being undetectable.”
To Chris, a 27-year-old undetectable male from Miami, Florida, this reality is all too familiar. “People seem to think the science in HIV prevention isn’t perfect and that they’re still at risk of infection,” he tells IN. “I’ve had multiple sexual encounters ‘fall through’ out of fear of infection, even with a condom.” Chris says gay dating apps in particular host a high percentage of uninformed individuals, and being educated by someone who is HIV positive on an app like Grindr or Scruff doesn’t promote the most trusted response.
“What I recommend may not always be practical,” Roth explains when pressed to recommend an effective way for someone to inform a potential sexual partner of their undetectable status. “There’s no ‘right’ way to do it,” he insists. “From my own personal experience, most guys who are undetectable and choose to pass on that information do it in a very matter-of-fact, ‘Oh, by the way,’ sort of manner.” This approach makes an undetectable status just another offhand trait of the person – similar to height or eye colour – rather than a big secret that the person is shrouding, further contributing to the oppressing stigma.
“The fact of the matter is that living with HIV isn’t a big deal anymore, thankfully. It’s a manageable chronic illness that is less invasive to treat than, say, diabetes [a pill vs. insulin injection, monitoring food intake, and so on],” Roth says. “But many people, because of the aforementioned fearmongering, do not treat living with HIV as such. However, there are campaigns out there to change the public’s perception of HIV, such as the U=U campaign, which have been instrumental in changing the public’s perception of HIV.”
There is no official word on whether drugs like PrEP have had any direct influence on the dwindling numbers of those infected by HIV, but Roth does confirm that stats show new cases of HIV have indeed declined since the advent of PrEP. “For the last few years, New York City and many other major cities have consistently seen the lowest number of new diagnoses per year, which I would attribute partially to PrEP,” he says.
However, he notes there’s still an epidemic occurring in certain populations, such as Black and Latino gay/bisexual men and women. “So, yes, HIV rates are declining,” Roth assures. “But it’s evident that PrEP doesn’t always reach the populations that need it the most.”
To ensure these communities have access to PrEP, we need to create access. To make this happen, Roth says we primarily need to make the drug more affordable. One month’s worth of Truvada is over $1,600 without any coverage. (For more, check out the #BreakThePatent campaign at breakthepatent.org.) “This, combined with the socioeconomic barriers to medical care these communities face, creates a major obstacle in getting PrEP to those who need it the most,” he says. “We also need to continue to educate folks and get the word out there about PrEP. We need to help individuals reassess their HIV risk, since many tend to underestimate theirs.” For more information on PrEP and HIV prevention, visit your local doctor or sexual health clinic.
How does it work?
Antiretroviral treatment (ART), which brings the level of the HIV virus to such low levels that blood tests cannot detect it, works by controlling the replication of HIV in the body. It reduces HIV’s ability to make copies of itself. For most people, the virus becomes controlled within three to six months of treatment. Once a doctor has confirmed that a patient is undetectable, and so long as the individual continues taking their treatment and attends regular viral load monitoring appointments, there is no way they can pass on the virus.
How frequently these status appointments occur depends on how long the individual has been HIV positive. If it’s been a longer period of time, patients may visit every four to six months. For newer diagnoses, patients usually revisit one month after starting their medication, then again in three months, and eventually move to less frequent tests at the medical provider’s discretion.
BOBBY BOX is a prolific freelance journalist in Hamilton, Ont. He currently works as contributing editor at Playboy.com and has had the privilege to speak with the world’s most recognized drag queens, including, most recently, Trixie Mattel and Alaska Thunderfuck. While proud of his work, Bobby is not above begging. He asks that you follow him on Twitter at @bobbyboxington.