We are not dirty, we are not a threat, and we are not disease vectors. In fact, we are the solution. People living with HIV who achieve viral suppression, who become undetectable, are the solution to the end of new HIV infections in the United States… When we look back 20 years from now we’re going to judge ourselves in terms of how well we responded to this opportunity.
— Dr. Rich Wolitski, person living with HIV and Acting Director for the Office for HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services
When Dr. Wolitski delivered that speech at the closing plenary of the 2016 United States Conference on AIDS (USCA), he received a standing ovation. He was referring to this year’s newest findings of HPTN 052 and the PARTNER study, which showed that people living with HIV who are undetectable are not transmitting the virus to their negative partners.
How wonderful that something many of us have assumed for years has been proven to be true. So now we can spread the news and encourage people with HIV to seek treatment and stick with it. And hey, there’s nothing like a little intercourse au naturel with your partner to reward yourself for being undetectable, right?
How about we take this to the next level?
Our newsletter is like a refreshing cocktail (or mocktail) of LGBTQ+ entertainment and pop culture, served up with a side of eye-candy.
Not so fast. There is some strong resistance to a message that equates undetectable to untransmittable, and it’s not coming from where you might think.
Here are five reasons why this breakthrough message matters.
1. The science is solid
The PARTNER Study recorded 58,000 acts of penetrative sex without condoms between 1,000 positive/negative couples, in which the HIV positive partner had an undetectable viral load. There were no infections between the couples. Not a single one. The same results were reported in the HPTN 052 study and the empirical evidence to date. As Dr. Wolitiski said in his USCA speech, “this is a game-changing moment in the history of the HIV epidemic.”
Resistance to the conclusion that undetectable people pose no risk of infection has been either a matter of scientific data scrutiny or a fear that people may not actually be undetectable when they think they are. Let’s break that down.
A review of the argument against saying “zero risk” is enough to make you cross-eyed. It is based on the premise that nothing, really, is without risk. Detractors of the non-infectious message will calmly explain the perils of placing any risk at zero and then hypnotize you with statistical origami. Suffice it to say that proving zero risk is statistically impossible. You risked electrocution by turning on your device to read this article.
There will always be somebody who claims a terminally unique HIV infection, even if the precise circumstances of their claim may be murky. Weird things happen. People who drink alcohol sometimes spontaneously combust. It happens a couple times a year. But you don’t see warning labels about it slapped on every bottle of Wild Turkey by overzealous worrywarts.
And yes, there is the possibility that someone might develop a viral load if they are not adherent to treatment and then transmit the virus. But the message here is that people who are undetectable cannot transmit HIV. If you stay on treatment and are undetectable you will not transmit HIV. Can we please celebrate this simple fact without remote qualifiers?
It is also important to note that a Canadian consensus statement concluded that any “viral blips” or sexually transmitted infections (STIs) were “not significant” to HIV transmission when someone is undetectable.
2. Major health experts are on board (but not all community leaders).
Public health leaders, from the New York Department of Health to the National Institutes of Health (NIH), have embraced these findings and its meaning to people with HIV, while community advocates and organizations have been reluctant to get on board, citing a theoretical risk of infection. Or maybe they consider changing their fact sheets and web sites an enormous bother.
The Prevention Action Campaign and their seminal message #UequalsU (undetectable equals untransmittable) was founded on the energetic efforts of a man named Bruce Richman. He entered the HIV advocacy scene a few years ago, seemingly out of nowhere, carrying aloft the banner of undetectability. Richman gathered signatures of health experts the world over for a consensus statement about the research, while cajoling every U.S. HIV organization in sight to adopt language that removes the stigma of infectiousness from people who are undetectable.
This skepticism from our own community reduces people with HIV, again, to a problem that must be managed. It suggests that those of us who have achieved undetectability don’t have the judgment to keep taking our medications or to see our physician regularly to be sure our treatment plan is still effective. It keeps us in the role of untrustworthy victims unable to make decisions that will keep the rest of you safe from us. What infuriating, stigmatizing nonsense.
3. This is about HIV. Only HIV
Auxiliary issues often creep into this debate that may be well-meaning but only muddy the waters, such as the fear that promoting the message of non-infectiousness will lead to more sexually transmitted infections (STIs) because of the freedom it allows (see also: critics of PrEP, the birth control pill, and any other vehicle that might lead to unbridled sexual pleasure).
Rates of STIs — which were on the rise before the advent of PrEP or news from the PARTNER Study — are deeply concerning but ultimately tangential. We are in desperate need of comprehensive sexual health programs, to be sure, but in this instance I feel compelled to “kill the alligator closest to the boat.” This is about being HIV undetectable, not syphilis impermeable. Being undetectable will not prevent other infections or address promiscuity or remove stubborn stains.
Advocates are also sensitive to the continued compartmentalization of our community, between those who are positive or not, who is on PrEP or not, and now, between those with HIV who are able to achieve viral suppression and those who cannot, despite their best efforts. I sympathize with this new divide among HIV positive people but believe the greater good – removing shame and stigma from those who are not capable of transmitting – shouldn’t be downplayed. All HIV positive people of good will can and should celebrate this development, regardless of their own viral load.
Terribly important work is being done to repeal and reform HIV criminalization laws that prosecute people with HIV for not disclosing their status to a sexual partner. Our defense is often led by all of this growing science showing that the defendant never posed a risk to their partner in the first place, due to their use of protection or the fact the defendant was undetectable and therefore rendered harmless.
Continued assertions that undetectable people might pose a risk to others could be used in the courtroom against people with HIV. Imagine the glee with which prosecutors might explain to a jury that “zero risk” is impossible and defendant Joe Positive posed a threat, however small, to his sexual partner and should be jailed for it. Put obscure doubts into the heads of a jury, and another person with HIV gets a 30-year sentence for daring to have sex at all.
5. This profoundly changes how people with HIV view themselves.
Internalizing the fact that I cannot transmit HIV to anyone has had an effect on me that is difficult to describe. I can only liken it to the day the Supreme Court voted for marriage equality. Intellectually, I knew I was a gay man and a worthy human being. But on the day of the court’s decision I walked through the streets of my neighborhood with my head held higher. Something had changed. I felt whole.
In my thirty-five years living with HIV, I have never felt exactly that way. I deserve to. And so do millions of other people with HIV.
Of all the arguments to adopt the message that undetectable people cannot transmit HIV, that enhanced feeling of self-worth may be the most important reason of them all.
Mark S. King, founder of My Fabulous Disease, is Queerty’s HIV/AIDS writer
Aromaeus
*grabs popcorn* this is gonna be good
IDoNotHaveToAgreeWithYou
Except people on prep still get infectioused.
ChrisK
@IDoNotHaveToAgreeWithYou: Yawn. The % is so small it’s not even relevant. Two cases so far out of millions of uses. Next misinformation….1, 2, 3,
Aromaeus
@IDoNotHaveToAgreeWithYou: At least one of those guys admitted to intentionally sleeping with people who were positive and ended up getting a strain that’s highly resistant to drugs so that’s far from the norm.
IDoNotHaveToAgreeWithYou
@ChrisK: It’s only relevant to bug spreaders. I’m sure the ones that caught it found it to be quit relevant.
IDoNotHaveToAgreeWithYou
ops irrelevant to bug spreaders
Tracy Pope
@IDoNotHaveToAgreeWithYou: Your use of the term “bug spreaders” indicates your preconceived ideas of us vs them as far as HIV+ persons and your self. This attitude precludes you from any serious discussion of the matter.
Roan
Great news! However, wear a condom.
NateOcean
Though well written, this article if too full of snark and sarcasm to be taken seriously.
Oh, and self-contradictory:
“If you stay on treatment and are undetectable you will not transmit HIV. Can we please celebrate this simple fact without remote qualifiers?”
Gosh, I detect at least two qualifiers in that very statement.
JerseyMike
GREAT NEWS.. Still rap it up..
ChrisK
@NateOcean:It is important and backed by HHS with two recent studies. The larger message is getting more people tested and into treatment.
jdboston617
@NateOcean: I think the author is using his tone because of his personal experience juxtaposed to his joy feeling a sense of liberation.
ChrisK
@Tracy Pope: I missed that. Yep. When they resort to demonizing people the argument is over. Says everything about them though.
dwes09
@Alistair Wiseman: “Get off your fucking high horse.”
Says the man constantly on his high horse to someone arguing for the value of facts over fear-driven fictions!
That’s quite a laugh.
nmharleyrider
I will agree that it is less like to be transmitted by someone who is undetectable but everything I have read leads me to believe that is not 100% true.
PRINCE OF SNARKNESS aka DIVKID
No shame in being HIV neg either and proclaiming it
jimontp
@IDoNotHaveToAgreeWithYou: You should read the article, before making irrelevant comments.
This is NOT a story about PrEP (Negative men who take a prophylactic dose of HIV drugs to prevent infection- where there have been 2 cases of seroconversion, probably due to the Negative guy not taking the med daily) as opposed to HIV Positive men who have an undetectable viral load. Do you understand that? Positive men who take more than one drug to achieve an undetectable viral load don’t skip doses or they wouldn’t be undetectable. Get it? There are NO cases of Positive men who are undetectable transmitting HIV. That was the whole point of the article, but unfortunately you got seemed to have missed it.
truckproductions
People lie.. period.. For years the poz community has tried to shame the neg community for not sleeping with poz men.. They often use the fact that people who say they are negative could be lying as a reason.. well by that logic, someone who is supposedly “uninfectious or undectable” could also be lying. I think the push to shame the neg community is disgusting. It isn’t ok to bully people into feeling badly for taking their health seriously.
Brian
HIV was used as a political weapon to bash bisexuality in men. It was used by women who fear the presence of male homosexual tendencies in the men they date or are married to.
When men can swing both ways, it ruins a woman’s business model and empowers men. That’s why women fear it so much.
jimontp
@nmharleyrider: Did you actually click on the links to the SCIENTIFIC studies? Undetectable positive men WERE 100% percent “true” as being uninfectious. It doesn’t mean that positive guys, even undetectable ones, can’t transmit OTHER STIs, just like negative gay men.
ErikO
It’s not true that you can bareback with someone that’s “HIV+ and undetectable” and not get infected. I know men who were infected by other men who were HIV+ but undetectable since they thought it was perfectly safe to have bareback anal sex. This includes both tops and bottoms.
ErikO
@truckproductions: Very true, you also have A LOT of poz men who are in complete denial about how when they have bareback sex with other HIV+ men that they’re at risk for other STDs, getting re-infected with the HIV strain they have, and getting infected with new strains, and infecting the other person with a new strain of HIV.
ChrisK
@truckproductions:”For years the poz community has tried to shame the neg community for not sleeping with poz men”
In what way? I’ve yet to see that.
jimontp
@NateOcean: I didn’t note any “snark and sarcastism,” in the article. It simply stated the results of scientific studies. There are no “qualifiers,” it simply states that HIV positive men who are undetectable and are compliant with meds (else they would NOT be undetectable) cannot infect negative men. Why the hell can’t you celebrate that? SF is the only city that has a goal of zero HIV transmissions. Early testing, everyone positive on HIV drugs as early as possible to get to undetectable, PrEP treatment for negative men.
And guess what? Lowest rate of new HIV seroconversions in the US.
ChrisK
@ErikO: Yeah, I think I’ll go with the reputable studies from the HHS of 58,000 people that say you can’t vs the Eric troll with obvious bias. I know someone who knows someone that said they did. Bullshit once again troll.
jimontp
@ErikO: You need to actually Google reinfections with HIV resistant strains. It’s a myth. There are a couple of examples of very newly infected (untreated) guys who got another strain of HIV (from another untreated HIV positive guy). Your comment is completely irrelevant to what this story is about- UNDECTABLE HIV POSITIVE men. Come on, stop dragging up all these bizarre stories from 15 years ago- or you could actually site some scientific studies that support your uniformed comments.
Chris
Europeans take the same position: undetectable = uninfectious.
But this applies only to HIV, not to the many other STIs out there. And so, the conservative view — wrap it up — still seems like a good practice.
I agree that, in light of the science, serosorting is based on belief.
Geeker
Wrap it up!
Jack Meoff
At the end of the day the HIV infection rate is not dropping so people are obviously contracting it from somewhere so if all these undetectable men are not transmitting HIV then who is infecting the newly seroconverted?
ErikO
@jimontp: No it’s not a myth. If you want to play with fire and have bareback sex with HIV+ men who claim that they’re ‘untectable’ you can go do this and get and transmit all the strains of HIV that you want, while those of us who are intelligent will use condoms instead of taking toxic PreP.
ErikO
@ChrisK: You’re the only troll here. If you actually believe that flawed study and bareback with HIV+ men who are undectectable, it should surprise nobody that you’re this much of an idiot with a death wish.
Heywood Jablowme
@Jack Meoff: “so if all these undetectable men are not transmitting HIV then who is infecting the newly seroconverted?”
That’s easy – it’s guys who HAVEN’T BEEN TESTED YET and therefore are not being medicated for it. They’re the ones infecting the newly seroconverted.
Seriously, is there something about this very simple concept you are unable to comprehend?
Heywood Jablowme
@ErikO: Does the article advocate having bareback sex? No it does not.
Heywood Jablowme
@ErikO: Does “jimontp” advocate having bareback sex? Does he even mention that subject? No he does not. He DOES mention other STIs, which implies he’s well aware that condoms are still advisable. Yet as usual you insist on changing the subject in your attempts to confuse the issue.
And I totally agree with you about condoms, it’s just a different subject.
DMRX
@Aromaeus: haha. Yep. And all the usual goofballs.
seaguy
@Tracy Pope: At the very least it shows someone who has a very narrow minded biased view and needs to educate themself.
ChrisK
@ErikO: Nothing I hate worse then a dumber then shit know it all smart ass like yourself. Those studies have been embraced by the NY Dept of health and the NIH but I guess you know better then they do. Go jump of the nearest bridge troll.
ChrisK
These studies are impressive though.
The PARTNER study:
no linked HIV transmissions in PARTNER study after couples had sex 58,000 times without condoms.
HPTN 052:
HPTN 052 enrolled 1,763 HIV sero-discordant couples – where one person is HIV-infected and the other is not – at 13 sites in nine countries. The majority of the couples were heterosexual (97%).
XzamilIoh
@ChrisK: Just because you can Google it doesn’t mean you know what you’re talking about.
ChrisK
@XzamilIoh: Jesus Christ some of you are thick in the head. If you’d of bothered reading the article you’d of realized that the study information is in there that I was referencing.
BigWill
@Alistair Wiseman: Have you considered volunteer work? A lot of retirees find it a fulfilling way to fill their time. My mom, for example, volunteers one day a week at the hospital in her town. There’s a children’s shelter, too, that’s heartbreaking to see. There are severely disabled babies and children whose parents simply deserted them, so volunteers, a lot of themretirees like yourself, go there just to rock them. Something like that would make you a happier person and you wouldn’t have so much time to read and comment on sites you loathe.
Happy holidays to you.
Tracy Pope
@Alistair Wiseman: Learned opinion is one thing. Blathering simply to be heard is another. This is especially true when verifiable truths are being disputed. If you believe that puts me on a “high horse” it’s not me who has a problem.
Tracy Pope
@seaguy: I don’t disagree.
Xzamistletoe
@ChrisK: Please ignore Captain Obvious masquerading as me. He will be dealt with soon enough.
Danny279
Mark King is one of the most vile people I have ever read about. His life story is stomach turning. This is the guy who wrote here on Queerty about a year ago that he is proud of having HIV. Not surviving HIV or managing HIV or overcoming obstacles associated with HIV. No, he proclaimed that he is proud of being infected. He’s a disturbed individual. He has also written here that gay men should accept that sexually transmitted disease is part of being gay, an attempt to use homosexuality as a cover for his own disastrous choices in life. He is the last person whose recommendations I would trust.
ShowMeGuy
This is great news.
If you have HIV take these pills every day for the rest of your life so you stay “uninfectious”. If you do not have HIV take these other pills every day for the rest of your life to help keep you from contracting HIV…..but if you do contract HIV you can switch over to those first pills.
Sounds like Big Pharma is the winner.
ChrisK
@Danny279:You’re the only one here who carries this hate for the man. For years now. Mark has been a HIV activist and opened his life up to help others. All you know how to do is tear people down. You’re nothing though. Just a very disturbed pathetic troll.
ChrisK
@ShowMeGuy: Great news for people that already have HIV and of coarse the public at large.
ChrisK
@Xzamistletoe: Yeah, I’ve gathered that already.
Goforit
@BigWill: Thanks “Big” Will. That’s the best chuckle I have had reading these comments in a long time.
ErikO
@ChrisK: Take all the raw poz loads you want from “HIV but undetectable” guys. Don’t be surprised when you wind up HIV+ and get other STDs.
idahosa_wisdom
hi