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HIV-Positive and 'Undetectable': What Does It Really Mean?

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It is impossible to have a modern conversation about HIV and HIV stigma without having the term "undetectable" used, misused and abused. Those involved in HIV advocacy certainly have strong opinions on how the term that refers to an HIV-positive person's undetectable viral load should be used (and who is using it incorrectly). Some herald the term as a badge of honor worn by those who are compliant with their treatment and open about their HIV status, while others would scold the same group of people for using the term as an excuse to engage in unsafe sexual behavior. Either way, oversimplified accolades and mud-slinging morality judgments have no place in a conversation about HIV stigma, prevention and the term that is a result of compliance with medication. With many gay men still unclear about what being "undetectable" truly constitutes, how do we get to a place where we can discuss what it means and doesn't mean without all of us looking dirty in the end?

For those who are still unsure, an HIV-positive person can achieve undetectable levels after undergoing antiretroviral therapy (ART). A level of a person's HIV viral load is what causes them to be more or less likely to transmit the disease. An undetectable viral load reduces the likelihood of transmission by 96 percent. Once a person achieves an undetectable status, it is possible to remain at this level provided that the person is compliant with their ART medication.

An education on the specifics of HIV as it is today, including the meaning of being undetectable, should be mandatory reading for gay men, regardless of HIV status. It is critical that the entire community understand where we are in terms of HIV research. No matter how far removed you are from the HIV pandemic, you are still susceptible to the virus (especially if you think you aren't).

Now, unless we find a way to infuse subliminal HIV messaging into the speakers of every H&M in the country, casual conversation amongst peers is the next best method of effective education. But, as with many discussions concerning HIV, the topic quickly turns into the blame game. So who loses? Everyone.

For the sake of conversation, let's liken a person whose viral load is undetectable to a person who is HIV-negative. With both classifications, you get tested regularly to make sure that you are still safely in your category. But unlike being HIV-negative, discussing the meaning of an undetectable status almost immediately gets bogged down by shame mongering and moral accusations. Use of the term is often ridiculed, immediately placing judgment on the HIV-positive person who speaks about his undetectable status.

The following quotation was taken from a post that asked people how they think we can make progress in eliminating HIV stigma:

I'd like to hear more responsible discussion in our community about how dangerous and reckless it is to use the term "undetectable" given the implications of treating "undetectable" status as if it were really something different from being positive.

This claim wasn't given with malicious intent, but it does give a lucid demonstration of the difficult nature of discussing HIV-related topics without subconsciously casting judgment.

In fact, people whose viral load is undetectable should never stop talking about their HIV status. Do it at the gym, on the subway and even at Sunday service (if that's your sort of thing):

"Did you catch the last inning of the Rangers game last night?"

"Hell, no, I don't watch sports. But my viral load is 57!"

A person discussing their undetectable status is a beautiful thing because it means that they have been tested, are on treatment and are open and honest about their HIV status. The idea that the term "undetectable" is only used to lure unsuspecting prey into performing high-risk sexual acts with someone who is HIV-positive is both stigmatizing and criminalizing. This notion removes all responsibility from the other party when they have just been given the information they need to protect their own health. And in fact, it is their responsibility (and no one else's) to protect their own health.

Far too often, our community mistakes silence as an admission of innocence. If no one asks about a person's HIV status, no one tells. Worse, a person will assert their HIV-negative status even if it's been months, or even years, since their last HIV test.

Yet these proverbial question marks walk around each day, unscathed by denunciations associated with their bedtime behavior. They aren't reduced to sweeping stereotypes of being sexual pariahs even though their sketchy HIV status could possibly place a person at much greater risk than someone who is undetectable.

In the realm of sex and dating, the responsibility lies with you to make the appropriate choices to protect your health. Unfortunately, people are slutty, nobody likes using condoms and everybody is a liar. But that doesn't mean that we have to muddle the value of an undetectable viral load and debase a group of people who are at least willing to be upfront about their HIV status.

The sexual acts of gay men do not exist in two separate vacuums. If they did, it would certainly be much easier to squash the transmission of the virus. Therefore, the conversation about what it will take to decrease stigma and increase HIV testing must also exist without uninformed generalizations that could silence many before they even speak.

In order for a conversation about HIV and HIV stigma to have substantive meaning, assumptions, accusations and generalizations need to become "undetectable."