Is 'Undetectable' the New Safe Sex
-
Is 'Undetectable' the New Safe Sex
Source: HIVPlusMag
A groundbreaking new study is quantifying transmission risk for gay men when one partner has an undetectable viral load.BY Lucas Grindley September 15 2014 10:42 AM ET
The landmark Partner study that everyone is talking about—which tracked HIV transmission risk through condomless sex if the HIV-positive partner is on suppressive antiretroviral medication—has so far found not even one case of an HIV-positive person with an undetectable viral load transmitting the virus to a partner. But people in your everyday life may still be a little disbelieving.
“The most common response I get from disbelievers is that positive men use ‘undetectable’ as a way of getting people to sleep with them without a condom,” says Tyler Curry, an editor with the new group HIV Equal, who has written about his frustration with gay men still ignorant about what it means to be undetectable. “Positive men don’t want to transmit the virus to someone who is negative just as much as a negative person doesn’t want to become positive,” Curry emphasizes.
The Partner study itself comes with a series of warnings about what exactly the study has really found about undetectable viral loads. Researchers don’t recommend that undetectable gay and bi men have sex without the usual methods of protection, for example.
While some of this could be used as cover by skeptics, it also means positive people are left to understand and explain all of this science to a world that continues to stigmatize (and in some cases, criminalize) anyone with HIV.
Of the 1,100-plus couples taking part in the Partner study out of Europe, 40 percent are gay. This is the first time any study has so comprehensively investigated the risk of anal sex among men who have sex with men. To join, couples had to say up front that they sometimes don’t use protection—meaning no condoms, and the HIV-negative partner could not be on a daily PrEP, or pre-exposure prophylaxis, regimen.
In an analysis presented to the world in March at the annual Conference on Retroviruses and Opportunistic Infections in Boston, the study’s researchers also excluded any couple in which the HIV-positive partner’s viral load had gone above 200 copies per milliliter of blood. That’s the threshold at which they declared a person stopped being “undetectable.” Perhaps unnerving for anyone trying to keep their viral load down, that was the case for 16 percent of couples.
The first thing to understand about the Partner study is that some of the participants did contract HIV. Based on previous studies, researchers knew that odds were some of the negative partners would get HIV. So they put in place ways of identifying whether the undetectable partner had transmitted it to them.
Among gay men especially, the reality is that condomless sex outside of their primary relationship or marriage does happen with regularity. A third of the HIV-negative partners in gay couples reported having condomless sex with someone other than their primary partner, while just 3 to 4 percent of straight participants admitted the same thing. And what many experts already know about how HIV is transmitted still holds true: New infections usually come from people who are undiagnosed, who don’t know they have the virus, and who are not on treatment.
Partner researchers haven’t said exactly how many people contracted HIV during the study, promising only that the number would be released at a later date. But a phylogenetic analysis of the DNA from the strain of HIV showed it had not come from the undetectable partner. Meaning, the men who got HIV did so through someone other than their partner, who was undetectable.
More importantly, statistics show researchers should have seen 15 transmissions in straight couples and 86 in gay couples if partners hadn’t been on treatment. The chance of acquiring HIV from a partner who is undetectable very well might be zero. But that’s not what this study says, at least not yet.
The longer the study progresses and the more people who participate (Partner 2 starts this year and includes only gay couples), the higher confidence researchers can claim in their probabilities. Results so far are only preliminary and won’t be finalized until 2017.
The researchers themselves point out that their study isn’t the end-all for concerns about transmission. For example, they worked only with couples who said they hadn’t used condoms for two years, on average. Maybe transmission risk is greater the first time a serodiscordant couple has sex? They couldn’t know that from this study.
What researchers do is quantify levels of risk. A risk analysis published online in the journal AIDS in May attempted to make the basic point that risk accumulates over time, even if you’re using treatment as prevention. The chance of passing HIV to another person in a single year is less than it would be over a 10-year period, the study’s authors concluded, though they caution that the study is only a model and not meant to estimate actual transmission risk.
Partner researchers say a person with an undetectable viral load could indeed have zero risk of transmitting HIV. We’ve long known that it’s riskier to be the receptive partner during anal sex and that sex with ejaculation is riskier. So far researchers have also determined that the maximum possible risk for same-sex couples who have unprotected anal sex with ejaculation is only 4 percent, if the HIV-positive partner is on fully suppressive antiretroviral therapy. That small number is in itself big news.
Still, for some doubters it won’t make a difference.
“As far as dating goes, I don’t need to convince someone else that they are safe to date me because I am undetectable,” says Curry. “I give them the facts and they either accept them or they do not. Either way, I know what it means to be undetectable and I know that I am safe from ever transmitting the virus so long as I stay compliant.”
In Curry’s own relationship, he talked with his boyfriend about what it means to be undetectable when they first began dating. “But the topic quickly turned into a conversation about trust,” he said. “Undetectable, positive, negative, whatever…in a relationship, it is all about trust.”
-
Thank you for posting that.
-
And now how to get the message to those potential onine dates who prefer 'clean'.
-
And now how to get the message to those potential onine dates who prefer 'clean'.
That's the battle that a lot of people are sadly struggling with. Even if there's absolutely no risk of transmitting HIV to someone else, failing to disclose your status can land you a criminal charge for Aggravated Sexual Assault. Sadly, I know this all too well when a sexual partner of mine lied to the police and said that I didn't tell him that I had HIV, when in fact I most certainly did. As sad as it is to say, that's the reality that we are facing at this day and age.
-
Even if there's absolutely no risk of transmitting HIV to someone else, failing to disclose your status can land you a criminal charge for Aggravated Sexual Assault.
Of all the partners I have had since being sexually active (circa 1984 lost virginity with sexcrime as soundtrack) only 2 guys ever disclosed their status to me prior to engaging in intercourse. To be fair one of those two was in the middle of a rather large group scene and I hadn't made my way to him at that point but technically I was made aware of his status by him prior to contact.
TWO! I'd love to post the ratio to those who never said anything but let's just guestimate that I have had more than say a dozen partners. Heck, let's round up and guess I may have had 20 partners. Even at that rate of 2 to 20 I would guess more than a few didn't disclose.
My online presence now always says "undetectable" and I also stress the fact that I am "dirty". On so many levels :blind:
-
Yes… Far too often people don't disclose their status in an anonymous or group sex type scene. Most of them do not disclose their status from my experience because they're undetectable. The rational behind that is that as per what the article outlines, undetectable viral load more or less means damn near NO risk of infection.
-
When I was negative I always assumed everyone I had sex with was positive. My first long-term relationship was with someone who was positive (and not one of the 2 who informed me of status prior to contact) so it wasn't necessarily an impediment for me to have sex with an individual who identified as HIV+ even before the concept of undetectable was out there.
Now that I am positive I should make the swap mentally and assume all partners are negative but I haven't. Since I stopped going to bathhouses (4 years now also surely just by coincidence 4 years without contracting the dose once) most of my sexual contact has had some form of negotiation via online ads so I haven't had to say "Oh by the way…".
I will admit to a few public encounters where I could be charged as I did not disclose...
-
In some cases, as much as the law states that disclosure is required, I cannot really pass judgement on someone for not disclosing. Anonymous public hookups like cruising in the park, not asking questions, or in some cases, not even being able to identify the other person are such situations where I have a different view than the law around disclosure. Given the whole thing with the undetectable viral load, it would stand to reason that the law is a little out-dated.
Say you go to a bathhouse, and you see someone blindfolded in a sling in a dark corner, it's pretty obvious what they want, and that they do not care. In such a case, if you as the undetectable top decide to dive in raw, disclosure in my opinion shouldn't be necessary under those pretenses. The same holds true for the bottom. If they're in a sling and don't care, it is equally the responsibility of the other person to protect themselves if they're concerned with it, especially if the person in the sling is undetectable. Sadly though, the law is quite clear that disclosure still must occur.
All this being said though, it will be interesting to see how long it takes for the legal system to catch up with the facts that while there is no evidence that proves that it is impossible to transmit HIV with an undetectable viral load, but there sure is an overwhelming amount of evidence that statistically seems to indicate that an undetectable viral load is actually safer than sex with a condom. Condoms have been known to break, slide off, or otherwise occasionally fail in some way. If used properly and they do not slide off or break however, they are a proven method of preventing HIV as well. If you ask me, ZERO cases of infection from an undetectable viral load over the 10 - 14 years that the different studies were conducted sounds like a whole lot safer odds than a reasonable bet that infection is not possible, knowing that there is always a chance that the condom could break.
This is the kind of information that more people should know. There's a whole lot worse things than HIV that are possible that you can get a LOT easier than HIV itself at this day and age. I provide information like this as a reference for people to be able to make their own choices for themselves, knowing that they can make their decision proplerly informed with all the facts. Just because something is possible, doesn't necessarily mean that it's likely.
-
I am willing to disclose in an anonymous situation but when one comes at me in unprotected manner be it top or bottom without discussion I then assume they are making their own judgement call.
What really gets me is the guys advertising online for bareback sex negative only. Twice i have taken the time to explain (because I was hoping for a little sneaky pete) that if they really are negative and wish to remain that way they would be better to seek out the guys that identify as undetectable as opposed to negative.
I also know there is a large segment of guys who willfully attempt to spread the virus. Pretty much anytime the ad says negative looking for bareback I assume this is what is happening.
-
I am willing to disclose in an anonymous situation but when one comes at me in unprotected manner be it top or bottom without discussion I then assume they are making their own judgement call.
I couldn't agree with you more. The fact of the matter is that even the dumbest of people know that there is a "realistic possibility" (in the words of the law) that the person with an unstated status could be HIV+. It is also true that even the dumbest people know that there is a "realistic possibility" that a person who has identified themselves as being HIV- could actually be HIV+ and either not know it, or are lying about it. If you're really all that worried, you wouldn't just engage in random sexual encounters without at least inquiring about your partner's status.
What really gets me is the guys advertising online for bareback sex negative only. Twice i have taken the time to explain (because I was hoping for a little sneaky pete) that if they really are negative and wish to remain that way they would be better to seek out the guys that identify as undetectable as opposed to negative.
I never quite thought of it that way until you pointed it out actually.
You do raise a good point from a medical perspective. Most people who have HIV and don't know it are generally not far from the seroconversion stage. When this happens, the viral load is often rather high, thus elevating the risk. By the same logic, you at least know that if they identify as being undetectable, you at least have the peace of mind of knowing that that you do not have to worry about how the possibility of finding out later that your partner was wrong about their status for some reason.I also know there is a large segment of guys who willfully attempt to spread the virus. Pretty much anytime the ad says negative looking for bareback I assume this is what is happening.
That is a safe assumption in terms of risk factor. I do know that there are some people out there who will still be honest about it at least. As much as I do not understand such people, there are some HIV+ people who seek out HIV- partners for bareback sex with the goal of infecting them because somehow that gives them sexual gratification, when both partners know what they're getting themselves into and still want to excercise their free will to go ahead with it anyway, who am I to judge? hehe
-
honestly, I cringe when i see sex ads on apps from guys you know the profiles that when you read between the lines is like…
hey im a slapper with an arse that is open to more traffic than a 7/11 store , but ya know i only bareback with neg guys so its cool
cringe worthy , I could say "oh well its their own lives", but unlike the US , people in Australia subsidise 90% of HIV medication
I lived for 11 years with an HIV positive partner who contracted HIV via molestation he always hated the fact that he was HIV+
he always said he wished that he could have dodged this bullet and would nevereven entertain the notion of risky sex knowing what he knows now
he would tell me some stories of when he would speak to gay youth for NAPWA , that used to make me roll my eyes in horror.
I just don't understand the blasé attitude of people who bareback , why should your irresponsibility for your own health be a burden on Medicare ???I'm not going to apologise for being hard line about this ,and Ive been to many a funeral of older gay men that i have looked up to as role models, however they contracted the illness in the 80's before education about prevention , im not sure about education in other peoples neck of the woods but in Australia a lot of money is invested in HIV education in schools in public places , on bill boards and its not teaching abstinence either as ive read they d o in America, its teaching people gay straight or otherwise to not be ignorant and teaching different methods of safe and safer sexual practices
Ive over heard young gays guys in the club that i work in talking about it so casually, as if the meds are no big deal if you do become HIV + its really perturbs me.
i cant even count the number of times ive had to watch my ex doubled in pain from cramps , diarrhoea nausea and that's just side effects of the meds , im not even gonna list the anguish you go through as a sero-discordant partner staying by your partners side in hospital for 24 or more hours wondering if this bout of the flu that they have been smacked around by is going to evolve into p.c.p or some other HIV opportunistic infection. -
honestly, I cringe when i see sex ads on apps from guys you know the profiles that when you read between the lines is like…
hey im a slapper with an arse that is open to more traffic than a 7/11 store , but ya know i only bareback with neg guys so its cool
cringe worthy , I could say "oh well its their own lives", but unlike the US , people in Australia subsidise 90% of HIV medication
I lived for 11 years with an HIV positive partner who contracted HIV via molestation he always hated the fact that he was HIV+
he always said he wished that he could have dodged this bullet and would nevereven entertain the notion of risky sex knowing what he knows now
he would tell me some stories of when he would speak to gay youth for NAPWA , that used to make me roll my eyes in horror.
I just don't understand the blasé attitude of people who bareback , why should your irresponsibility for your own health be a burden on Medicare ???I'm not going to apologise for being hard line about this…
You shouldn't have to opologize for that. You are entitled to have and express your opinion and views.
That being said though, does knowing the factual observations and statistics of maintaining an undetectable viral load influence your view on unprotected sex in some situations?
-
Just as I don't need to apologize for having and expressing (albeit in edited format) my opinion or views.
I cringe, no, honestly I fucking die a little more inside (poke me in there and see I am pretty much dead anyway) with the amount of judging and blaming that goes on in what allegedly should be my community. Don't worry Muriel you won't need to roll your eyes or clutch your pearls or recoil in horror. My irresponsibility with regards to how I contracted the plague is totally my responsibility and I don't try to shift the blame on to anyone else nor do I offer up how it happened for you to deem whether twas a worthy seroconversion. One of the ways I take ownership is by offering myself up to the Mengeles of the world allowing them to pump me up with their experimental therapies and giving my very life essence over to them on a regular basis in the hopes that others may benefit from what is clearly my lack of concern for my own health.Take comfort in the fact, like everyone else on this nasty piece of rock, I will die eventually.
Next up on the docket, judging apples, the cause of man's descent.
-
I won't begin to deny that there is a lof of judging and shifting of the blame onto others that goes on around the subject, especially in cases where people are not sufficiently informed. That is a part of the reason why I disagree with making failure to disclose HIV status a criminal matter. My view on that is that sex requires 2 people, so the responsibility shouldn't just be one-sided.
When properly informed of things like an undetectable viral load, it definitely redefines what the word "safe" in "safe sex" actually means when it comes to HIV. I know all too well the kinds of things that happen to people, based solely on the fact that they're HIV+. I myself am a victim of such things on a very large scale. Education on the actual facts is the only way to change that sadly.
-
Just as I don't need to apologize for having and expressing (albeit in edited format) my opinion or views.
I cringe, no, honestly I fucking die a little more inside (poke me in there and see I am pretty much dead anyway) with the amount of judging and blaming that goes on in what allegedly should be my community. Don't worry Muriel you won't need to roll your eyes or clutch your pearls or recoil in horror. My irresponsibility with regards to how I contracted the plague is totally my responsibility and I don't try to shift the blame on to anyone else nor do I offer up how it happened for you to deem whether twas a worthy seroconversion. One of the ways I take ownership is by offering myself up to the Mengeles of the world allowing them to pump me up with their experimental therapies and giving my very life essence over to them on a regular basis in the hopes that others may benefit from what is clearly my lack of concern for my own health.Take comfort in the fact, like everyone else on this nasty piece of rock, I will die eventually.
Next up on the docket, judging apples, the cause of man's descent.
If worrying about another human being is judgemental , then so be it , im judgemental
if trying to educate younger gay men that just because HIV may not be a death sentence , and that pills are available ,the who cares if you get it attitude is not fine
I dont take comfort in anyone dying , i have a lot of HIV+ people in my life and i care for them all , i would like however, for the lack of a better term , Gay youth , to wake the fuck up and realise that you still need to protect yourself , and yeah so what if i am horrified , a human being should care about another human being.and Mr Mazda to answer your question ..for me personally undetectable is not safer sex , i will always use protection.
-
and Mr Mazda to answer your question ..for me personally undetectable is not safer sex , i will always use protection.
As you wish… I'm all for the freedom of choice, which includes a person's right to choose if they want to engage in a risk, and if so, the extent of the risk that they're willing to take. As long as you make that decision knowing all the actual facts, then it is an informed decision as it should be.
-
If worrying about another human being is judgemental , then so be it , im judgemental
if trying to educate younger gay men that just because HIV may not be a death sentence , and that pills are available ,the who cares if you get it attitude is not fine
I dont take comfort in anyone dying , i have a lot of HIV+ people in my life and i care for them all , i would like however, for the lack of a better term , Gay youth , to wake the fuck up and realise that you still need to protect yourself , and yeah so what if i am horrified , a human being should care about another human being."why should your irresponsibility for your own health be a burden on Medicare", are there no prisons? are there no work houses?
-
"why should your irresponsibility for your own health be a burden on Medicare", are there no prisons? are there no work houses?
Just to set the recotd straight, keeping someone in jail is MUCH more expensive to the system than jut providing their medical needs. Not only that, but I can tell you first hand that jail is definitely NOT a place you want to be when you're HIV+, especially since they are not exactly all that with it with medications in jail. I happen to be lucky enough to have survived 12 months of such an ordeal, without somehow developping a resistancy to the medication.
The other question that comes to my mind is do you mean to say that there should be no provisions to make accomedations to subsidize medical coverage for HIV meds, which easily run more than $3000/month? Most people don't even make that much in a month before taxes, yet alone being able to pay for rent, food, etc. on top of the cost of the medication.
You also seem to have the assumption that everyone who is infected with HIV got infected as the result of negligence. This is simply not the case. The whole point of this article was to establish that there is too much stigma surrounding the subject of HIV, since it's a proven fact that in the last 14 years or so, there has been not one case of HIV transmission (even through unprotected sex) when the person has been on HIV meds and maintained an undetectable viral load.
There's much more to consider than just negligence as well. As I have mentioned in other forum posts, my HIV infection was definitely NOT the result of my negligence. In fact, I actually declined sex with the man who infected me several times before it was physically forced upon me anyway, despite my refusal. While it may be true that a lot of HIV infections are the result of negligence, it is not a fair assumption to just assume that everyone who is infected with HIV is infected because of some kind of negligence on their part. At this day and age, we should be breaking down that kind of barrier, stigma, and incorrect way of thinking, rather than promoting it.
-
If worrying about another human being is judgemental , then so be it , im judgemental
if trying to educate younger gay men that just because HIV may not be a death sentence , and that pills are available ,the who cares if you get it attitude is not fine
I dont take comfort in anyone dying , i have a lot of HIV+ people in my life and i care for them all , i would like however, for the lack of a better term , Gay youth , to wake the fuck up and realise that you still need to protect yourself , and yeah so what if i am horrified , a human being should care about another human being."why should your irresponsibility for your own health be a burden on Medicare", are there no prisons? are there no work houses?
Sorry MrMazda I think MsCommunication has taken the stage. "why should your irresponsibility for your own health be a burden on Medicare" was a previous statement from antstorm that stuck in my craw and I was just following up the theme with a Scrooge quote. Sometimes when I get frustrated I have been known to speak and not think.
To be clear, I am + and do not go out promoting the disease. That being said, acting like it's a death sentence and certain individuals opinion's on the subject remind me of having Ronald Reagan in the White House once more.
Undetectable is the new safe sex, or at the very fucking least using a condom & having sex with someone who is undetectable is incredibly "clean" which is sort of what originally interested me in this topic. I think it's important, as previously mentioned, to get this message out there. Again, I am not promoting a bareback lifestyle (actively anyway) but what I do want to promote is ridding the world of the backward thinking. It's not the eighties or the nineties any longer, we are living in the future.
