Browsed by
Month: February 2014

The ‘Undetectable’ Paradox in Discussing HIV

The ‘Undetectable’ Paradox in Discussing HIV

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 activism 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 in treatment and open with 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 mudslinging moral 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 does 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 viral levels after undergoing antiretroviral therapy. The viral load affects the chance that they will transmit HIV. According to an article in Journal Watch HIV/AIDS Clinical Care, one study indicated that early antiretroviral therapy reduced the likelihood of transmission by 96%. Once antiretroviral meds help a person achieve an undetectable viral load, it is possible to remain at this level provided the person continues to take the medication as directed.

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 status. It is critical to the entire community to 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 among our peers is the most effective method of education. But, as with many discussions concerning HIV, the discussion quickly turns into the blame game. So who loses? Everyone.

For the sake of conversation, let’s liken a person with an undetectable viral load 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 quote 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 made with malicious intent, but does give a lucid demonstration of the difficulty of discussing HIV-related topics without subconsciously casting judgment.

In fact, people who are undetectable should never stop talking about their status. At the gym, on the subway, and even at Sunday services (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 they have been tested, are on treatment, and are open and honest about their HIV status. The idea that the term “undetectable” is used only to lure unsuspecting prey into performing high-risk sexual acts with someone who is 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 it is, in fact, their responsibility to protect their own health (and no one else’s).

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

Yet these proverbial question marks walk around every day, unscathed by denunciations associated with their bedtime behavior. They aren’t reduced to sweeping stereotypes of being sexual pariahs even though their pseudo-negative HIV status could possibly place a person at much greater risk than that of 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 we have to muddle the value of an undetectable viral load and debase a group of people who are at least willing to be up front with their status.

The sexual acts of gay men do not exist in two separate vacuums. If they did, it would certainly be much easier to end the transmission of the virus. Therefore the conversation about what it will take to decrease stigma and increase 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.”

HIV Victims and Villains: Who is Really at Fault?

HIV Victims and Villains: Who is Really at Fault?

There is a common assumption among the sexually active homo population that it is the responsibility of HIV-positive men to disclose their status before engaging in bedroom gymnastics. Based on this assumption, a person who doesn’t mention his status before he tries and fails to make a baby with another man silently asserts that he is HIV-negative by default. Even if a person living with HIV is undetectable and protection was used, he would be considered reprehensible, immoral and altogether villainous character if he failed to disclose his scarlet plus sign to his unknowing HIV-negative partner. But when it comes to the laws of responsibility in HIV disclosure, sometimes there is more than one suspect in a crime.

The Scene of the Crime

The following scenario is based on a true story

Parker is a young, successful and single gay man living with HIV. Nathan is of the same homo vein, but he is HIV-negative. The two met while Parker was at a business conference and Nathan was on vacation with several of his friends. A mojito at the hotel pool quickly led to martinis at the closest gay bar. Dinner was served, flirtation escalated and Nathan ended up back in Parker’s room for a little more than dessert. The fast and frenzied pace of this out-of-town romance caught Parker by surprise and he failed to find the right moment to disclose his HIV status (and Nathan never asked). His viral load was at an undetectable level and they used protection, but his conscience wasn’t satisfied with this threshold of safety.

The Confession

Parker and Nathan parted ways the next morning with plans to meet up for a drink later in the day.  By six o’clock, the weight of the guilt over not disclosing had Parker in need of more than just a strong pour on his vodka gimlet. He needed to clear the air.

Parker told Nathan that he was HIV positive. He explained that he was on medication and had an undetectable viral load. He said that since they used a condom, his health was not at risk, but that it was important for Parker to be honest about his status.

Nathan was visibly shaken and admitted that Parker should have disclosed his status before they had sex. He was concerned because there was a lot of kissing and oral play that took place.  Parker explained the reality of transmission and that Nathan had nothing to worry about, but the damage was done. Nathan felt victimized and he was sitting across from the smoking gun.  Needless to say, the two men didn’t order a second round.

For the jury of public opinion, the judgment of who committed the crime and who was the victim receives a unanimous vote. But before the sentence of shame is handed down to Parker for not disclosing his status, let’s look at who had the motive to commit the crime.

Parker did want to tell Nathan about his HIV status. As a man who was actively managing his disease with treatment, it was important for him to be up front about being positive, even if there was no health risk involved. However, many people fail to understand that when you become positive, you aren’t handed an operator’s guide on how to handle your new status. The variables of sexual psychology are limitless when concerning dating and HIV. Although he failed to disclose that he was a positive man, he had taken the steps to protect Nathan and himself—both by using a condom and being steadfast in his treatment regime.

Nathan is a sexually active gay man who, by default, is part of the HIV community. With one out of every five gay males being HIV positive, it is his responsibility to protect his own sexual health.  It’s true—Parker did not disclose that he is HIV positive. But Nathan didn’t disclose that he was HIV negative, nor did he ask to know Parker’s status before the clothes started to come off. In this scenario, Nathan has a motive to stay negative. Therefore, he is also guilty of committing a crime of not disclosing his status and not inquiring about the status of his sexual partner.

This is only one out of many criminal scenarios that many of us find ourselves in when it comes to dating, dirty talk and disclosure. When it comes to sex, there are always two (or more) suspects whose motives should be investigated. And when it comes to protecting each other’s health, the burden is mutually shared and the responsibility is equally divisible, regardless of status.

I always disclose my HIV-positive status because it is in the best interests of my health, not yours.

HIV Positive, Unapologetic and Fabulous

HIV Positive, Unapologetic and Fabulous

The decision to come out of the closet as HIV-positive was one that required many long and somewhat uncomfortable conversations with my bathroom mirror. I would study my reflection, trying to see if I could tell the difference between the person staring back and the guy who now only exists in pictures. I still wore his face, his clothes still fit me and I could still manage to emulate his same outward demeanor, but it was a farce. Something felt different. For the first time since coming out as a gay man, I felt like I was hiding.

Still, I managed to escape the reflection and lose myself in the comforts of old habits. I spent time with my friends laughing, dancing, drinking too much vodka and sneaking cigarettes when no one was looking. We talked about sex and dating, and I managed a good front for a couple of months.

Although my secret identity was acceptable, and maybe even preferable to some, I had never been very good at keeping up a poker face. While eating lunch with my sister or sipping wine with my friends, my truth was beginning to thrash about like a pissed-off fish out of water, getting more and more desperate to breathe. I realized that the longer I kept my mask on, the deeper it cut into my skin. So I dug in my heels, fixed my hair, threw on a smile and braced myself for the turbulence.

I came out of the closet as HIV-positive. Not only did I come out but I used enough explosives to blow up my little door so that only a few ashes remained.

Telling my story gave me freedom. I had dithered on whether to publish my status right up until the moment it went viral, but the doubts I was wrestling with were eviscerated within mere seconds. Almost instantaneously, I was inundated with people who only had empathy and a willingness to begin a new conversation. The judgment of strangers that I had fretted over before seemed stale.

Furthermore, I received messages from men across the country who were going through experiences similar to my own. They told me about their fears, the dread that lived in the pit of their hearts and their battles with depression. Weaved within these messages, however, was a sense of hope that maybe they, too, would begin to open up about their HIV-positive status.

I also received a fair share of criticism. Some thought I was flippant, maybe even cavalier in my approach to HIV awareness. Nevertheless, it seemed that these responses stemmed from a similar vein of fear — fear of forgetting the past. I do not want to forget, by any stretch of the imagination. Instead, I want to pay tribute to those who have lost their lives by embracing the fact that HIV is not something to hide from under the covers anymore, and that we should modernize our approach to prevention.

The truth is that I am just not that scared of HIV (but saying that can really piss off some of the old-guard activists). My doctor said I might lose, at most, two years off my life because I am now HIV-positive. Honestly, I don’t even accept that answer. At 29, I think I’ll have quite a few years to wait around for a better one.

I was told by a friend to not read the feedback to the piece, but I couldn’t resist. Although there were some pretty scathing remarks, I was able to remain fairly unshaken. Sure, the baseless health threats and character digs stung a little, but it only took a minute to snap out of it. However, it was a comment meant to defend my story against the negative remarks that eventually sent me reeling. A reader had made a comment in response to several remarks that suggested I was negligent and moronic with my approach to the topic of HIV: “Don’t worry… those people are just jealous of your former fabulous life…” Former?! I guess I didn’t realize I was supposed to bow my head and slowly abscond to the local HIV support group in silence while the violins played.

No, absolutely not. I had found a way back to myself. I could, again, claim the face in the mirror as my own. The bratty nuances and cocky tendencies that I had admittedly occupied became authentic again. Quite simply, I found a way to like myself once more. If, indeed, my life was “fabulous” before (and I am not quite sure if it was), I stand firm in the assertion that it is just as “fabulous” now. So if you found my first account to be rife with gay stereotypes of stylish nods and trendy clichés, I plead guilty. It was an honest glimpse into my world as I see it.

Being diagnosed as HIV-positive and deciding to publicly own my status has given me lucidity, understanding and drive. I embrace the lot I have been given and plan on capitalizing on this platform for all my fellow homos out there. But don’t get me wrong: As I begin to drag this conversation out of the closet and take it with me to hang out with the boys, I plan on doing so with a healthy amount of self-tanner, copious doses of sarcasm and a shot of tequila every now and then (but, for the sake of growth, maybe I would let go of the secret cigs, because there is nothing fabulous about that).

We can all recognize that at one point or another, we all could have made the one mistake that might have made all the difference. I fervently hope that you never do, but if just maybe you did, you should not be afraid to get tested. If you take care of yourself, you no longer have to lose the parts of you that you love. Who knows? Maybe you can even shed some of the parts that you don’t.

And yes, you can still be “fabulous.”