Undetectable=Untransmittable: Now What?

Partners may have different statuses, but they can be attuned to each other's sexual health

by John Francis Leonard

plus-minusWell, it’s finally here. I, and many of us, have been waiting for it with bated breath. Another study, this one much more conclusive, that tells us what we’ve long suspected about the transmission of HIV. It’s been found that condomless sex, what many of us desire and hope for, carries almost no risk of transmission between partners where one is negative and not on PrEP and the other positive and undergoing treatment with an undetectable viral load. This is as true for heterosexual couples as it is for gay male couples. Could this be the game changer we’ve been hoping for?

An earlier study in 2008 said much the same. What’s now commonly referred to as the Swiss Statement, due to its country of origin, had a few flaws however. At the time, I had an informative discussion about its findings when I approached my doctor in what could fairly be described as a “smug” state of satisfaction. To me, logic already dictated that if the virus was undetectable in my body fluids, then certainly I was not infectious and this study bore me out. “Not so fast,” said he, always happy to burst my proverbial bubble and teach me something. The study in Switzerland was limited to heterosexual couples and did not take into account anal sex, always the gold standard of HIV transmission. He did inform me of the study I’m talking about today, but it was in its earlier stages then and needed much more time.

Well, the time is here and the findings are compelling. The new PARTNER Study, this time out of Denmark, tracked 888 couples, two-thirds heterosexual and one-third gay male. The numbers are not perfect, but they are startling. The risk in male-female couples not using condoms was .03 percent. In male couples, only slightly higher, .07 percent. Eleven partners did contract HIV, but findings showed they contracted it outside of their relationships. The results were recently published in the July 12 issue of The Journal of the American Medical Association. By contrast, the efficacy of PrEP among supposedly compliant and recently tested male sexual partners varies by report from ninety to ninety-nine percent. Compliance with a medication regimen as well as regular testing is of vital importance in both negative individuals on PrEP as well as serodifferent partners. The findings concluded no increased risk of transmission with other STIs, but risk of contracting them must always be considered.

Now, what does this mean for us, the men and women, gay and straight, who are living with HIV every day taking advantage of current treatment models and leading healthy, long, productive lives? There are two sides of the coin. For myself, positive and undetectable, it means that first I can relax a little in my casual sexual encounters. That said, I still feel strongly about my continued obligation to inform any and all potential partners of my status. This still means awkward conversations and a high likelihood of rejection. If I wasn’t successful in talking a man into having safe sex with a condom in this small city, I’m unlikely to sway him with these new findings. With as seemingly little attention this study has gotten in the media thus far, a gay male population with woefully inadequate knowledge of HIV and AIDS, already will remain unswayed. Luckily for me, turning a quick trick has lost many of its charms anyway; it’s just not where my head’s at. I hope, and feel ready for, a solid relationship, hopefully leading to marriage. As far as potential mates, I’ve cast a much wider net and I’m talking to men further afield. The last one didn’t pan out. We were both positive, however, and that was an important selling point. There was no need to worry about transmission. And yes, I’ve heard about the case of reinfection with a different strain. That was not something we worried about.

All along though, throughout the many false starts and disappointments of that interaction, there’s been someone else. A little further afield is someone who’s first and foremost a dear friend regardless of what will or won’t develop between us. He is in fact negative but well informed, ready to go on PrEP, and tolerant of a small risk of transmission. This new study was great news for us. We have an incredible sexual energy and dialogue between us. I’ve rarely met someone as compatible with my sexual needs and fantasies. We both want there to be no barrier between us. We want to be as intimate as two people can be and for us, that means sex without a condom. We will meet soon and its very important to me that he still be on PrEP, even after these new findings. He feels that he should be on it anyway, so there’s no conflict there. I want every protection available stopping short of a condom; and with these advances in research and protection, it looks like we will be fine. Bryan is very special to me and I want to be cautious.

What this all boils down to is the need to have an open, honest, and running dialogue with our partners. Ultimately, I feel, the final decisions as far as protection and prevention lie with the negative partner however. If that means a condom, that means a condom. We all need to talk about this new research as much as possible. The news needs to be told and spread, information is powerful. There was a very powerful slogan in the early ACT UP movement that you still hear today: Silence=Death. Both we and our partners owe it to ourselves and each other to stay educated and informed.

John Francis Leonard is an advocate and writer, as well as a voracious reader of literature, which helps to feed his love of the English language. He has been living with HIV for thirteen years and he is currently at work on his first novel, Fools Rush In. Follow him on Twitter @JohnFrancisleo2.