This is an article I wrote for UK magazine - Gay Times. It caused quite a reaction at the time. It was published in the March 2009 edition. I have reproduced it here as I think readers of this blog may be interested.
March 2009 Issue; Gay Times Magazine
There is an elephant in the room and it needs to be talked about. Someone’s got to do it! I am going to put my neck on the line and just say it.
Advances in HIV treatment over the past decade and the presentation of a Swiss scientific study at the IAS conference in Mexico City last year, which claimed that HIV-negative women may be able to conceive safely by having unprotected intercourse with their HIV-positive male partner – as long as the partner’s seminal viral load was undetectable is becoming common knowledge, and is now causing a shift in the sexual behavior of HIV-positive gay men. The cat is out of the bag.
I can say from first-hand experience that I know the implications of the Swiss scientific study, and other research, that suggests those who are HIV-positive and have an undetectable viral load are certainly less or completely non-infectious to others, is changing behavior amongst HIV-positive gay men. Just go online, to gay dating websites, or specific barebacking websites, and people are now asking the following questions when discussing potential sex with a new partner. It goes something like this; “I’m positive, do you bareback? Are you on meds? What is your viral load?” The answers to the above questions are influencing the decisions that individuals make about how they will have sex with another positive person. That is to specifically seek out other HIV-positive men to have sex without condoms as a preference. Previous given advice has warned against this because of the risk of becoming re-infected with different or drug-resistant strains of the HIV virus. However, if the suggestion by the Swiss scientific study is that those on meds, and who have an undetectable viral load are much less likely to transmit the virus, or may be non-infectious, does this change the previous advice given?
HIV organisations are being tight lipped about this. I know because I rang a few of them to get advice about the safety of oral sex (the other elephant in the room) and the implications of having an undetectable viral load and the level of risk for HIV transmission in these circumstances, just to see what they said. They were as cautious as ever, and played down the significance of an undetectable viral load, and the Swiss scientific study.
HIV organisations need to come out with some sort of position statement on this, and if they already have done so (I haven’t seen any), then they need to make it as accessible as the other health promotion information they produce. I get the feeling that the point where we are at now is similar to where we were in 1986 and thereafter. Where debates rage between the stakeholders of HIV PLC about what is fact, what is fiction, what is ethically, morally and legally right and wrong, what is safe, what isn’t? I don’t know if it really is the case that the findings of the Swiss scientific study are concrete? An undetectable viral load in the blood, may be different to seminal viral load? The inference is still there. However, I get the feeling that many of the HIV organisations, who are players, don’t want people to have this information. Perhaps they believe that it could undermine their safer sex campaigns, or is it because they have just got clunky and unused to dealing with the new challenges and changes that HIV presents today, because the obituary pages in the gay press have gotten a lot smaller, and there is pride and comfort with what has been achieved by way of progress over the years? Come on guys, keep up! Just not talking about it, or playing down the significance of the Swiss scientific study doesn’t have any impact on the decisions that people are making now about their own sexual behavior.
We could wait for more research, and it is and will be done in the future. The honest truth is that WE WANT TO BELIEVE that the findings of the Swiss scientific study are true. That is human nature, a desire to have penetrative sex where one’s cock or arse doesn’t involve a rubber balloon. However condoms are dressed up or portrayed as great fun by health promotion literature masquerading as gay sex mags, let‘s face it… they aren’t. It may be wrong to say it, but THAT IS what people are thinking. It is being reflected in the changing behavior of a growing number of HIV-positive gay men. Call it a reality check if you like.
