“Undetectable Viral Load, WTF does that mean?”

This is probably the most often asked question I get while doing my community and outreach work with gay and MSM next to “where can I get tested?” It is a word that a number of gay men are using and hearing more often when speaking with potential sexual partners as it relates to their own level of HIV identified on their last viral load test. So WTF does it mean?

Let’s start with a dictionary definition for “undetectable: (1)

Adj. Not easily seen, invisible – impossible or nearly impossible to see, imperceptible to the eye.
Adj. Barely able to be perceived

Now “undetectable” as it relates to a person living with HIV means: When the number of copies of HIV cannot be detected by standard viral load tests, an HIV-positive person is said to have an “undetectable viral load.” For most tests used clinically today, this means fewer than 50 copies of HIV per milliliter of blood. (2) There are more sensitive tests available that detect less than 20 copies per ml. However, the test used in Alberta as of January 7, 2013 is the Abbott RealTime HIV-1 Assay that detects virus up to less than 40 parts per ml.(3)

For persons living with an HIV infection, “undetectable” is the ultimate goal of the treatment medications taken to reduce the amount of virus. There are many treatment options available that are tailored to meet the needs of the individual rather than a one treatment fits all approach. It is most important to know that “undetectable” does not mean HIV can’t be transmitted to another person. It means only that the person with HIV is less likely (up to 96% in some studies) (4) to transmit HIV to another. We also know that “undetectable” in the blood does not always mean undetectable in other body fluids that are known to transmit HIV. Studies have shown detectable virus in semen, breast milk, vaginal and anal fluids, even when blood tests show HIV levels to be “undetectable”. (5) These are good reasons for maintaining condom use as part of preventing transmission of HIV, as well as other STIs.

What being “undetectable” means is that

The person is aware of their HIV status as being positive.
Their treatment medications are working to suppress the level of HIV below 40 copies per ml. making them less likely to transmit HIV to another person.
They are actively engaged in their health care with regular visits for blood work and doctor consultation leading to healthier lives.
The immune system is likely in good shape and they experience fewer health issues related to HIV infection.
They are being upfront and honest with potential sexual partners and providing an opportunity for dialogue and education to others. (6)

Why should we talk about “undetectable viral loads” anyway? For starters, it is the best way to begin to address the stigma and discrimination that remains for positive people who are by law (in many places required) to disclose their status to others. I have heard some people say that HIV positive people are using “undetectable viral load” as a way to have sex without condoms. The best response to this comment is from Tyler Curry of the Huffington Post in which he says:

“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.” (7)

There are still many questions and concerns that remain when we speak about “undetectable viral loads” especially when it comes to using barriers like male condoms, insertive (female) condoms or dental dams. These tools should be included to reduce the risk of HIV and other STIs regardless of having an undetectable viral load.

I am HIV positive, have been on treatment for over 15 years, have had an undetectable viral load during this period and I still use condoms. I have a partner of 14 years who remains HIV negative as a result of using many of the available prevention tools and strategies known to reduce HIV transmission risk.

I think it is important for everyone to remember that in the world of sex and dating, the responsibility is our own for making choices to protect our health. I am happy to know that HIV positive people are sharing their status and undetectable viral loads to better inform partners, community and society as a whole as it may impact the ongoing stigma and discrimination that exists.

In order for the conversation about HIV and HIV stigma to have substantive meaning, assumptions, accusations and generalizations need to become “undetectable” – Tyler Curry (7)

Video undetectable: http://betablog.org/video-undetectable-viral-load/
Video why it is important: http://www.youtube.com/watch?v=RIAOGXOGNOo

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