Ian Howley  Words by Ian Howley | @ianhowley


FS surveyed 3,140 gay men and found 44% of HIV-negative men that would not have sex with an openly HIV-positive man.

In an era of undetectable viral loads, better HIV treatment, and changing attitudes it’s a little worrying that when we conducted our Big Gay Sex Survey we found that 44% of HIV-negative gay men said they would not have sex with someone who told them they were living with HIV.

So we decided to reach out to these men and ask them directly, why?

Does no mean no?

Meet Derek, 26 from Leicester. Derek was one of the men who told us he would say no to sex with someone who is HIV-positive. Derek told us he just didn’t want to put himself at risk. “It’s not that I don’t like HIV-positive men, but I just would be too scared that they would pass on the virus to me.”

Ashley, 22 from Croydon responded to the question by telling us: “I’ve had bareback sex with someone before and afterwards he told me he was HIV-positive. I freaked out and shouted at him. He should have told me before we had sex. I ended up on PEP for a month and luckily the results came back as negative. It’s put me off having sex with HIV-positive men for good.

James, 28 from Newcastle told us: “I think I’m fairly clued-up on HIV and if someone were to tell me they were HIV-positive I think I would be polite enough not to make them feel bad about their status but I just wouldn’t feel good about the sex if I knew.

Zid, 19 from Bolton told us that he just doesn’t know enough about HIV: “I think if someone told me they have HIV I’d freak out a little. I don’t want to become HIV-positive. I don’t think I know enough to make a decision to have sex with them, even with condoms.”

Barney, 22 who is originally from Canada but living in London said: “I feel I should have the right not to have sex with HIV-positive men. I want to remain negative and putting myself in that situation is a no for me.”

What is undetectable?

Do HIV-negative men know what ‘HIV-undetectable’ is?

In our survey, up to 49% of HIV-negative men said they didn’t know what HIV-undetectable meant. Only 51% knew for sure.

We explained that HIV-undetectable means that the amount of HIV in the body is so low that it can’t be detected in a standard test and the chance of HIV being passed on during sex is very low.

We then asked if it would make a difference if a guy told you they were HIV-undetectable?

9% of those who said “I would never have sex with someone who is HIV-positive” now said it would make a difference if they were undetectable.

67% still said no and 24% said ‘not sure’. So just by explaining what HIV-undetectable means we managed to make a third of men, who previously wouldn’t have sex with a positive man, reconsider their stance.

When we explained what HIV-undetectable was to Derek, Ashley, James, Zid and Barney all five said this was a game changer in their decision.

Derek told us, “I had no idea what undetectable was. I thought that once someone had HIV they could easily pass it on. I thought the medication was only just to stop the virus from killing them. I think now I would reconsider my decision, yes.”

James told us: “I’ve heard the term undetectable used before but never really looked into it. Now I know what it means I don’t think I’d have a problem having sex with someone who is HIV-positive. Though I’d still insist on condoms.”

Ashley said: “I think if I knew what HIV-undetectable was I would have asked that question before putting myself on PEP. The nurse at the clinic never even asked me about his viral load. This makes me think there is not enough education around viral load. We need to be doing more. So to answer your question, yes I think I would change my mind about having sex with someone who is HIV-positive now”.

Zid told us: “I had to google what HIV-undetectable was and found a video on YouTube that explained it. It put my mind at ease a little. I still think I don’t know enough about HIV to make that decision but learning what HIV-undetectable is has made me want to know more. I think I wouldn’t be as scared now”.

Barney said: “OK, this is something I didn’t know about. I guess I’m guilty of not doing enough research into sex with positive men. I think many of us are. Would I still say no? I’m not sure. I need to do some more reading to put my mind at ease”.

Is rejecting hiv-positive men the best safer sex strategy?

We asked GMFA’s Matthew Hodson about what needs to be done in regards to educating gay men about viral load and sex with HIV-undetectable men. He told us:

“As a safer sex strategy, it just doesn’t work. We’ve known for some years now that someone on treatment is very unlikely to pass on the virus. How unlikely? Well you’re more likely to be infected from sex using a condom with someone who isn’t on treatment than you are to be infected from sex without a condom with someone who is on treatment. So when someone says that they’re going to avoid John because he has HIV (and is on treatment), and then runs off with Jonah, whose status is unknown, they’re taking a far bigger sexual risk.

“Avoiding sex or a relationship with someone just because they’re living with HIV isn’t a good strategy: it won’t prevent you from becoming HIV-positive, it won’t reduce the number of new infections and it contributes to an unacceptable caste system within our communities.”

Do you have to have sex with HIV+ Men?

Of course you don’t have to have sex with anyone, whether HIV-positive or negative. But rejecting HIV-positive men based on their status alone encourages men to not disclose their status.

The chances are you have had sex with someone who is HIV-positive and undetectable already – they just didn’t tell you. We put this to all five men and these were their exact response:

Derek: “I’ve never actually thought about that. I just assumed anyone who is HIV-positive would tell me”.

James: “I have thought about this before. But I just thought if he’s positive surely he won’t put me at risk.”

Ashley: “Well this has been the case for me. And now that you say it I think I’ve probably had sex with more than one HIV-positive man in my life. I actually feel rather silly now for rejecting someone who’s open about their status.”

Barney said: “You’ve just made me assess my thinking around sex. This is something I should have done a long time ago.”

Zid said: “I’m still a little worried about sex with positive men but I know now I need to educate myself a bit more” 


VIRAL LOAD AND HIV-UNDETECTABLE

What is viral load?

Simply put, viral load is the measure of the amount of HIV in the blood of an HIV-positive person. A high viral load means there is lots of the virus present. A low viral load means there is much less of the virus present. HIV drugs reduce viral load and by doing so, allow the immune system to recover.

What is an undetectable viral load?

When HIV drugs are working well, an HIV-positive person may have an undetectable viral load. This means that the amount of virus in the person’s blood is lower than the amount a blood test can measure. It does not mean that the virus is gone or that the person is HIV-negative again.

Can someone with an undetectable viral load pass on HIV?

Yes. A person with a high viral load is more infectious than someone with a low viral load. A person with an undetectable viral load is much less likely to pass on the virus during unprotected sex, we can’t say with certainly that there is no risk at all but any risk is small.

Key points about viral load

Someone can have an undetectable level of HIV in their blood, but at the same time have higher levels of HIV in their cum and pre-cum.

Someone’s last viral load test may not be a good measure of their viral load at a later date. Viral loads fluctuate, especially if someone doesn’t take their treatment as directed.

Viral load is often very high just after someone becomes infected, often before they are aware that they have HIV.

No-one with an undetectable viral load transmited HIV in the first two years of the PARTNER study...

An early analysis of an Australian-based study of gay male couples of opposite HIV status (serodiscordant couples) has so far seen no transmissions from the HIV-positive partner within the couple.

PARTNER reported no episodes of transmission during 16,400 episodes of anal sex (including condom-protected episodes) in gay men.

Recruitment to the new study began in late 2013 in three Australian cities (Sydney, Melbourne and Brisbane), and now also includes Bangkok in Thailand and Rio de Janeiro in Brazil. Most of the HIV-positive partners are on treatment and have an undetectable viral load.

During the study’s first year, 152 couples provided data. A total of 5905 episodes of anal sex were reported. No transmissions between couples have so far been seen in the study.

Although there have been zero transmissions, this does not necessarily mean a zero chance of transmission.


HIV-positive men read out mean messages



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