Why “undetectable for HIV” means you should still use a condom

By | 2nd December 2017

Articles and videos from the media and gay (ill)health organisations are full of half truths and wishful thinking about men being undetectable for HIV.

It’s true that if an HIV+ gay man truly does have an undetectable viral load then you are unlikely to contract the virus from him, even if you don’t use a condom for anal sex. The problem is: how do you know for sure that he is undetectable?

Lets look at some scenarios…

1/ Matthew was undetectable for HIV when he visited the sexual health clinic three months ago. However, because he has been having bareback sex he has since contracted a different strain of HIV. This has caused his viral load to increase. He is no longer undetectable and may pass on HIV if you don’t use a condom with him. Matthew doesn’t realise yet and tells you in good faith that he is undetectable. But that will be little consolation if you end up HIV+ for life.

2/ Liam has a personality disorder. He is a compulsive liar. Liam loves bareback sex (it’s how he became HIV positive) and will tell you anything to get what he wants. He has a high viral load and isn’t even on medication, but he tells you he is undetectable so he can persuade you to fuck without a condom. He says that you will be “stigmatising” him as an undetectable HIV+ gay man if you don’t fuck raw. If it wasn’t for the fact that you already know Liam is HIV+, he would have no problem lying and telling you he is negative. He is addicted to bareback sex and, for him, undetectable is just another convenient lie in the toolbox of deception.

3/ Greg drinks a lot, takes illegal drugs and can’t get it together to take his HIV medication as instructed. So, although his viral load was undetectable at his last test, it has risen because of his chaotic lifestyle. He poses a threat to you because neither of you know this.

4/ Will has been feeling under the weather for the last week. He doesn’t realise it yet but has contracted a sexually transmitted disease due to not using condoms. Despite the lack of symptoms so far, the infections have caused his viral load to increase and he is now at risk of passing on the HIV virus to you. However you have both seen a video put out by a gay (ill)health organisation which shows an undetectable man saying “you can’t get HIV from me” so you both are unaware of the danger.

5/ Ian has been HIV+ for some years, taken his meds regularly and been undetectable and always used a condom. He now believes Undetectable=Untransmitable as promoted  by the gay (ill)health organisations and believes he is no risk to his long term partner and they can ditch the condoms. However with a compromised immune system due to having HIV he has caught a nasty flu bug which has caused his viral load to spike. He is no longer undetectable unbeknown to him and is putting his long term partner at risk.

The solution

Always use a condom for anal sex, whatever the other guy tells you. Don’t be afraid to walk away from the situation if necessary. An undetectable diagnosis is just a snapshot of a moment in the past. He may be acting in good faith but that isn’t good enough when your entire future health depends on it. He may be lying and using emotional blackmail to get what he wants.

Used correctly, a condom means you are extremely unlikely to contract HIV even if your partner is highly infectious. However our advice is to walk away from any situation where a man is reluctant or resentful about using a condom, as these are the devious guys who remove or damage condoms during sex.

A condom also protects you against other sexually transmitted diseases which are rampant amongst gay men who don’t use condoms. In one recent study of HIV negative men on PrEP, 48% contracted an STI during the trial period. By comparison, talk to some older gay men who have always used condoms and you’ll discover some have never had a sexually transmitted disease, while for others a minor STI has been a rare experience.

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