When Matthew Taylor first learned that somebody living with an undetectable HIV viral load poses no risk of transmitting the virus to others, you’d think he might have celebrated. Taylor has been living with HIV since 2001, but the news didn’t resonate with him right away.
“It was great to hear it,” he tells me, “but I wasn’t personalizing it and so I was still operating as if there was risk.”
Viral load is the amount of HIV in the blood of an HIV-positive person; the more HIV in the blood, the higher the viral load. HIV medication can lower your viral load within three to six months, until it becomes undetectable — meaning the level of HIV is too low to be detected by a test. HIV/AIDS groups are now encouraging people to understand the science that someone who has undetectable levels of the virus does not pose a risk of transmission to their sexual partners, as demonstrated by recent studies.
Taylor works at the Health Initiative for Men (HIM) in Vancouver as its outreach program manager so he understood what this information meant, but didn’t think it applied to him because he had internalized so much shame over the years.
While Taylor had been dating or looking to hookup online, he always felt anxiety about disclosing his status to potential partners, though he would always inform them. Some men would ask him for more information about HIV and being undetectable; others rejected him, and some men would block him without explanation.
“I had these sort of core, at the time, issues with self-worth and self-esteem and confidence,” he says. “Sort of, like judgements and shaming and all the things — internalized homophobia — but then added to it was this real thick layer of shame and judgement and phobia that I had around my status.”
About five years ago, Taylor decided to out himself on his online profiles in order to curb the rejection and ignorance that he’d experienced. Not only did he indicate that he was living with HIV but he also shared that he was in recovery from addiction.
“I just said, you know like, ‘Hey, this is me.’ You know, if you’re cool with that, great. If you’re not then I’m not the guy for you.”
He met his partner, Ray Harrison, two and half years ago while Harrison was doing a three-month practicum at HIM. Harrison says Taylor told him about his status on their first date.
During their first few months together, they used condoms but wanted more intimacy; they began exploring the possibilities of condomless sex and made an appointment with Taylor’s doctor.
According to the US federal guidelines, pre-exposure prophylaxis (or PrEP), a preventative medication that reduces the risk of getting HIV, is recommended for people who are HIV-negative and are in an ongoing sexual relationship with a person living with HIV. Two and a half years later, the couple now has condomless sex, but not because Harrison has started PrEP.
“Given the information we had, [PrEP] didn’t really seem necessarily relevant to our situation,” Harrison explains.
“Yeah, we asked the doctor,” Taylor continues. “We said, ‘What about PrEP?’ and she was like, ‘Well, PrEP is great for, you know, situations where it’s sort of appropriate, but this really isn’t one of those situations.’”
“Operating on the undetectable equals no risk of transmission, why would you use PrEP?” Harrison explains. “It just seemed an additional medication that was not needed.”
Despite everything that Taylor knew about undetectability, it took his doctor assuring him that there was no risk to finally believe it.
When I asked what it was like to have condomless sex for the first time, Harrison laughs. “It was amazing, yeah, and I wouldn’t go back if not needed.”
“Not having that extra barrier between us is really fantastic,” he continues. “It’s an amazing intimacy.”
Taylor agrees that it was a powerful experience, offering a deeper level of intimacy and closeness. They communicated and were honest about their needs and fears, and going through the process together strengthened their relationship, they say.
Despite the possibilities for such mixed-status couples where one partner is living with HIV and the other is HIV-negative, 76 percent of people living with HIV in Canada are on antiretroviral therapy (ART) and 89 percent of those people have an undetectable viral load, but that doesn’t mean that they’re aware that undetectable equals untransmittable. According to Taylor, doctors don’t always have or provide this information either, maybe because they haven’t been educated on the science or maybe because they bring their own biases to the table.
“There’s definitely still a very pervasive stigma around HIV in the medical profession and so there’s judgment. You know, doctors: they’re human, right?” Taylor says. “We’re all human, so we’re going to make judgments and we’re going to operate on some of those judgments and, unfortunately, I think some of the medical professionals still operate that way.”
“Maybe it’s old school, maybe it’s ignorance, maybe it’s judgment, maybe it’s personal bias,” he adds. “Maybe, I don’t know what. Or maybe it’s just a fear themselves of actually standing behind the science?”