Sex after diagnosis: my journey to believing that undetectable HIV viral load means uninfectious

Published 20, Feb, 2017
Author // Joshua Middleton

Joshua Middleton tells of how he addressed self-stigma and maintained a sexual identity post-diagnosis.

Sex after diagnosis: my journey to believing that undetectable HIV viral load means uninfectious

To read the entire  article by Joshua Middleton, visit, here.

An image of the moment I was diagnosed HIV positive remains vivid in my mind. The feelings and emotions that ran through my body like a lightening bolt that day are not easily forgotten. They will be with me forever, as will my feeling of infectiousness upon hearing the words that have played in my mind like a broken record all these years: "Josh, I am sorry, but you are HIV positive." I remember telling myself that this would be the end of the road when it came to my sex life. Children? Forget it. That would never happen. Who would ever want to be with me, and how could I bring myself want to be with someone else again when condomless sex got me into this situation in the first place?

The first time I had sex after my diagnosis, it was with a sex worker in Tijuana, Mexico. This was a major step for me. At the time, I had not yet started treatment. I knew enough about HIV to understand that by using a condom I would be protecting both her and me. I longed not only for the physical affection I felt I would never again receive, but also mentally I wanted to prove to myself that sex was not out of the picture. I went into a small brothel labeled a "massage parlor." You know those ones, right? Where happy-endings are not only a hope, but a guarantee. Well, yeah, it was one of those. In typical red light style, they had all the women line up, and I chose the one I would spend the next few hours with. As I glanced over, I saw a beautiful woman in her early thirties with long black hair and green eyes. Let's call her "Alejandra."

I didn't know whether I could bring myself to disclose at this stage of my diagnosis. I knew it was the right thing to do, even though we were both protected by the condom, but I didn't know how she would react. I figured that I needed to tell her, even if she was a sex worker providing a service. And so, I did.

Not only was Alejandra very understanding, but she gave me the boost of confidence I needed to move forward. I'll be frank with you: Despite her acceptance, I was just not ready to have sex yet. The mental image of my diagnosis played over and over in my mind. I couldn't help but feel "dirty," a word I know is grotesque when describing HIV status. It wasn't because of the act I was engaging in, the person I was having sex with or even the place itself. I could not focus on the pleasure but only the fear. "What if" this condom breaks? How is she going to react? How am I going to feel if something happens and know I was the one responsible for it? My viral load was around 28,000 at the time, and I knew I was "most" infectious the days, weeks and months following my seroconversion.

It was a night that I used sex as a method of coping. It was a night that I will never forget. It was before I learned what an undetectable viral load truly means. Within a month of starting treatment, I achieved my goal of "undetectability." At the time, I was a fresh, new advocate and the news of treatment as prevention was still considered "iffy" in the minds of many. I knew the fear well. I had good intentions in telling people that they should always use a condom. I was still learning about prevention myself while trying to share what I knew with others. The idea of telling someone not to use a condom if they were adhering to their meds was just crazy to me. The idea of pre-exposure prophylaxis (PrEP) also seemed crazy. I had myself convinced that I needed to see X amount of studies before I could promote such things.

I was convinced that condoms were the way we would end this epidemic, until one day it all clicked. I went from not believing the research, to believing there was not enough research, to stating, "Well, there is still a risk," to full acceptance where I can now say without a doubt, "There is no risk." I came to realize that not logic but shame and fear were clouding my advocacy and my sex life.

To read the entire article by Joshua Middleton, visit, here.           

About the Author

Joshua Middleton

Joshua Middleton

My name is Joshua Middleton and I am a HIV+ heterosexual newly diagnosed male from Murrieta, California  that is putting a face to this virus. I am an activist, blogger, v-logger, and educator. I am one of millions of people battling this virus day in and day out looking to share my experience in an effort to prevent others from ending up in my same situation.