Undetectable – Big Deal or No Deal? Take two.

This is the second of three articles by PositiveLite.com writers on “what undetectable means to me.” Read Bob Leahy’s earlier take on this topic here.  Wayne Bristow will follow later this week.

Three months after I started anti-retroviral therapy (ART), I got a call from my doctor. Even though my next appointment with him was still a week away, he phoned me because he wanted to give me the good news right away. My lab results had just come back showing that my HIV viral load had reached an undetectable level.

He was excited for me and I was excited myself. Why? Because the goal of HIV treatment is to reduce the amount of virus in the blood to a level so low that it cannot be detected by the standard tests. Being “undetectable” confirmed that ART was working for me. HIV had been stopped in its tracks; it’d been defeated in its attempts to damage my immune system. It was a milestone that I celebrated that day and continue to celebrate because my periodic viral load tests still come back undetectable. 

Reaching this status was a personal demonstration in my own life of what everyone had been saying in recent years. That, thanks to ART, HIV is different now. It’s no longer the death sentence it once was but is, instead, a chronic, communicable disease that can be controlled by medication.

This is a big deal as far as I’m concerned. I’m of the generation that was most affected by the AIDS epidemic of the 1980s and early 1990s. The majority of my peers, gay guys  in the prime of their lives, were either dead or dying. At that time, there was no treatment that could have saved them. I was one of the lucky ones in that I didn’t become infected at that time, but to this day I still grieve the loss of those men - my friends, colleagues, loved ones, drinking buddies and sex partners.

Many years later, as the result of some decisions I made that I now regret, I became HIV-positive myself. But, because of the anti-HIV drugs that are now available, I’m not going to die of AIDS like my friends did 15 or 25 years ago. Rather I’m going to live the kind of active, healthy life that they could only have dreamed of. Achieving an undetectable viral load is a marker of that expectation.  

I’m fortunate in that I was diagnosed early, have access to ART and am the patient of a knowledgeable and caring physician. It was he who advised me to go on ART immediately after my diagnosis because he believes that long term outcomes are better if treatment is started early. Everything I’ve subsequently read and learned confirms that belief. On top of that, I tolerate my drugs so well that I could go from one day to another not thinking about HIV at all (except that my role as assistant editor of PositiveLite.com won’t allow me to do that!).

For many others, however, having a chronic illness such as HIV can be exhausting, unpredictable and isolating. Finding good care and treatment may be hard. And having HIV can, all too commonly, be fraught with stigma and discrimination. Meanwhile, other HIVers of my generation are long-term survivors who often suffer significant side effects and damage to their bodies caused by the toxicity of an earlier generation of anti-HIV drugs. So celebrating my own good fortune is tempered by this knowledge.  

That having been said though, having an undetectable viral load provides me with a positive sense of being in good health with good long-term health outcomes. Baring a cure, I anticipate dying with HIV, not of it.

The status of being “undetectable” also gives me a sense of positive self-esteem and emotional well-being. I’m not diseased. What I have is a well-managed, chronic illness. It’s unfortunate, but it’s nothing to be ashamed of. It’s part of the human condition.

This, in turn, has enabled me to feel good about being out of the closet, as it were, with respect to my HIV status. Proudly labelling myself, as I do, an HIV-positive gay man is a profoundly liberating experience. People can see that I’m healthy, enjoying life and contributing to the community through volunteer work (if I hadn’t reached the age of retirement, I’d still be working) and that’s allowed me to become a role model of sorts.

One of the most important outcomes for me of having an undetectable viral load is that it’s lessened the burden of worrying about infecting others when I have sex. A number of recent research studies have demonstrated that, with certain caveats, a person taking HIV treatment with an undetectable viral load in their blood should not be considered sexually infectious. Indeed, Julio Montaner, one of Canada’s and the world’s most respected HIV scientists, has publicly gone so far, in an exclusive interview with PositiveLite.com, to state that he’s “very comfortable that [ART] is at least as protective - or more - than condoms”.  

From this knowledge comes my desire to focus my energies on fighting against the criminalization of HIV non-disclosure. Because those of us who do what we have always been taught to do and wear a condom when we should or if we have an undetectable viral load - or both - don’t pose, in the words of the current law, a “significant risk” of infecting our sexual partners. What we do have, however, is a responsibility to protect our own health while not harming the health of others. That applies whether we’re HIV-positive or HIV-negative or don’t know our status. 

So, to summarize. I realize I’m privileged and don’t represent every HIVer out there, but I rejoice in my “undetectable” status. It allows me to live an active, healthy life with the expectation that, when the time comes, it’ll be old age not HIV that I’ll die of. It gives me a sense of emotional well-being that enables me to be proudly poz and to give back to the communities to which I belong. And it lessens the worry of infecting those with whom I have sex. For all these reasons, I feel blessed to have an undetectable viral load. As I said at the beginning, it’s a status that I celebrate every day.