At least once a week I explain to someone why two HIV- guys cannot "spontaneously create HIV out of thin air" and infect one another. That suggests to me at least two things: that guys get through our school system outrageously under-equipped for sex (which they were probably having even then...) and that the paranoia about HIV is such that guys fear the virus is lurking everywhere, ready to pounce on them unexpectedly. What a stressful weight to drag into bed with you all the time!And then, on the other end of the spectrum, I have men asking me what seem like very advanced questions. Guys who want the statistical odds of bottoming unprotected and the percentage of Ottawa guys who both know and don't know they are HIV+ so they can concoct some sort of formula that will calculate their risk if they go bare using lots of lube and the dude pulls out before he cums, for example. (Please don't email me for the answer to this question -- it doesn't exist!)
What's really amazing is that all of these guys - all of us guys - are having sex together. The dude who asked me the other day, "Yeah but what is HIV? Like, what would it mean if I got it?" is having sex with the man who's been positive for 20+ years. And he's having sex with the young guy who swears he's negative but hasn't actually been tested for about 18 months with as many partners in that time. All these different knowledge levels, all these different degrees of risk people take, all these different assumptions people make about others based on "the kind of guy he is" or "yeah, but it's not like I met him at the baths!"...
Just lately guys have started asking me online about viral load. Which, on initial thought, seems like a really great evolution - guys are weighing up risk factors when they know they are having sex with a partner whose HIV is different than their own. Yet this positive development is also ripe for confusion. Consider what it means when one guy in a gay chat room is poz but undetectable and another guy isn't even really sure what HIV is. How do these two negotiate risk?
The chatter in the conversation below agreed to let me share this text as a learning tool for others. I really appreciate his openness.
Chatter: hello...what is undetected HIV? I have seen that a lot on profiles lately
Nico: hey there
Nico: how are you doing?
Chatter: good and you?
Nico: I’m good thanks
Chatter: so, ummm....what is undetected HIV? sounds more ominous than detected HIV
Nico: i'm happy to explain that for you
Nico: i get this question more and more often, which reflects a change in guy's online profiles, like you said
Chatter: yes
Chatter: there are several of them on here
Nico: yup
Nico: just a sec, pulling up some good links for you
Chatter: thank you
Nico: so (correct me if i'm wrong), what you are starting to see in profiles is HIV+ men letting guys know that their VIRAL LOAD IS UNDETECTABLE
Nico: they are not saying their HIV is undetectable, but rather their viral load
Chatter: no, they are saying their HIV is undetected
Nico: ok
Nico: are you able to find an example profile i could have a peek at
Nico: that way we'd be looking at the same concrete example
Chatter: let me see if i can find one....(sorry I am training a slave at the same time as speaking with you)
Chatter: a bit distracting
Chatter: lol
Nico: i can imagine!
Nico: if you think about it, it doesn't really make sense if someone says "i have HIV but it isn't detectable". what would that even mean? if it isn't detectable, then how would an HIV test have detected it?
Chatter: exactly
Chatter: that is why i was confused
Nico: i am pretty certain they are talking about their VIRAL LOAD
Nico: do you know about viral load? if not, i am happy to explain
Chatter: ok, must be. please explain
Chatter: otherwise makes no sense
Nico: right
Nico: i'll explain : )
Nico: A viral load is a test that measures how much virus is in the blood stream of somebody who is HIV+.
Nico: Who takes this test? Someone who has already been diagnosed as HIV+.
Nico: Basically, it measures the HIV virus' activity in your blood. The amount of virus in your blood also shows you how quickly or slowly the virus is multiplying. In general if your virus is very active, the T-cells will be destroyed and your T-cell count can begin to go down.
Nico: So a high viral load means the virus is more active and present in that person's body. A low viral load means there is less of the virus in the blood and it is less active.
Nico: So what does "undetectable" mean?
Nico: If the viral load drops so low that it is below the benchmark at which the viral load test can detect it, we say that that person's viral load is "undetectable"
Nico: Are they still HIV+? Yes. Is the virus still present in their bloodstream? Yes.
Nico: But it is only present at very low levels.
Nico: Does that make sense? Any questions about all of that info?
Chatter: ahhhh
Chatter: okay
Chatter: so in theory then, i could be tested for HIV and get negative results, but still be positive?
Nico: No that's not really what it means.
Nico: I'll explain a bit more.
Chatter: please
Nico: The reason why what you just said is EXTREMELY unlikely to happen (after waiting the standard 3 month window period between infection and getting an accurate test result, of course) is because in the first year or so after infection, a person's viral load sky rockets very high. later it comes back down to a more moderate level, but it is in the very first part after infection (when a person is least likely to know their status!) that their vial load is highest. that means they are at their most infectious at that stage
Nico: But that's a really good question you asked.
Chatter: cool
Nico: The reason you are starting to see VIRAL LOAD being mentioned in poz guy's online profiles these days is because of a new development that happened last January
Chatter: ?
Nico: It's really cool that you're curious about all this stuff. I'm happy to explain about the "January development". Want me to?
Chatter: yes please
Nico: ok
Chatter: but i have to go get ready for work...even masters have bills to pay
Chatter: lol
Nico: well.... i have an alterative solution, actually….
Nico: so many guys ask me about viral load now that i wrote a short little explanation of it online:
Nico: http://tinyurl.com/SwissStatement
Nico: if you copy that link down, you can read all about it any time that works for you
Chatter: thanks, i have bookmarked it
Posts
2 comments:
I am constantly surprised at ho little people know about HIV - whatever their sexual identity. This appears to be more common among younger people (late teens and twenties) who test for HIV, but is not exclusive to youth. They know they are scared of HIV, but they don't really know what it is they are scared of. Their ignorance of HIV leads to unnecessary anxiety but also puts them at risk for HIV infection as they don't know about the risks for transmission. We need a really back to basics national campaign to put HIV into perspective, so everyone knows what HIV is, and how it is transmitted. Those of us who were sexually active in the 1980s were well educated about the risk, etc, but even those in my generation need to be reminded to slow down transmission rates in gay men especially.
"We need a really back to basics national campaign to put HIV into perspective, so everyone knows what HIV is, and how it is transmitted."
How right you are! If only we had an opportunity where we knew *everyone* would be present so we could share this information in one single cost-effective session. Oh wait, we do. It's called SCHOOL. Too bad our politicians are too afraid of backlash to make comprehensive sexual health education a provincially-mandated, standardised component of every child's schooling......
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