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Will HIV Ever Be Safe Enough for You?

There is a classic episode of Oprah from 1987 that can still raise my blood pressure. That year, the tiny town of Williamson, West Virginia, became part of a national discussion about AIDS when Mike Sisco, who had returned to his home town to die of the disease, dared to step into a public pool.

The community freakout was immediate. Sisco was quickly labeled a psychopath (rumors emerged accusing him of spitting into food at the grocery store), and the town pool was closed the next day to begin a Silkwood-style pressurized cleaning.

Soon thereafter, Oprah Winfrey arrived with cameras for a town hall forum about the incident.  Fear was the order of the day. "If there's just one chance in a million that somebody could catch that virus from a swimming pool," the town's mayor told Winfrey's worldwide audience, "I think I did the right thing."

Sure. Why not react in the most extreme way possible, if there is a chance in a million?

Williamson citizens were not swayed by health officials who calmly explained the established routes of HIV transmission and the impossibility of infection from a pool. "The doctors can say you can't get it this way," a woman countered, "but what if they come back someday and say, 'We were wrong?'"

Indeed. What if? If there's a chance in a million...?

That broadcast might have remained a sad footnote in HIV/AIDS history, an instructive example of people ignoring scientific fact to protect a satisfying fear, if history didn't enjoy repeating itself so much. Today, though, the willful ignorance isn't coming from uneducated residents of a southern town you can barely find on a map.

It's coming from gay men. And they are just as threatened, frightened, and dismissive of science as the townsfolk of Williamson were thirty years ago.

Recently, research known as The PARTNER Study was presented at the prestigious Conference on Retroviruses and Opportunistic Infections (CROI). PARTNER proved something HIV advocates have long suspected: people with HIV with an undetectable viral load are not transmitting the virus to their partners. The study included nearly 800 couples, all involved in an HIV positive/negative relationship, gay and straight, with the positive partner maintaining an undetectable viral load. Over the course of two years, more than 30,000 sex acts were reported and documented (couples were chosen based on their tendency to have sex without condoms).

Not a single HIV transmission occurred during the study from someone with an undetectable viral load. If PARTNER had been researching a new medication, they would have stopped the trial and dispensed the drug immediately.

The PARTNER results bolster the prevention strategy known as "Treatment as Prevention" (TasP), meaning, a positive person on successful treatment prevents new infections. To date, there is not a single confirmed report of someone with an undetectable viral load infecting someone else, in studies or in real life.

Just don't tell that to a sizable contingent of skeptical gay men, many of whom took to their keyboards to dismiss the PARTNER findings. Phrases like "false sense of security," "positive guys lie," "junk science," and "if there's even a small risk" appeared on Facebook postings and in web site comment sections. The people of Williamson must be slowly nodding their heads.

Resistance to the PARTNER study corresponds with stubborn doubts about PrEP (pre-exposure prophylaxis, or HIV negative people taking the drug Truvada to prevent infection). Although virtually every nervous argument against PrEP has been overruled by the facts, naysayers continue to either reject the evidence outright or make moral judgments about the sex lives of HIV negative gay men on PrEP.

Yes, there are unknowns. There always are when scientific studies meet the real world. And every strategy will not work for every person. But the vehement rejection of such profound breakthroughs suggests there is something more, something deeper, going on in the minds of gay men. What is it?

Our collective memories of AIDS horror are hard to shake, and that's a good place to start. On a gut level, any study suggesting that HIV could be neutralized is met with a weary doubt. Good news is no match for the enduring grief that has shadowed us for 30 years.

The PARTNER study also threatens the view that positive men are nothing more than risks that must be managed. The study kills the HIV positive boogeyman. It means positive gay men who know their status might actually care enough about their health to seek out care, get on treatment, and become undetectable. And, once the positive partner is no longer a particular danger, both partners would bear responsibility for their actions. What an enormous psychic change that would require in our community.

It's tough to do that when fear creeps in and "what if?" fantasy scenarios take hold. What if my partner missed a dose yesterday and, even though HIV meds stay in the bloodstream for extended periods, his viral load has inexplicably shot up? What if he isn't being truthful about his viral load? What if he doesn't know?

The greater threat, folks, isn't positive guys who think they are undetectable but are not. It's men who think they are HIV negative but are not. But we'd rather stay focused on the positive person being at fault, because, well, people with HIV lie a lot. We miss doses constantly because we have a death wish or we're too busy finding our next victim.

I have some "what if?" questions of my own. What if these unrealistic fears were meant to stigmatize and isolate HIV positive people? What if I am undetectable and feel no responsibility to discuss my status with a sex partner because I don't care to engage in a science lesson? What if everyone availed themselves to prevention options that worked best for them? What if my HIV status were none of your damn business?

These risks could be alleviated, of course, if everyone simply protected their own bodies when having sex with people they don't know or trust. But that would place an equal burden on negative men, and what a bother that is.  Better to leave that discomfort to those with HIV, vectors of disease that we are. Just consider us criminals, lying to you about our viral loads and spitting in the food in Williamson, just waiting to infect you when we get the chance.
As long as we're giving undue attention to fantasy scenarios we're not focused on the real threats. The rates of STD's are up. Young gay black men in the United States don't have proper access to healthcare and have infection rates worse than any developed country. Our community is plagued by  alcoholism, addiction, and mental illness. Do we want to debate established science or should we devote that energy to other challenges to gay men's health?

If you still have the arrogance to believe you could win the HIV Powerball Lottery and be the one person who gets infected in ways science has disproven, you're perfectly entitled to that point of view.

Here are some helpful instructions, however. Carefully step away from your computer and don't touch the cords because 50 people die of product related electrocutions each year. Walk slowly to your bedroom, being mindful of debris in your path because slip-and-falls kill 55 people every single day. Once there, refuse food or water because, well, you never know. Now slip into your bed of willful ignorance and try to make yourself comfortable.

The good people of Williamson are keeping a spot warm just for you.


p.s. In the time it took you to read this article, the number of people who were infected by someone with HIV who had no viral load was zero.

Mark on:


Show Comment(s)

Comments on Mark S. King's blog entry "Will HIV Ever Be Safe Enough for You?"

AMEN!!!!! As usual, Mark, you are right on!!!!!

More "you should all be barebacking with us" pablum directed at the HIV negative majority. Reality check... The recent Advocate cover story on San Fran's HIV efforts spoke of a 50% viral suppression success rate, while nationally the rate was reportedly 25%. So Mark is breaking out the Champagne a bit early, based on an adherent couples study, waving his naughty finger at the audacity of neg guys to sero sort.

Fantasy headline: "The Justice department has brought federal civil rights charges against 243 users of the social networking tool Grindr for using the expression "clean" and "ub2". Those charged also refused to sleep with Poz guys who are now statistically only capable of transmitting the virus 75% of the time."

My comment is to David: Mark is not telling you to have sex with pos guys. He's saying that NEGATIVE guys, that don't know are the ones spreading HIV. People who KNOW they are positive do not sleep around and spread HIV.

Frankly, the nasty treatment I receive online from other gay men around my positive status is WORSE now than in the 90's.

I blame it on the loss of social venues where we can hang out and meet each other.

Mark, thanks for your articles. They are important.

That is great but 2 yrs is not a long time. Lets try 10 yrs or twenty yrs. We should study these couples, what they are doing and what they are not doing. this is the begining of good news. People who chose that path should be studied along with all gay men. Lets find out what ups your risk or lowers your risk. Also this is a small sample set, Lets do it in other cities, and see if it hold up. Also I know that you can go yrs before you pop the test. in 1983 dr Groopman at BIDMC grew the virius from my blood bet i did not kick of the regular test till 1990. HIV can fly under the radar, for a very long time. Also ther might be that the men mildly exposed, some how deal with the virus. We have not studied how much HIV it takes ( amount ) to start a true infection. Nobody has even done tests on rats to see if very low amounts of HIV cause infections. Also dif strains might act differently. We just have not done the science and we should. time for THE HIV MANHATTAN PROJECT. WERE WE PUMP IN BILLIONS INTO RESEARCH...

Bravo. Fantastic article I wish everyone would read. Paranoia always seems to run rampant in the face of scientific facts when gay men are the subject. With proper treatment and an undetectable viral load we can finally be liberated from the shame and stigma. Spread the word Mark and thanks!

This is a great article. But want to remind readers that Oprah returned to the tiny town of Williamson, West Virginia in her final season to confront the town about their original reaction. It was a moving experience seeing the ever powerful Oprah holding the townspeople accountable for what they said and how they reacted originally in the 80's. to their own community member. Many had changed their tune and Oprah held their feet to the fire during the broadcast. I was very touched by this effort on Oprah's part, to revisit this stunning chapter in the epidemic and the towns horrible reaction.

As a person Living with HIV I have enormous respect for both the original (horrifying) show and Oprah's return to the town. She could have ignored the issue but faced it head on as she originally did all those years ago. For that I am forever grateful.
Props to Oprah!

Arlie, thanks for mentioning Oprah going back years later to Willamson and how many of those attitudes had changed over the years. I had intended to mention that in the piece. The link in the post will take you to a review of both the original town hall and the followup.

I just re-read Michael Callen's 1989 essay "in Defense of Anal Sex" which took D.C.'s Whitman Clinic to task for suggesting back in the day that people avoid anal sex because it was perceived as too risky for transmitting HIV. Callen's essay makes some good points, many of which stood the test of time and remain valid in 2014. Callen's arguments seemed to be directed at a very particular group-- those for whom giving up or to some extent changing sexual behavior, was off the table. I see some parallels to King's arguments. Both provoked a weird laissez faire response in me. If an HIV negative person in Callen's 1989 world or King's 2014 world feels comfortable engaging in a particular activity, let's respect that choice. But who are we to judge others for sero-sorting and saying no to Poz people. Even if all the studies say that undetectable means no risk, it's their body and as long as they say no politely, why should anyone care?

I worry that the war against stigma and (vilification?)of guys who refuse to date or sleep with Pozzies is sending the wrong message. It perpetuates PWA as "victims", albeit in a new way. Having HIV is bad enough but now there's a big drum beat emphasis on "keep your guard up because everyone potential partner is going to reject you". This might be the experience of some living in small towns, but in any large urban city, there's a large enough Poz community and enought enlightened neg people for this not to be an issue. What am I missing? Is this specific to certain age groups or demographics? Or like other comments have pointed it out, are you overly fixated on and lambasting the ones who won't have you.

JS, it's a fair question to ask if I might be overly fixated on the negative folks who see us as dangerous, rather than recognizing that there are a lot of negative people who understand the science and have no such hang-ups. I really do understand the difference.

Frankly, even though I qualify myself by referring to "a sizable portion of skeptical gay men," I know I'm provoking people. I'm mirroring, I believe, the frustration of a lot of other poz guys, as evidenced by some of the comments here. Because I'm observing the views of only a portion of gay men doesn't make their ignorance any less irritating to me.

Outstanding article. I just wish it were being picked up by mainstream press.

I have disagreed with this author in the past, but if do this story spot on.

I recently encountered a negative guy that rejected me in 1998 after I disclosed to him. He was terrified of course, since we had barebacked (without climax). I told him I would let him know when the funeral was if he cared to come. I saw him a little while later and he said he talked to a doctor so he wasn't so afraid. Fastforward to last week: He was surprised when I told him who I was and he said I was looking great (he on the other hand had become morbidly obese). I asked him what his status was and he said, "negative". So I said, "SEE? there really CAN BE safe sex with HIV".
I walked away from him.
Another guy I had used a condom with but did not disclose to him 15 years earlier, became irate when I told him my status after we met on facebook again. "You could have infected me!" and I said, "but thats just the point: I didn't infect you" and he said, "WEll, now I have to go get tested again"..I asked, "after 15 years?! gimme a f--cking break!!!"
we didn't talk again...
At least, if anything, I was able to get them to think...if only for a second...

That's great news, really it is. However, if you were HIV negative you would be singing a different tune. Everyone should take responsibility for their sexual health regardless of status but if you know you are positive it's is just as muchyour responsibility to tell your partner as it is for them to ask you to wear a condom. I would bet all my worldly posessions that if you could go back in time and not become HIV positive you would. I'm sure if you could go back in time and speak to your younger self you would change the circumstances that led to you becoming infected. If the person that infected you had only told you , you could have made your own choice to whether you were willing to take the chance or not. and I'm am sure you would have still been wanted to know even if they had or were undetectable at the time. so I don't agree with your theory of not wanting to go into a " science lesson" with your partner if you are undetectable. Remember you were negative once and I'm sure you would have appreciated a science lesson back then. So although we'll written artical you lost the the most important point , that being HIV positive is no longer a death sentence and you can have a healthy , responsible , sex life. You sound irresponsible to me and inconsiderate. And if you were wondering. I always use a condom, I am a woman and I'm negative.

"But that would place an equal burden on negative men, and what a bother that is."

What a nonsense statement that is. You are talking out of both sides of your mouth. You state this then complain when negative men reject any kind of sex with positive men or have fear of HIV. A fear that has kept them negative.

There are many negative men who put the burden on themselves and go out of their way to avoid HIV. They do it by avoiding drug fueled sex parties and multiple partner situations and extreme promiscuity, by using alcohol responsibly, by asking potential partners if they are STD free and HIV negative and by always using condoms regardless of the answer. They have to navigate liars, irresponsible people who don't know their status, people who think "undetectable" means HIV negative and people with all sorts of unhealthy attitudes. I ask this question to check the general attitude of a person. If they even blink on it I'm not having safe sex with them.

HIV will never be safe for me. Undetectable? The viral load fluctuates and who knows what it is at the time of sex. It might be undetectable at the point of a test but I have no idea what is happening at any other time. I wouldn't risk it with a condom and is always why I ask specifially if someone is HIV negative. I ask this in an attempt to reduce the risk of safe sex to make it as safe as possible, though of course you can never be totally sure of anyone status no matter what they or their doctor states.

HIV is way too much of a serious disease to not take very seriously. I learned this a very long time ago from all the public service messages and warnings. I took it seriously then and I take it seriously now. I don't understand the attitude of many HIV + people with regards to the way many HIV - people feel and behave. If I was HIV+ I would always only have safe sex with HIV + people. I would never put a negative person at risk no matter how big or small. I wouldn't want to deal with that or a persons fear of it. That said, I'm sorry that so many people have HIV and I hope someday it is eradicated. But until that time, I am doing all I can to avoid it. And unlike many other serious diseases, HIV is completely avoidable.

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This page contains a single entry by Mark S. King published on March 12, 2014 10:22 AM.

Our Problem with Being 'CURED' of HIV was the previous entry in this blog.

When People with HIV Became Suicide Bombers is the next entry in this blog.

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