At first glance, the news couldn’t seem to be better for AIDS/HIV activists and educators. In the past few years, large urban centres in North America have actually reported drops in HIV infection rates among gay and bisexual men. The fall is attributed to the drug regimens many HIV+ men are taking, which lead to a significant drop in their viral count—in many cases, rendering the HIV in their blood undetectable. This means they are able to have sex with other men without infecting them. But many familiar with the long struggle to educate men who have sex with men about how to stay negative say the results have set off some alarm bells. While low viral counts are obviously a good thing, activists worry a sense of complacency will set in for gay and bisexual men, threatening what is already a fragile commitment to safer-sex practices, in particular condom use.
“This news is definitely a double-edged sword,” says Anthony Buccitelli, education and prevention coordinator for AIDS Community Care Montreal (ACCM). “This clearly will lead some HIV+ men to think that sex without condoms means they can’t infect anyone, while HIV– people may also believe unprotected sex with HIV+ people is basically risk-free. People will be assessing the risks in certain sexual situations in different ways.”
Buccitelli notes that as news has spread of lower viral loads among HIV+ men in North American urban centres, there has also been a rise in other sexually transmitted infections (STIs), including gonorrhea and syphilis. “These other infections could make the HIV+ more infectious, which would then counter the good effects the drugs they’re taking are having,” he notes.
Jean-Pierre Pérusse, an AIDS activist who himself has been HIV+ for over a decade, says he is deeply concerned about how this changes the mindset around seroconversion. “Theoretically, it is true: if we got everyone tested around the world, put everyone who was positive on drugs, made sure their viral counts were brought down and continued to carefully monitor them, then yes, we could stop the spread of HIV.”
But Pérusse is quick to point out that that is not the reality most people face. “Many people aren’t getting tested, for whatever reasons. And it takes time to get to a point where your HIV levels are undetectable. I’m at that point now, but I have a doctor I see regularly. It’s taken me several years of trying different levels of medication to get to the point I’m at now, where I’m having minimal side effects.”
Pérusse says one of the worst misperceptions younger people have about HIV is that it’s now entirely manageable through the use of the so-called cocktail of meds. “I really hate the use of the word ‘cocktail,’” he says. “It makes it sound like a party. It’s not. There are still serious side effects while you’re on these drugs.” Pérusse knows this only too well; last year, his boyfriend committed suicide, saying he could no longer stand the effects of the anti-HIV medications he was on.
“Learning that you’re undetectable means regular consultations with a doctor,” says Pérusse. “People can’t even get a doctor in Montreal right now.”
Sebastien Goulet, who contracted HIV several years ago, says he sees a real change in the online sex and dating milieu for gay and bi men. “I’m very open about my positive status online. Negative guys will offer to have unprotected sex with me when I tell them I’m undetectable. But I won’t have unprotected sex with negative men. The risk is still there. I’m not going to be the person who’s going to put that other person at risk.”
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