Undectable - An HIV +/- Guide to Dating

Finding Mr. Right

Mixed Status Relationships

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Learn how to navigate dating when your status is mixed

So you’ve met Mr. Right…or maybe Mr. Right Now, but his HIV Status is different from yours. How do you navigate dating or even a casual hook-up? Being virally-suppressed, or “undetectable” is key to minimizing HIV transmission to the HIV negative partner. So what is “undetectable”?

What is Undetectable?

Being “undetectable” means that while HIV is still present and the person is still HIV positive,  the amount of virus in the body is so low that current standard testing cannot detect it at the time of testing. There may be temporary increases in viral load between tests.
How does someone with HIV become “undetectable”?

With a little help from science. It’s very unusual to have an undetectable viral load without the help of antiretroviral therapy, or ART. ART works to stop the virus from replicating (making more copies of itself) inside the body. If someone’s viral load is undetectable, it means the HIV meds are working and they should definitely continue taking them to maintain the “undetectable” status. If someone stops taking HIV meds, then HIV will resume its attack on the immune system and the person’s viral load will increase.

Why is being “undetectable” important when dating or hooking up with someone who is HIV positive?

Because the amount of virus in the blood is so low with someone who’s positive and “undetectable”, the chances of HIV being transmitted to someone is extremely low, maybe even closer to zero than we realize according to this recent study. Someone is much less likely to contract HIV from someone who is adherent to their HIV meds and “undetectable” than someone who doesn’t know their status and could be infected without knowing it. If someone is infected and doesn’t know it, then the viral load in their blood and semen is exponentially higher, making HIV easy to transmit. This is where most HIV infections happen among men who have sex with men. Remember, if he’s had one sexual encounter since his last test, his status is a question mark.

Do I need to use condoms if someone is “undetectable”?

Condoms are still one of the most effective methods of preventing the spread of HIV. Whether you’re the HIV positive partner or the HIV negative partner, no one wants a good roll in the sack to have lasting repercussions. If you’re hooking-up, or just starting to date someone, safer sex should always be non-negotiable. There are a number of factors that can cause the levels of virus to fluctuate between tests – and other STIs that come along with unprotected sex are a big factor. Someone who’s HIV negative with an STI could be up to 5-times more likely to contract HIV if exposed to it. Someone who’s HIV positive with an STI is much more likely to have a detectable viral load – making transmission to someone else much easier can affect overall health. Regular STI testing and treatment plays a big role in reducing HIV transmission. Additionally, viral loads are only measured in blood samples, not semen or other sexual fluids where the levels may vary.

Can a person’s viral load can become detectable between tests?

Viral load is a measure of the HIV virus in a blood sample on the day of the test. If someone is regularly taking their HIV meds without missing doses, their viral load will typically remain undetectable or at very low levels. However, there are a number of things that can cause someone’s viral load to increase between tests. STIs are a big factor that can increase a person’s viral load in the genital fluids. Viral load increases have also been found when a person’s body is fighting a cold, flu or other infection. Additionally, missing doses of HIV meds or not being adherent to the ART routine can cause a person’s viral load to increase. There are also indications of regular “blips” in viral load. If someone is living with HIV and also has a viral load increase, they may be able to transmit HIV more easily to an uninfected partner. If you’re dating someone who’s status is different than yours, the positive partner should get regular testing to ensure the viral load becomes and stays undetectable.

We’re in an long-term, monogamous relationship and he’s “undetectable”. Can the condoms come off?

Consistent condom usage is still one the most effective ways to stop HIV transmission. But if you’re starting to have conversations about taking condoms off in your mixed-status relationship, have an open and honest discussion with your partner about ways of reducing the risk of HIV transmission and these other things to consider:

  • Stay Adherent to HIV Meds:  Regular viral load testing will determine if the ART the HIV positive person is using is working. Taking HIV meds that are shown to reduce viral load to undetectable levels every day, without missing doses, will help reduce the risk of transmission to the negative partner – although the risk is not zero.
  • Consider Pre-Exposure Prophylaxis or PrEP:  PrEP is a pill taken once a day by the HIV negative partner that has been shown to prevent HIV infection by 92 – 99%. PrEP must be taken every day to be as effective as possible. The combination between someone positive who is “undetectable” and someone negative and on PrEP has shown that the risk of transmission is extremely low – although the risk is not zero.
  • Reduce Higher Risk Sexual Activity:  Unprotected, receptive anal sex is the highest risk sexual activity for HIV transmission. If you’re thinking of taking off the condoms and want to continue to have anal sex, having sex that isn’t “rough” and using ample amounts of lube can reduce microscopic tearing that can open the door to HIV infection. Also, consider engaging more in lower risk activities such as sensual massages, mutual masturbation and/or oral sex that have a lower risk of HIV transmission – although the risk is not zero.
  • Are you REALLY monogamous?:  If your relationship is open, regular HIV testing for the negative partner is critical, as well as regular STD testing for both partners. STDs increase the likelihood of becoming infected with HIV for the negative partner and can increase the viral load in the positive partner, increasing the risk of transmission. If you’re straying outside of the relationship and aren’t being honest with your partner about it, use protection to reduce the risk of bringing STDs into the relationship and maintain a steady STD testing schedule (every 3 months).
  • What if the Negative partner becomes Positive?:  Both partners should answer this question honestly with each other before shedding the condoms. Contracting HIV is not only a difficult diagnosis for the person who just tested positive, but can also bring strong levels of guilt and regret for the positive partner who infected the person they love. These are feelings you may have to face if you remove a tool from the prevention toolbox and the negative partner becomes positive. Having an idea of how it will affect you and your partner up-front will help to ensure you’re both on the same page, and what risks you’re each willing to take.
  • Define Ground Rules:  Sometimes shedding condoms doesn’t necessarily mean they come off for every type of encounter in your relationship. Having an honest conversation with your partner may reveal that you both feel comfortable accepting risks about certain sexual acts without a condom, but not comfortable with others – such as receptive anal sex with the HIV negative partner. While the risk still isn’t zero, you’ll both be on the same page about what risks you’re willing to take.
What if an accident happens?

So – you’ve decided to hook-up or start dating someone who has a different status and you’re taking precautions to prevent HIV transmission. But an accident happens such as a condom break or a drunken moment where you don’t make the same decisions you usually would sober. What’s next? Learn about Post-Exposure Prophylaxis (PEP) and how it can help prevent HIV if an unexpected exposure happens. But you’ll need to act quickly – PEP is most effective if taken within 72 hours of exposure – and shown to be more effective if taken sooner – although it’s not 100%.

With the improvement of HIV meds (ART), the introduction of PrEP, the availability of free HIV / STD testing, and a variety of protection methods available for free at IGNITE’s Condom Bar, the ability for people of different status’ to hook-up, start dating or enter into a relationship without the HIV negative partner becoming infected is greater than ever. HIV is considered now to be a treatable chronic condition with a number of tools in the prevention toolbox. While no one wants to become infected or to infect someone else – HIV doesn’t have to keep you from finding Mr. Right, whatever your status is.