Undetectable viral load

The other statement  from the study, which related to the way effective HIV medication reduces infectiousness was: 'When a viral load is undetectable, condoms are not needed to prevent HIV transmission.' Only 4 per cent agreed with this.

While it is heartening to see that most gay men with HIV are not simply throwing away their condoms because their viral load is now undetectable, to deny that lower viral load means you are less infectious is clearly contrary to scientific evidence.

Certainly, there are other issues at stake when it comes to considering levels of infectiousness with an undetectable viral load. Your last viral load test was a snapshot and the figure may be different today than it was a week or a month ago. This is because:

• It is possible to have viral load 'blips' - where viral load is suddenly, and often only temporarily, detectable. 
• The presence of other sexually transmitted infections (STIs) can increase viral load. 
• Viral load levels can be different in blood than they are in other body fluids.

Much of the doubt within the debate about whether undetectable means uninfectious may be down to mixed messages about the Swiss Statement, since it was seen as being controversial and irresponsible by many at the time it was made. However, since then the evidence has been validated and supported by further studies which have proved that reducing viral load reduces the degree of infectiousness by around 96 per cent. 

So why might this message not have been taken on board by those gay men who are living with HIV? One reason may be that HIV clinicians, governments and HIV organisations have been understandably very cautious when it comes to endorsing a message which goes entirely against the historical message of 'always wear a condom'. Public health messages tend to operate in a black or white way. Everyone has been singing from the same hymn sheet of consistent condom use for the last 30 years. To consider changing or adding to that message when there are nuances, makes for a more complex health promotion message, which in turn is harder to get across simply. 

However, if we are ever to have open and honest conversations with each other and to educate our families, friends and most importantly, our prospective sexual partners, we need to be secure in our own understanding of the biology of HIV and its treatment. It is no wonder that many of us worry about disclosing our HIV status to sexual partners if we are still worried about being a potential health threat, despite the fact that the majority of us are on treatment with an undetectable viral load.