Rick believes that the reason his partner avoided getting tested back then was stigma. He believes that his partner, and many others like him, didn't get tested so he could avoid the dreaded possibility of being HIV positive. Though HIV-positive people are now living long and well, he says, fear and stigma help keep the epidemic alive. Treatment as prevention and PrEP allow some gay men to have sex with less fear, "in particular guys who find themselves barebacking or who are in magnetic (serodiscordant) relationships." But he views stigma as being the big issue.
Rick sees the ongoing evidence of stigma in his work as coordinator of Gay Poz Sex (GPS), a program that seeks to improve the sex lives of HIV-positive gay men. He says that HIV stigma and fear prevent poz men from making sex- and health-related decisions that would lead to the outcomes they want. Social media are providing more opportunities for sexual connections but don't always lend themselves to meaningful conversations or connections.
Rick says that a healthy, happy sex life is about physical and emotional intimacy, trust and knowing how to ask for what you want: "It's about your own comfort level with yourself and exploring your sexuality and what it is that you like. It's hard to set boundaries if you don't actually know what you're into."
Trevor Hart stresses that a sense of empowerment can help a person living with HIV move beyond the negative feelings that stigma can incite. It helps people "to assert themselves sexually," he says, "to get what they want out of sex, whether it's intimacy or pleasure, or other things. People also feel empowered to make safer personal decisions about their sexual health."
Both Joanne Otis and Trevor Hart agree that one's physical health, sexual health, well-being and happiness are inextricably linked. "A combination of those elements help you meet your social and sexual needs," says Joanne.
"It was a self-fulfilling prophecy," Jonathan Postnikoff told himself the day he tested positive for HIV six years ago, his thoughts spiraling out of control. "'You're that little gay boy who grew up fearing HIV and now you're positive.' That fear was something I'd been taught to feel. That if you have HIV, you're somehow dirty," he told me over the phone from Vancouver.
The fear of becoming HIV positive ran deep and took time to recover from. Today things are very different. Jonathan now identifies openly as an HIV-positive and undetectable gay man, which allows him to cut to the chase and find what he is looking for online, whether it's sex or dating or true love. "I put my status out there because I want to weed out the people who won't talk to you because you're positive."
Being open and upfront about his HIV status also attracts the type of men he wants: those who are either undetectable like him, on PrEP or just open-minded and willing to learn. It also gets the conversation about HIV and STIs started, which ultimately destigmatizes them. "If he has no STIs and I have no other STIs," Jonathan says, "then the risk of contracting or transmitting HIV is close to zero. If the guy's upfront and says, 'I'm on PrEP,' and I say 'I'm poz,' that's it. That's the end of the conversation."
Jonathan points out that guys who are on PrEP must adhere to their meds and monitor their health similar to the ways that HIV-positive people do, with regular checkups to test for HIV and other STIs. This makes them more aware of their health. "When I'm cruising online and see that someone is on PrEP, it relaxes me and puts me more at ease. It's an indicator that this guy has done his homework and knows what he's talking about. That's the type of guy I seek out."
He believes that the future is bright for people like him who live in cities where HIV-positive people can expect a degree of understanding and openness to the changes that are happening in HIV treatment and prevention. "When I seroconverted I thought I would be single for the rest of my life. Now seeing the possibilities out there makes me a lot more hopeful that I won't be single forever," he laughs.
But that optimism about his own romantic future needs to be expanded beyond the bright lights of the big city to everyone living with the virus, including those in small towns and rural areas. "We still have lots of work to do to make that a reality for everyone living with HIV."
|Treatment as Prevention|
Research has shown that taking HIV treatment every day as prescribed and maintaining an undetectable viral load not only protects your health as a person living with HIV but it can also radically reduce the risk of HIV transmission. This is called treatment as prevention (TasP).
TasP has made a huge difference in the lives of serodiscordant couples -- where one partner is HIV positive and the other is HIV negative -- because it helps relieve the potential anxiety that one or both partners may have about transmitting the virus.
What does undetectable mean?
When HIV treatment is taken consistently, it can cause the amount of HIV in your blood (your viral load) to drop to levels so low that the most sensitive HIV tests cannot detect it. The virus is still there but is undetectable.
In Canada, undetectable is usually defined as fewer than 40 to 50 copies of the virus per millilitre of blood. This is a far cry from the 30,000 or 40,000 copies per millimetre of blood a person with a high viral load can have.
How well does TasP work?
If you maintain an undetectable viral load, your chances of transmitting HIV to a sex partner are extremely low.
For TasP to be effective, an HIV-positive person must maintain an undetectable viral load. Most people can achieve this by adhering to their HIV meds and seeing a healthcare provider regularly to monitor their viral load. Your healthcare provider can also offer testing and treatment for other sexually transmitted infections (STIs), as well as ongoing adherence and risk-reduction counselling.
If you are in a sexual relationship with an HIV-negative person, your partner should also get tested regularly for HIV and other STIs. If you are just starting HIV treatment, your HIV-negative partner can go on PrEP for six months while your viral load gets down to undetectable.
To provide an extra layer of protection from HIV and protect you from other STIs, you can also use condoms.
If your viral load rises due to missed doses (poor adherence) or treatment failure (in rare cases ART stops bringing the viral load down to undetectable levels), this can provide a window of opportunity for HIV transmission. Having another STI may also increase the risk of transmission.