The Serocomplications of Dating and Sex
Recently clients have been coming to my office talking about the role of viral load sorting and serostatus disclosures in dating. These days, viral load sorting is the new, updated version of serosorting. Here's the problem: Viral load sorting is a perfectly reasonable way to make decisions about safer sex practices, and yes, an undetectable viral load is a form of safe sex. But so are PrEP (pre-exposure prophylaxis), condoms, gloves, dental dams and other latex barriers.
For decades, in response to sex shaming and stigmatizing efforts to serosort as a way to exclude, restrict and criminalize the sexual lives of people living with HIV, we called that exclusionary serosorting what it was: the moralizing of a virus that by definition is morally neutral. And just as we've been working to get the message out for 30 years that condoms are morally neutral, so should we teach this about viral load.
Anxiety, fear, shame and othering perpetuate HIV stigma. Viral load stigma is now what exclusionary dating clauses of "no positives" used to be. "Are you clean?" now means viral load. It isn't serosorting; it's viral load sorting.
Read: The Undetectable Problem: Trauma and Adherence (Part 1)
With serodifferent couples, I talk about the idea of serocomplicated. This means that when we talk about viral load or PrEP and TasP (treatment as prevention), the answers to risk assessment questions and what it means to tend to the health of everyone involved may change regularly.
I talk about this with couples around issues of sex, intimacy and fertility. So maybe this is an argument for viral load sorting as part of negotiating what constitutes safer sex as a task of intimacy-building in ongoing relationships: not excluding people with detectable viral loads from the realms of sexuality and desire, but making viral load simply another form of informed consent in safer sex negotiations.
What constitutes personal "failure" isn't the rise and fall of a viral load but the moralism of viral absolutes and the policing of bodies.
Undetectability and Criminalization
In the movement to decriminalize HIV, I worry that with increased focus on getting everyone seropositive to undetectable we are creating a larger divide between people with access to care and bodily stability and those without. If we start to claim that because someone is undetectable and therefore uninfectious, they should be immune to criminalization based on serostatus, then we will continue to leave those who remain detectable vulnerable to stigma, persecution and prosecution. And those who remain detectable will increasingly be under-resourced and under-cared for, and therefore will continue to comprise predominantly people of color, sex workers, immigrants and the economically disenfranchised.
Additionally, from a global and immigration perspective, those who continue to struggle with viral load detectability will be those with co-occurring infections such as hepatitis C and, in developing countries, TB and other immune-compromising illnesses.
Risk and Memory
Most days, I want to have answers for my clients, for my friends, for my colleagues and for myself. I get cranky about the cheeriness of the campaigns that approach destigmatization and HIV criminalization as though the answers are simple because the virus is no longer scary.
Detectable viral loads remind us that HIV/AIDS is not over, not anywhere close to being contained in the Global South and under-resourced parts of the industrialized world, and not over in those who have survived thus far. Detectable viral loads remind us of what we've lost and what we might still lose.
People living with detectable viral loads remind us of the bodily experience of what is still at stake. Complex grief and serocomplications are parts of our embodied histories that will not be erased.
Are you undetectable? It's a question about whether the imprint of viral occurrence is visible in someone's bodily and psychological experience moving through the world: whether it is possible for him or her to forget.
When we focus on viral load undetectability, we're focused on the possibility of respite from remembering and respite from risk. The truth is that all intimacies come with risk. But for so many decades now, HIV has taken on such symbolic representation of the ultimate risk -- of death -- that now, with the potential to nullify that risk, we forget that a residue of risk exists in any connection.
What if we could get to a place where people living with HIV aren't stigmatized for their viral loads but cherished and coveted for their self-determination and survival?
What if the presence of detectable viral loads in any of our communities reminded us of the work we have left to do to ensure that everyone is protected from criminalization and tended to with equal access to medical care and choices?
What if, as communities impacted by HIV, we could get to a place where viral loads, detectable and not, are signs of lives lived hard and full and stories left to share?
Keiko Lane, M.F.T., is a psychotherapist and educator in Berkeley, California. She writes and teaches about the intersections of queer culture and kinship, oppression resistance, racial and gender justice, HIV criminalization, reproductive justice, and liberation psychology.