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Taming our fear of HIV

Article by Sam Knottypup
Artwork by cumpug

My high school education dates back to the late 90’s in the Quebec province. Back then, we had classes that addressed our concerns over our burgeoning sexuality. A good chunk of it was based on the prevention of sexually transmitted and blood-borne infections (STBBIs). What I memorized was that we had to protect ourselves from many infections, but mostly from the scary HIV, which was incurable and could lead to AIDS and death. I grew up interiorizing this fear.

Years passed. Medical science evolved. But like many, I haven’t pursued studies in healthcare or sexology. Thus, I held on to the knowledge acquired from my high school years.

The way I saw it, having unprotected sex was like opening a gate that led to risks of catching HIV and other STBBIs. It’s indeed the case.

The way I saw it, having unprotected intercourse with an HIV positive person was literally consenting to be infected with the virus. It might have been true once. Now, things are different.

I eventually came to learn of new ways to prevent an HIV infection but it took a lot of time and many discussions to realize that one of the best ways to reduce the risk of infection was… to have sexual intercourse, even unprotected, with an undetectable HIV positive person!

Viral load and other jargon

Before going further, I want to stress the fact that this article isn’t a plea to have unprotected intercourse. Many infections, even the curable ones, build resistance to current treatments by mutating via repeat transmission, amongst other things. Without any relevant and timely treatment, some STBBIs also have dire consequences for your health. I’m mostly trying to deconstruct unjustified discriminations that HIV positive people are still subject to today.

As a seronegative person, I’ve long held a fear of having sexual intercourse (protected or unprotected) with a HIV positive person.

Until I came to understand the concept of viral load.

Indeed, it is now an established fact that HIV treatments not only improve the quality of living of infected people; it also reduces the viral load to the point of making it undetectable. “Conclusive data shows that people living with HIV who follow their treatment and are given regular care maintain an undetectable viral load and thus don’t transmit HIV to their sexual partners”. [1]

This explains why, once I’ve made sure that the HIV positive person has an undetectable load, I can decide to have sexual intercourse, protected or not, solely based on the risk of transmissions of other STBBIs and not HIV.

As a matter of fact, from now on, we could even consider that it is less risky to be infected by HIV by having unprotected sex with a seropositive person who has a low viral load than with a person who pretends to be seronegative but neglects getting regularly tested for STBBIs.

HIV positive people are often infected via others who ignore that they are indeed carriers. One could argue that for this reason, having sex with a person who is aware of his seropositivity and undetectable viral load is not only safe, but is a legitimate way to decrease any risk of contracting HIV.

Options available for everyone

Of course, what I suggest above is true only if the HIV positive person follows his treatment adequately. A discussion and trust are always the best safety net in any relationship.

The evolution of available treatments has also given us the latitude not to put the full burden of transmission on HIV positive people.

Pre-exposure prophylaxis (PrEP) is a preventive treatment available in sexual health clinics that, if taken before a sexual relationship, will greatly reduce the risk of being infected during unprotected intercourse with partners who believe themselves to be seronegative [2]. Let’s remember that it is with this group that the transmission risk is the highest and not with people who follow their anti-HIV treatment well.

Another asset in the medical realm is the post-exposition prophylaxis (PEP), which is taken after a sexual encounter we believe could be at risk. However, it has to be taken within 72 hours following the act.

These treatments have to be considered like preventive means but ultimately don’t replace condom use, since they only have an effect on a potential HIV infection. It’s still nice knowing that they exist.

A world filled with outdated stigma

I have a steady sexual partner who lives with HIV and, even if I am seronegative myself, I have made the decision to have unprotected sexual relationships with him.

He shared with me that he’s still often subject to prejudice because of his condition. These preconceived ideas are based on fear, the history of HIV/AIDS, as well as the ignorance of medical advances.

The real question to ask a sexual partner who lives with HIV should be: “what’s your viral load?”. By asking this question, we show them that we are aware of the stigma seropositive people face, while still getting an relevant answer that can guide a thought out decision regarding or own sexual health.

Let’s stop fearing people who live with HIV. Our defense mechanisms that are triggered with a seropositive person should rather be activated with a person who declares himself seronegative because, as of today, HIV is transmitted regularly this way.

Let’s take our own responsibilities regarding our sexual health by using, if needed, preventive treatments which are now widely available.

And lastly, do I need to add that all that precedes is valid no matter your sex, gender or sexual orientation? We still hear way too often that PrEP is a treatment for gays. Meanwhile, HIV infections are currently climbing in the heterosexual world. In Quebec, for 10 years now, diagnostic has been decreasing within gay men whereas they are increasing for heterosexuals [3]. Don’t try to outsmart the virus…

And no matter your viral load, enjoy life!


Sam Knottypup

Active in the Montreal puppy community since 2016 under the pseudonym of Pup Knotty, Sam uses his political and cinematic knowledge to fight for struggles over body, sexual and gender diversity. In 2019, he contributed to the debates against the acceptability policies imposed on LGBTQIA2S+ communities when the photo of a young girl petting him as a puppy went viral on social networks. From then on, he participated in several Canadian media initiatives to demystify and humanize fetishistic practices.

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