There is some uncertainty amongst men when it comes to fucking without condoms with someone whose status is different to theirs and the associated risk of contracting and/or transmitting HIV, especially if the HIV-positive partner has a low or undetectable viral load level. This section explains what viral load means and what the concept of an undetectable viral load (UVL) means in relation to HIV risk.
Viral load refers to the amount of HIV circulating in the blood. To find out a person’s viral load, a doctor takes a sample of blood and sends it to a laboratory where a viral load test is conducted.
When the result comes back, viral load is indicated as a number. The number indicates the amount of viral copies per millilitre of blood (written as copies/ml). Viral load can range from below 20 to over one million copies/ml. In layman’s terms, viral load refers to the amount of virus that is in the HIV-positive persons’ body.
An undetectable viral load level is when the level of the virus in the body is reduced to a point that it cannot be detected by current tests. This does not mean that their body is free or cured of HIV, only that there is less than the test can detect.
In fact, all HIV positive people with an undetectable viral load still have HIV in their blood, as well as in blood cells, tissue and other bodily fluids. HIV-positive people on sustained anti-HIV treatment regimes are commonly able to maintain their viral load at low or undetectable levels.
The current research has indicated that if the HIV-positive partner has a sustained undetectable viral load level and is on effective treatment their ability to transmit HIV to the negative partner is eliminated during sex without condoms.
The PARTNERS Study, looked at over 22,000 cases of condomless anal sex between gay couples where one person was HIV-positive and had an UVL, and the other person was HIV-negative. They found that there were no cases of HIV transmission. This is just one of many studies regarding viral load and HIV prevention.
The body of evidence indicates that using an undetectable viral load level is the most effective way to prevent HIV transmission.
There is one factor that can make undetectable viral load ineffective in preventing HIV transmission, and that is when the HIV-positive persons’ viral load changes rapidly as a result of their anti-HIV drugs not working effectively. This rarely happens with someone who is on an effective and sustained treatment regimen, but if you have HIV and you are on antiviral treatment it is important to have your viral load level checked regularly to ensure that it remains undetectable.
Whilst the majority of positive people on treatments will have an UVL, there is a smaller proportion that for a variety of reasons don’t. This may be because there are issues taking the drugs as prescribed, having to try several different combinations of drugs over a longer period of time, or due to medical reasons, such as the intolerable side effects.
It is important to note that treatments do not automatically guarantee that people will have an UVL. However, taking treatments means taking control of your health. Virtually everyone who is on treatment has a significantly reduced viral load, giving them the best chance of maintaining their health and reducing the risk of transmission.
It’s important to understand that having an undetectable viral load will not protect you against other STIs and if you and your partner(s) intend on using this strategy to protect yourself against HIV then you should be having regular sexual health check-ups and keeping condoms in the mix as they remain the best way to prevent most STIs.