Some of us are old enough to remember when HIV carried with it a dire prognosis. A positive result was tantamount to a deep, existential concern for one’s own health and longevity, as well as for that of their partners. This fear struck deep in the LGBTQ+ community, with many gay men losing lovers and friends during the early years of the epidemic. The good news is times have changed thanks to the development of HIV treatments.
Although HIV still disproportionately affects members of the LGBTQ+ population, a person can live a long and productive life with HIV. In fact, even if you test positive for the virus, you can now be untransmittable to your partners. “Undetectable equals Untransmittable” or “U=U” is a concept borne of the past decade, backed by science, that says that if you are HIV-positive and on treatment and “virally suppressed” (no detectable virus in the blood after treatment), you cannot transmit HIV to any of your partners. What this means is that we want to treat each person seeking medical care as “HIV status-neutral.”
What do we mean when we say “HIV status-neutral?” It sounds a bit odd when we think about the stories and the movies and other representations of a patient waiting for their HIV test, with everything at stake in the result of that test, doesn’t it? But in reality, it means, in part, removing that fear and stigma around HIV when a patient sees their medical provider. The Centers for Disease Control recommends that everyone be tested for HIV, and that sexually transmitted infection (STI) checks and prevention become a routine part of a person’s medical care.
Regardless of the test result, we can prevent all new transmissions and ensure good health and quality of life for that patient and their partner or partners. You have likely heard about Pre-Exposure Prophylaxis (PrEP) by now. But just to recap, it’s one pill a day or, alternatively, a monthly injection, to 99% guarantee that, so long as you take that medicine regularly and as-prescribed, you cannot contract the virus. Maybe PrEP is right for you, or maybe there are other HIV prevention methods you and your provider can discuss. But either way, we can stop HIV.
Coming back to “HIV status-neutral,” how does this all fit together? Well, functionally, it means that when a person goes to see their medical provider they are tested for HIV, but the result is no longer an all-or-nothing proposition. If the test comes back positive, they discuss with their provider the right treatment for them, and start as soon as possible. Once viral suppression has occurred after taking treatments, that HIV infection stops with them. Partners are protected and the individual health of that patient soars to a basically normal prognosis. And if the test is negative, the patient talks with their provider about prevention options that may be right for them. Maybe they start taking PrEP, at which point they would be totally protected from HIV.
It’s great to know we have the clinical tools to stop HIV in its tracks. We just need to make sure people know about the options available.