Achieving an undetectable viral load is a great thing. “Undetectable” basically means the amount of HIV in your body is so low that it cannot be detected by current monitoring tests. It doesn’t mean one is cured or HIV-negative, but it does mean one can live a long and healthy life. That’s the primary benefit of an undetectable status, and it’s great news for the health and wellness of people living with HIV. But this can only be achieved through HIV treatment, and that means accessing quality health care.
The secondary benefit to an undetectable viral load is that it’s not possible to transmit the virus. This can have a profound impact on the relationships between HIV-positive and HIV-negative gay men. It changes the dynamics of sex and hookups. It can also help reduce stigma for the individual.
My participation in CDC’s “Start Talking. Stop HIV” campaign was an opportunity to articulate the experiences of undetectable status on the individual level. But I am fortunate enough to have access to quality health care and treatment. I’ve also been HIV-positive for 23 years, and my relationship to stigma can be different than those who are newly diagnosed.
The benefits of an undetectable status are groundbreaking and terrific news in the fight against HIV, but we can’t have a conversation about undetectability without addressing the structural issues that so many people continue to face in this country. Only around 50% of people living with HIV in the United States have achieved an undetectable viral load. There are lots of complex reasons why someone may not be undetectable. This does not make them stupid or irresponsible; it simply means that our system has failed them.
Accessing and maintaining engagement in health care in this country is a challenge. The Ryan White Program is a great safety net for people living with HIV, but it’s not perfect, and many people still slip through the cracks. Additionally, people still report facing homophobia, transphobia and racism from health care providers. Add on to that issues of mental health, homelessness and mass incarceration and you have numerous intersecting factors that influence one’s health.
Obamacare was a great advancement for health care in this country, but immigrants were left out. While Ryan White does provide for immigrants, it’s simply not enough. We are currently living through one of the most hostile times in history for immigrants. The Trump administration is openly racist and anti-immigrant. The treatment of immigrants creates fear in the community. If one perceives that accessing care could mean arrest or imprisonment, then that health care may as well not exist, because it’s inaccessible. And these fears are not misplaced when our government is imprisoning immigrants and separating families. A conversation about undetectable status must include a conversation about immigrants.
Reducing stigma associated with HIV does not simply mean gaining access to another group that is less stigmatized. We must think critically about stigma and look beyond the platitudes and buzzwords. We need to work to dismantle HIV stigma so that no one is stigmatized, regardless of their viral load. We cannot benefit from stigma reduction while leaving others behind. A conversation about undetectable status must include dismantling structural stigma.
History and the present show us that advancements in HIV don’t translate into getting such advancements to those who need them most. We’ve seen that in regard to PrEP and gay men of color. We must continue to advance the basic yet radical notion that health care is a right, and we must ensure access to quality health care for all.
We can change the conversation. Let’s start taking about justice when we talk about HIV and the need to achieve an undetectable status. Right now undetectability is a privilege. We must make it a right.