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What Does an Undetectable Viral Load Mean for HIV?

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Someone’s viral load is the amount of the HIV virus someone has in their system. If someone’s HIV status is undetectable, it means their viral load is so low that most tests can’t measure it. If someone is undetectable, it’s very unlikely that they’ll transfer the virus to anyone else.

Most people who are being treated for HIV using ART (antiretroviral therapy) have an undetectable viral load. This means it’s very hard for them pass on HIV. Most times people get HIV, it’s from someone who isn’t on ART, or doesn’t know they have it.

Is an undetectable viral load the same as not having HIV?

HIV is treatable but not curable, so someone living with HIV will always have HIV. If they have an undetectable viral load, the virus is still in their body, in very low amounts. So it doesn’t mean the person doesn’t have HIV anymore.

If you’re on ART, continuing to take your medication will keep your viral load undetectable.

Can someone who’s undetectable still pass on HIV?

Someone who’s undetectable has nearly no chance of passing HIV to someone else.

A recent study, called the PARTNER study, followed 1166 serodiscordant couples (where one partner is HIV-positive and the other is negative). In each, one partner was on HIV treatment and had an undetectable viral load. There were both straight couples and gay male couples, although there were more straight couples. The couples were having sex without condoms, and no one used PEP or PrEP (medications that lower people’s risk for getting HIV). In total, the couples had penetrative vaginal or anal sex about 58,000 times.

For the two years of this study, there were zero cases of the undetectable person giving their partner HIV. The PARTNER shows that HIV transmission might be nearly impossible when the positive partner’s viral load is below a certain number. However, we can’t say so for sure without more studies, and data over longer periods.

Overall, the PARTNER study shows that passing on HIV while undetectable is very unlikely, if not impossible. If the partners use condoms or PrEP (pre-exposure prophylaxis), that would reduce the chance even more.

How are undetectable people treated under the law?

Not disclosing your HIV-positive status to a sexual partner is criminalized in Canada. This means that if there is a “realistic possibility” of the HIV-positive person passing the virus to their sexual partner, they have to say so. If they don’t, the person living with HIV could be charged with a crime, usually aggravated sexual assault. This can happen even if they don’t end up passing on HIV.

The Supreme Court has only defined a “realistic possibility” when it comes to penetrative vaginal sex. If the person with HIV is using condoms and has a low or undetectable viral load, they don’t legally have to disclose that they’re HIV-positive. In all other situations of vaginal sex, there is a “realistic possibility” and they have to disclose, even if their viral load is undetectable.

There are no definite rulings yet from the Supreme Court about what counts as a “realistic possibility” when it comes to oral or anal sex.

I’m HIV-negative. What if I don’t feel comfortable having sex with someone who’s undetectable?

It is always your choice whether or not to have sex with someone. There’s nothing wrong with choosing not to if you’re not comfortable with it. Choosing not to have sex with someone for any reason doesn’t make you a bad person or serophobic (afraid or judgmental of people living with HIV).

If HIV status is the only concern for someone, it can make them feel more comfortable to learn about the chance of transmission. Most cases of transmission are from someone who doesn’t know they’re positive, so they’re not on ART and they have a high viral load. For some people, it can help to know that an undetectable person is very unlikely to pass on HIV.

However, many people’s fears around sex don’t have to do with the actual statistics of risk. But these emotions can still have severe impacts on their sex lives. It’s okay to consider your feelings while deciding to have any kind of sex.

See the resources below for more.

More info:

  • HIV: Undetectable = Untransmittable Consensus Statement

    Research done in the 2010s shows that people with an undetectable viral load can’t pass HIV to someone else. In 2017, a long list of organizations, hospitals, and doctors signed this statement saying that they support this idea.

  • Viral Load – AIDS.gov

    Defines what a viral load is (for people living with HIV), what a normal viral load means, and what changes in viral loads mean. 

  • An HIV/AIDS Roundup – Scarleteen

    Article that dispels common myths about HIV and AIDS and provides information about HIV prevention, testing and transmission.

  • Dating someone who’s HIV-positive – Ask Alice

    This article talks about the emotions and potential risks involved when people who are HIV negative date or have sex with someone whose positive, and talks about ways of reducing the risk of transferring the virus.

  • The PARTNER study – i-base

    An easy-to-understand interpretation of the 2016 results so far of the PARTNER study.

  • Info-Traitment (for HIV and Hep C)

    A list of help lines and support programs for up to date information on HIV and Hepatitis C treatment in Quebec. 

    Contact information is for one of several programs, AIDS Community Care Montreal’s. Phone line and one on one support available Monday to Thursday from 10h to 18h. See the website for other services.

  • HIV Disclosure and the Law – Canadian HIV/AIDS Legal Network

    Details on laws and case rulings surrounding HIV disclosure.

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