Do you have to disclose your HIV status if your viral load is zero?
What viral load is, what "undetectable" means, and why it can be hard for people with HIV to share their status. Answers from an infectious disease doctor and a clinical psychologist.
Do you have to disclose your HIV status if your viral load is zero?
Recently in Purpur's stories, an HIV-positive woman answered your anonymous questions. One answer drew the most mixed reactions. It was about how she, with a zero HIV viral load, doesn't tell partners or beauty salons about her status.
That's when we realised we know little about HIV (maybe you do too). So Purpur asked for help from experts at a friendly foundation that supports people living with HIV.
Now we not only understand the details of viral load, but also see better why it is hard for people with HIV to share their status.
This piece was prepared together with the foundation's experts: a clinical psychologist, an infectious disease doctor and a team of lawyers.
So what is viral load?
It is a measure of the amount of HIV in the blood. It is calculated by counting the number of viral particles in 1 millilitre of blood plasma.
Viral load can naturally rise and fall, so it is assessed together with CD4. CD4 cells are a type of lymphocyte, some of the most important cells of the immune system. Their number shows what state the immune system is in.
What levels of viral load are there? How is it checked?
An HIV-positive person regularly (every 4–6 months) takes a viral load test and a CD4 count test. These results allow the treating doctor to assess how much the virus has affected the body, prescribe antiretroviral therapy and monitor how well it works.
Normally there should be 500–1,500 CD4 cells/ml. Anything lower is a sign of problems in the immune system.
Viral load is considered high if the test shows more than 100,000 copies of the virus per 1 millilitre of blood plasma.
With antiretroviral therapy, the number of copies gradually decreases. When it drops below 10,000 copies of the virus, the viral load is considered low.
What does a zero viral load mean?
Modern medication makes it possible to reach a zero, or undetectable, viral load.
This means that an HIV-positive person cannot pass on the virus, even through unprotected sex.
Wow! But STIs and unplanned pregnancy haven't gone anywhere, so use condoms for any kind of sex.
An infectious disease doctor's comment
There is a rule, U=U, which means undetectable = untransmittable (this has been studied many times since 2008 in couples where one partner is HIV+ and the other is HIV-).
This principle applies only to sex; the risk of infection through other routes remains. For example: blood transfusion, breastfeeding or injecting drugs.
You cannot get HIV during cosmetic procedures (provided that salons use sterile instruments), and the procedures themselves don't involve heavy blood loss.
Why is it hard for people with HIV to share their status with partners or at salons? A psychologist's answer
To a large extent, it is because of fear of prejudice and the biased opinions of people who know little about HIV.
If a person with HIV is not fully informed about their condition themselves and hasn't accepted their status inside, it isn't easy to calmly share it with others. Telling new people about their status can also be retraumatising for people with HIV.
After bad experiences (and reactions), some people may withdraw into isolation and refuse contact with others, or sometimes even refuse necessary medical care. For some, even with a zero viral load, it is easier to stop going to salons altogether.
"I want to share my status. What's the best way to do it?" A psychologist's answer
It's best to choose a neutral setting and wait for the right moment, so you can talk calmly without being distracted by other things. When you have time and aren't in a hurry. This matters for everyone: the person who wants to talk about their status and the person who will be reacting to the news.
You can prepare and bring, for example, an information leaflet about HIV. The person you are telling about your condition may know little about HIV. Most likely, you'll have something to discuss, or you can simply be together.
People react to news in different ways. Try to prepare yourself emotionally for any reaction from the other person.
But remember that a first reaction is only a first reaction.
Later, after thinking over the new circumstances, the person may react differently.
