Staying positive: The realities of dating with HIV
The risks of having sex with an HIV-positive person have changed. The stigma hasn't.
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After eight years of living with HIV, Jason Cole is used to rejection and ghosting. But it still stings. It happened most recently when Cole was chatting with someone on the same-sex dating app Grindr.
“It was a great conversation. And it got as far as the point where we were talking about meeting up. And I actually brought it up with him: ‘Hey, have you had a chance to take a look at my profile? He said ‘no’,” said Cole, a writer from Brampton, Ont.
The profile is totally upfront. It says Cole is HIV-positive but undetectable: Thanks to antiretroviral treatment, the virus is under control and at very low levels in the blood.
“I didn’t hear from him after that. He blocked me.”
It wasn’t the first time something like this happened. Like many people living with HIV, Cole faces a lot of stigma from potential partners, plus “ignorant” remarks like “How did you get it?” and “At least you don’t have AIDS.”
“Very few have been from a place of nastiness. It’s from a place of fear,” Cole said.
Those fears — and the stigma that comes with them — are out of step with reality.
Thanks to powerful new drugs, there’s a vanishingly small risk of passing HIV to another person through sex if the virus is undetectable in the blood. If antiretroviral treatment is combined with condoms, the danger is close to zero.
You’re far, far more likely to get it by having unprotected sex with someone who’s in the highly contagious early stages of HIV infection, but doesn’t know it yet.
This suggests that the tough HIV talk prior to sex shouldn’t necessarily be “What’s your HIV status?” But “When was your last HIV test?” and, if the person is negative, “Are you taking PrEP?”
Pre-exposure prophylaxis or PrEP, known under the brand-name drug Truvada, is a daily medication that dramatically reduces the risk of contracting HIV.*
Paralyzing fears of having sex with HIV-positive people — no matter how safe it is — persist.
Public health messages about HIV prevention that try to scare people into safer sex contribute to the stigma, said Sarah Chown, executive director of YouthCO, which supports young people living with the virus in B.C.
And stigma, she said, is actually driving the epidemic.
“It makes it harder to access information. It makes it harder to talk to doctors and parents. And it makes it harder to disclose your status.”
“Rejection hurts and it’s awful,” for positive people Chown said. “And it really hurts because we know people with HIV go to great lengths to avoid passing the virus to others.”
Being open about your HIV status is not the only way to prevent infecting others, Chown explained. Using condoms, having a partner on PrEP, being undetectable and choosing not to have penetrative sex also work.
It's not just frowned upon to have sex without disclosing you're HIV-positive, it's illegal in Canada, even if you use a condom or have a low viral load (but not both). Both Chown and Cole called on the federal government to change this.
At YouthCO, young people practice disclosing their status with HIV-positive peers first. Some kids strategize by dropping various facts about HIV into conversations with friends and potential partners in the weeks leading up to the disclosure conversation, Chown said.
But the HIV-positive teenagers she’s working with today are not having a “substantially different” experience than eight years ago when she started, she said.
“We need to build a community that knows the truth about HIV, and that is supportive and welcoming to people living with HIV.”
HIV: By the numbers
In a study of 888 European couples with one HIV-positive partner in appropriate treatment, this was the number of new infections among the HIV-negative partners.
About 92 per cent
The reduction in the risk of HIV infection among people taking pre-exposure prophylaxis (PrEP) medication as directed.
The approximate number of people living with HIV in Canada.
Correction: July 19 2016 9:58 a.m. - An earlier version of this article incorrectly stated that Truvada is not approved by Health Canada for HIV prevention. Metro regrets the error.
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