Detectable vs Undetectable

[CaringguyinNJ]

Hi -

I'm not sure if I am posting this in the right section, so please forgive me if I am.  I have been reading so much information on this site as well as the Welcome threads to obtain as much information as I can regarding HIV.  My question is a HIV+ person having an undectable viral load vs a detectable viral load.  In short, I just started seeing a HIV+ guy.  From what he has told me, he is on medication and he is virtually undetectable.  My question is as follows...when someone is undetectable, does that mean that the risk of them transmitting HIV is low?  For example if I am performing oral sex on him and for some reason he ejaculated into my mouth (which I would always tend to avoid) by him being undetectable - does that mean the risk would be very low?  Now, if someone is detectable, and I did the same thing, does that mean that transmission of  HIV is easier?  I'm just confused on what this actually means.  I dont have to worry as he is undetectable and if and when intercourse comes into the picture, it will ALWAYS be protected.  I'm just questioning detectable vs undetectable.

I can't thank you all for your valuable input on this site.  As I said earlier, I just recently started dating a HIV+ guy and I am not looking at his having HIV as an obstacle as it can be overcome.  I just need to make sure that I am protecting myself, which when it comes to intercourse I always do.  I just have slight concerns regarding what I mentioned above.

Happy Holidays!

[komnaes]

Hey NJ,

Undetectable simply means an undetectable viral load result indicating that a specific viral load test cannot find any HIV in a given blood sample. It depends on the sensitivity of a specific test, but right now it usually means blood samples with below 50 copies/ml are described as having a viral load that is 'undetectable', or 'below the level of detection'.

But it of course doesn't mean you should just have unprotected sex with your friend as if he was confirmed HIV-. A person with undetectable VL still has the virus in his/her blood, but it's just in theory and mathematical term that the risk of transmission is lower, i.e. a person with undetectable VL is still capable of infecting another person in an unsafe sex situation.

Oral sex is not considered of high transmission risk, but most safer sex materials would advise you not to do so without a condom, in particularly not to allow that person to, er, shoot in your mouth. There are of course risk of other STDs and Hepatitis too.

Being in a relationship with one of us you and him should work out a bedroom plan that you both should stick to - there are lines that should never be crossed (penetration without condoms, etc), then the rest will depend on how comfortable you both feel.

Good luck and merry xmas..

[hotpuppy]

Caring,
  It's commendable that you are willing to do some research.  I read your other post.  Alot of guys never go as far as you do.  I know I didn't when I was neg.  So it's good of you.  I can also see from your questions that you are worried.  That's good too.  Fear is the only thing that will keep you safe and HIV neg.

  You are right to learn about HIV.  In particular you need understand how it's transmitted.  There are lessons that explain this.  If you have further questions that aren't addressed in the lessons, please feel free to post.  The only stupid question is the one you don't ask.

   As a gay male, you owe it to yourself to be vaccinated against Hep A and Hep B.  It's about $80 for a set of shots and it takes 2 sets.  The treatment is definately better than the cure.  Unless you enjoy being miserably sick, get your butt vaccinated.  Hep A you can get a restaurant.

   The rest of your sex is going to involve risk management.  It always will, so get used to it.  First off, HIV is not the only thing you need to be worried about.  Syphillis, Herpes, Clamydia, and Ghonorrhea can all make it easier for HIV to get in.  Think of those as a broken window and HIV as a thief that breaks in and never leaves.  It's important that you and your bf both be monogamous, and that you realize that he may cheat on you (or you on him) anyhow despite promising monogamy.

  I like to think of safe sex like a menu.  There are a variety of things that have very low risk.  Oral sex, kissing, etc are practically no risk.  For you to catch HIV from me through kissing I would need to gash my tongue and be profusely bleeding... in addition to you having a cut in your mouth.  Unless you are a vampire, I'd hope we wouldn't be making out if I was bleeding from the tongue/mouth.
  Oral sex.  Here again, you would need to have a cut, sore, and blood for HIV to get from one to the other.  Don't go deep flossing and sucking dick.  It's a bad practice.

Undetectable.  Let me give you an analogy.  Let's look at the risk of you getting hit by hail when you walk out your door.  Golfball sized hail.  I'm betting it would hurt.  If it's sunny and 90 out, the risk is low.  If there are dark clouds and it's raining, there is more risk.  Let's say sex is walking out your door and hail is HIV.  So what are the odds of getting HIV from having sex?  Depends on how hard it's coming down right?  If someone is undetectable, it means that in a drop of their blood the HIV virus cannot be found.  Right now, for most tests that means there are less than 50 copies of HIV.  If someone has 1,000,000 copies per drop... well, the odds are much higher.  Remember, it only takes one copy to give you HIV.   

Do not let undetectable fool you into thinking there is no risk.  It is less risk.  But there is still risk.  Typically bloodwork is done every 90 days.  So, worst case your bf's viral load could shoot up and he wouldn't know it for 90 days.

Condoms work.  Keep using them.

Let me balance your risk equation a bit.  17% of guys online lie.  25% don't know because they don't get tested or don't get tested regularly.  A test from 2 years ago when your drag name is bathhouse betty isn't good enough.  If you hop mattresses faster than a flea at the SPCA, a test 90 days ago may not be enough.  So, when you are dating someone who claims to be HIV Negative, you have a 50/50 chance of them being wrong.  The only HIV status questions that is almost always right, is positive.  Once you are positive, it doesn't go away.  Even if you test HIV negative today, that only covers you for 6 to 8 weeks.  So if you were whoring around last night and barebacking, the test today wouldn't catch HIV.

Some basic rules of thumb about HIV.
1) It likes protein.  Bodily fluids with protein are candidates for HIV.  This means: Blood, Semen, Vaginal Secretions, Urine, etc.
2) Saliva is thought to have an enzyme that kills HIV.  Don't bet on it with your life, but there is no protein there.
3) HIV is a relatively weak virus.  It cannot survive for very long outside the body.  Hepatitis on the other hand is something to be very concerned about.  Hep C in a needle can be infectious up to a week later.  HIV is rumored to die about a minute after leaving the body.  i.e. if I prick my finger and a drop of blood hits the ground... you need to be concerned for about a minute. 

Suggestions on dating a poz guy.
1) Talk to him.  You'll both feel better.  Work out a plan and a what if.
2) Realize he is probably as scared about infecting you are as you are about getting infected. 
3) Get tested regularly for HIV and other STDs. 
4) Get vaccinated.  You can make him sick alot easier than he can make you sick.  It's a BIG deal if we catch a cold.  At a minimum: Hep A/B, Flu shot, and Tetanus. 
5) Get lots of condoms and lube.  Keep them everywhere you might have sex.  Keep them where they are safe.  Condoms do not do well in high heat or extreme cold.
6) Agree on a "emergency landing" plan.  What will you both do if you are out of condoms, out of lube?  Figure it out now.  The time to discuss this is not in the heat of the moment when you are both ready for sex and or in the middle of it.
7) Discuss your disaster plan.  What will you do if a condom breaks?  What will you do if you do somehow become infected?  What will you do if you make your bf deathly sick because you got the flu and gave it to him?  Yes, the flu can kill someone with HIV.  Figure these things out before they happen.  It gives both of you an opportunity to participate in the fix. 

Btw, condoms rarely break when used properly.  Properly means with lube and put on gently.  They are not a paper bag and shouldn't be shoved on.  Some brands work better than others.  Some brands feel like they are made from 1" thick latex, and others feel like pure joy. 

Lastly, get all this crap out of the way.  Don't get so bogged down in worrying about HIV, Hepatitis, Syphillis, Loose Jet Engines, Stray Meteorites, or your mother in law that you forget why you fell for this guy in the first place.  Worrying sucks, Love rocks, Life is too short to be bogged down in horseshit.

[Ann]

1) It likes protein.  Bodily fluids with protein are candidates for HIV.  This means: Blood, Semen, Vaginal Secretions, Urine, etc.

Urine is NOT infectious. Blood, semen and cervicovaginal fluids are.

HIV is rumored to die about a minute after leaving the body.  i.e. if I prick my finger and a drop of blood hits the ground... you need to be concerned for about a minute.

Er, no, you wouldn't have to "be concerned for about a minute" in the scenario described. You wouldn't have to be concerned at all. For a start, the ground isn't going to get infected, so no concern there. Two, if you stuck your finger in this drop, you won't get infected through intact skin - or a cut finger either. Hiv is not successfully transmitted once it's out in the environment.

If an hiv positive person cut themself and was bleeding, and an hiv negative person cut themself at the same time and the two people rubbed their wounds together, THEN you might have something to be concerned about. But drops of blood on the ground? NO WAY.

Hiv doesn't "die", because it's not "alive" in the first place. Viruses aren't alive. What happens is the outer covering of hiv is very easily damaged by small changes in the environment. It only remains intact and able to infect when it's in the specific environment the body provides.

When the outer covering is damaged, it cannot latch onto other cells and infect them. Also, it can only infect a very few, very specific types of cells. These types of cells are mainly found in the urethra, the anus/rectum, and the vagina. This is why as long as serodiscordant couples use condoms for anal or vaginal intercourse, they don't need to worry about infection. Yep, it's that simple. Thousands of serodiscordant couples will testify to that fact.

Pup, I know you mean well, but what you've written here is quite alarmist.

Ann

[bill1322]

"alarmist" Good Lord! why? because of drops of blood? or because it's not couched in the "Master of Social Work" gobbledygook we expect hear?

If we had a few more answers like 'the Pup's,' in language we can understand, real life, anecdotal and personal, instead of the 'safe sex' crap we're fed, more of us might be able to deal with a 'normal' sexual life, cautious, but kinda normal.

This response propably helped the original poster more that your quibble about 'alive or dead' or 'blood on the floor'. He didn't care about that stuff - he wanted to know how to act, react and deal with a real life situation. You didn't bother to answer him but picked a nit with the responder - your answer did nothing but piss me off.

I noticed, in a big way that none of the 'social worker' types answered on the 'Positive/Positive' thread on another forum with any kind of real information. However my question was answered, with real life talk, experience, anecdotes and examples. There are more questions in that thread that many of you could answer if you were to be honest and draw on your real life experience.

None of us know the 'final answer.' But I'm better off knowing what my fellow Pozzers are doing than knowing how long the blood takes to die on the floor.

[CaringguyinNJ]

Hotpuppy,

Thank you very much for your thorough response to my posting.  I really do appreciate it.

[Ann]

Bill,

If you've ever read some of the threads in the Am I forum, you'd know exactly why I called the drop of blood comment alarmist. Unfortunately, those people do come over and read threads in these other forums and you can bet your bottom dollar that one or more of them will pick up on Hot's comment and freak out about it.

Sorry I pissed you off - but I'm not going to stop correcting misinformation when I come across it here. ~shrug~

Ann

[Miss Philicia]

but I'm not going to stop correcting misinformation when I come across it here.

And we thank you for this.

[bill1322]

Bill,

If you've ever read some of the threads in the Am I forum. . .

If this is the "AM Gatherings" forum, no I never read it, it seems like a travel agents blog. If on the other hand it's the "Forum Gatherings" under "Off-topic" forums, I don't read it either. Seems some bright social worker has changed the name of the forum to make everything clearer to us.

Sorry I pissed you off - but I'm not going to stop correcting misinformation when I come across it here. ~shrug~

Ann

Good - that is as it should be and we all appreciate it. Tone and style mean a lot in answering delicate questions, as I'm sure you know.

Bill

[Ann]

Bill,

"Am I" is shorthand for the Am I Infected forum. It's scary reading.

I don't know where you get the idea any of us are social workers, we're not. (at least none of the moderator team are)

I didn't think there was anything "off" in my tone, I even made a lame attempt at humour. (The ground isn't going to get infected.)

Ann

[Miss Philicia]

Bill, what's up with the continual social worker rants?  I don't get it, but whatever.

Ann is referring to the "worried wells" in the Am I Infected portion of these fora.  It's the first forum listed in the index, and it's the 3rd most used section of AIDSmeds.com hence Ann's concern/comment.

As far as tone/style well, I think that's subjective and everyone is going to come away with something different most assuredly.  You know, kind of like your social worker comments...

[hotpuppy]

We are all able to disagree and move forward.  Ann is correct... HIV doesn't "die" or "live".

However, I was quoting content from NextStep® a well established class given by Legacy Healthcare a Houston based ASO.  The quote about blood is a verbatim comment.  It may help to understand the full context of the quote.  The speaker was comparing HIV to Hep C.  Hep C remains infectious for quite sometime. 

The proper comment should have been that HIV is not thought to be an infection risk after approximately one minute outside the body.  However, I am not a virologist (and I doubt very many others on here are either).  I recommend that anyone reading this practice universal protection and treat all blood as potentially infectious.  HIV isn't the only bug in the field.

While I understand that some of us may disagree, I believe what I wrote to be accurate based on information provided to me by reputable, real-life, in-person and credible sources.  There is a substantial amount of misinformation out there regarding many HIV topics, and this thread isn't the spot to attack it.

For those that have read this far... my comments are intended to be big picture.  Not an exercise in minutae of HIV risk theory.  If I could convey only one thing, it is that I wanted the original poster to get some risk awareness education so that he can develop a comfort with activities that he and his partner deem to be low risk.

Our collective opinions are just that, opinions.  In my opinion, based on the information I have read, Hepatitis is a substantially more infectious bloodborne virus that remains infectious long after leaving the host.  HIV on the other hand is relatively fragile and is thought to be un-infectious in a reasonably short period of time after leaving the host (human). 

I can't state it strongly enough.  Please do your own research.  Knowledge is truly power and while I'm happy to point you in the right direction I would also encourage be your own advocate.  Negative or Positive you still need to be involved in your own healthcare.  Doctors, Nurses, Counselors, and Educators are all human and do their best, but they don't have the vested interest in you. 

As for those who may wish to misread my comments, attack them, or otherwise protest.  Because it's dificult to find absolute answers in many instances, I am often forced to evaluate the credibility of information, opinions, and articles.  I find that the bulk of the popular experience is a useful indicator of where the facts are likely to reside.  That works for me, your mileage may vary.  If you need to understand more about that comment go look up my post on co-infection.

As for those who may disagree.  I welcome your contrasting opinions and contributions and discourage simple attacks.   

Ann - no hard feelings.  I understand where you are coming from.  I had the urine thing mixed up.  I classify things as safe, unsafe, and nasty.  Urine exposure is in the nasty category for me which is to be avoided at all costs.  I understand some people enjoy fetishes associated with Urine and I hope that they have a golden time... it's just not for me.

[RapidRod]

2) Saliva is thought to have an enzyme that kills HIV.  Don't bet on it with your life, but there is no protein there.

Incorrect info above;  there is  437 identified proteins in saliva. There are ten enzymes found in native saliva have been determined: acid phosphatase, alkaline phosphatase, total esterases, cholinesterase, lipase, sulfatase, beta-glucuronidase, beta-D-galactosidase, lysozyme, and hyaluronidase.


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