Post Submitted by Renato Barucco, Transgender Family Program Manager at Community Healthcare Network

When the National Association of People with AIDS (NAPWA) launched National Gay Men's HIV/AIDS Awareness Day in 2008, the goal was to bring attention to the disproportionate impact of the epidemic on gay men. While NAPWA no longer exists, LGBT health advocates still consider September 27th an important opportunity to raise awareness and to cheer the progress we’ve made in treating and preventing HIV.

Biomedical prevention strategies such as Pre-exposure Prophylaxis (PrEP) and promising research on mixed-status couples are profoundly impacting the way we perceive, interpret and respond to the HIV/AIDS epidemic. Earlier this year, I argued there exists several more HIV statuses besides HIV-positive and HIV-negative. I’m excited to build on those thoughts today in an effort to counteract harmful misconceptions, to keep the conversation about HIV/AIDS open and vibrant and, of course, to mark National Gay Men's HIV/AIDS Awareness Day.

Here are at least five possible ways to make sense of one’s HIV status; from the safest to the most problematic.

1. HIV-negative (and using combination prevention strategies)

Combination prevention strategies refers to the many ways people can keep themselves from contracting HIV. Folks in this group use HIV testing and counseling as a form of prevention. They test for HIV on a regular basis (for gay and bisexual men the recommendation is once every 3-6 months). They use condoms consistently and correctly. As an extra layer of protection, some men in this group are regularly taking PrEP, a daily dose of HIV medication to reduce their risk of acquiring the virus. Those who decide that PrEP is not for them know that in case of emergencies or incidents (e.g. condom breakage, condomless sex while intoxicated, or forced encounters), they can count on Post-Exposure Prophylaxis (PEP). PEP is an HIV prevention strategy that involves taking HIV medications immediately after a single high-risk event. PEP can stop HIV from making copies of itself and spreading throughout one’s body, but the medication must be started as soon as possible, but no more than 72 hours after exposure.

2. HIV-positive (with undetectable viral load)

People in this group know their HIV-positive status. They see a medical provider regularly and take their HIV medications as prescribed. Consequently, the amount of HIV in their blood is lower than the threshold detectable by available tests, commonly referred to as being “undetectable.” An undetectable viral load reduces likelihood of HIV transmission. People living with HIV who regularly take their medication can significantly reduce the risk of passing the virus onto others by as much as much 96%. Moreover, an ongoing study of mixed-status couples has yet to identify a single case in which an HIV-positive person with an undetectable viral load transmitted HIV to their HIV-negative partner, by either anal or vaginal sex.

3. HIV-positive (not in treatment, unknown viral load)

It is now known that an undetectable viral load improves health outcomes in HIV-positive people and lowers their risk of transmission. Yet, only one out of four HIV positive people living in the United States is reaping the benefits of HIV treatment. The remaining folks are not linked to medical care, were not retained in care, are not on medications, or don't adhere to their treatment as prescribed. As a result, they are more likely to pass the virus onto their sexual partners. There's a silver lining in this group: people who are HIV-positive and not in treatment at least know their status. Knowledge gives them the chance to protect sexual partners and successfully navigate the barriers that keep them from accessing treatment.

4. Unknown HIV status

About 20% of HIV-positive people in the United States do not know they are infected. They’ve either never been tested for HIV or tested too long ago for all sorts of reasons: fear, stigma, or they honestly believe they are not at risk. The truth is that all sexually active people are at risk for HIV. The Centers for Disease Control and Prevention (CDC) recommends HIV testing for everyone between the ages of 13-64 at least once as part of a routine medical visit. Some of these folks are well aware they should get tested for HIV and hopefully they will test soon.

5. Self-proclaimed HIV-negative (without regular testing)

This is a troublesome group. At some point these folks tested negative for HIV. Months or even years later, they believe their status hasn't changed. They may have condomless sex with other self-proclaimed "neg" men. Sexually active people who use condoms inconsistently and do not test for HIV regularly cannot be sure of their negative HIV status. On top of a lack of actual knowledge, an additional complication for this group is the faulty sense of awareness. They fail to recognize that their HIV test results expires every time they have risky sex.

All week, HRC is helping to raise bolster attention surrounding National Gay Men's HIV/AIDS Awareness Day with a fact-based social campaign. Knowledge is powerful armament in the battle to end the HIV/AIDS epidemic. Like and share now to #BeintheKnow

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