Do people feel ashamed if they're not using condoms -- and does "being undetectable" have a role to play there?
Micah: The message that's been out for 30-some-odd years is that you use a condom or you're bad. So yes, sex without condoms is stigmatized.
Some people in BBE will stand at the top of the tallest mountain and shout, "USE A CONDOM EVERY TIME!" In one way, it's good to have a cheerleader saying condoms are important; at the same time, we know that not everybody is going to be able to use condoms, or want to use condoms, or have the self-efficacy to use condoms every time. There's a risk context: alcohol and other substances, survival sex, fear ...
Blue: I recently talked with two different people who'd had condomless sex in the past few weeks and were saying, "I know it's bad." I really tried to validate for them that they weren't bad people, and I asked them to think about what was going on in that moment. They both said they consistently use condoms, so my question was, "What was different this time?"
Because a lot of the time, we just want connection. We want to feel needed, and wanted, and like someone is attracted to us -- and that's valid! It doesn't make you bad, it makes you human.
Micah: I always remind people, "I want you to have a healthy sex life. Condoms are one way to do it, but that's not the only way." I remind folks that there are other options to reduce risk -- like having an undetectable viral load, being the receptive partner [if HIV positive], having oral sex or manual sex -- so they don't feel like they are going to have a finger wagged at them for saying they didn't use a condom every time.
It sounds like they could also feel proud that, by taking care of their own health and having an undetectable viral load, they are also helping protect their partners.
Micah: Yes. That is something they talk about and that we validate. It's part of the culture of how we talk about risk reduction at BBE.
What would you say is the most important thing men in DREAAM and BBE need to understand about undetectable viral load?
Blue: That it's attainable. That's it's not out of reach. It's attainable if they are in a space where they can get into care, see their doctor regularly, and take their meds. It's not going to be an easy road; you have to work at it like anything else, but it's an attainable goal.
Micah: I like that; that's important. Another thing that's important for the BBE folks to understand is the health benefits that are correlated. If you have an undetectable HIV viral load, what does that mean for you if you're exposed to hepatitis? What does it mean for HPV [human papillomavirus] infection? What does it mean for your cardiovascular health?
There are so many ways in which HIV can impact our immune systems and have a systemic effect on our lives. If you can get your viral load undetectable, how will that affect other parts of your health? How does being undetectable affect your mental health? How does your viral load affect any meds you take for your mental health, or any ways you self-treat?
And what will it mean for the amount of virus in your semen? If there were more research about the correlation between viral load in blood and semen, and people could understand that getting to undetectable brings all these other benefits with it, that would give them a hell of a reason to work on getting their viral load undetectable.
Blue: Yeah, we have a guy who just got back on his HIV meds, and he said, "Wow, I feel better!"
Micah: Right! This discussion of all the potential benefits of undetectable viral load really speaks to the fact that the work Blue and I love to do is holistic by nature. Through and through, at the core, it is holistic health -- because the people we work with do not think about HIV as the sole thing going on in their lives.
The HIV public health approach that we all currently "live" in is grounded in the biomedical, and yet people have whole, complex lives within systems that are correlated and connected. We have to understand how HIV works in their system, in their community. The way we talk about HIV prevention and care needs to be holistic to be powerful.
To learn more and connect with Black Brothers Esteem, visit the group online or call 415-487-8018. Curious about the DREAAM Project? Call 415-575-0150 (ext. 273) to find out more and get involved.