Sex After Diagnosis: My Journey to Believing That Undetectable HIV Viral Load Means Uninfectious

Josh Middleton
Josh Middleton
Vincent Carrella

An image of the moment I was diagnosed HIV positive remains vivid in my mind. The feelings and emotions that ran through my body like a lightening bolt that day are not easily forgotten. They will be with me forever, as will my feeling of infectiousness upon hearing the words that have played in my mind like a broken record all these years: "Josh, I am sorry, but you are HIV positive."

I remember telling myself that this would be the end of the road when it came to my sex life. Children? Forget it. That would never happen. Who would ever want to be with me, and how could I bring myself want to be with someone else again when condomless sex got me into this situation in the first place?

The first time I had sex after my diagnosis, it was with a sex worker in Tijuana, Mexico. This was a major step for me. At the time, I had not yet started treatment. I knew enough about HIV to understand that by using a condom I would be protecting both her and me. I longed not only for the physical affection I felt I would never again receive, but also mentally I wanted to prove to myself that sex was not out of the picture.

I went into a small brothel labeled a "massage parlor." You know those ones, right? Where happy-endings are not only a hope, but a guarantee. Well, yeah, it was one of those. In typical red light style, they had all the women line up, and I chose the one I would spend the next few hours with. As I glanced over, I saw a beautiful woman in her early thirties with long black hair and green eyes. Let's call her "Alejandra."

I didn't know whether I could bring myself to disclose at this stage of my diagnosis. I knew it was the right thing to do, even though we were both protected by the condom, but I didn't know how she would react. I figured that I needed to tell her, even if she was a sex worker providing a service. And so, I did.

Not only was Alejandra very understanding, but she gave me the boost of confidence I needed to move forward. I'll be frank with you: Despite her acceptance, I was just not ready to have sex yet. The mental image of my diagnosis played over and over in my mind. I couldn't help but feel "dirty," a word I know is grotesque when describing HIV status. It wasn't because of the act I was engaging in, the person I was having sex with or even the place itself. I could not focus on the pleasure but only the fear. "What if" this condom breaks? How is she going to react? How am I going to feel if something happens and know I was the one responsible for it? My viral load was around 28,000 at the time, and I knew I was "most" infectious the days, weeks and months following my seroconversion.

It was a night that I used sex as a method of coping. It was a night that I will never forget. It was before I learned what an undetectable viral load truly means.

Within a month of starting treatment, I achieved my goal of "undetectability." At the time, I was a fresh, new advocate and the news of treatment as prevention was still considered "iffy" in the minds of many. I knew the fear well. I had good intentions in telling people that they should always use a condom. I was still learning about prevention myself while trying to share what I knew with others. The idea of telling someone not to use a condom if they were adhering to their meds was just crazy to me. The idea of pre-exposure prophylaxis (PrEP) also seemed crazy. I had myself convinced that I needed to see X amount of studies before I could promote such things.

I was convinced that condoms were the way we would end this epidemic, until one day it all clicked. I went from not believing the research, to believing there was not enough research, to stating, "Well, there is still a risk," to full acceptance where I can now say without a doubt, "There is no risk." I came to realize that not logic but shame and fear were clouding my advocacy and my sex life.

I wanted to share the feeling of empowerment with others, and this notion has been strengthened by the recent findings of PARTNER study, along with statements by leading experts in the field. It was one thing to see the studies done on others and a whole other thing to put it into practice in my own life.

Since the beginning of my last relationship, I had insisted on a condom. However, I again reminded myself of the evidence. With each negative test on her part and each doctor's visit confirming I was still undetectable, it was clear to me that the science I was sharing with others was not just numbers on a page but something real. I had seen it with my own eyes. It was now confirmed not only by studies but also by personal experience: Undetectable truly does equal uninfectious.

What did this news mean for me? Well, it meant that I could finally enjoy sex again. Sure, a condom is something I still use as a method of contraception when the girl I am with is not on other forms of birth control. I practice monthly testing to ensure I am clear of any other sexually transmitted infections. But when in a serodiscordant relationship, it has proved to be a game changer. And, the thought of having children, something I once thought to be impossible, is now a real possibility. I don't have to worry one bit about HIV transmission because the studies clearly state what many have been afraid to fathom all along: The risk is zero.

Reaching undetectable is not only going to help me live a near normal lifespan like everyone else in the world, but it's also going to protect whatever partner I choose to have sex with or settle down with. No longer am I driven by fear but rather passion, just as it should be. This doesn't mean that disclosure is off the table. Unfortunately, we still have stigmatizing laws surrounding this topic; moreover, morally I believe it is always the right thing to do. Now, whether the government should be getting involved in peoples' sex lives is another topic entirely.

Above all, an undetectable viral load helped me reach a point of acceptance with the virus. It made me realize that I have control over HIV: That's right, me -- not the other way around. When I was detectable, I felt helpless as HIV continually multiplied in my body without my permission. Now the tables have turned, and HIV has nothing on me.

Sure, taking a pill once a day may be an inconvenience. But it's a small price to pay when my life and the lives of others are concerned. Reaching this point in my journey was not easy, but now that I have reached it, I couldn't be happier.

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Read Josh's blog, PozitiveHope.