Undetectable

[RandyC]

I am traveling to several cities over the next few weeks and thought I might hire an escort at one of my destination cities. I found someone who interested me and sent an email to inquire about availability. After a disappointing experience recently when an escort was unable to perform with a condom on, I am now very clear that I only play "safe" to make sure that any potential hire understands my expectations. He responded that he is fine with "safe" and that he is undetectable. I am very happy and very impressed that he volunteered this information but I am now honestly conflicted about hiring him. I always play safe and know that anyone can be infected but am concerned that the fact that I now know he actually is infected will put a damper on the activities. I am a not proud of my feelings but I am really not sure what to do. Please do not ask for a name as I will not provide one as this is his story to tell. I won't name the city either although the escort is not local to that city. Looking for intelligent, kind and thoughtful input.

[+ nycman]

Knowledge is a double edged sword.

 

I wish I didn’t have the same doubts and confusion as you, but the truth is I often have.

 

In the end, I did the simple math. I’ve been with hundreds of men. Many of them had

to have been HIV+. I just didn’t know it at the time. Take a deep breath. Realize that

the man who has had the honesty to tell you the truth about his status is thousands

of times more trust worthy than the men who have kept silent.

 

If it really freaks you out (and it’s ok if it does, you’re human), I’d say be open and

honest with him. Discuss your fears and concerns. If your willing to try and get

over your phobia (and in this day and age, it is a phobia) discuss with him what

you’re comfortable doing. You may find that this openness, honesty, caring and

compassion takes your sexuality to an entirely new level.

Edited November 24, 2018 by nycman

[+ sam.fitzpatrick]

There is quite a bit of information on the subject of undetectable = untransmittable. Here is a link to one such article.

 

https://www.positivelyaware.com/articles/undetectable-equals-untransmittable

 

Perhaps reviewing some of these studies will help you reach a decision.

[rvwnsd]

@sam.fitzpatrick posted the same information I was searching for. Thanks for posting.

 

The one thing I'd add is by him telling you he is HIV+ undetectable there's no guessing or assuming. You now know his status and can take whatever precautions you wish to take.

[+ FrankR]

I am very happy and very impressed that he volunteered this information but I am now honestly conflicted about hiring him. I always play safe and know that anyone can be infected but am concerned that the fact that I now know he actually is infected will put a damper on the activities. I am a not proud of my feelings but I am really not sure what to do.

I find your humanity and honesty refreshing. It is hard to admit that we have blind spots. Honestly, it wouldn't change the equation for me - I always go into a meeting assuming that there is a STD present; and plan and play accordingly. There is no need to be ashamed of your feelings: they are exactly that - Your...Feelings. The only thing I would add as unsolicited advice is that when it comes to communicating with the provider, be honest and be kind (but from your post above, I expect that is a given).

[rossthebosssf]

Like the saying, "I'm clean" the same could be said about "I'm undetectable". Just because someone tells you that, it doesn't mean you're in the clear or that it's true. People lie. With that said, make your own informed decision and protect yourself to the extent that it makes you comfortable. While I have had unsafe fun with guys who said they're undetectable, it's only because I was on PrEP so there was somewhat a fail safe. Have you considered getting a prescription? It might put your mind at rest. Especially if you use a condom in addition to PrEP. There's lots of programs out there that make it easy to get and quite affordable if not free.

[Guest]

I am traveling to several cities over the next few weeks and thought I might hire an escort at one of my destination cities. I found someone who interested me and sent an email to inquire about availability. After a disappointing experience recently when an escort was unable to perform with a condom on, I am now very clear that I only play "safe" to make sure that any potential hire understands my expectations. He responded that he is fine with "safe" and that he is undetectable.

Well, if you hire escorts with any regularity, it's a pretty safe bet that you've had sex with someone who has HIV and didn't disclose it to you. Don't kid yourself. If you are uncomfortable with the idea of having sex with someone who has HIV, you shouldn't hire escorts. And some of the escorts won't be undetectable. That being said, he may be truthful about the fact that he's undetectable, but that only means he was undetectable on the day he was last tested, which, presumably, isn't the day you're being intimate with him. If you only want to have sex with people without HIV, only have sex with men you know and trust well enough to be sure of their status. So, condoms with everyone, and then you have to ask yourself whether you want to also have the additional protection of Truvada/PrEP. Whether you want to add PrEP probably depends on how often you have sex with men whose HIV status you can't be sure of, and what exactly you're doing with them (oral being much less hazardous than receptive anal). Adding the Truvada brings the risk of transmission almost down to zero, but long-term use of the drug can lead to kidney and bone damage.

http://www.thebodypro.com/content/72567/weighing-risks-of-tdfftc-prep-side-effects-in-peop.html

Life is about evaluating risks and benefits. I might be killed by a drunk driver or someone else every time I drive to work, etc., but we don't live in a risk-free world. Why did the chicken cross the road? Presumably not because it enjoyed the risk inherent in crossing the road, but rather because it felt there was something on the other side worth the risk.

[Guest]

This table gives a good idea of the risks of transmission for any given sex act with someone who's HIV positive and not undetectable:

http://www.poz.com/pdfs/P04-14p53.risk_transmission.pdf

According to that table, being undetectable reduces the risk by 96% or more. Condoms reduce the risk by 80%, and Truvada alone by 92%. If he's detectable, and he fucks you without a condom, but without ejaculating in you, your risk for transmission would be 0.65%, probably a risk few wise people would take. Adding the condom reduces the risk to 0.077%. Truvada alone reduces the risk to 0.05%. The two together, 0.01% (1 in 100,000). Of course, the condom introduces no medication risks, but the Truvada adds medication risk while reducing transmission risks. Of course, these risks are per sexual act. So if you have a lot of sex with people who are or might be HIV+, the medication risk stays the same, but your protection benefit increases greatly.

[wbtravis]

I have to say that I am impressed with this thread. The poster was honest about his concern and as I read on, I braced for hate and judgment. Instead, I saw support and information. SO very cool of you guys, and refreshing as hell. We’re navigating a lot in the world of non-monogamous sex, and I am grateful for this resource.

[Mydavid]

I have a question:

If he checked 2 months ago, and it was undetectable, what's the possibility that he is not undetectable any more now?

Edited November 26, 2018 by Mydavid

[rvwnsd]

I have a question:

If he checked 2 months ago, and it was undetectable, what's the possibility that he is not undetectable any more now?

A quick Google search revealed several results, but a Q&A posted on Beta with Barry S. Zingman, M.D., medical director of the AIDS Center at Montefiore Medical Center in the Bronx and professor of medicine at Albert Einstein College of Medicine seemed to be the most comprehensive and well-written. One of the questions is:

 

Q: If I’m undetectable, is there a chance my viral load will become detectable again?

A: Being undetectable does not mean that you are cured of HIV. There are three instances when your HIV viral load might come back and be detectable again.

 

The most common instances are so-called viral “blips.” Blips are when your HIV levels become slightly detectable, but at a very low level, and then goes back to being undetectable again. People may experience viral blips when they take their HIV medications every day. Viral blips are usually due to issues in the lab, such as some slight error in the test or in the test conditions in the lab. Occasionally they are due to a slight but true increase in the viral load due to a stress such as an illness or a vaccine. Viral blips, in which the viral load goes right back down to undetectable soon, are considered harmless. There is no appreciable chance that a person with a viral blip will transmit HIV to another person.

 

People also become detectable when they stop taking their HIV medications or take them only partially. It may take between a week to several weeks after stopping HIV treatment for HIV to become detectable again, but people will see the levels of virus in their body go up to detectable levels.

 

The least likely scenario for a person to go from being undetectable to detectable these days is if the virus in their body becomes resistant to the medications they are taking. (“Resistant” means the medications have stopped working against HIV.) This is very rare for people who take their HIV medications every day, because the HIV medications we prescribe these days (and at least for the last 10 – 15 years) are very powerful and control HIV very well if taken properly. Resistance is no longer something that is expected to occur, no matter how long a person is treated, as long as they take their medicine well.

He also addresses the meaning of "Undetectable", as follows:

 

Q: If my viral load is undetectable, can I transmit HIV to other people?

A: I’m very happy to say that we know the answer to this. If you are undetectable, and have been on HIV medications for at least six months, and you continue that treatment, the risk of transmitting HIV is effectively zero.

This finding has been well-established over the last six to seven years by multiple research studies. After studying thousands of couples, over many years, research has shown that if an HIV-positive person is on effective HIV medications for at least six months, is undetectable, and stays on their HIV medications, they will not transmit HIV to other people.

The Q&A is a good read. I'd advise reading it and referring back when questions come to mind.

[corndog]

According to that table, being undetectable reduces the risk by 96% or more. Condoms reduce the risk by 80%, and Truvada alone by 92%.

 

I think that it worth taking a moment to let this sink in: Current science is telling us that PrEP and U=U are significantly safer than condoms, which I think we all consider the tried-and-true gold standard.