Sean Glenn: HIV and Undetectable Transmission

During a therapy session a few weeks ago, my behavioral health provider asked me a question, "Why do you remain compliant?" (That is to say, "why are you taking your anti-retroviral medications?") To my surprise, my answer left him at a loss for words. After considering every possible vantage, I responded, "I take my medication for the sake of and as an act of service to the community around me."

I could discern the look of perplexity on his face at once. "Really?" he asked, "You don’t take it because of the health benefits and the guarantee of a greater longevity of life? I don’t think I’ve ever heard a patient respond that way."

"No," I responded, "because none of that is really up to me. I could get hit by a bus tomorrow; there are an innumerable myriad of ways that I could die unprepared, and a good 99% of them have nothing to do with the fact that I’m HIV-positive. I give my mortality up to God — we were all ordained to return to the dust one day. I just don’t know when. As such, I think it is more important for me to take my medication to ensure that no one around me contracts the virus from me. It’s the small role I can perform in an effort to eradicate the virus. Nothing would thrill me more at the end of my life than to know that this thing dies with me. That, I guess, is why I work to remain undetectable."

Of course, the virus will likely not die with my passing body, but we are getting closer to such a reality.

As Arthur Campbell Aigner’s eschatological hymn declares, "God is working his purpose out as year
succeeds to year: God is working his purpose out, and the time is drawing near; nearer and nearer draws the time, the time that shall surely be, when the earth shall be filled with the glory of God as the waters cover the sea."

For those living with, and among, the reality of HIV, the qualifier "undetectable" is a step to this divine purpose.

Yet, there exists, within the LGBT community at least, a long standing suspicion of the HIV sero-marker "undetectable." Conversations with some (as well as comment threads on HIV-related articles) display, even in the face of overwhelming scientific findings, a readiness to stigmatize the sero-positive and read "undetectable" as an excuse to "behave poorly and selfishly."

The science, however, may be in and my long standing beliefs seem to hold true in the face of the empirical evidence: treatment as prevention works. In a world where abstinence education simply will not hold among many communities, and where (despite the vast accessibility of condoms) unprotected sex continues its appeal for many partners seeking such a level of intimacy, treatment as prevention is demonstrating a long-ranging efficacy for the reduction of HIV transmission rates.

A landmark Partner study, which "tracked HIV transmission risk through condomless sex [where] the
HIV-positive partner is on suppressive antiretroviral medication—has so far found not even one case
of an HIV-positive person with an undetectable viral load transmitting the virus to a partner." This is
enormous news for both the sero-positive and sero-negative communities. Although researchers fully
disclose the fact that these findings are not yet the final telos for the study of transmission, the results
so far are telling.

As I mentioned in an article a few months back (HIV and Corporate Profit: Recognizing the needs of a Community), treatment as prevention is a method of preventing HIV transmission by ensuring that those who are sero-positive are receiving regular medical care and are taking an anti-retroviral medication so that their viral load (the measurement of viral duplications per milliliter of blood) remains suppressed.

While the scientific findings regarding the efficacy of a suppressed viral load as a part of the treatment as prevention model are indeed exciting, the broad-reaching social implications are somewhat frustrating. As Lucas Grindley comments, "What many experts already know about how HIV is transmitted still holds true: [n]ew infections usually come from people who are undiagnosed, who don’t know they have the virus, and who are not on treatment."

In my own experience, the day-to-day medical realities of life with HIV are seldom what keep people
from knowing their status. While my last article focused heavily on the imperative that anti-retroviral
medication be made as readily and easily available as possible, I also posit that stigma is an enormous
roadblock in the treatment as prevention model. Treatment as prevention only works when people
are willing to know their status, without fear of the systemic, legal, and historical project of HIV
stigmatization, especially as the greater impetus toward reducing medical and scientific illiteracy is
thrust upon the shoulders of the sero-positive.

It is, to say quite simply, an exhausting reality. I can no longer count the times I, among friends,
colleagues, strangers, and prospective lovers, have had to haul out the facts about transmission rates
among those who know their status versus those who do not. I can no longer count the number of
instances wherein I have heard a young man say, "I would get tested, but I’m too scared to."

These words, "I would get tested, but I’m too scared," could very well have been on the lips of the young man from whom I contracted HIV nearly four years ago. Had he known his status and had he been on an anti-retroviral regimen, the trajectory of my own life may well have looked quite different. But systems of stigmatization stood in the way of his own self-knowledge. Indeed, these same systems often stood in the way of my own self-knowledge. This was by no means his or my fault. It is, however, the reason I refuse to hide. It is the reason that I refuse to let HIV-stigmatization go uncriticized, even if it means deeply questioning the assumptions of some in my social circles.

As a church, both denominationally and ecumenically, we are called by the wounded yet living Christ to deeply question any and all manner of stigmatization. There was a slogan often rung out in the streets of protest in the late 1980s, "Our Church Has AIDS." This is still true. As members of the Body of Christ, we share each other’s wounds, and, as such, we are called into the process of reshaping (though never actually erasing) those wounds. If we share each other’s wounds, we share each other’s stigma. We are bound in the Eucharist to Christ’s own death and resurrection, yet also are bound to each other’s wounds, stigma, death, and resurrection, here and now.

The church can, therefore, lead in the project of treatment as prevention. The realities of HIV in our own communities should be openly discussed, and education about the various ways (not just abstinence) of navigating such a world should be requisite. We can end stigma together; and, if we end stigma, we may just be able to end HIV.



Sean R. Glenn is Integrity's Diocesan Organizer for Massachusetts. He is a composer and conductor of sacred choral music, and holds a Masters in Theological Studies from Boston University and a Master of Arts in Music from the Aaron Copland School at Queens College. His home on the web is www.seanglenn.com.


Sean Glenn is the Diocesan Organizer for Massachusetts