Abstract
It is now established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. Previous research has shown that ‘being undetectable’ changes how HIV‐positive gay men experience their sex lives. But how does it affect gay men’s reproductive behaviours? And what influence does it have on views about parenthood at a time when gay fatherhood has become more socially accepted and publicly visible? Drawing on qualitative interviews with patients and clinicians at four HIV clinics in London, we identify differences in how interviewees talked about the possibility of having children for HIV‐positive men. Both groups, unprompted, frequently referred to sperm washing as a method enabling safe conception. However, whereas clinicians talked about sperm washing as an historical technique, which is no longer necessary, patients spoke of it as a current tool. The men rarely mentioned being undetectable as relevant to parenthood and, when prompted, some said that they did not fully understand the mechanics of HIV transmission. Our findings offer new insights into how biomedical knowledge is incorporated into people’s understandings of living with HIV, raising important questions about how the meanings of being undetectable are communicated.
Highlights
It is established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners
The dominant clinical position has shifted from the recognition that having an undetectable viral load significantly reduces the risk of HIV transmission to the more recent acknowledgement that, for people living with HIV whose viral load is undetectable, there is effectively no risk of transmitting HIV to a sexual partner (Cohen 2019, Rodger et al 2019, The Lancet HIV 2017)
We present findings of a qualitative interview study conducted at four HIV clinics in London between May and December 2016, shortly before U = U received official endorsement from major medical and public health organisations including the British HIV Association and the US Centers for Disease Control and Prevention, but when ‘undetectable’ had already become a common category used by people living with HIV (Persson 2016, Race 2015, Young et al 2019)
Summary
It is established that people living with HIV who have an undetectable viral load and adhere to antiretroviral treatment cannot transmit HIV to their sexual partners. The dominant clinical position has shifted from the recognition that having an undetectable viral load significantly reduces the risk of HIV transmission to the more recent acknowledgement that, for people living with HIV whose viral load is undetectable, there is effectively no risk of transmitting HIV to a sexual partner (Cohen 2019, Rodger et al 2019, The Lancet HIV 2017). This shift is captured in the slogan ‘Undetectable Equals Untransmittable’, or ‘U = U’, launched by Prevention Access Campaign in 2016. We encourage finding ways to effectively communicate about the implications of being undetectable which could guide considerations of gay, bisexual and other men who have sex with men about the possibility of having children, and foster a more holistic understanding of HIV transmission
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