2017 Is the Year That HIV Stigma Is Finally Loosening

This May, Hans Berlin, an HIV-positive gay porn star, gave an acceptance speech at the Grabbys, an annual awards show for the gay-porn industry. Hans was accepting an award for best threeway for a scene from Skins 1 (link NSFW), a bareback flick. This marked the first year (also NSFW) that bareback studios were nominated in the award show's history.

"We've come a long way, if you think about it. Thanks to PrEP and treatment as prevention, it is safe to show condomless scenes," Berlin told the audience, referring to methods for preventing transmission among those who are HIV-negative and HIV-positive, respectively. "For HIV positive performers like myself, there's still a lot of studios that I cannot work for because our studios are testing for the virus and not for viral load… We have to get the message out. 'U equals U': Undetectable equals untransmittable. The science is clear about that."

Despite how clear the science is, the message is still in the process of catching on—and for everything modern medicine has done to make HIV serodiscordant sex safe, stigma against HIV-positive people remains high.

Since 2015, two studies—named HPTN 052 and PARTNER—have confirmed that when an HIV-positive person is on antiretroviral therapy (ART) and has achieved an undetectable viral load, or when the number of copies of HIV in one's blood falls below levels that tests can detect, they effectively cannot transmit the virus. It's a prevention method known as treatment as prevention, or TasP. Not a single person living with HIV in either study who'd been undetectable for at least six months transmitted the virus to their partner. And that was among thousands of couples studied.

This past July, two months after Berlin's acceptance speech, an additional study titled Opposites Attract was presented at the International AIDS Society Conference on HIV Science. And it really punctuated Berlin's point. Among the study's 343 gay mixed-status couples and 16,889 condomless sex acts, there were zero HIV transmission among those with an undetectable viral load.

Last week, on the eve of HIV/AIDS Awareness Day, big news came when the Centers for Disease Control and Prevention (CDC) released a statement that publicly acknowledged that those on ART who maintain an undetectable viral load "have effectively no risk of sexually transmitting the virus to an HIV-negative partner." With the CDC officially behind the science, 2017 has become a watershed year in the understanding and acceptance of HIV undetectability, proving what many have known for years.

The CDC's announcement is a huge victory, particularly for the Prevention Access Campaign (PAC), one of a handful of awareness campaigns promoting TasP. Each of the studies have had what some would call caveats. Across all three, nobody who maintained undetectability transmitted the virus. Some HIV-negative participants did acquire the virus for other reasons, such as from partners who hadn't achieved undetectability, or from people outside their relationship. But the founder of PAC, an HIV activist named Bruce Richman, has been challenging the idea that they're caveats at all, insisting that words matter. He's been working hard to get HIV/AIDS service organizations to update their language when discussing the effectiveness of treatment as prevention and what an undetectable viral load really means. And it makes sense: When the CDC says "effectively no risk," that's a much more powerful message than something like "low risk."

Watch activist Peter Staley talk about his work with ACT UP to fight the AIDS crisis in the 80s and 90s:

Since PAC launched their "U=U" awareness campaign in 2016, they've gotten more than 400 organizations from 58 countries behind the message. It didn't come without a fight, though; Richman told me many organizations were reluctant to go all in.

Eric Sawyer, the vice president of public affairs and policy at the HIV nonprofit Gay Men's Health Crisis (GMHC), attributes that reluctance partially to the fact that few wanted to be the first to endorse such a statement. Couple that with the widespread prejudice that many feel toward those living with HIV, and it starts to begins to become clear why the "U=U" message may have been a hard pill to swallow.

"I think part of it is also based on the long term stigma of the virus and, you know, the absolute terror that has been associated for so long with being HIV-positive—that there has been kind of an internalization of that view of, 'I'm a disease, fatal, carrier of a fatal illness,'" Sawyer said. "That internalization and fear that you could do somebody bodily harm makes it hard to accept this kind of news."

The greatest factor in how someone internalizes an idea like undetectable = untransmittable, Richman wrote me, is where they hear it from. In the US and many other parts of the world, the CDC is one of the highest authorities on HIV prevention. The hope is that a statement from them will change the tide.

"I hope it encourages people living with the virus to have a higher opinion of their self-worth, and helps them destigmatize their own feelings about their HIV status," Sawyer added. "But I hope it also helps address the stigma, discrimination, and fear HIV-negative people have of HIV-positive people."

And despite all the progress made over the last year, the LGBTQ community—where the U=U message is sorely needed—is still rife with HIV stigma.

"I'm hoping that with the expanded knowledge of 'U=U,' and with the increased uptake of PrEP, that that divide and that 'us versus them' attitude will start to evaporate," Sawyer said, "and that more HIV-negative people will stop being adamant about not having sexual contact with people who are positive—because it still really exists to an alarming degree today."

Though public acknowledgment by the CDC is a huge step forward, the fight isn't over yet.

"There's still a lot of work to be done getting the message out accurately with our partners, especially in parts of the world where we see the most intersectional stigma and prejudice," Richman wrote. "And we need to really use this message as the public health argument for universal access to treatment, diagnostics, and services to keep people with HIV and their partners healthy."

And though HIV stigma is still widespread, Berlin's story may underscore the brighter future ahead for those living with HIV.

Berlin told me that since he gave his acceptance speech in May, he hasn't noticed any effects on his career or within the industry. He's still unable to work with some studios because of his serostatus, but what he found surprising was that despite coming out that night as a porn performer living with HIV, nobody made a big deal about it.

"Nobody hopped on that, and I also did not get less or more work after that. So far nothing has changed; no one on Twitter or anything said anything bad about me being positive and doing bareback porn," he said.

He was expecting a greater reaction to it, and said he wonders whether the lack thereof is due to shifting attitudes toward HIV, whether being HIV-positive within an industry like porn is no longer a big deal, or some greater force. Whatever the case, the fact he hasn't faced harassment or discrimination, by his own measure, for coming out as positive is breathtaking—and another bright point in what's been a remarkable year indeed.

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