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Stop Stigmatizing HIV-Positive Sex

The reaction to the sex life of a newly crowned Mr. Gay New Zealand is a reminder that our cultural baggage surrounding HIV is as heavy as ever.

"If you take your medication, [HIV] is a perfectly manageable thing to live with," said Charlie Tredway. "What you have no control over is how others will treat you once you give them that information."

Tredway was recently reminded of that fact in a very public way. On February 12, he won the title of Mr. Gay New Zealand, a pageant that aims to build future leaders within the local gay male community. The 33-year-old HIV/AIDS educator made no secret of his status—in fact, he made it a central part of his campaign, promising that if he won he would use the title to promote HIV education and stigma reduction.

Stigma did not prevent him from winning the competition, but it did threaten to spoil his celebration. Within days of his win, commenters on a local gay blog post went wild, tying him to a profile found on an unnamed "barebacking website." The New Zealand Herald picked up the story a week later, with an editorial to follow decrying the dangerous and "disappointing" message Tredway had sent to his community by "support[ing] unprotected sex." It contends that Tredway's message was unwelcome because the New Zealand Ministry of Health and some public health organizations still promote unflagging condom use. 

Condoms remain the safest way to protect against several STDs, but it's no longer the only way to prevent HIV. While the Herald article notes that "HIV infected people must take 'reasonable steps' to avoid transmitting HIV" by New Zealand law, it fails to realize that Tredway does, in fact, take an extremely reasonable step by maintaining an undetectable viral load, a transmission prevention strategy known as TasP (Treatment as Prevention).

The op-ed notes that Tredway informs his partners of his status, but makes no mention of his undetectable status. It's a key factor in HIV transmissibility, meaning that lab testing is unable to detect the virus in his blood. Multiple studies have shown that being undetectable makes transmitting the virus onto others nearly impossible; in one, called the PARTNER study, 888 straight and gay serodiscordant couples (in which one was HIV-positive and undetectable, with the other HIV-negative) had condomless sex 58,000 times. The virus wasn't transmitted once.

The CDC, which endorses TasP—alongside the World Health Organization's UNAIDS program and a slew of global health organizations and medical figurespredicts that if 80 percent of HIV-positive Americans were able to achieve undetectability, it would prevent more than 160,000 new infections by 2021. (For context, more than 39,000 Americans became HIV positive in 2015.) For HIV-positive people, maintaining undetectability through rigorous treatment is as important a prevention strategy as any, including using condoms. Tredway also maintained that he uses condoms in the majority of his sexual encounters, and only has unprotected sex with HIV-positive men or HIV-negative men on PrEP, a treatment that reduces one's risk of acquiring HIV.

"Nobody needs to die of AIDS anymore, but it still happens," said Andrew Goodman, a practicing HIV specialist and the associate director of medicine at the Callen-Lorde Community Health Center in New York City. "It happens because people don't have access to healthcare or housing. It happens because of depression, anxiety, chaos. That's what kills people. That's what takes lives."

When we spoke, Tredway didn't seem too upset by the negative press—annoyed, yes, but not upset. But as someone who has lived with HIV for 11 years and works as an HIV/AIDS educator, currently serving as the community engagement officer of the New Zealand AIDS Foundation, the implication that Tredway doesn't understand how to prevent the transmission of HIV felt like "a case of 'show me the receipts,'" he said. Just as bad, his critics relied on outdated science to make their point, ignoring that Tredway's sex life reflects current recommendations from medical and public health organizations.

"To tell me I don't know what fucking HIV is. I mean, come on," Tredway said. "What's actually outrageous and detrimental is outdated science and moralism that isn't grounded in where we are now with our approach to safe sex. Whether that means TasP, regular testing, condoms, PrEP, or many of those in tandem, they are all very, very important. If all we needed were condoms and moralistic judgment, we would've ended HIV decades ago."

Spreading misinformation about HIV can be harmful, as it contributes to an already prevalent stigma surrounding the virus and those who have it.

"Stigma can easily become violence," said Darlene Torres, co-director of client services at the Anti-Violence Project, an organization that aims to reduce violence against LGBTQ and HIV-affected communities. "The point is to dehumanize a person. The shame is intentional, and the message is that they are dirty, shouldn't exist or have a life of happiness, safety, or respect."

That's the kind of callous cultural attitude that made a friend of Tredway think it was OK to say, "Well, we always knew you were gonna get it," after first learning of his HIV diagnosis. It's what made another think it was acceptable to tell random people at a nightclub about Tredway's status.

"The more visibility you get, the more you break through the misconceptions of what it means to live with HIV," said Tredway. "[I want to] break down some of those barriers that say we're not as good as the rest of our community. That we're not happy. That we're someone to be afraid of. That we're not just normal, wonderful people, in the same situation as everybody else."

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