In spite of my expensive, state-of-the-art pharmaceutical cocktail, in spite of having the best AIDS doctor in the city, in spite of the much-touted "End of AIDS," my membership in the undetectable elite has suddenly been revoked: The virus is back. And my survival, once more, is in question.
Yet only last week, in my doctor's waiting room, I was thinking how nice it would be not to have blood drawn. Just once to drop in, say hello and tell him how great I was feeling. My treatment was working, my viral load undetectable. Side effects were few and easy to tolerate. HIV was only distantly troubling. Why call all this into question with the painful stick of a needle?
I was living the glory days of my infection, working hard to beat the virus. And winning. I had self-confidence and peace of mind. I felt handsome and successful. I had found the courage to out myself as positive all over the place because I could temper the bad -- "I have HIV" -- with the good -- "But I'm undetectable." I was even beginning to worry more about my friends worrying about me than I did about my own health. Undetectable was blanket reassurance in a word.
Not that I was taking my treatment success totally for granted. Life has taught me that the key to overcoming disappointments is to expect them, and at the heel of every happiness lunges a "This is too good to be true" skepticism. So my state of mind from moment to moment was actually a bizarre mix of euphoric confidence, secret paranoia and pure panic. The only thing that clarified this mess was my lab work. But curiously, with each passing month -- each undetectable -- my anxiety only increased. And my obsession with the all-powerful PCR intensified.
Such was my confused mood when the strange fantasy of skipping my lab work seized me. Whatever the potentially threatening scientific, medical, laboratory truth about my virus on that particular day, maybe I just didn't wanted to know. Did I already somehow sense that my virus had broken through? I wonder.
More than anything, I wanted to diminish the power the lab work has ... er, I mean had over me and, for that matter, my doctor's power, the drugs' power and the power of HIV itself. I wanted to wrestle free from an obsession, refocus a life centered on test results, take a flying leap off the HIV merry-go-round of pills, test tubes, results, pills, test tubes, results, pills ...
Alas, I didn't escape from the doctor's office unstuck. And when I returned the for the results, my worst nightmare was confirmed.
I put off telling anyone the bad news. I was ashamed and shaken, shocked and tongue-tied. Words failed me -- especially because the vocabulary I once used to talk about my health had been narrowed down to that single undetectable. If I no longer am that, what am I? How could I explain a state of affairs that neither I nor my doctor nor even "Man of Last Year" Dr. David Ho understands? Are there any new combinations that might work for me? Could the test result be wrong? A mistake by the lab? Someone else's blood? Am I about to get sick? How long do I have to live? Will my friends feel -- as I do now -- that my days are numbered? If I tell them, will they cry?
I racked my brain to solve the how and why of my treatment failure. Is it somehow my fault? I frantically reviewed my behavior and scrutinized my memory. Did I have unsafe sex and get re-infected? Is it because I took my Crixivan with food or at 10:30 one night instead of at midnight? Did I ever, in the past 10 months, miss a dose? Or is it an error of physiology, some kink in a gene? What has shortened my life? Because suddenly my life did seem shorter.
So that was then. This week I'm convinced that being undetectable, while definitely desirable, is grossly overrated. I gleefully cast my mind back to the time before viral loads, that quaint, nostalgic era when only CD4-cell counts mattered. In order to cope, I have decided to change my terms and redefine my assumptions, like a child who tempers his sadness, disappointment and anger at not getting what he wants with the insistence that he never wanted it in the first place. I can and will live with a detectable viral load.
Now all I have to do is believe it.