Without a knowledge base in public health, the first populations most vulnerable in the HIV epidemic—LGBT people, sex workers and people who use drugs—had to develop prevention strategies. This work was both political and creative. The art collective Gran Fury created posters and ads with overt sexual and political messages.
“Kissing Doesn’t Kill” was a poster and a bus ad in New York City. The full line, “Kissing Doesn’t Kill: Greed and Indifference Do,” stretches across the top above three couples: an interracial heterosexual one, an interracial gay one and an interracial lesbian couple. They kiss above the line “Corporate greed, government inaction, and public indifference make AIDS a political crisis.”
While these phrases situate the poster as political critique, my 20-year-old self found the kissing a revelation. This was an intimacy that was safe when sex itself was deemed “unsafe.” The art inspired me to think about sex acts that do not transmit HIV.
Fast-forward to the Positive Women’s Network–USA Summit in 2014, where more than 200 women with HIV and a few allies gathered to address needs. I was lucky to be invited to a roundtable on race in diverse coalitions.
Afterward, I attended a workshop on HIV prevention—viral suppression, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). During the presentation, a woman shared that even though she was virologically suppressed, her partner took PrEP and they used condoms. “Why?” the moderator asked. “Because I can’t believe I’m not infectious,” she admitted softly.
How many of us carry this weight? I’m not the only one in the room who teared up. After decades of being afraid of HIV, of acquiring it and then being nervous about contagion, of not feeling good enough to be desired or loved, I find the information on virologic suppression almost too good to accept.
Studies show that when a person’s HIV is undetectable on a viral load test, there is not enough active HIV in the system to transmit the virus. Viral suppression is being touted as a practical cure: If everyone with HIV were virologically suppressed, the logic goes, then no transmissions would occur. This strategy assumes that virologic suppression is a static space and, once achieved, a person stays suppressed.
Sexually active people are faced with another HIV dilemma and even more questions about prevention. Considering viral suppression as an indicator of non-infectiousness, what is the practical difference in being HIV negative or living with undetectable HIV? How does this impact my own sex? Does viral suppression mean that the condoms are off? Is there a point to serosorting anymore? Why do gay men still use the identifier DDF (“drug and disease free”) in online sex ads?
I am virally suppressed. I do not know if I believe I am not infectious. I don’t know if it’s just the HIV or if this is a burden carried under my ethnic skin my whole life. My queer body has never signified the all-American boy next door. The HIV added another layer.
To engage in discussions about HIV and vulnerability is to have meaningful dialogue about sex and drug use. This is difficult in the United States. We have to do the work of defining the ways that we are comfortable with sex and substance use—by ourselves and with others. We have to adjust to discomfort. We have to make a language out of our desire and pain. We have to witness others’ fumbling attempts. We must make space for compassion, even in sex and substance use.
I will meet the men who will help figure out this new era of HIV prevention. I will learn from doing it. I will write about it for you.