If a pos man faithfully takes meds and is undetectable, am I, a neg man, sane in taking his cock bare?
He has no virus in his semen or blood. None. You cannot get a virus that isn't there. The cohort study is now 30 k strong. The research on U = U is rock solid. You cannot get HIV from him. So is it sane? I'm definitely not going to answer that. You must.
Now the case in which a man SAYS he's neg (last test after last hookup? If yes, neg. If no, unknown), you are engaged in the riskiest of all behaviors. Most transmissions are in this group.
Undetectable only means he was on that day of the test, which takes some time to get results.. It doesn't mean that they aren't still HIV+..
HIV POSITIVE means you have antibodies for the virus. Antibodies are immune cells. You don't get transmission from antibodies. Quite the opposite. They kill viruses. So HIV+ is not the same as infectious. It's not relevant. What's relevant is viral load. No virus, no transmission. And HIV needs lots of copies to infect. Missing doses even dozens in some cases isn't going to elevate viral load high enough to cause transmission. HIV positive folks who take ARVs are safe, health minded and not a risk of any kind.
It is true that undetectable means unable to transmit. The guy you meet on Scruff who says he's negative may be lying (or just inadequately informed), but the guy you meet on Scruff who says he is undetectable may be just as unreliable. I would be much more confident with a partner I know well enough to know he's taking his meds than a hookup, I suggest that is the main criterion for choosing bareback. But everyone needs to be thoroughly informed about the risks of other STIs that are becoming epidemic, and not always easy to treat.
It is true that undetectable means unable to transmit. The guy you meet on Scruff who says he's negative may be lying (or just inadequately informed), but the guy you meet on Scruff who says he is undetectable may be just as unreliable. I would be much more confident with a partner I know well enough to know he's taking his meds than a hookup, I suggest that is the main criterion for choosing bareback. But everyone needs to be thoroughly informed about the risks of other STIs that are becoming epidemic, and not always easy to treat.
The research is very clear. I've actually done it myself as well. The percentage of people who use the term 'undetectable' in social media but who are actually able to transmit is very, very low. No one generally claims HIV status as a means of avoiding stigma. Undetectable is not the best lie (and most sites don't require the status be filled which means most avoid it ) Negative is the best lie. And the percentage of people who claim negative status who are either lying or don't know is as high as 60%. You have made a false equivalency here. On BBRT, the percentage of people who claim undetectable but who may be able to transmit is less than 1%. They use 'don't know' instead.
Your advice that knowing a person is better than online is generational (the idea that you know a person well enough to know they are compliant if that person is not your spouse is astonishing. One, it's against privacy regulation to gather that data, and two if you aren't spying on someone your ability to detect lies is no better weeks in than before, perception is not an effective method). Most people think they are able to establish whether a person is HIV positive or not or telling the truth or not. The success rate is well below 40% and in some studies lower than 30%. The reality is hookup sites are what is used and that's not changing. The research has established that contra your assumption, some sites are far more predictive of accurate data on risk and have low percentages of transmission risk. None of the ones studied were as bad as personal perception.
It's really important to understand the topic before suggesting that the most unreliable statement with highest risk is no more risky than the most reliable statement. Undetectable status isn't something that goes away overnight. You have to go off anti retrovirals for days, sometimes weeks and in my case 3 years before you have enough virus in your semen to infect. The notion that people who have been on regimens faithfully and who see physicians 8 to 4 times a year doing bloods to check viral load are deliberately or even accidentally getting their viral loads high enough to infect is stigma based fantasy. There's no evidence that this is true and a lot that it isn't.
I am a senior level HIV history and culture researcher and an expert on this topic. I'm not doing this for my own enjoyment. I'm doing it because so many of you seem to have no problem sharing incorrect and potentially life threatening information despite being told otherwise. It's dangerous and it puts people at risk. The proper harm reduction advice is to use safer sex methods, avoid taking semen or blood during sex, get regular tests, and make decisions about your choices well rested, with risk in mind and try to limit number of partners.
If you must go with no condoms, take PrEP. If not, HIV undetectable status is statistically the most reliable statement of risk. It is the lowest by far. Yes, there have been spikes of other STDs. These are due to public health cuts, new reporting, antibiotic resistant strains, more travel, boomer retirement (seniors homes are hotbeds of clap and syph) and in some cases gay sex parties and drug use. This is widely reported but statistically not in the lead. I keep coming back to the use of this trend to create fear. Until the condom is used in oral sex the claim that no condom M2M sex is a vector that deserves a stigma halo and that there's a reliable way to be less risky that isn't one I mentioned is a fallacy.
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