The Freddie Guide to: Having an HIV+ Partner

What is HIV?

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HIV stands for Human Immunodeficiency Virus. It’s a virus that attacks the immune system and stops it from working properly, making someone more vulnerable to infections and diseases.

HIV is transmitted when bodily fluids – like blood, semen, breast/chest milk, and vaginal or rectal fluid – get into the bloodstream of another person. If it's not treated, it can cause severe immune dysfunction and make someone vulnerable to fatal infections and diseases. This stage is known as Acquired Immuno-Deficiency Syndrome, or AIDS. 

Thanks to modern HIV treatment, AIDS is now rare in countries like Canada and the US. However, global access to treatment remains unequal.

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An HIV history lesson

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In 1981, rare illnesses started to appear in healthy, young gay men in the United States. At first this was called Gay-Related Immune Deficiency (GRID). In 1982, this was re-named as AIDS.

In 1983, scientists in France identified HIV as the virus that causes AIDS. And in 1996, the first effective treatments for HIV were discovered. These treatments are known as Highly Active Antiretroviral Therapy, or HAART. They are still in use today.

When HAART arrived, over one million people globally had died of AIDS-related causes. In North America and Europe, HIV/AIDS mostly affected marginalized groups like Black and Indigenous people, people who inject drugs, gay/bisexual men and trans women. Stigma and discrimination towards these groups meant they were neglected by medical and political authorities. For example, President Reagan did not deliver a speech on AIDS until 1987 – by that point, over 4,000 people had died in the United States alone.

HIV/AIDS didn’t actually start in 1981. In fact, people of colour and injection drug users in the US had already been dying of unexplained illnesses. These were largely ignored because of racism and stigma towards drugs. When the virus was finally noticed, it carried stigma because of how it is transmitted – sex and drug use – and the communities it mostly affected.

‍Although treatment has come a long way, this stigma persists.

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How is HIV treated?

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HIV invades cells in the immune system and then makes copies of itself. HIV treatment works by stopping the virus from invading these cells. When HIV can’t get into someone’s immune cells, it is unable to multiply and their immune system stays healthy and strong.

HIV treatment cannot cure someone of HIV. However, it can manage the virus extremely effectively. In fact, someone who is diagnosed with HIV today and starts treatment promptly can live as long as an HIV-negative person. 

The amount of HIV in someone’s blood is measured by something called a “viral load”. When their HIV treatment is working properly, their viral load can drop so low that they would not test positive on common HIV tests. This is called “undetectable”. For most people newly diagnosed with HIV, they can reach undetectable within a few months of starting treatment.

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Can you get HIV from someone who is undetectable?

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No! When someone living with HIV is undetectable, they cannot transmit HIV through sex.
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The risk is not very low or extremely low – it’s zero. This is known as “Undetectable = Untransmittable”, or “U=U”.

The science behind U=U comes from multiple studies that followed thousands of couples where one partner is living with HIV and one is not. These studies included straight and gay couples who all had condomless sex. There were zero HIV transmissions between partners when the partner living with HIV was undetectable.

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I’m HIV-negative, what does that mean for me?

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If you are in a monogamous relationship with someone who is undetectable, then they cannot transmit the virus to you. In these situations, you do not need condoms or PrEP to prevent HIV.

If you are in an open relationship or having casual sex, PrEP can be prescribed to help prevent HIV transmission with other partners. PrEP is a medication which helps prevent HIV when taken as prescribed. PrEP can have a risk of reduced kidney function and bone density, but this risk is low. A recent study of 14,000 PrEP patients found 0.9% had these problems.

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What about STIs?

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PrEP and U=U are HIV prevention tools only – they do not prevent sexually transmitted infections (STIs). If you are in an open relationship or have not yet been tested with your monogamous partner, you can use condoms or DoxyPEP. DoxyPEP is a medication that you can take after condomless sex that may help reduce the risk of some STIs. DoxyPEP can cause temporary digestive issues like nausea, but taking it with food can help.

Some researchers have also cautioned that using doxycycline for DoxyPEP may increase the risk of antibiotic resistance, particularly when used inconsistently. Public health units are carefully considering these risks alongside the benefits of reducing STI transmission. At the time of writing, DoxyPEP has been formally endorsed by America's Centers for Disease Control and Prevention. The Public Health Agency of Canada is currently conducting its review.

If you have an open relationship or are having casual sex, make sure you get regular STI testing and treatment as needed. If you’re on PrEP, you’ll automatically be enrolled in STI testing every three months.

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What to do when someone shares their HIV status

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Some communities face a higher burden of HIV, which means that if you are part of them it is more likely that you’ll know someone with HIV. For example, if you’re a gay man then you are more likely to have HIV-positive friends or partners. It also means you’re more likely to be in situations where someone shares their HIV status with you.

For many people living with HIV, disclosure can be intimidating. This is because of rejection, judgment or even violence that might have come with it before. If someone discloses their HIV status to you, here’s a few tips to help the interaction go smoothly.
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Do…

• Be supportive, calm and reassuring. Say “thank you for sharing that with me”. 
• Show them you already know about HIV treatment and transmission, like U=U
• Use person-first language like “person living with HIV”

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Don’t…

• Make it about you. Try to avoid “I” statements, which can place the emphasis on your emotions instead of your partner’s.
• Use words like “infected” to mean HIV-positive or “clean” to mean HIV-negative. These perpetuate stigma.
• Ask someone how they got HIV. This is irrelevant, and has no effect on someone’s health! It also implies that some transmission types are “better” than others.

If you’ve got more questions about living with HIV, try doing some research online first. This will show your partner that you’re willing to educate yourself, and can save them time and effort. You can use resources like CATIE to learn more.

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To conclude

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If your partner is living with HIV, you have multiple options for HIV prevention.

If they are undetectable, you can stop using PrEP or condoms to prevent HIV transmission when you are both comfortable. Their HIV treatment will prevent you from getting HIV.

‍We only recommend this in monogamous relationships. If you are in an open relationship, it is a good idea to use PrEP or condoms to protect you with other partners. 

If they have a detectable viral load, then use PrEP or condoms to prevent HIV transmission. We also recommend regular HIV testing.

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