Being undetectable is something that many people living with HIV aspire to, but for me it is not a goal.
This is a structured goal of United Nations, agencies, national strategies and clinical staff. The new slogan “UNDETECTABLE = INTRANSMISSIBLE” dominates my Facebook, and I find it very interesting because it seems that all that serves to be undetectable is to avoid transmitting the virus. We do not talk about opportunistic infections, CD4, inflammation and other things in which maintaining a low viral load, also supports.
I am NOT undetectable right now, and of all the moments of my life in which I felt “infectious”, no one wins this one. Some of the speeches about undetectability often do not contemplate what it means for other people to be undetectable. Somehow, it sounds as easy as lowering the volume of music, and I even feel excluded for not being that “a la mode” as some people living with HIV make it looks. Very often is used as some kind of stigma shock absorber, and without even noticing we create more layers of stigma.
The fear of transmitting the virus, I believe that at some point, if not constantly, almost most of all had experienced, and for that reason I fully understand the value of being “UNDETECTABLE = INTRANSMISSIBLE “. If you can do it, great and from the bottom of my heart, I congratulate you. However, there are other things that have priority for me, including that each person, irrespective of his or her HIV status, has the tools to live a pleasurable and healthy sex life. In other words, that the protection of a person, does not depend entirely on me, because that causes me even more stress, than the probability of transmitting the virus.
Personally, I feel that using our undetectability primarily as a risk reduction tool within national plans and global goals, even if prevention programs do not contemplate it (tremendous contradiction, by the way), is another way of giving us greater responsibility in our beds. Above all, when the main purpose of undetectability should be OUR QUALITY OF LIFE, and I find insulting that even when taking my medications, I have to do it thinking about other people too? Girl!
I have changed schema several times, at least three (3) times. This is not to mention the changes I had before the age of nine (9) with protocols and AZT per vein that I received until seven (7). To be exact; AZT by vein, staduvine, nelfinavir, emtricitabine, ritonavir, atazanavir and nevirapine. Up to the present raltegravir, abacavir and lamivudine liquid, tablet and combination.
When you have been living with HIV for at least fifteen (15) years, you may have changed therapy several times, perhaps in less time. I am not sure how many schemes I will have available, but I know that at this point I do not have many left. Especially with combinations in a single pill, because sometimes you are not resistant to all medicines that have a single pill have, but there are discarded alternatives that might be viable, and that, I think, is the downside.
Being aware that I do not have so many alternatives of therapy, changing the schema and burning them, for not achieving being undetectable, is not a good business for me. If I can keep my CD4 at a good level, and I can use other things that complement, my priority, and this is very personal, is to have good CD4 count, not to be undetectable. Usually a low viral load, goes hand in hand with high CD4, but not always.
I plan to live, at least until my fifty (50) years, and I know I will live more, but that is my minimum, so I think of the schemes available for at least, my next 20 years of life. That there will be more options later? Yes, but I cannot count on that now. That a cure may come out later? I hope so, but it is not something I can count on while I burn my available possibilities.