Thursday, July 8, 2010

What does “undetectable” mean?


In technical terms, “undetectable” (with regard to HIV infection) means that the level of HIV in the blood is below the threshhold for detection, typically below 50 parts per milliliter.  During early stages of infection and before treatment, these levels can soar into the hundreds of thousands and even millions.  With aggressive treatment, levels will settle down to the thousands, the hundreds, and below.  There is a direct connection between this level and how infectious a person is apt to be; a major goal of treatment is to keep these levels suppressed, both to reduce risks of infection and simply to keep HIV from progressing into AIDS and further compromising the individual’s immune system.

Here are two web pages for some more info:

Please note that I’m not a doctor nor an expert on HIV therapy, so I can’t evaluate the details of those pages.  I’m just someone who (a) pays attention and (b) wants to help decode some of the codewords people use online.


“Undetectable” often gets used in online profiles to indicate a person who is in a healthy, monitored state regarding his HIV infection, someone who participates in treatment.  It is intended to defuse HIV-phobia, where guys are scared to have sex with HIV-positive guys.

Risky Behaviors

As with any of the phrases I’ve been writing about, though, “undetectable” is sometimes used as a codeword, something either used or interpreted to mean something other than the technical meaning.

In this case, there is an obvious connection that gets made between “undetectable” and “not infectious”.  This is an incorrect connection, of course, because the person is not cured; he is still infectious, albeit believed to be far less so.  This incorrect connection can lead sex partners to assume that unprotected sex with such a person is “safe”.

(Of course, some people are going to read this and be all offended because they think I’ve just accused them of trying to lure HIV-negative guys into having unprotected sex with them, when they are really just trying to put their health status out there.  Calm down, boys: I’m saying that some men use “undetectable” as a codeword for that result, and that some men read that as a coded invite for unprotected sex.  If you don’t use it or read it that way, super, but don’t lie to yourself: you know some guys do.)

Of note as well is the monitoring schedule.  Just as with HIV tests, which are only accurate at the time of testing, “undetectable” was the state at testing time.  Viral load testing is done every 2–3 months, so if the person has had an immune system change, including a change of therapy, a “drug holiday”, been sick, or gone on a bender — and heck, just day-to-day shifts can occur — what was “undeteactable” then may not be now.  (Add to this that some guys rarely or never update their profile text, especially not portions which would change their chances of getting laid.)  And thus coded use or reading of the term has an added risk attached.

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