My mate got an STI from his undetectable buddy – could he get HIV too?
“Charlie, I can deal with the gono, it can be treated quickly and easily as soon as it’s diagnosed, but this is a bit more serious, yeah!?” The urgency in his voice indicates where his head’s at. I’m just here to support my best friend while he battles believing he could become HIV positive.
The clinically dull waiting room has the kind of chairs that look inviting, but are evidently not designed for comfort. Positioned opposite, a young woman drops the glossy magazine she idly flicks through. As she picks it off the floor, I fleetingly catch her eye, wondering if it was Tom’s tone or mention of an STI that caused her to flinch.
I’m tempted to wander off into soap opera style fantasies that put me as the main character wearing my best mate’s shoes. But this is not my drama.
I reply with a hushed tone “OK. We don’t know that anything’s serious yet… besides, you’re here doing something about it. It’s Blake. He’s undetectable — you won’t need PEP.” The young woman glances up once more, but Tom seems oblivious even if I’m not.
“It’s Blake. He’s undetectable – you won’t need PEP.”
“Is that your expert opinion?” snaps Tom “Blake blows a load in me every time we fuck and I have no idea how long he’s had gonorrhea for!” Turning closer towards him I notice someone in my peripheral vision fidget awkwardly. But it’s pointless obsessing over what anybody else in earshot thinks. I need to focus on supporting Tom.
It’s no secret my best mate’s fuckbuddy, Blake, has HIV. He’s very open about it. I can appreciate what Tom sees in him. Unapologetic, outspoken and fine looking all American boy through and through, plus emotionally intelligent too. I think he’s the first openly HIV positive guy I met who talks about what it means to be undetectable. When he and Tom first started hooking up I think I’d heard of it, but didn’t really understand it means he can’t pass on HIV.
“But he’s undetectable. You know that, and you know what it means.” Despite his frantic phone call earlier begging me to join him at the clinic, I’m still not fully grasping what he’s so worried about. Tom’s usually cool about HIV and sex stuff.
Exasperated, Tom’s reply hangs awkwardly in the air “I thought I did, but what if the gono makes his viral load spike? Then what?”
I don’t have an answer. I reach out and gently squeeze his arm, as if somehow a simple act of camaraderie will make it all better. I genuinely wish it would.
“…but what if the gono makes his viral load spike? Then what?”
An upbeat young doctor breaks the atmosphere calling in a patient, but it’s not Tom. Rather than sitting in silence I feel it’s best to encourage him to talk it out.
Sitting by my side, his eyes fixated on the neatly arranged squares of ugly, durable carpet, Tom explains how Blake phoned him not long after leaving his place this morning. They’d spent the night together. The first time since Blake got back from a trip back home Stateside. Blake went for sexual health tests earlier in the week and got a call from his clinic first thing this morning — he’d tested positive for gonorrhea.
It’s the first time Tom’s potentially acquired something since he’s been with Blake. For all his knowledge and usual comfort to enjoy sex with someone who’s undetectable, Tom’s anxiety of sharing an HIV status with someone he appears to love is all too real.
Listening to him speak, the waiting room’s background noise fades out and I find my eyes staring into space, arranging the pieces of information into something I’m trying to make sense out of.
Something sharply snaps my attention back in to the room. My focus suddenly intent on the dog-eared poster pinned above the young woman reading her magazine. It proclaims ‘Syphilis may increase the amount of HIV in cum and pre-cum.’
Suddenly I get where he’s at… Does it make a difference if Blake’s on treatment? Is it just syphilis, or can other STIs do that too? What do I really know about this stuff?
“Look, even if his viral load is up — which you don’t know for a fact — you’re still within the 72 hour window period for PEP to help prevent HIV.” I wonder out loud what Blake’s take on it is “What did he say about how this affects his viral load?”
Tom’s body shifts noticeably in the chair. Did I touch a nerve? “He didn’t say anything… I didn’t ask. I was barely holding it together on the phone. What kind of message does it send when I’m freaking out about not knowing whether he can pass on HIV or not?” For all his worrying, the prioritisation of Blake’s feelings in all of this is immensely admirable.
I reply “So… I’m not Blake, and I don’t have HIV. But he’s doing just fine. And knowing Blake, I’m sure he’d be sensitive about informing you if he believed you were at risk.”
Tom relies on sarcasm to volley back “Oh, thank you for reminding me I’m overreacting here. Nice.”
But I’m not playing “Buddy, I get this is about you and you’re scared right now, but Blake is very much alive and well, and so are you…” Testing my privilege as best mate with a wry smile and just one eyebrow raised, I add “Even if you are riddled with gono.”
My humour pays off and is met with a friendly “Watch yourself!” before he continues his train of thought. “I feel awful for doing this. How can I tell him I was scared of him?”
“I feel awful for doing this. How can I tell him I was scared of him?”
There’s permission to jovially shift the mood “You’re all good and this is gonna work out fine. Hey, once this is all over, remind me to kick your ass about handling Blake with kid gloves. Talk with him!”
Any opportunity for a comeback is cut short by an older, softly spoken doctor calling “Thomas”.
With a reassuring smile and the gentlest of nods in Tom’s direction as he rises, I’m left with just the company of my own thoughts and the returning temptation to contemplate what if I were him. What if I meet my own Blake? Is the comfort of all my knowledge enough for me to be intimate without being afraid?
It’s too warm in the waiting room. My mobile seems like a good distraction until Tom returns. Hopefully with PEP.
It’s been a month now. Tom just finished his course of PEP this week. Apparently he wouldn’t normally get it as Blake has been undetectable for more than six months, so there’s no risk of him passing on HIV. But knowing Tom’s determination and the possibility of having an STI, he got it prescribed anyway. His next tests are due in two months, and emotionally he’s in a good place.
Tom already knew about PrEP and the doctor suggested he consider it as an ongoing HIV prevention strategy. Even though he’s safe barebacking with Blake, I know he’s thought about it with other guys.
He and Blake did talk. Blake was awesome about the whole thing. He even explained that for his many years of being on treatment, having an STI has never resulted in his tests showing as detectable. He reckons it’s because he’s good with taking his HIV meds every day. Though he did emphasise the importance of getting regular tests to ‘seek and destroy unwanted stowaways’ as he puts it.
As for me, I hooked up a few times. Nothing unusual. The PrEP dude I met a few months back who was keen to fuck me raw hasn’t been so chatty of late. I guess if his other conquests offer it up without a rubber, guys like me may not be as appealing to him. Still, I’m doing just fine. I mean, I could go on PrEP, but I don’t know how I feel about doing it just so I can bareback. I guess I’ll cross that bridge when I come to it.
For people living with HIV who aren’t on treatment, having an STI such as syphilis can cause an increase in viral load. However, for people who are currently using effective HIV treatment, STIs appear to have no or very little impact on viral load.
The current scientific consensus is that there is no risk of HIV transmission from a person living with HIV who is on antiretroviral therapy and has achieved an undetectable viral load for at least six months.
PEP is a one-month course of anti-HIV drugs intended to prevent HIV acquisition after possible exposure. PEP is best started within 72 hours after exposure, and ideally, as soon as possible. Get PEP explains how and where to get PEP wherever you’re based in Australia. Discover more in PEP: Protecting you against HIV when you need it.
Charlie’s previous story involves negotiating safe sex with a PrEP user: He told me he’s on PrEP and wanted raw sex. Here’s what I said.
To discover more about the topics raised in this story, check out the following articles:
If you want to discover more about HIV prevention, treatment and other sexual health topics, check out our Knowledge Hub or contact your local LGBTI health organisation.