Top 10 Stigma-Busting Myths About HIV

Don't fall for fake news; here are true facts.
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On World AIDS Day, it remains vital for everyone to have complete and accurate information about HIV. There have been new and exciting developments in HIV control and prevention like PrEP, but this also means that understanding HIV and how it’s transmitted can sometimes be more complicated. Here are some key myths that need to be set aside so we can all have sex safely and without undue fear:

1) Everyone with HIV is infectious and can transmit the virus:

FALSE. Several studies show that people with HIV who take HIV medication as prescribed and who, as a result, have what is known as an “undetectable viral load,” do not transmit HIV. Having sex with an HIV+ person who has an undetectable viral load is safer than having sex with someone who does not know their HIV status.

2) Condoms are the only way to prevent HIV:

FALSE: Condoms are a great way to prevent HIV and other STIs if they are used correctly during every sexual encounter, but they are not the only way to prevent HIV. Pre-exposure prophylaxis (PrEP) is medication you can take every day if you are at risk of HIV exposure.

Emergency post-exposure prophylaxis (PEP) is medication taken after condomless sex or other possible exposure to HIV. It must be taken as soon as possible after exposure and continued for a period of 28 days.

HIV treatment is also HIV prevention. People with HIV who start and stay on medications and who achieve an “undetectable” level of virus in their blood do not transmit the virus. Undetectable=Untransmittable. U=U.

3) PrEP is only for gay men:

FALSE: Not everyone at risk for HIV is gay, bisexual, or a man. Studies show that PrEP works for people of all genders. Having an honest discussion with a clinician about the kinds of sex you have and types of drugs you may use can help you decide if PrEP is right for you. PrEP is a powerful prevention tool that can significantly reduce the risk of contracting HIV while supporting a healthy, happy, and pleasurable sex life. Not everyone needs PrEP, but it is important that everyone knows about it as an option for their sexual health strategy.

4) The communities most impacted by HIV are also the ones starting PrEP the most often.

FALSE. Data from the company that produces Truvada, the pill approved for PrEP, shows that many men who are sexually active with other men are starting PrEP. Although this is great news, PrEP uptake among Black and Latino men has been much slower, despite the fact that these men make up the majority of new diagnoses. Women of color are also overrepresented in the HIV epidemic but are not showing rapid uptake of PrEP. There are many reasons that this disparity exists, but stigma is high on the list of causes. PrEP needs to be a part of routine primary care and sexual health services to lessen the stigma.

5) People with HIV who have undetectable viral loads in their blood may still have virus in their genital fluids and can transmit HIV.

FALSE. Although there may be small amounts of the virus occasionally detected in the semen or vaginal fluid of people with HIV who have undetectable viral loads, the virus is thought to be incapable of multiplying or replicating. Even though highly sensitive tests can occasionally detect the virus, the risk of it transmitting is effectively zero. Undetectable = Untransmittable. U=U.

6) People with HIV on effective medication who have an undetectable viral load sometimes have “blips” of virus in their blood — that means that they are infectious.

FALSE. “Blips” are episodes during which small levels of virus can be detected in the blood of someone living with HIV who is on medication and has achieved an undetectable viral load. This happens occasionally and often represents a virus that cannot replicate, a lab error, or a technical issue with the viral load test. Regardless of this small, temporary spike of detectable virus, people who are on medication that are undetectable do not transmit HIV. If someone has a “blip,” it is important to repeat a viral load test to make sure that the spike was truly temporary and not a result of resistance to medication. Increases in viral load due to the virus becoming resistant to a drug are not temporary, but resistance is less likely if medications are taken as directed.

7) I have to be on PrEP to have sex with an HIV-positive partner who is undetectable in order to prevent contracting HIV.

FALSE. Starting PrEP is a very personal decision. If your sexual partner has HIV, is taking medication for HIV, and has achieved and maintained an undetectable viral load, their risk of transmitting HIV is effectively zero. For some people, PrEP represents another layer of protection that allows them to enjoy sex with less anxiety, regardless of the fact that Undetectable = Untransmittable (U=U). HIV prevention needs to be customized to the personal needs of who is using it. In other words, a belt may keep your pants up, but it may feel better to also wear suspenders.

8) People newly diagnosed with HIV should wait and think about treatment for a few months before starting medications.

FALSE. In general, there is no reason to wait to start HIV (or antiretroviral) medications if you are newly diagnosed. There is an exciting movement to encourage people to initiate treatment on the day of their HIV diagnosis rather than waiting for weeks. HIV is, after all, an infection, so it is important that we treat it that way. Starting medications upon diagnosis reduces the time that your body’s immune system is exposed to HIV, which minimizes damage. Starting medications early can also rapidly lower the amount of virus in your blood to undetectable levels, effectively eliminating the risk of HIV transmission.

9) I shouldn’t have sex with someone who has an HIV status that is different from my own.

FALSE: There are many strategies you can use to have a happy and healthy sex life with people who have a different HIV status than you do. Condoms help prevent HIV and other STIs if you use them correctly and consistently. If you are positive, treatment prevents HIV transmission. If you are negative, tools like PrEP and PEP can nearly eliminate your risk of HIV. We shouldn’t limit who we love or who we are physically intimate with based on a single test result or the number of pills they take. It is important to have open conversations with your partners and clinicians to make sure you create a prevention strategy that works for you.

10) An HIV-positive test is bad news.

FALSE: The only bad HIV test is the one you don’t take. Any result, positive or negative, is an opportunity to stay healthy. If you are negative and at-risk for HIV, there are many options to keep you negative, including condoms, PrEP, and PEP. If you are positive, you can start treatment immediately to stay healthy and to prevent HIV transmission. To end stigma, we must stop looking at HIV status as “bad” or “good,” “clean” or “dirty.” Knowledge is power.

Demetre C Daskalakis, MD MPH is Deputy Commissioner for the Division of Disease Control, New York City Department of Health.