GMFA HIV-undetectable: sex without fear Words by Matthew Hodson | @Matthew_Hodson I guess we’ve all been thinking about fear recently. Fear is a perfectly rational response to danger. Fear can keep us safe. But a state of perpetual fear is not sustainable and it is not healthy. As many of us have declared loudly in recent weeks, we cannot and we will not live our lives in fear. Fear is never far removed from any discussion of HIV. Fear was there in the first HIV prevention campaigns of the 1980s, as a giant tombstone engraved with ‘AIDS’ thudded to the ground. There is still fear at the heart of almost any conversation when an individual says to a friend, a family member or a sexual partner: “I have HIV”. Since the AIDS crisis first hit us, many gay men’s sex lives have been tainted by fear. The sex we have, which should be an expression of intimacy, passion, lust, tenderness and joy, has all too often been accompanied by thoughts of ‘is this safe enough?’, ‘will I be OK?’ or ‘will he be OK?’ Given this context, it’s perhaps understandable that large numbers of gay men choose to have sex under the influence of drugs that suppress their inhibitions. But now we are at the start of a new era. We now know that someone who is undetectable on treatment will not pass the virus on to their sexual partners. If you’re in a sero-discordant relationship (one person with HIV, one without), or just having sero-discordant sex, and the guy with HIV is undetectable you can choose not to use condoms without fearing HIV transmission. In terms of HIV prevention, if condom use is safer sex, then sex with someone who has maintained an undetectable viral load is even safer sex. Those of us who are living with HIV have been told for years that our bodies, our love (or, prosaically, our cum) is dangerous. This has had a profound emotional impact on many people. The idea that we do not pose a risk to our partners can be hard to take in. For many the fear is too deeply ingrained to be easily wiped away. This understanding of the impact of treatment on prevention has come at the same time as people have become increasingly aware of PrEP, with significant numbers of gay and bisexual men in the UK accessing it by ordering it from overseas suppliers. For some men, PrEP has not only made their sex safe, it has granted them freedom from fear while having the sex that they enjoy. As one new PrEP user wrote to a colleague recently: “For the first time since I came out eight years ago, I’m not afraid of sex and HIV doesn’t feel inevitable.” It’s entirely possible that as we free ourselves from the anxieties of HIV, we can give greater consideration not just to what full sexual health means to us personally, and how we achieve it, but also to how we treat each other sexually and romantically. Sex without fear need not mean sex without care. I remain a condom advocate. They’re cheap, simple and prevent transmission of a host of STIs, including HIV. But I refuse to condemn people who can’t, won’t or simply sometimes don’t use them. I’d rather find practical solutions to help all people avoid transmission of HIV. If it bothers you that other people are enjoying sex, you might need to consider who it is that really has the problem. If the sex you have has never been spoilt by fear, that’s great for you. But if fear has been your companion, take comfort, it need be so no longer. Sex should be fun. Sex should be passionate, loving, crazy, tender, hot, mind-blowing and all manner of adjectives that declare that this is something that our bodies were designed to enjoy. I don’t want to live my life in fear. And I don’t want anyone else to either. Matthew Hodson is the Executive Director of NAM aidsmap.