Becoming “Undetectable”: Longitudinal Narratives of Gay Men's Sex Lives After a Recent HIV Diagnosis

Abstract

We explore gay men's sex life narratives following their diagnosis with an acute or recent HIV infection. All participants received an acute (n = 13) or recent (n = 12) HIV diagnosis and completed a series of self-administered questionnaires and in-depth qualitative interviews over a one-year period or longer. Over the course of four qualitative interviews, participants frequently spoke of the role of medications (e.g., decisions to start treatment) and changing viral loads (e.g., discourses of becoming "undetectable") in relation to their sex lives since being diagnosed with HIV. Many men talked about milestones relating to initiating medication and viral load as informing their shifting sexual behaviors and identities as HIV-positive--or "undetectable"--gay men. The narratives of our participants provide insight regarding complex negotiations and processes of decision-making over time related to sex, counseling needs, treatment initiation, viral load, and the significance of undetectability as an emergent identity.

Embodied, clinical and pharmaceutical uncertainty: people with HIV anticipate the feasibility of HIV treatment as prevention (TasP)

“…More recently, researchers have been investigating the various ways in which TasP as a biomedical technology and a technology of biomedicalisation is playing out in the intimate and social lives of people with HIV: that is, investigating the emerging social and intimate uses of TasP beyond reductions in HIV transmission on a population level (Davis, 2015;Grace, et al, 2015;Persson, 2016).…”

“…Grace has reported on the integration of norms around infectiousness (or non-infectiousness) associated with HIV treatments into identity formation and sexual practices of those recently diagnosed (Grace, et al, 2015). These researchers are addressing vital questions about the extent to which TasP is a disciplining and/or liberating technology and how it might be being used in novel ways by those engaging with it.…”

“ … it’s almost therapeutic, right? Because it’s almost like that session that I never had”: gay men’s accounts of being a participant in HIV research

“…Whether participation in national gay men's health surveys such as SexNow (CBRC, 2015) and GCPS (Holt, 2013) or involvement in smaller qualitative or mixed methods studies (Grace et al, 2014(Grace et al, , 2015, advancing research with and for communities of gay men is reliant on their interest in, and commitment to, participation. Through a novel analysis of participant narratives, we have used rich accounts of the self-described, interrelated impacts of study participation to reveal the ways in which the methods of quantitative and qualitative public health data collection may produce unintentional and unexpected effects for participants.…”

“…3. One approach, employed in our study with HIV-positive gay men, was to include a psychologist in our team to help develop an understanding of therapeutic dynamics and the ability to establish boundaries in our interviews (Grace et al, 2015; http://acutehivstudy. com/).…”

“…We conducted mixed methods research with a cohort of HIV-negative gay men (Grace et al, 2014) to build upon our research with gay men recently diagnosed with acute or recent HIV infection (Gilbert et al, 2013;Grace et al, 2015). In this paper, we draw upon the rich narrative data of our HIV-negative study participants to elucidate some of the complex emotional and behavioural impacts of mixed methods study participation.…”