Like any other group facing oppression and injustice, LGBTQ2S+ people have often had to channel a deep sense of resilience, patience, and pure grit as they advocate for themselves.
Homophobia, transphobia, biphobia and the myriad other “phobias,” “isms” and forms of hate consuming the heads and hearts of some people who inflict suffering and inequity onto others are pandemics that have been here much longer than COVID-19.
Marriage equality, access to quality healthcare, nondiscrimination protections in housing, education, employment, and even public spaces are still battles being waged by LGBTQ+ people worldwide.
What sets HIV/AIDS apart from these other issues is the unique space it occupies in the collective conscience of many people. It is a medical condition that has been weaponized by public opinion—fueled by homophobia and bigotry—so that those living with HIV must also shoulder the burden of managing ignorance.
Few other infections in the world carry such a malignant stigma, and those living with HIV/AIDS are often subjected to public shame. However, it’s 2021, and the growth of the internet, advancements in science, and access to reliable healthcare resources have repositioned the LGBTQ2S+ community to better combat hatred, both internal and external to the community.
Freddie Magazine interviewed staff members at HIV/AIDS organizations in Canada. With them, we discuss the culture and misinformation surrounding HIV/AIDS, ways of managing it, having sex with someone who is HIV positive, and what we can be doing to get transmission rates down to zero.
The History of HIV
Human Immunodeficiency Virus (HIV) is an infection that attacks the immune system. If the infection isn’t treated properly, it can turn into Acquired Immunodeficiency Syndrome (AIDS).
There can be three phases to an HIV infection: acute, chronic, and AIDS. In the acute stage, when HIV is first introduced into the body, it attacks and merges with white blood cells called T-helper cells. These cells help the body fight off diseases and infections. After merging with HIV, however, HIV cells begin to rapidly reproduce themselves, taking over more and more cells.
In the chronic phase, this form of reproduction slows, but HIV is still attacking cells. When undetected / untreated, HIV continues to damage white blood cells. This will eventually turn into AIDS, which signifies a very high viral load and a severely compromised immune system.
Progressing into the AIDS stage means that the person is highly susceptible to opportunistic infections that can further deplete the immune system and cause death in many cases.
Antiretroviral treatment uses several drugs (often into only one pill) that attack the virus at multiple stages and shut down the reproduction process to keep the immune system healthy. The first antiretroviral drug, AZT, was introduced in North America in 1987, and advancements since have been made to make the medication more robust and effective for those living with HIV.
The first known case of HIV transmission in Canada occurred in March of 1982. After the initial detected cases in Canada, transmission rates grew significantly in the 80s and 90s.
“Young, healthy gay men were suddenly and inexplicably dying,” said John Maxwell, executive director of AIDS Committee of Toronto (ACT), a direct service organization committed to reducing HIV infections and supporting those living with the disease and those at risk of contracting it.
“No one knew the cause of this. HIV—the virus that causes AIDS if left untreated—had yet to be discovered. There was no treatment, no cure. With government and mainstream health organizations largely silent, communities had to rely on their own for support.”
ACT was founded in 1983 and would join organizations like the AIDS Committee of Ottawa (ACO) and AIDS ACTION NOW! (AAN) in caring and advocating for those living with HIV and AIDS. As time moved on, these institutions would boldly continue their work of advocacy, direct support, and education.
According to Gary Lacasse, executive director of the Canadian AIDS Society (CAS), advocacy was unique in that “in the beginning, people who were living with HIV and dying of AIDS demanded to be heard and be at the centre of their care model. They achieved this, and [their advocacy] became the model for so many other illnesses.”
HIV/AIDS advocacy would set the standard for how leaders, advocates, and activists would educate and mobilize around treatment and cures for other illnesses and health disparities
Living With HIV
Within a month of contracting HIV, some people will experience a range of symptoms, from rash and fever to mouth sores and swollen lymph nodes. However, not everyone experiences these symptoms during the acute phase of the infection.
HIV can be transmitted through bodily fluids during sex, the sharing of needing or syringes, or it can be transmitted perinatally (or transmission between someone who is pregnant and their child).
The use of condoms and medicines like pre-exposure prophylaxis (PrEP) is key to reducing transmission rates. If you think you’ve had sex with someone who has HIV, post-exposure prophylaxis (PEP) is also an option to prevent HIV transmission, but the medicine must be taken within 72 hours of sexual contact.
Being HIV positive can present a fair amount of bigotry, judgement, and prejudice regarding the people in your life who know your status. Like any other person living with a medical condition, people with HIV are entitled to respect, dignity, and acceptance - regardless of their decision to disclose or not disclose their status.
Here are some terms you should know related to HIV:
- Person (or people) living with HIV–This is called “people first” language and centers the humanity of the person before the infection they have
- HIV–This is a virus you can be diagnosed with; AIDS is a condition and is not transmissible
- Mixed status/serodivergent– A pairing of one person living with HIV and one person who is not
- Treatment as prevention– A practice wherein HIV treatment not only keeps HIV positive people healthy, but also ensures they cannot transmit HIV sexually
- Know your status– A common refrain reminding sexually active people to regularly get tested for HIV and other sexually transmitted infections
- CD4 count– This is the number of healthy white blood cells in your system; for those living with HIV, it is essential to keep this number high and stable
- Antiretroviral drugs (ARVs)–Medications used to stop the spread of HIV in the body
- Antiretroviral treatment (ART)–A collection of antiretroviral drugs used to treat HIV, usually delivered as a single pill
This list is in no way comprehensive, and there are many more terms to learn and understand when it comes to HIV and its transmission.
Here are some terms to avoid:
- Clean–Referring to oneself as “clean” is a status judgement that connotes that someone living with HIV is “dirty.”
- HIV/AIDS victim or carrier–These terms disempower those living with HIV and define them as worthy of pity, sympathy, or rebuke.
- HIV infected–Another term that stigmatizes those living with HIV. Instead, use HIV-positive, or living with HIV
- Full-blown AIDS–It’s preferable to say someone has Stage 3 HIV or just AIDS.
- Unprotected sex–Today there are many ways to prevent HIV, a preferable alternative is “condomless sex.”
- Promiscuous–A judgemental term; there’s nothing shameful, or wrong about being sexually active
Having Sex With Someone Living With HIV
If you are HIV negative and are having sex with someone who is positive, there are some pretty straightforward rules to follow.
- Educate yourself. Know what being HIV positive means today, and what U=U is. Today, there are many reliable resources to read from and better understand advancements in treatment and prevention.
- Check your bias. We all have biases and judgements.. With enough education and learning from those living with HIV, we can make healthier decisions and treat each other with respect.
- PrEP can be an option. PrEP medicine is highly effective and dramatically reduces transmission between sexual partners. If you don’t know what PrEP is or are interested in taking the medication, speak to your doctor. We have a free PrEP assessment you can take if you'd like.
- Compassion. Above all else, people living with HIV deserve compassion and respect. Learning that someone is HIV positive is not an invitation to block them on an app, cut off contact, or rule out the possibility of a sexual relationship. PrEP, PEP, consistent condom use, and well-informed knowledge are the greatest resources we have to protect ourselves and others.
The term “Undetectable is Untransmissable,” or “U=U,” is a term often used by some people who are HIV positive to describe the risk—or lack thereof—of transmission when having sex with another person.
“What this means is someone who is living with HIV who has an undetectable viral load cannot transmit HIV sexually,” said Max Housany, men’s outreach coordinator for AIDS Committee of Ottawa.
So, if someone living with HIV tells you that they’re “undetectable,” it means that the amount of HIV in their system is low, and therefore not enough to transmit to another person via sex.
There have been many great strides in the campaign to reduce HIV transmissions to zero. PrEP and PEP are both social and scientific game-changers that are making real-life impacts for the LGBTQ2S+ community.
At the heart of caring for those living with HIV are two simple, yet vital principles: education and acceptance. We owe it to ourselves—and our communities—to learn about what HIV is, recent advances in treatment, how it’s transmitted, and how to prevent it. From there, it’s imperative that we treat those living with HIV with dignity and respect.
We all have the collective power to reduce transmissions and keep our communities healthy. The best treatment to combat HIV is how we treat ourselves and each other.