Growing awareness movement 'empowering' for people living with HIV

People living with HIV say they look forward to a day when the science behind the virus is stronger than the stigma. Some believe there’s more hope than ever due to a growing campaign known as “Undetectable = Untransmittable” — or U=U.

Disclosure of HIV status before sex still a grey zone in Canadian law

With daily medication and regular check-ups, a person living with HIV may bring their viral load level down to a point where studies show there's almost no risk of it being transmitted via sexual activity. However, viral loads can climb back up based on numerous factors, including stopping medication and abusing alcohol or drugs. (Soe Zeya Tun/Reuters)

People living with HIV say they look forward to a day when the science behind the virus is stronger than the stigma.

Some believe there's more hope than ever due to a growing campaign known as "Undetectable = Untransmittable" — or U=U.

Four Sudbury organizations — including Sudbury Pride, Réseau Access Network, Sudbury Action Centre for Youth (SACY) and the Seeking Help Project — have added their names to a list of over 700 groups worldwide to have joined the cause.

They're raising awareness about the science surrounding HIV transmission.

In Canada, public health units and the Department of Justice both acknowledge studies that show an HIV-positive person who regularly takes medication and presents a viral load below 200 copies per milliliter of blood has a "negligible" to no risk of transmitting the virus.

That's contingent on people with HIV continuously taking daily prescribed medication and receiving updated check-ups and lab results every four to six months.

Richard Rainville is the executive director of Sudbury's Réseau Access Network, which focuses on awareness and harm reduction surrounding HIV/AIDS, Hepatitis C and related health issues. (Supplied)

Richard Rainville is Réseau Access Network's executive director.

"It's based on research, and it's based on the fact that individuals who are living with HIV, who are actively involved in an antiretroviral treatment, and whose viral load is undetectable, cannot transmit the virus sexually to other folks," explains Rainville.

"It hasn't stopped us from promoting the continuation of condoms, not necessarily because of the HIV, but because of other sexually transmitted borne infections, or anything else for that matter."

Rainville emphasizes that HIV may still be transmitted during breastfeeding or by sharing needles, even when viral loads are undetectable.

According to the Canadian government's fact sheet on HIV non-disclosure and criminalization, "Persons living with HIV have a duty to disclose their HIV status before sex that poses a 'realistic possibility of transmission.'"

Otherwise, individuals can still be charged with aggravated sexual assault and aggravated assault.

But the Department of Justice, based on a report released in 2017, adds that, "The criminal law should not apply to persons living with HIV who have engaged in sexual activity without disclosing their status if they have maintained a suppressed viral load (i.e., under 200 copies of HIV per millilitre of blood), because the realistic possibility of transmission test is not met in these circumstances."

The Supreme Court of Canada ruled in 2012 that disclosure is not necessary when a person possesses a low or undetectable viral load, and a condom is used.

But an argument-based "realistic possibility of transmission" test is still applied on a case-by-case basis, even when an accused's lab results show the virus to be untransmittable.

Normalizing disclosure

Eric Cashmore has been living with HIV since he was sexually assaulted in 2008. He calls the U=U movement empowering.

"It says, listen, you know what, maybe I am living with HIV, but I am not a threat to public health. Therefore we refuse to be seen as harmful to the public, because we're not," says Cashmore.

"We have priority populations that are most affected by HIV, but it affects everyone. It doesn't discriminate."

Eric Cashmore has been living with HIV for the past 10 years. (Benjamin Aubé/CBC)

Cashmore believes that even individuals with undetectable viral loads shouldn't take the science as a reason not to disclose to potential sexual partners.

"The opposite is actually true," offers Cashmore. "It allows for disclosure. If I say I'm HIV positive and I'm undetectable, I show that person my lab results that confirm I've been undetectable for six months, this standard has allowed me to safely have that conversation with that individual.

"They now feel that information I'm giving them is accurate because it's backed up by science."

Despite the conclusiveness of studies and their legitimization by legal and public authorities, Cashmore believes it will take many more years for the facts surrounding HIV transmission become widely understood.

Rainville, who has been working in the field of HIV and hepatitis harm reduction for nearly three decades, agrees.

"In the early years, folks were concerned about being in contact with HIV through the use of a toilet seat, so we've come a long way, and we recognized that, but it took a long time to get there," says Rainville.

"I hope the U=U campaign will definitely make a difference, but I don't expect it's going to happen overnight."