The elephant in the bedroom- HIV, intimacy and infectiousness in the age of viral undetectability

Advances in HIV medication now mean that people living with HIV (PLHIV) that have reached the treatment goal of viral undetectability are sexually uninfectious (U=U) (Rodger, Cambiano, Bruun, et al., 2016). This opens up the possibility for PLHIV to safely forego condom use and use treatment as prevention (TasP) as part of safer sexual practice. Activists, academics and others have highlighted the idea that the U=U message can and will mitigate the anxiety around sex for PLHIV and lead to the de-stigmatisation of HIV more broadly (NAM, 2017). Embedded in this idea is the notion that uninfectiousness and the biomedical normalisation of HIV it implies will translate to a naturalisation of PLHIV as sexual citizens (Persson, 2013; Squire, 2010). Furthermore, this hinges on the idea that HIV-related stigma is singularly contingent on knowledge of infectiousness rather than an understandings of stigma as a highly complex social phenomenon that is keenly implicated in the reproduction of asymmetric relations of power (Link et al, 1989; Link Phelan, 2014). This paper proposes to critically interrogate such notions, exploring the possibilities and limitations of the discourse of U=U in the face of competing discourses and within the socio-cultural and historical context of HIV and AIDS as one of the most stigmatised illnesses in history (Brandt, 1988; Sontag, 1988; Treichler, 1987, 1999). The author will argue that despite the assertions made in respect of the stigma-reducing effects of U=U, intimacy and infectiousness remain uncomfortable bed-fellows for many PLHIV for whom sex is often mediated by deep-rooted fears of contagiousness. Analysis will be situated within a Foucauldian (1976, 1982) and Bourdieuian (1991) theoretical framework, and data gleaned from qualitative interviews with people living with HIV in Ireland will be used to support the argument that even in the age of viral undetectability HIV continues to be the elephant in the bedroom.