Putting the Fear of Semen to Bed

I know that a person living with HIV who is on treatment and has an undetectable viral load cannot sexually transmit HIV. So, I’m frustrated by a recent study that suggests people still need to worry about HIV transmission between serodiscordant couples.

The study, presented at the American Urological Association Annual Meeting, showed that there can still be detectable viral RNA and DNA in the semen of a person with HIV, even though their viral load is undetectable in blood tests. Although this information has actually been known for a fairly long time, the report made it sound like the findings were new, shocking — and revolutionary. The researcher made it sound like it was something that people living with HIV and their partners needed to be concerned about.

But I’m here to assure you that you don’t need to worry. It is true that HIV RNA or DNA may be present in semen, especially in the first year that someone is on treatment. But HIV RNA and DNA aren’t infectious. They’re just genetic material, and not the whole virus. You need the whole virus in order for HIV to be viable and able to infect a living cell. It’s like finding a human leg on the ground and thinking it can walk. You need the whole body, not just a leg to walk.

“We have known for decades that HIV genetic material exists in bodily fluids of those living with HIV who are virally suppressed,” Dr. Carl W. Dieffenbach, Director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, reiterated recently on ImStillJosh.com. “On its own, HIV genetic material, RNA or DNA, is not infectious. It is not ‘whole virus,’ which is needed for HIV to infect a living cell.”

Another study, published in Clinical Infectious Disease, was reported on in Infectious Disease Advisor with the sensational headline, “HIV RNA Replication in Semen Occurs During Antiretroviral Therapy.” The suggestion that HIV replication occurs in semen, even when the person with HIV is in treatment also sounds like new and frightening findings; scary information for people living with HIV and their intimate partners.

But don’t worry. The headline is misleading. The study was not about viral replication in semen. Instead, it was an important study looking at the time it takes for people to reach undetectable viral loads using different types of treatment. The study looks at HIV RNA in the testes, which shows evidence of the virus. But, again, HIV RNA is not infectious.

If your HIV is undetectable and you stay on your meds, you don’t need to worry about HIV in your semen.

So, do whatever you’d like with your — or your undetectable partner’s — semen. It’s safe. And so is your undetectable partner.

Bruce Richman is the founder of Prevention Access Campaign and the Undetectable = Untransmittable campaign, which educates the public on the scientific consensus that people living with HIV who have an undetectable viral loads cannot transmit HIV to others.