Less than 40% of poz guys have undetectable viral load?

[rawTOP]

Just saw this graphic in an article I was reading…

I was a little shocked to see that only 37% of people with HIV have an undetectable viral load. Based on what I see online it just seems a lot higher than that. Or are the guys lying about being undetectable?

It's also a little unexpected that only around half of people with HIV have medical care. That also seems really low.

Do these numbers ring true for any of you? They seem wrong to me.

[Pozside905]

I tell dudes im on meds all the time but never have been on meds

[rawfuckr]

Just saw this graphic in an article I was reading…

Do these numbers ring true for any of you? They seem wrong to me.

Numbers seem just fine to me. It's 37% undetectable of all those who are infected. Half of those infected don't even know they are poz, so you have a 50% there. Then some of those poz who are aware, are not on meds, most likely because lots of providers are still using the 'wait for low CD4 count' rule. They you have the rest who is treated and can get to UD, about 37%. Sounds about right.

[seaguy]

Why do people lie about shit like being on meds then they are not. Is it out of desperation, a desire to get revenge causee someone pozzed them?

[wood]

I tell dudes im on meds all the time but never have been on meds

well thanks for being an asshole.

Honestly its people like you that give responsible HIV+ people a bad reputation.

People on meds are highly unlikely to infect others, yet you are, and lie about taking medication.

[Poz1956]

The "Treatment Cascade" is the current vogue "thing" in HIV treatment circles. It's a report card, and a measurement of how effective a healthcare system is at Testing, Diagnosing, Linking to care, Retaining in care, Starting people on ARVs, Achieving an undetectable viral load, and Keeping people in care and virally suppressed. RT's graphic is missing a couple of the steps. The cascade is a good metric for health care officials to see which areas are most in need of improvement.

I think it's bad info for the general public. For example, RT more or less jumped to the conclusion that only 37% of Poz guys are undetectable. That's not what the cascade is showing.

The New York State numbers are actually pretty good. It shows the outcome from increasing funding for HIV testing from a few years ago. The US national treatment cascade shows a rate of Pozzies who are undetectable is 18%. The one recently released for my city shows 46% retained in care and undetectable. (It also added in deaths at each step, which highlighted how many people are diagnosed at a very late stage of immuno-suppresion. Some died within seven days of diagnosis.)

• The first number is ALL the people estimated to be Poz
  
• There is usually a second number showing what percentage who have actually received a Poz diagnosis (missing in this graphic)
  
• The next number shows how many are linked to care. That doesn't mean on meds. It just refers to the percentage who have visited a clinic, had some follow-up blood work done, or seen a doctor -- At Least Once since their diagnosis
  
• The Empire State Building in this graphic represents the percentage who are routinely getting blood work done, and seeing a doctor for some form of HIV care (again - they may not have started meds). It's usually referred to as "Retained in Care."
  
• Some versions of the treatment cascade show a bar for the percentage of people on meds
  
• The final line is the percentage of All people estimated to have HIV, who are on meds, and have achieved an undetectable viral load (usually for a minimum of one year)
  

The Treatment Cascade represents the entire population, and includes the homeless, drug addicts, heterosexuals, immigrants from countries where HIV is endemic, as well as gay & bi men (and other MSM). I think a version showing just gay men would look a bit different. There would still be a big gap between the number estimated to be Poz, and the guys who were tested and knew they were Poz. We know our testing rates are a lot higher than the general population. I suspect the drop offs from there, to undetectable would be less dramatic.

The realities of access to routine care, and insurance coverage for antiretrovirals are where the US charts take a big hit. Imagine what a Treatment Cascade of Gay Black men in a Southern state would look like.

I worry that some will look at a treatment cascade bar chart, and think that the last number represents the percentage of guys on meds who have achieved an undetectable viral load. I've seen studies that range for 87% to 95% of people on meds achieve an undetectable viral load. The majority of the rest fall between barely detectable (just above 40) to just below 500. Well below the 1,000-1,500 threshold where transmission could occur.

Please remember that a Treatment Cascade shows how well a health care system works at testing, retaining people in care, and getting them on treatment. It does not discuss how well drugs work, for guys on treatment.

[rawTOP]

Numbers seem just fine to me. It's 37% undetectable of all those who are infected. Half of those infected don't even know they are poz, so you have a 50% there.

I thought it was more like 1/4 didn't know.

The "Treatment Cascade" is the current vogue "thing" in HIV treatment circles. It's a report card, and a measurement of how effective a healthcare system is at Testing, Diagnosing, Linking to care, Retaining in care, Starting people on ARVs, Achieving an undetectable viral load, and Keeping people in care and virally suppressed. RT's graphic is missing a couple of the steps. The cascade is a good metric for health care officials to see which areas are most in need of improvement.

I worry that some will look at a treatment cascade bar chart, and think that the last number represents the percentage of guys on meds who have achieved an undetectable viral load. I've seen studies that range for 87% to 95% of people on meds achieve an undetectable viral load. The majority of the rest fall between barely detectable (just above 40) to just below 500. Well below the 1,000-1,500 threshold where transmission could occur.

Yeah, I get all that, the only thing I may have misstated is saying "guys" in the title. I still find 37% a bit shocking. I'd love to know the percentage for MSMs / gay guys.

[TigerMilner]

well thanks for being an asshole.

Honestly its people like you that give responsible HIV+ people a bad reputation.

People on meds are highly unlikely to infect others, yet you are, and lie about taking medication.

Well said Wood. Assholes abound.

[Poz1956]

I tell dudes im on meds all the time but never have been on meds

Research shows that around 50% of guys say they will never knowingly play with a Poz guy. Amusingly it get as high as 68% for guys that have never been tested. My personal experience says that there is a good chunk about that (maybe 20-30%) who don't agree with "Never" but turn down Poz guys when the situation comes up. They'd cross the serosatus divide if they loved the guy, or felt some real connection, but not for a one night stand.

When I try to discuss the protective level of undetectable viral loads with "Think they're Neg" guys, there always seems to be a sticking point around this issue. Since most people are going to reject a Poz guy as soon as he reveals his status, I've always felt that it was illogical that someone would lie about meds, adherence, and viral loads. I've always figured that if a guy was going to fib to fuck, he'd lie about his status.

The serostatus unknown guys always counter that a Poz guy might lie about being on ARVs, taking them regularly without skipping doses, and his viral load. He'd do it just to get laid. They insist that admitting he's Poz does not mean the rest is the truth. We go round and round and round, between my view and theirs.

I guess they're right, and I've just been proved an idiot. There really are sociopaths who will reveal their status, and lie about the rest.

It's comments like this that make me continually reevaluate whether or not I want to contribute to this community. This just added another tick to the "Not" column.

[everopen1]

I believe the statistics are probably closer to real than making an conclusion based on hookup websites. I believe many guys lie for sex. Even With all the advances in the last 35 years with gay rights, marriages , and wider acceptance of gay and gay lifestyles we are our worst enemy. We need speak the truth to each other. the best thing about our lifestyles diversity is there are othrr like us. if you're chaser we have an app, LTR we have an app, charms we have an app, cheaters there is an app, activist another app, neg only an app for that. we need to telling what they want to hear but rather be honest with who we are and they will find us. I rarely get political but after the week I've just gone through somebody needs to say this. And yes I know what this website is. And yes that is why I'm here. And yes all my profile answers are honest. If you don't like the profile move on. That's the power we have individually

[bearbandit]

Remember also that "undetectable" is a moving target. A few year ago 400 or 500 was considered undetectable. The number decreases as the VL test used becomes more sensitive. My last hospital just raised the undetectable number from 50 to 70, because that was the limit of the result that their new lab could provide. There are a few hospitals in the UK that consider undetectable to be under 20. Also worth bearing in mind is the fact that it takes a VL 1,000+ to be definitely infectious (however weakly).

[Guest JizzDumpWI]

Well said Wood. Assholes abound.

Am I the only one who sees the irony that assholes are often tops (or in the instant case, vers)?

[rawTOP]

Remember also that "undetectable" is a moving target. A few year ago 400 or 500 was considered undetectable. The number decreases as the VL test used becomes more sensitive. My last hospital just raised the undetectable number from 50 to 70, because that was the limit of the result that their new lab could provide. There are a few hospitals in the UK that consider undetectable to be under 20. Also worth bearing in mind is the fact that it takes a VL 1,000+ to be definitely infectious (however weakly).

To that point isn't the graphic above a bit misleading? Wouldn't "well-controlled" be more of an objective and set it in the 200 to 500 range? That achieves the public health goals they're looking for, etc.

[bearbandit]

The obsession is with the number: I've been recalled to the clinic when I've blipped over the 50 mark (87) having had two zero results immediately before. I guess the point is that the earlier a rising viral load can be spotted, the sooner evasive action can be taken, whether it's a review of food-with-drugs, adherence or simply a warning that resistance (which can't be detected below VL 1,000) may be developing.

[Poz1956]

Treatment Cascade graphs are meant for health care professionals. There is a lot of jargon in the reports that accompany these charts, and Undetectable is defined in the accompanying text. The target audience understands the meaning of Undetectable in the context of the area covered by that specific treatment cascade analysis. I don't think you'll get these guys to use dumbed down language.