The undetectabilised body: Embodiment of undetectable viral load among people recently diagnosed with HIV
1. Abstracts based on Formal Research Work1 Australian Research Centre in Sex, Health and Society, La Trobe University
2 School of Population Health, University of New South Wales
3 Central Clinical School, Monash University
Abstract
Introduction/objective(s)
U=U (‘Undetectable equals Untransmittable’) is a discursive intervention intended to reduce stigma by emphasising the absence of HIV transmission risk between sexual partners when the virus is suppressed to undetectable levels. While there has been much attention given to knowledge about, and belief/confidence in, U=U (among both people living with HIV and their sexual partners), there has been much less emphasis paid to how people living with the virus embody either their ‘undetectable’ or ‘untransmittable’ status.
Methods
As part of in-depth interviews in two studies of people recently diagnosed with HIV (undertaken between 2019 and 2025), participants were asked about their viral load results since diagnosis, their knowledge of viral load and other clinical markers, and the importance they placed on reaching and maintaining an undetectable viral load. Drawing on theories of embodiment, and using a critical discourse analytic approach, we explored the ways in which participants incorporated knowledge about viral load – and specifically undetectability – into their experience of living with HIV.
Results
Among the 64 study participants (median age 33 years; 60/64 male) knowledge of viral load prior to their HIV diagnosis was very limited (even among the gay and/or queer-identifying men in the study).
Experiencing [un]detectability. Most participants reached an undetectable viral load within 3–6 months of initiating antiretroviral therapy. Undetectability provided evidence that antiretroviral therapy was ‘working’. Reaching undetectability was articulated as a linear narrative (i.e. as having a before and after, with the latter understood as an ongoing state). Even viral ‘blips’ (low, detectable, viral load results) served to reinforce the perceived stability of undetectability.
Embodying undetectability. Participants reported experiencing bodily effects such as increases in energy or confidence as a result of becoming ‘undetectable’. These effects were contrasted with feelings prior to starting treatment and/or receiving an undetectable result (e.g. anxious, dirty, viral, contagious).
Unimagining transmissibility. Participants’ accounts provided insights into how discourses related to viral load – in particular U=U – have created a link between viral load and (the possibility of) sex. This link operates not only at a discursive level, but is also felt via specific sensations, which are described by way of metaphors relating to sexual desire (e.g. a ‘switch’). Importantly, non-transmissibility is contingent on the embodied practice of taking medication.
Discussion/conclusion
All participants were diagnosed in 2016 or later – so their experiences of living with HIV heve been entirely within the ‘U=U’ era. Findings from this study illustrate the embodied effects of discourses related to viral suppression on the ways in which PLHIV understand their positive status. Increasingly, PLHIV experience their bodies through biomedical technologies and discourses. We argue that incorporating UVL is a process, and that the bodies of PLHIV therefore become undetectablised through incorporating biomedical information into their own understandings and practices.