Interviewees talked about factors that helped them get used
to relying on an undetectable viral load to prevent HIV transmission.

The fact of repeatedly having condomless sex helped men lose
their apprehensions:

“What’s given me
confidence is [partner] and I have been doing unprotected sex for a long time
and he’s been okay.”

Men often experimented with condomless sex before it became
a habit:

“We went through an extended
period where sometimes we would [use condoms], sometimes we wouldn’t, and
[partner] would get tested. This period must have lasted about nine months or a
year with him not being positive, until we finally said, “I’d be buggered to
it.””

Because they were taking part in the Opposites Attract
study, couples were tested at least twice a year. The HIV-negative partner’s
test results showed that he still did not have HIV and the HIV-positive
partner’s test results showed that he was still undetectable. The researchers
say that although couples knew based on scientific evidence that having an
undetectable viral load was effective prevention, it was the act of physically
seeing consistent test results that made the concept less abstract – it was proof
that the strategy was working.

“As each year went on,
you tended to worry about it less because I’d been with [partner] for a while
and had many incidents of unsafe sex, and I was still negative, so I could see
that the risk wasn’t high. The worry about catching something became less.”

Being in a strong, communicative relationship was an important
factor ­– partners were committed to, trusted, and were familiar with each
other. Men could be confident that their partner was taking the necessary steps for
them to be confident in having an undetectable viral load. One HIV-negative
partner explained:

“I know his
personality and he’s structured and organised. But I also know that he takes
responsibility for his part in my health and so I have faith and trust in him
that if there was an issue with bloods, we would talk about it.”

HIV prevention was a ‘project’ in many relationships –
something discussed and negotiated as a couple. Partners were confident that an
undetectable viral load would work for them because they managed it jointly,
and it was the manifestation of trust, commitment, and familiarity that
facilitated mutual responsibility.

This was not the case when men had casual partners. Within
his primary relationship, this HIV-negative man was happy to rely on his
partner’s undetectable viral load. He had a different attitude with other
sexual partners:

“[Partner] and I have
trust and an understanding. But when you first meet someone and they tell you
that [they are undetectable], then I’m like, “Yes, but I only just met you. So
I don’t know your history. I don’t know who you are.””

Relying on an undetectable viral load for HIV prevention may
be appropriate in ongoing, committed relationships with good communication, but
less so in other contexts, the interviewees suggested. For HIV-positive men, it
would mean asking a casual partner to trust them. For HIV-negative men, it
would mean placing trust in someone they did not know well.