For people living with HIV, treating early is a big step in taking control. It means living a healthy life - with a stronger immune system, reduced chance of developing other serious illnesses, and drastically improved life expectancy.

Most people living with HIV who are on anti-retroviral treatment - but not all - can achieve an Undetectable Viral Load, which is when the amount of HIV in their blood can't be detected by a standard viral load test. Maintaining undetectable for more than six months means there's no chance of HIV passing on during sex.

We spoke to Damien Rule-Neal about how having an Undetectable Viral Load has impacted his life, his sex life and his mental health.

Losing Control

When Picton’s Damien Rule-Neal was diagnosed with HIV 18 years ago, official guidelines stated that he couldn’t go on treatment immediately because his CD4 count was too high. Before the CD4 threshold was removed in 2017, people living with HIV had to wait until their immune system was sufficiently damaged - with a CD4 count of 500 or below – to be able to get access to HIV medicines. For Damien, the result was a year of trying to come to terms with living with HIV, while being unable to do anything about it.

“It promptly shut down my sex life and put me on a bender with alcohol for almost 12 months,” he says. “It got to the point where I was waking up without remembering what I had done the night before and that was pretty scary – so from that point on I didn’t really drink anymore.”

Instead, he threw himself into work alongside those living with HIV by starting a social work degree at AUT, got a job on the Positive Men’s Health team at the New Zealand AIDS Foundation and became a tester at NZAF's Burnett Centre in central Auckland.

Getting to Undetectable

Two years later, and with a CD4 count less than 200, Damien finally started his treatment but initially struggled with the medication, which was giving him nausea, hallucinations and dizziness – even leading to a fall. After a few months of not coping, he changed his medication and within another six months became undetectable.

“Once I changed my medication to something that was much better for my overall health, I haven’t really looked back,” he says. “I was undetectable pretty much straight away, and my health has gotten progressively better over the years.”

The now 44-year-old says the initial reasons he wanted to reach undetectable was not just for his own health but also for the health of his partner Shane, who he’s been with for the whole 16 years he’s been on anti-retroviral treatment.

After doing their research, including a trip to a conference in Melbourne where UVL was discussed in terms of safe sex and risk of transmission, the couple stopped using condoms - after about a year of consistent tests that confirmed his undetectable status.

Shane still tests every six months or so and is still HIV negative.

UVL and a Re-invigorated Sex Life

As well as the clear health benefits, Damien says his treatment and regular UVL tests lifted a great burden concerning his mental health – and meant a resurgence of his sex life with Shane.

“It was pleasing to know that I couldn’t give somebody else HIV,” he says. “And that someone else wouldn’t potentially have the burden of having to go through what I went through. Not having that worry made a huge change in my life.”

“Shane and I had always enjoyed a pretty robust sex life – but if anything it increased a little bit more after I was undetectable because if we were out and about somewhere and in the heat of the moment, it would just happen naturally rather than thinking that we couldn’t do anything because we might not have a condom.”

Test Regularly, Treat Early

The message these days is to get tested regularly so that, in the case of a positive diagnosis, you can get on treatment as soon as possible. Long gone are the days of having to wait until your CD4 count has dropped through the floor.

And Damien says just starting the treatment can be a great relief – especially as it can prevent some of the destructive behaviour he went through 18 years ago.

“Once they’ve got a positive diagnosis, I see a lot of people suffer from the guilt, and how that totally kills their libido because they think they can pass it on,” he says. “So the faster they get on the treatment, the faster they can become undetectable and that burden is lifted."

“It can have quite an effect on an individual’s mental health.”