‘In reference to HIV, what does “undetectable” mean to you?’: Results of a small survey at an HIV testing site in San Francisco

Objectives: ‘Undetectable’, a term describing HIV viral load at the level of non-transmissibility, appears to be used as a stigma-reducing term on dating apps and is predictive of condomless sex. Anecdotal evidence about the meaning of the term suggests that a mix of both accurate data and misinformation can abound. We sought to uncover what range of meanings the term ‘undetectable’ holds for a cohort of HIV testers at a free HIV testing facility along mid-Market St, San Francisco. Design: A four question survey with additional demographic questions was administered to 130 individuals at the testing site. The resulting answers were then coded as ‘informed’, ‘uninformed’, or ‘misinformed’ and correlated with demographic measures, including residential zip code of the respondent. Results: Residents in the Castro district were most likely to associate ‘undetectable’ status with medication adherence. The most misinformed zip code with respect to the meaning and implications of the term ‘undetectable’ was the Tenderloin, which corresponds to the San Francisco zip code with the lowest rates of HIV suppression. Compared to MSMs, heterosexuals were the most uninformed; while racially, Asians were the most misinformed and Blacks the least misinformed. Older men seem most cautious about using ‘undetectable’ as a risk-reduction strategy. Significance: The study highlights the degree to which certain neighbourhoods and demographics have assimilated the concept of ‘undetectable’ and how viral suppression is maintained, while pinpointing neighbourhoods for additional outreach to correct identified misinformation.