Even with a very low viral load in his blood, an AIDS patient can still have a high viral load in his semen.
While antiretroviral drugs offer an efficient means of preventing the replication of HIV in the blood, shedding of HIV may occur in semen, so that other persons can become infected during unprotected sexual intercourse. This occurs in particular if the male genital tract also has other viral infections.
... the SNSF-funded scientist studied the semen of 114 HIV-infected men undergoing treatment who have sex with men. She found that the seminal fluid of 11 of the men contained a considerable quantity of HI viruses, even though the viral load of the blood of all of the men was very low. In eight of these 11 cases, Gianella Weibel also found evidence of various forms of herpes.
Some of these herpes viruses, such as cytomegalovirus, often remain unnoticed. However, if the viruses infect the male genital tract, they locally activate the immune system. As a result, there is a build-up of immune cells, including those in which HIV replicate, in the genital area. [emphasis mine]
I think eternal vigilance is needed to prevent disease transmission. Not just HIV, but a plethora of diseases, STDs and otherwise.
That some men are HIV + or HIV/unknown regularly have unsave sex, is irresponsible and head-in-the-sand. Mistakes happen, and sometimes there is loss of inhibition due alcohol, drugs, love, low self esteem, depression.... and accidents / condom breakage can happen - rarely.
But sometimes, reading gay men's websites, it feels to me like it's a badge of honor, or political right, to have unsafe sex. It's not. It's irresponsible and childish.
Well, it's easy for me as an older man to decry the behaviors of the young..... but when I was young, they were dying right and left, and at least some of us were left to grieve. I always thought, "what if I have HIV, and pass it on to this guy who I like / love? How will I feel about that?" Instead of "me. me. me. me.".
I'm an old curmudgeon.
Sentient, an elder of the tribe and a wise man.