Question

Can I rely on U=U? I feel guilty and anxious despite being undetectable for many years

9 October 2026. Related: All topics, HIV transmission, PrEP, Sero different couples, Sexual health.

Hi everyone, I am HIV-positive and have been on Biktarvy for many years. I take my medication every day, usually at 10:00–10:20 pm, and I have been undetectable for around eight years.

My latest viral load result in June was undetectable, and my CD4 count is around 1,100. My HIV clinic has repeatedly reassured me that I can rely on U=U.

However, I have been struggling with significant anxiety, especially over the past year.

Whenever I have sex with someone and they later develop symptoms such as a sore throat, cough, runny nose, headache or fever, I immediately become afraid that I might have infected them with HIV.

Recently, a woman I was intimate with developed cold-like symptoms about a week after we met. Another man I was intimate with also became ill around a week after our encounter.

I know that these symptoms are common and that their timing does not prove I transmitted anything, but I cannot stop connecting these events to myself.

Even hearing someone cough can trigger intense anxiety and make me feel as though I am going to lose control.

I have consulted doctors, nurses and a psychologist at my HIV clinic. They have reassured me that, with sustained viral suppression, HIV cannot be transmitted sexually. I take my medication consistently, yet whenever someone becomes ill, I start doubting everything I have been told.

I also struggle with feelings of guilt. I have had several sexual partners recently, and I sometimes wonder whether my anxiety is a sign that I should slow down and reconsider my approach to intimacy. I am believer, and sometimes I worry that God might be trying to tell me something through these events.

I do not know whether this is a genuine reflection of my values or simply anxiety making me feel guilty.

My main question is: has anyone else experienced this kind of persistent anxiety despite being undetectable for so long.

Answer

Answer: Simon Collins

Hi there

Thanks – we sometimes get similar emails so other people experience this too.

After five years of being undetectable and good adherence, your viral load is probably less than 5 copies/mL. Most of any virus is also likely to be defective and not able to actively reproduce anyway. Maybe do your own research on this, including look at the studies about U=U:
i-base.info/u-equals-u

Your levels of anxiety sound extreme though. So your reactions are likely related to earlier experiences – either in life in general or about HIV. But if you won’t let professionals help you, and don’t believe them, then perhaps find alternatives to having sex.

Or maybe try finding partners who are also living with HIV, or who are on PrEP, or just use condoms.