Not Just Condoms Stop HIV

April 2008

This past January, Switzerland’s Federal Office of Public Health released a study claiming that HIV-positive individuals whose viral loads are fully suppressed by anti-retroviral therapy (that is, “undetectable”) “do not transmit HIV by sexual means.”

The Swiss study included three caveats to this remarkable claim: the HIV-positive person had to adhere to their medication regimen diligently, his or her viral load needs to have been undetectable for at least six months, and he or she should not be experiencing any other sexually transmitted disease.

For many years, experts have warned that although successful antiretroviral treatment can lower HIV blood levels to effectively zero, there could remain the possibility that the virus would persist in seminal (or vaginal) fluids, and thus condoms were still required for penetrative sex to protect against HIV transmission. The new Swiss study explicitly puts the kibosh to that thinking.

After 14 years of follow-up of 393 serodiscordant couples (one partner HIV-negative, one HIV-positive), not a single one of the HIV-negative partners was infected by his or her HIV-positive partner on a fully-suppressive antiretroviral regime, even when having regular unprotected sex; by contrast, 8.6 percent of those partnered with an HIV-positive person not on treatment became infected. Additionally, the Swiss researchers note that with effective antiretroviral treatment, if any HIV remnants can be detected in genital secretions, they are no indication of infectious virus, since such remnants are defective and non-propagating.

Thus, the Swiss researchers unambiguously conclude: “All epidemiological and biological evidence indicates that the successful use of antiretroviral therapy allows us to rule out any significant risk of HIV transmission.”

Regrettably though, AIDS prevention groups, instead of welcoming the Swiss news, have sought to downplay its significance, warning that it did not adequately consider anal sex, that some infinitesimal risk could still remain, that it “confuses” the use-a-condom-everytime message that has been central to so many years of AIDS prevention education.

Indeed, it seems that almost all AIDS groups have overlooked the potential the Swiss study has to offer in HIV-transmission prevention efforts.

First, news that effective treatment stops HIV sexual infectiousness creates a new incentive to get tested. Right now, many untested guys, or guys tested long ago, want to be able to present themselves to potential partners as “clean” so as to enjoy condomless and/or less-anxiety-ridden sex. They fear that bad test news would impair their sex lives, so prefer the reckless bliss of ignorance. If testing could lead to treatment that salvaged both life and better sex, more individuals who now don’t know they have HIV (and are thus partly-witting vectors of transmission) would instead get tested, and treated — thereby eliminating their virus from the epidemiological pool. In fact, the Swiss study suggests that the best way to stop HIV transmission is through effective treatment of those infected.

Secondly, news that having HIV does not equal infectiousness can serve as antidote to the hare-brained strategy of making sexual conduct decisions based on a partner’s perceived status; indeed, having unprotected sex with someone who, in good faith, professes to be “negative” — but who might be recently-infected by the guy(s) he just told the same thing — almost certainly involves higher risk than the same sex with someone who’s been on an effective anti-HIV cocktail, since it is at the early stages of infection that HIV is most transmissible.

Thus, instead of rejecting the recent Swiss findings, those truly interested in preventing HIV transmission will welcome them, both as good news for those HIV-positive, one step further relieved of being diseased pariahs, and for those HIV-negative and looking to remain so.

Pasted from <http://guidemag.com/magcontent/invokemagcontent.cfm?ID=272298A4-1CF5-4B21-893D56ED5CA3BA67>