The challenge for the new Safe Sex 2.0 effort will be trying to capture the attention span of someone who lives life and thinks in 140 characters. In this Internet age, we in the HIV+ and HIV- community (basically that is everyone) have been given the dual-edged sword of the internet as a tool for advocacy and outreach.  The internet is definitely useful in finding the answer to almost anything, and it has exponentially increased the means by which information can be disseminated to the masses.  However, the internet has also created vast, huge, and deep canyons between us, where we are only as connected as our wi-fi signal allows us to be. 

Back in the “old days”, we in the older gay community used to go to gay bars.  At those gay bars there were bowls of free condoms.  They were right there on the bar or by the door so that they were always on hand. Back then, we cared about protecting our community.  Back then it was not as controversial or offensive to talk about or insinuate safe sex. Safe sex was viewed as a normal, healthy part of the greater gay conversation. 

At some point though, this changed. Bars are no longer the meeting places of gay men.  Grindr, Scruff, and Adam4Adam have taken their place. Face to face caring was replaced by the cold glow of a computer screen.  Our community became diffused and fragmented and it dispersed like smoke in the wind. There were always those that didn’t go to the gay bars, just as there are those who do not go online today, but they were in the minority I believe.  

Our sense of community has been replaced by a transactional approach, where one’s personal opinions seem to trump the collective wisdom that has been tempered by experience.  Collaboration and compromise have been thrown down the toilet, to be replaced by the louder squeaky wheel of personal, selfish freedoms.

Now, if you were to talk about safe/safer sex or condoms, a method that is clinically proven to reduce HIV and other STDs, you are yelled at, or someone posts a pages long diatribe about how out of touch you are, and how it is their God-given right to have unsafe sex. They pull one tenuous statistic (that successful HAART treatment prevents 96% of HIV transmissions) and they have built an amendment to the sexual constitution, much like gun proponents clutch onto the 2nd Amendment. They ignore the fact that an undetectable viral load in the blood is NOT equal to an undetectable viral load in semen or in anal fluids/tissues. 

And so, the uninformed and unwilling shun proven methods of safety: condoms, HIV testing, non-sexual forms of intimacy.  (Apparently in the age of Grindr, intimacy seems to be an outdated concept as well.)  And then when they contract HIV, they then have this sense of confusion and incredulity, knowing in the back of their mind that they knew their risk all along but chose to ignore it and live in the moment.  There is even a hashtag for that, #YOLO (You Only Live Once).  

Because one in five urban gay men do not even know their HIV status, it is imperative to again find a way to encourage HIV testing and to advocate condom use. People proceed with actions based upon their perception of risk, as opposed to the actual risk at stake.   Stigma is still very high and the pervasive HIV stigma within the gay community (as well as outside of the gay community) prohibits those at the highest risk for HIV from getting tested. When those at highest HIV risk continue to contract the virus year after year after year, there should be a more aggressive approach to HIV testing and condom use.   

It is ironic that studies have shown that when a person is diagnosed with HIV, that person’s sexual behavior becomes safer. They care more about not wanting to infect others. But on the flip side of that is the callous carelessness that pervades young gay men, who believe their greatest source of angst is over what to wear to a Lady Gaga concert.  These guys repel conversations about HIV/risk/safety like Teflon repels an egg.  If you try to mention HIV, they all the sudden stop texting you back, or they fade from your Facebook...they become silent and they disappear.  

I believe there needs to be a new call to action, one in which the new ways of the internet and the social media expertise of the young are merged with the proven, effective methods of prevention.  And through all of this we must figure out how to burn of the fog that has settled on everyone regarding HIV:  for the older people who are tired and exhausted from 30+ years of advocacy and for the young, know-it-all youth who live in ignorance and bliss.

I wish I had the answer on how to do that, because until that answer is figured out, I fear we will again see a rise in HIV infections.  I believe the coming storm will rival the pre-HAART era. Before HAART, people died because there was no medicine.  Now, I believe stigma and indifference has become just as deadly as those early days. 

About the author: I am 38, a gay male from Knoxville, TN who is not ashamed of my HIV+ status. I am optimism personified. I am strength realized. I am just me.

Website: embacingpozitivity.blogspot.com.Twitter @jjemcdonald 

“Some people are going to think, ‘Oh god, why did he not take steps to prevent HIV? Why did he act recklessly, and who the hell does he think he is, I saw people die from AIDS!’” A friend and colleague whose candor is always helpful said this to me over lunch recently, and his words have stuck with me over the past day

Most interestingly, I’ve noticed that those most receptive to my messages are under 30, those 30-50 are generally receptive but ask more poignant questions, and those over 50 are oftentimes, not always but often, openly hostile to my writing on bareback sex and HIV. In the next few months, I’m going to be speaking at several sexual health seminars and symposiums, and I’ve been assessing my own writing and essays on sex, barebacking, HIV, and personal responsibility, and I’ve reached the same conclusion that I originally had when I began writing on HIV and sex; that is, we are inadvertently sustaining HIV infections and continuing this epidemic because we are unable to confront our past honestly and without emotion.

I was born in 1984. Personally, I have no firsthand recollection of Ronald Reagan’s presidency, Ryan White, Arthur Ashe, the AIDS quilt’s beginnings, Rock Hudson, C. Everett Coop, or the obscene neglect the United States government took in relation to HIV/AIDS throughout the entire 1980s.  Rather, all of my knowledge of these things, people, and movements comes from oral histories from LGBT elders that are my friends, exhibits at places like the William Way LGBT Community Center’s stellar John J. Wilcox, Jr., Archival space, named after a man I am heartened to have called a friend, and from textbooks and documentaries. In addition, when I began to go through puberty and learn about the physical and sexual changes taking place in my body, it was the late 1990s, Bill Clinton was president, HIV/AIDS organizations and infrastructure had been in place for over a decade, and my teachers, parents, and mentors knew how HIV was transmitted, how HIV was not transmitted, and HIV’s timeline of progression in the human body.

When I was growing up, there was no plague where funerals were being attended every week. There were no candlelight vigils, there were no large scale protests interfering with traditional institutions of power and policy in the United States; rather, there was knowledge, there were early concepts of treatment that are still being used today, and there was a local, state, and federal government trying its best, guided and sometimes provoked by activists and advocacy organizations, to respond most effectively to HIV/AIDS.

Instead of learning about HIV through my own experiences or through seeing friends or loved ones suffer or die too early, I learned about HIV as an abstract concept far removed from my own life. Of course, this abstract viral boogeyman was as frightening as it was imaginary; after all, when our own innate fears are coupled with histories, real or not, of our elders and teachers, we manifest these fears in irrational terror and paradoxical behavior, like posting links on Facebook to condom campaign websites but barebacking someone we met on Adam4Adam because he said he was “clean.”

For years, I was terrified of this virus because it had seemingly no effect on me or my own circle of friends and family; rather, it was something that we knew existed, we knew how to prevent, and we knew how it attacked the human body, but this knowledge was predicated on the idea that I was born, luckily, at a time where I did not become a man or a sexual being until long after the early days of the virus spreading rapidly through the gay community. Of course, the only reason HIV/AIDS took off throughout the gay community is because gay men engage in anal sex which allows for easy access for the blood barrier to be crossed between sexual partners because of, often entirely unnoticeable, usually microscopic abrasions and tears around the skin on the penis or inside the anus.

Contrary to the belief of some misguided idiots who think HIV/AIDS was god’s divine judgment toward those of us who like to kiss men, HIV only seemingly “picked” the gay community because of this fact; if straight women were clamoring to engage in anal sex like gay men typically do, they would have been the ones who bore the brunt of HIV/AIDS. Instead, because gay men are the ones who engage in this, admittedly fun, activity, we were the ones who suffered the most during the early days of HIV/AIDS. And, to this day, the LGBT community overall, including transwomen and gay men, are dramatically disproportionately affected by HIV because of this fact.

So, like the Holocaust, the early days of the HIV/AIDS epidemic are a mere idea my generation and the generations after mine have to learn about from our elder peers, from our teachers, or from our books. We have no concept of the human tragedy endured by millions; we have no firsthand account of what things were like. And, this is why our experience as HIV+ people born post-AIDS outbreak is entirely different than that of those who lived during this time as sexual adults. Now, this is not to say that either experience is better or worse; rather, our experiences are equally as valuable and equally deserving of a seat at the table when it comes to outreach, prevention, and care.

Notwithstanding, if we are to successfully combat the tide of rising HIV infections brought on by what older folks like to call “recklessness” but what I like to call “natural human behavior,” we must be willing to honestly look at ourselves and admit that nobody has a monopoly on HIV/AIDS, and the fact that someone lived through something does not automatically give them deference on opinions just as the fact that I am HIV+ most definitely does not give me absolute authority on all things related to HIV. Rather, on the logical and science-based merits should we approach HIV/AIDS today without the baggage and trauma, both experiential on part of our elders and vicarious on part of my generation.

This is the current approach of the more misguided folks in our LGBT elder generation, generally, in relation to HIV: tossing out HIV stigmatic slurs like calling me, literally, a “murderer;” browbeating young men who bareback as “reckless;” advocating condom use over everything else; making people who bareback feel bad about themselves; shrilly obsessing over death when telling 20 year olds about the 1980s instead of honestly admitting that you were at the DCA club also getting topped on the truck bed at the bar; claiming falsely that dental dams are used widely to prevent hepatitis and so should condoms for anal sex; ignoring the fact that part of sexual liberation means engaging in natural human sexual activity like bareback sex; and, ignoring all scientific literature that refutes every single backward notion born out of 1990 and early treatment that effectively was more toxic than HIV itself.

If this approach worked, then we would not be seeing a steady rise in HIV infections.

 So, let’s stop damaging the lives and futures of young people today by taking a step back and stop forcing other people to obsess over our own memories, effectively refusing to allow these men and women to experience life on their own without the specter of a de facto Holocaust; the time of this period is over. We have antiretroviral treatment with no side effects that literally both gives us life expectancy into our 70s while simulanteously preventing us from being able to transmit HIV whatsoever (when we adhere to this medication); we are not dying, we are living. And, we are not frightened anymore because now that some of us have seen HIV for what it is. In particular, we know that HIV is a virus that will kill us if left untreated but that it is also a virus that is, today, incredibly manageable with the right governmental approach toward treatment availability like exists here in Philadelphia.

Human tragedy should never be swept under the rug or forgotten. And, we should strenuously remind folks that these things went on, that good men and women died needlessly and far too soon. But, we should not predicate our public health efforts and prevention efforts on the idea that we should force people to remember our dead friends or a tragic decade that future generations had nothing to do with. After all, if this fear-based approach was effective, nobody would get HIV anymore.

The fact that I’m writing this and HIV+ refutes that hypothesis.

This article originally appeared on Josh’s own blog here.

Conscious choices make for better sex. Discussing our options is vital if we’re going to break the statistical stalemate of HIV infections for gay men. Is another bio-medical approach advancing the interests of gay men? While options are necessary, few of us in this country have access to one of the latest: PrEP. It seems many local health authorities have barely begun to dive into the mix. If we are going to get anywhere on this we need to shake it up. More conversations are needed. 

Jody Jollimore is the Program Manager for Vancouver’s Health Initiative for Men. These gays have changed the West Coast landscape of gay men’s health. This group of smart gay men roll out an inspiring collection of comprehensive wellness programs, promotional health campaigns and other gay men’s events. Their work is evidence based. As regional leaders in the field they also put out position papers to help set the tone and evolve the conversation about issues important to gay men’s health and wellness. I sent Jody a short set of questions to survey the impact of PrEP.

Their position paper on PrEP is here.   

[PrEP sound-bite: Pre-Exposure Prophylaxis is a new HIV prevention method in which HIV negative folks take a daily pill to reduce their risk of becoming infected. It has made a much needed splash in the bio-medical prevention tool kit]. 

Robert:  Thanks Jody for taking time out of your intense schedule. To start, has your position on PrEP evolved since you posted your paper last spring? What new research informs your present understanding of the efficacy of PrEP?

Jody:  No, our position on PrEP remains cautiously optimistic. Health Initiative for Men continues to welcome new HIV prevention options for gay men and we welcome more research on PrEP as one of those options. Since creating our position paper, no other major research studies have produced findings, so we are still relying on iPrex data.

Recently the guys at HIM have been hearing of PrEP research studies in the UK and France, and even as close as Montreal and Toronto. We look forward to the results. 

With Treatment as prevention going full steam I’ve been having powerful conversations about individual vs. population rights. How does HIM as an organization navigate the complexity of individual rights/health needs of gay men and those of population rights/health as the paper suggests?

As difficult as it can be at times, we're trying to avoid some of the politics associated with individual rights versus population rights dialogue. Ultimately, we recognize that for the best possible health outcomes to be achieved there must be some balance between the rights of individuals and the rights of the population. Instead, we view our role not to advocate for a particular rights-based dialogue, but rather to provide trusted, tailored and targeted health promotion that gives gay men (and other men who sex with men) sexual health options.

Are gay men in Vancouver, that HIM knows of, employing PrEP as a health strategy? If so is there any evidence, anecdotal or otherwise, that it is working? Who is evaluating this process?

Yes, while strictly anecdotal, we have heard of a few guys who are using PrEP as a prevention strategy, but to date these cases have been guys who have HIV positive boyfriends or partners (and in serodiscordant relationships). Preliminary findings from one of our more formal research partnerships (The CIHR Team in the Study of Acute HIV Infection in Gay Men) tell us that very few guys even know about PrEP, and of the sample of roughly 180 guys, no one had used it. We do know of guys in Toronto who are using PrEP and writing about it (in PositiveLite.com I believe). 

Other than the position paper how are you educating BC gay men about PReP?

Most recently Health Initiative for Men attended a think tank on 'communicating risk to gay men' hosted by CATIE in Toronto. As members of the think tank we contributed to a document that will serve as the basis for a national information campaign developed by CATIE, targeted to gay guys, delivered by HIM and other organizations in Canada. We also have a team member who sits on the advisory committee for the new chapter of the Canadian AIDS Society Guidelines for Assessing Risk (Biological Factors). Both documents will include information on PrEP specific to gay men and other men who have sex with men.

What role does PrEP play in the social discourse of gay men’s health?

PrEP has really opened the door for a discussion on HIV prevention strategies other than condom use. Long thought of as a dirty secret, the reality is that not all gay men wear condoms, and now for the first time since the 80s we can actually talk about it. For years, gay guys have been using other strategies like looking for partners with the same HIV status and even getting tested with partners, to avoid picking up or passing on HIV. Yet, prevention messaging remained somewhat static, centered almost exclusively around condom use, long after guys had discovered other ways of reducing transmission.

While I think open and nonjudgmental discussions about condom use and other HIV prevention options are long overdue, I find it surprising that PrEP has initiated that conversation, since iPrex participants were actually counseled to use condoms while taking PrEP. Whatever the reason, gay guys are discussing HIV prevention again, this must be a good thing!

What do you foresee as the future of PReP as a strategy? 

PrEP is not for everyone. Even with an increased effectiveness, there will be guys who will not want to use medication for HIV prevention and will opt for other biomedical options like condom use and regular testing. Others will continue to use certain behaviours to reduce their risk (oral sex rather than anal, etc). PrEP, like condoms, needs to be considered an option for preventing HIV. As more research is conducted, a greater understanding of PrEP will help gay guys weigh those options with more certainty.

All the best Jody, for you and the HIM team - and on behalf of gay guys (if I can be so bold) thanks for all your good work. Thanks for building on a strong legacy and making the gay health care scene fresh again. 

Being an HIV advocate means straddling two different, diametrically opposed worlds.  Engaging in battle on two fronts, much like a war, I advocate for both HIV+ (us) and HIV- people (them).  Each battle has it's own challenges and rewards, some of them immediate but most of them are unknown or more long-term in the rewards. 

It is sometimes hard to juggle two hats - fighting for those with HIV and fighting for those who do not have HIV.  Both groups of people have their separate challenges.  

People who perceive themselves to be HIV-negative (one in five do not know they have HIV) often believe they are not at risk for HIV.  HIV is something from the 80’s, they say.  I can just take a pill and be fine, they say.  I am not someone who could get HIV, they say.  But all of these assumptions are false, based on ignorance or they chose to keep their head in the sand.  HIV is something that happens to “those people” (you can fill in the blank here with gay, sex worker, drug addict, homeless person, etc.) and they go to extreme mental limits to make sure nobody thinks they are one of “those people”.  Ignorance is only bliss until you get HIV, then... 

...then you become one of “us”.  All of a sudden all of your assumptions go out the door.  You are pulled roughly and violently into the world of HIV, your head no longer in the sand.  Like a grim rebirth, at the moment of your diagnosis you become someone else.  Your soul is laid bare, your very self begins to crumble in upon itself, and microscopically you begin to become repaired, each new particle of yourself knitting itself into a new Phoenix.  It may take years to rise up from the ashes of your old self.  It may happen immediately for the few and for the determined and for the strong.  

When you as an “us” becomes the new “us”, you become what was known to your former self as “them”.  And a funny thing happens...one day you realize the barrier you erected between “you” and “them”, though it is a very tall and very thick wall...that wall is composed of sand.  Being diagnosed with HIV is a huge tsunami, impossible to ignore, definitive in its power to transform. 

Advocating for myself as a person with HIV means I want to ensure I am safe, protected, and that I can always get my medications.  I definitely see the need for eliminating HIV criminalization, expanding access to lifesaving medications, and for reducing the still-awful stigma of this virus.   Becoming someone with HIV has added whole new dimensions to my life that were not there before, words such as “disability”, “Ryan White”, “adherence”, and “deductible”.  I suddenly pay very close attention to the fine print of any insurance plans I am able to choose from at work.  For me, I always look to see what kind of prescription coverage is offered, as that is my absolute main concern.  At one place I worked at for years, our HR decided to change insurance companies.  My monthly out of pocket expense for my meds shot up from $100 to $400 a month.  I paid more for my medicine than I did for my rent.  Needless to say, I had to go back on Ryan White to afford them, which always makes me feel guilty because there is a waiting list for ADAP in most states. 

Part of me finds it so much easier to fight on the side of those with HIV.  It seems easier to me to fight for more funding for HIV, to help people newly diagnosed just feels like more of a good deed.  It is definitely more appreciated.  I get more immediate satisfaction by being a resource for the newly infected. 

But the other part of me, the part that drives me the most, is the part of me that wants to fight for others, “them”...those who do not have HIV.  I want to do everything possible, shouting from the rooftops at the ignorance and complacency that causes HIV infections to rise every year.  I want more than anything for people to stop doing the things that are dangerous.  I want those who still have a choice to have the options available to them to be able to make a choice.  I guess you could very well call me an advocate for HIV negativity. 

Advocating on behalf of those who perceive themselves to be HIV- always feels like I am alone in a stadium, shouting loudly to the empty seats.  People who think they are HIV- close up when you say “HIV”.  The word conjures up the image of sex, gay or straight.  It conjures up images of needles stuck in someone’s arm.  It conjures up images of starving African children with their famine-swollen stomachs and their skeletal faces.  It forces someone to come face-to-face with mortality, another subject to be studiously avoided at all costs.  

The silence of the HIV-, especially in gay males, is deafening.  It is much easier for someone to convince themself they are not one of “those” people than it is to admit to themselves how many times they had unprotected sex last year.  But if you mention HIV to them, like a key unlocking a door, they remember that night they had sex without a condom...but wait, “he told me he was clean, so I don’t have to worry about THAT time”...or that other time...or that other time.  Like the emperor and his new clothes, they convince themselves they too are fine, nothing to worry about, now stop talking to me about HIV. Let’s talk about Lady Gaga instead.  

This is an edited version of an article originally appeared on Jason’s own blog, Embracing Pozitivity, here.  

About the author: I am 38, gay male from Knoxville, TN who is not ashamed of my HIV+ status. I am optimism personified. I am strength realized. I am just me. 

Website: embacingpozitivity.blogspot.com.Twitter @jjemcdonald

This article by James Wilton originally appeared on the CATIE http://www.catie.ca/en/home  website here. 

Une version française est disponible ici.

The sexual transmission of HIV occurs after an exposure to fluids that contain HIV, such as semen and fluids from the vagina and rectum. Research shows that a higher amount of HIV (viral load) in these fluids increases the risk of HIV transmission and that a lower viral load decreases the risk.1

Treatment, viral load and HIV transmission

The viral load in the blood of a person living with HIV is measured to monitor the success of antiretroviral therapy (also called ART, HAART or cART). Successful HIV treatment can reduce the viral load in the blood (and other bodily fluids) to undetectable levels and thereby reduce the risk of sexual HIV transmission. In fact, a research study known as HPTN 052 found that the risk of HIV transmission among heterosexual serodiscordant couples was 96% lower when the HIV-positive partner was on treatment.2 (In serodiscordant couples, one partner is HIV-positive and the other is HIV-negative.)

Undetectable viral load does not mean that there is no virus, but rather that the amount of HIV in a bodily fluid is below a level that tests can detect. (Tests used in some places, such as Canada, cannot detect HIV if there are less than 40 copies of HIV per ml of blood, while tests used in other parts of the world have higher limits of detection.)

Also, not all people living with HIV who take HIV treatment and have an undetectable viral load in the blood also have an undetectable viral load in their other bodily fluids. Research suggests that of those people living with HIV who have an undetectable blood viral load, 5 to 48% can have detectable virus in their semen, vaginal fluid and rectal fluid.3,4,5

Although previous research has demonstrated that treatment can reduce the risk of HIV transmission in heterosexual couples, it is unclear exactly what the HIV transmission risk is when a person’s blood viral load is undetectable. A recent systematic review6 of the literature was conducted by Dr. Mona Loutfy, one of Canada’s leading infectious disease specialists, and colleagues to gain a better understanding of this risk.

Systematic review

The authors searched for published studies that followed serodiscordant heterosexual or same-sex couples over time. The main purpose of the review was to find studies that met the following criteria:

• the HIV-positive partner was on antiretroviral treatment
• the number of HIV infections in the HIV-negative partner was recorded
• if HIV transmission occurred, the HIV-positive partner’s blood viral load was measured close to the time of transmission

The authors identified only three studies that fit all of their criteria. These studies followed a total of 222 heterosexual couples from Brazil, Spain and Uganda.

An additional three studies were identified that fit all of their criteria but did not measure the viral load of the HIV-positive partner near the time of HIV transmission, including the HPTN 052 randomized controlled trial. These studies enrolled a total of 1,304 couples on treatment.

Overall, these six studies contained 2,975 person-years follow up of treated couples. This is the equivalent of following 2,975 couples for one year. The vast majority of these couples were heterosexual and only a small number were same-sex couples (3% of the couples in the HPTN 052 study were same-sex).

Number of HIV transmissions and HIV transmission risk

In the three studies where viral load was measured, no HIV transmissions occurred among couples where the HIV-positive partner was on treatment and the viral load was undetectable.

In the additional three studies, for which viral load was not measured, a total of four transmissions occurred. However, it is not known if the viral load of the HIV-positive partner was detectable or undetectable at the time of transmission. All of these HIV transmissions occurred shortly after the HIV-positive partner started treatment; therefore, the viral load was likely declining but still detectable when transmission occurred.

In these six studies, the definition of undetectable viral load ranged from less than 50 copies per ml to less than 500.

The lack of HIV transmissions in these studies does not mean there is no risk of HIV transmission when the viral load is undetectable. Using data from all six studies (but excluding the four HIV transmissions that occurred in the additional three studies), the authors calculated that when the viral load is undetectable, there may be a 1% risk of HIV transmission per 10 years of relationship and sexual activity.

Limitations of the study findings

There are several factors—other than viral load—that can influence the risk of HIV transmission between serodiscordant couples and may partly explain the lack of HIV transmissions observed in this review. As a result, the authors of the systematic review listed several caveats to their findings, including the lack of data on:

1.Extent of condom use 

Condoms are an effective method of preventing the transmission of HIV and many STIs and couples in these studies may have been using condoms often. For example, in the HPTN 052 study, 96% of the couples reported using condoms every time they had sex. Although people often say they use condoms more than they actually do, condom use may have played an important role in keeping the number of HIV transmissions low in these studies.

2. Same-sex couples and type of sexual intercourse

The vast majority of the couples enrolled in the studies were heterosexual and were (likely) having mostly vaginal sex. Therefore, it is unclear how much these findings apply to same-sex couples and other couples who mostly have anal sex. Some researchers think the risk of HIV transmission when undetectable may be higher for anal sex compared to vaginal sex.

3. Rates of sexually transmitted infections (STIs)

STIs are known to increase the risk of HIV-positive people transmitting HIV and HIV-negative partners becoming infected. STIs may increase the risk of HIV transmission even when a person’s viral load is undetectable. However, most of the studies reviewed did not provide data on STIs other than HIV; therefore, the review could not evaluate their impact.

In general, the risk of having STIs is lower among stable heterosexual couples (particularly those who are monogamous) than among people in casual relationships. Also, in some studies, such as the HPTN 052 study, participants were provided with regular STI testing and treatment which can help to further reduce the rate of STIs. A low number of STIs among couples in these studies may have decreased the risk of HIV transmission.

Conclusion

This systematic review supports previous research showing that treatment can significantly reduce the risk of HIV transmission among heterosexual couples. The authors concluded: “Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health.”

Research is ongoing to gain a better understanding of the risk of HIV transmission (a) when the HIV-positive partner’s viral load is undetectable and condoms are not used and (b) in same-sex serodiscordant couples where the HIV-positive partner is taking ART.

RESOURCE:

Understanding Risk: A Conversation

REFERENCES:

 1. Baeten JM, Kahle E, Lingappa JR et al. Genital HIV-1 RNA predicts risk of heterosexual HIV-1 transmission. Science Translational Medicine. 2011 Apr 6;3(77):77ra29.

 2. Cohen MS, Chen YQ, McCauley M et al. Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine. 2011 Aug 11;365(6):493–505.

 3. Marcelin A-G, Tubiana R, Lambert-Niclot S et al. Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma. AIDS. 2008 Aug 20;22(13):1677–9.

 4. Sheth PM, Yi TJ, Kovacs C et al. Mucosal correlates of isolated HIV semen shedding during effective antiretroviral therapy. Mucosal Immunology. 2012 May;5(3):248–57.

 5. Sheth PM, Kovacs C, Kemal KS et al. Persistent HIV RNA shedding in semen despite effective antiretroviral therapy. AIDS. 2009 Sep 24;23(15):2050–4.

 6. Loutfy MR, Wu W, Letchumanan M et al. Systematic Review of HIV Transmission between Heterosexual Serodiscordant Couples where the HIV-Positive Partner Is Fully Suppressed on Antiretroviral Therapy. PLoS ONE. 2013 Feb 13;8(2):e55747.