About 10% of gay men taking antiretroviral treatment have low levels of HIV detectable in their semen, according to new research. 

In the study, a low but detectable viral load (between 50 and 500 copies/ml) was associated with the presence of HIV in semen.

There is currently a lot of discussion about the effect of HIV treatment on infectiousness and the use of HIV treatment as prevention. Research conducted in heterosexual couples has shown that antiretroviral therapy that reduces viral load in the blood to undetectable levels (below 50 copies/ml) reduces the risk of sexual transmission by 96%. (PositiveLite.com editors note: the research to which this refers - HPTN 052  - measured the impact of early treatment, not undetectable viiral load, two entirely different concepts..  We have questioned aidsmap.com about the accuracy of their statement.)

But there have been rare case reports of HIV transmissions in the presence of an undetectable viral load.

Untreated bacterial sexually transmitted infections (STIs) such as chlamydia and gonorrhoea may cause viral load to increase in genital fluids, even if a person is taking effective antiretroviral treatment.

Doctors in the United States wanted to see if infection with human herpes viruses also had an impact on viral load in genital fluids.

They monitored blood and semen samples taken from 114 gay men. All were taking HIV treatment and had a blood viral load below 500 copies/ml (88% had a viral load below 50 copies/ml).

HIV was detected in the semen of 10% of the men. The average viral load in semen was low – 126 copies/ml. Whether or not this level of HIV in semen is associated with transmission is unknown.

Detection of HIV in semen was associated with the presence of two viruses of the herpes family – high semen levels of CMV (cytomegalovirus) and detectable EBV (Epstein Barr virus) in semen.

“The association between isolated HIV shedding and high-level CMV replication and EBV replication in the genital tract suggests that the presence of these viruses could play a role in HIV transmission…these findings have important implications for the development of strategies to reduce HIV transmission,” comment the researchers.

They also found that 36% of study participants with a detectable viral load were shedding HIV in semen compared to 6% of participants with an undetectable viral load.

A urethral bacterial STI was diagnosed in 4% of men, but these untreated infections were not associated with the presence of HIV in semen.

For more detailed information on HIV transmission, visit our online resource HIV transmission and testing.

This article originally appeared in aidsmap news, May 2013. Read the full article here.

 This article first appeared on the CATIE website here.

Une version française est disponible ici. 

Summary

HIV viral load is the amount of HIV (or number of virus) in the bodily fluids of someone living with HIV. It is measured in the blood as part of routine clinical care. A higher viral load is associated with a higher risk of HIV transmission. Research shows that successful HIV treatment can reduce the viral load to “undetectable” levels and this can reduce the risk of HIV transmission. However, HIV transmission may be possible when the viral load is undetectable because there is still virus present in the blood and other bodily fluids. The risk of HIV transmission when taking antiretroviral treatment may increase if sexually transmitted infections (STIs) are present, doses of medications are missed, or drug resistance develops. This risk may also be higher for anal sex than for vaginal sex.

What is viral load and how is it affected by HIV treatment?

HIV viral load is the number of copies of HIV in the bodily fluids of someone living with HIV. It is measured as the number of copies of the virus in one millilitre of fluid (copies/ml). Viral load is measured in the blood and is used to monitor the progression of HIV infection and the success of HIV treatment. It is not commonly measured in other bodily fluids, such as semen, vaginal fluid or rectal fluid.

HIV treatment consists of a combination of at least three drugs that are normally taken daily. The goal of HIV treatment is to reduce the production (also called replication) of HIV, raise levels of CD4 T-cells, and slow disease progression. HIV treatment is also called highly active antiretroviral treatment (HAART) or antiretroviral therapy (ART).

With successful HIV treatment, the viral load can become very low or “undetectable” in the blood and other bodily fluids.

What is a “normal” viral load?

There is no such thing as a “normal” viral load. The viral load in the bodily fluids can change as a result of several factors, such as the stage of HIV infection and HIV treatment.

During the first few weeks after becoming infected with HIV, the viral load in the blood and other bodily fluids is very high. This stage of HIV infection is known as the acute infection stage and at this time the viral load can reach levels higher than 1 million copies/ml.

The acute HIV infection stage only lasts for a few weeks and then the chronic stage of HIV infection begins. During the chronic stage, the viral load begins to decrease and – after a few months – the viral load stabilizes at a lower level.

If HIV treatment is started, the viral load can be reduced to “undetectable” levels in the bodily fluids within a few months. However, if doses of medications are missed or HIV develops resistance to treatment, then the viral load will increase.What does it mean to have an “undetectable” blood viral load?

“Undetectable” means that the number of virus in the blood is below the limit that viral load tests can detect. Viral load tests used in Canada cannot detect HIV in the blood if there are less than 40–50 copies/ml. Therefore, an undetectable viral load means the amount of virus in the blood is too low to detect, it does not mean that there is no virus present.

Is the viral load in the blood associated with a person’s risk of transmitting HIV?

Research shows that a lower amount of virus in the blood is usually associated with a lower risk of transmitting HIV to others, and a higher viral load is associated with a higher risk.

The amount of virus in the blood is usually correlated with the viral load in the semen, vaginal fluid, and rectal fluid (the fluids commonly involved in the sexual transmission of HIV). This means that when the viral load in the blood decreases, it generally also decreases in the other fluids.

However, the viral load in the different bodily fluids is never exactly the same. For example, the viral load in the semen, vaginal fluid or rectal fluid can sometimes be higher than the viral load in the blood.

Does HIV treatment reduce the risk of sexual transmission of HIV?

Successful antiretroviral treatment can lower the viral load in the blood and other bodily fluids to undetectable levels and this can reduce the risk of sexual HIV transmission.

A randomized controlled study known as HPTN 052 found that HIV treatment reduced the risk of HIV transmission between serodiscordant heterosexual couples by 96% (equivalent to a 26-fold reduction in risk). A serodiscordant couple is where one partner is HIV-positive and the other is HIV-negative.

Couples in the HPTN 052 study were mostly heterosexual, mostly reported having vaginal sex, and were provided with regular adherence counselling, viral load tests, testing and treatment for sexually transmitted infections (STIs), and prevention counselling and free condoms. Therefore, this study demonstrated the effectiveness of treatment in reducing the risk of HIV transmission through vaginal sex when pills are taken regularly, drug resistance is monitored, and STIs are managed. Antiretroviral treatment may be much less effective than 96% when these conditions are not met.

No studies have been completed among populations who mostly have anal sex, such as some gay men or other men who have sex with men (MSM). However, a working group meeting hosted by the World Health Organization in 2011 concluded that “there is reason to believe that early initiation of ART for HIV prevention will benefit MSM, transgender women, and others who have anal intercourse, although the magnitude of the effect may be different from that observed in serodiscordant heterosexual couples.” In other words, HIV treatment reduces the risk of HIV transmission for gay men and other MSM, but it may or may not be as effective as for heterosexual couples in the HPTN 052 study.

There are ongoing studies that are trying to get a better idea of how well HIV treatment can reduce the risk of HIV transmission among gay men and other MSM.

Is HIV transmission possible when the viral load in the blood is undetectable?

Although the risk of sexual HIV transmission is reduced when the viral load is undetectable, the risk of HIV transmission may not be eliminated.

Many people who have an undetectable viral load in the blood also have an undetectable viral load in other bodily fluids. However, undetectable does not mean that there is no virus, only that the amount of virus is below the limits that tests can detect. Therefore, HIV transmission may still be possible because there is still virus present.

Also, it is possible for people who have an undetectable viral load in the blood to sometimes have detectable (although lowered) levels of virus in their other bodily fluids. A higher level of HIV in the semen, vaginal fluid, and rectal fluid may increase the risk of transmission when the blood viral load is undetectable. However, it is unclear how often this happens and how significant it is in terms of HIV transmission. Research shows it may be more common if a person has an STI, but can also happen in the absence of STIs.

What is the risk of HIV transmission when the blood viral load is undetectable?

Although we know having an undetectable blood viral load can greatly reduce the risk of HIV transmission, it is unclear exactly what this risk is reduced to.

In the research conducted so far, there have been no recorded HIV transmissions among heterosexual couples where the HIV-positive partner is on treatment and their blood viral load is undetectable. However, this does not mean the risk through condomless sex is zero. All of the couples studied to date have also reported using condoms often. This makes it difficult to determine the risk of HIV transmission when no condom is used.

Although there have been no studies among gay men and other MSM, there has been one report of HIV transmission occurring between two men when the HIV-positive partner had an undetectable viral load.

Also, the risk of HIV transmission when the viral load is undetectable may not be the same for all types of sex. This risk may be higher for anal sex than for vaginal sex, particularly if the HIV-negative partner is the receptive partner (bottom) during anal sex. This is because receptive anal sex generally carries a higher baseline HIV risk than other types of sex.

There are ongoing studies following serodiscordant heterosexual and same-sex couples who are taking HIV treatment, have an undetectable viral load, and do not always use condoms. These studies will provide a better understanding of the risk of HIV transmission when the viral load is undetectable and no condom is used.

What does this all mean for people who want to use HIV treatment to prevent HIV transmission?

There are no simple answers on viral load, HIV treatment and their relationship to HIV transmission and prevention. However, there are key messages for those who want to use HIV treatment to reduce their risk of HIV transmission:

• Check to make sure the blood viral load is undetectable before starting this approach and get frequent viral load tests to ensure it remains undetectable while using this strategy. It is generally recommended that the viral load be undetectable for 6 months before using this approach.
• Take pills exactly as prescribed. Adherence to treatment is critical to keep the viral load undetectable in the blood and prevent the development of drug resistance.
• Get tested regularly for STIs (including, syphilis, gonorrhea, chlamydia, and herpes). STIs can increase the risk an HIV-positive person transmits HIV and an HIV-negative person becomes infected with HIV. If either partner has an STI, start treatment immediately and try to avoid condomless sex during this time.
• Ask your doctor about vaccinations for hepatitis A, hepatitis B, and human papilloma virus (HPV).
• Using other HIV prevention strategies as much as possible – particularly condoms and lube – will help reduce the overall risk of HIV transmission.

References

Wawer MJ, Gray RH, Sewankambo NK et al. Rates of HIV-1 Transmission per Coital Act, by Stage of HIV-1 Infection, in Rakai, Uganda. Journal of Infectious Diseases. 2005 May 1;191(9):1403 –1409.

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.

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

World Health Organization. WHO and U.S. NIH Working Group Meeting on Treatment for HIV Prevention among MSM: What Additional Evidence is Required. Geneva; 2011 Nov.

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.

Stürmer M, Doerr HW, Berger A, Gute P. Is transmission of HIV-1 in non-viraemic serodiscordant couples possible? Antiviral Therapy. 2008;13(5):729–32.

Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nature Reviews Microbiology. 2004 Jan;2(1):33–42.

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.

Late at night, I research and write by myself so I can avoid confronting the fact that I am alone, typically until I pass out from exhaustion. Gradually through the evening, as sources for my stories and colleagues I’m collaborating with over long-term projects go to bed themselves, I’m left alone at my computer, occasionally Googling a fact that I’m curious about; tonight, I learned about the history of Prussia.

Thoughts randomly piece themselves together until a great idea hits me, I write it down, and then my aimless reading continues. Sometimes, I’m chasing a lead and poring over ethics complaints and campaign finance disclosure forms. Other times, I’m refreshing my knowledge of American or military history. And, tonight, I purposefully watched the digital clock on my computer until 12:00 AM hit to reach another year of sobriety from alcohol; today, May 6, is the day that I decided years ago that I was finally done with drinking. 

At one point in my life, I had a good job serving my community, a good partner whose boundless compassion and understanding was remarkable, a quaint suburban home, and a good network of friends with reputable backgrounds and even more respectable jobs. Yet, during that very same period of my life, and for years prior, I had generally functioned as an alcoholic.

Somehow, I had always managed to apologize away the missteps, the rare flashes of rage, and the endless sadness, literally bouts of uncontrollable sobbing, that inevitably ensued when I became drunk. At some inexact point years ago, however, the functioning component of my alcoholism started to disintegrate and more of my work was sloppy, more dinners with my husband were missed, more hangovers caused more missed trains, and, eventually, I lost the very thing that I so desperately wanted my entire life: love.

Jung said that we do not wish to hear someone say “I love you” but, instead, “I understand you.” And, for me, this is a truth that I have found only once in my life and that was because it was coupled with love. Sometimes, I will hear someone inexperienced with long-term relationships wax poetically about the perfect nature of his newest adventure; candidly, I indulge myself in these sophomoric romps to, feel, at least for a short while, capricious and giddy. Indeed, there is a fleeting joy in being, for all intents and purposes, idiotically infatuated. But, the one thing that I rarely hear and have never uttered in years is the sincere, and quiet, appreciation of imperfection inherent in love and understanding between two human beings: the pensive tics, the bedhead cowlicks, the sometimes terrible sense of humor, the earnest goodwill found in whomever you truly love.

These imperfections are the essence of the love that we truly seek, whether we know this or not is irrelevant because it is true. And, at one point in my life, I had this love. Though, being an alcoholic, and a particularly nasty, narcissistic one at that, I threw that all away in exchange for doing whatever I wanted to do. This is, indeed, the surest way to destroy a relationship.

Let no maudlin drunk or repentant (at least today) sinner convince you otherwise: we do things as human beings not because we are compelled by nature or illness but, instead, because we choose to do these things.

We cheat on our wives because we are lustful and, for some reason, decide to not have a candid conversation about a non-monogamous yet loving relationship. We steal from public coffers because we desire greater wealth and material instead of appreciating the things we have and choosing to live within our means. We belittle others because we have the power to do so and can feel better about ourselves in the process, and there is no complexity in our motivation anymore than there is complexity in the fact that we must sleep every night as it is our biological function. Whether or not we choose to resist these motivations, to instead cultivate the noblest components we are endowed with is entirely our decision. We are not powerless nor are we weak. On the contrary, we are empowered to deliberately make decisions that have inevitable consequences, be they good or bad.

And this is the most frightening part of being human.

If we are not compelled by force to behave in a terrible way, then we have chosen to deliberately defy our ethics and the better parts of our innate characters and have opted, instead, to give in to the most repugnant and damaging aspects of our animal nature. We become drunkards, drug addicts, narcissists, mean-spirited misanthropes, or, as is typical, whiny, weak-kneed explainers who would rather use these very tools of manipulation, drink for instance, to excuse away our behavior disingenuously rather than confront the fact that our characters are, at least for some of us, inherently predisposed toward unethical acts. This predisposition is not immutable; we can change how we behave and how we cope with life in order to focus our energies in more socially acceptable and rewarding ways. Some folks call this cognitive behavioral therapy; others call it Alcoholics Anonymous. Personally, I call it ethics.

As the years go by and the length of time between the last time I was drunk and “now” continues to increase, I realize that I know very little considering I have experienced so much. Oddly, my knowledge seems to have an inverse proportional relationship to my age and experience; and, this is unnerving. For if part of getting older is recognizing that you are fully responsible for your mistakes, then you must logically realize that you are where you are because of, mostly, your own actions combined with a small number of lucky encounters.

These small chances, these opportunities presented by chance, fate, or God himself, are often hard to identify, but they exist and your actions in response propel your own trajectory down one of many different paths presented to you.

Personally, I chose an unhappy path for a very long period of time, a path that unfairly involved others to a tragic degree. And, I cannot change this, nor can I possibly ever find redemption for these actions and words. Rather, I can simply try harder and hope that those opportunities I once had will present themselves again only in a more recognizable fashion with, I assume, a different set of characters. Hopefully, I will recognize these opportunities more perceptively than I did when I was an active drunk, otherwise I am destined to repeat my mistakes and the idea of happiness, of that love, will always be the dream that I put off every evening, opting instead to read about history or write about politics until I fall asleep.

Today, I am still sober. And, I am still putting off going to bed. Even so, it is much easier being alone sober than it is drunkenly sobbing. And, for that, I am glad I made the choice to continue my sobriety today. I expect that this will continue for some time; after all, you get quite used to not drinking and, interestingly enough, are sort of puzzled after a while why people drink at all, or why you did it in the first place. Then again, there is no puzzle to it.

We do these things because we want to do them.

This article first appeared on Josh's own blog here.

California! I just got back from California for the second time – and it was awesome; I didn’t want to come back. My friends and I went to Palm Springs, Laguna Beach and Los Angeles. 

In Palm Springs, when we got there, the temperature was 39 degrees Celsius. It was hot, hot hot! We had rented a house since there were five of us. The house was beautiful, with a great pool, which we spent much time in. We made tasty drinks, and had tasty snacks. I got a great tan. 

My one friend who lives in L.A didn’t know I had HIV. I decided to use the opportunity to tell her. But first she was talking about how flaming my outfit was - pink shirt and lime green capri pants, and then for the pool I was wearing super short swim shorts. She said she didn’t remember me dressing like this. I told her I am so much more comfortable with myself now. She asked “what changed?” and I told her about the group therapy program I did last year and then I told her I have HIV. 

I was scared she might react badly, as she can be abrupt and abrasive sometimes. But instead she said, “I’m sorry and I love you” and hugged me.  And then we all had a big group hug and that was that. It was awesome; a huge weight was lifted off my shoulders and we continued like nothing happened. I have amazing friends! 

We tried to go shopping in Palm Springs but it was way too hot. We walked around for twenty minutes and decided to retreat back to the house. Nothing like a nice cold beer to cool you off. We spent four great days in Palm Springs. It was amazing just to relax and not have to worry about anything nor feel obligated to do anything. 

We then headed off to Laguna. I love Laguna; it is such a cute beach town, right on the ocean, with lots of cute, unique shops.  But one shop I didn’t like because the owner was insane! 

I tell my (women) friends I am going to go take a look  at a mens clothing store I’d seen. They head down the block. I was wearing pink shoes, lime green manpris (capris) and a pink shirt. As soon as I walk in, the woman in the store comes over and says “You’re so obviously not afraid of colour, this will be so much fun.” I smile and think “cool, she seems easy going.” 

She starts grabbing clothes - pants, shirts, and shorts - puts her arm around me and shoves me into the dressing room. I humour her. First I try on the shorts. I hear her say “my rule is you have to come out and show me.” I hate aggressive sales people, so I‘m annoyed but I humour her. I show her the shorts and shirts. I try on the pants, I love the pants! They are magically soft. I look at the price tag. My heart leaps, $185 for a pair of pants! I go out and show her, she swoons over them. I have to admit my butt look fabulous in them, I would do me. 

I go back in the dressing room and try to take them off but they are too tight. What if I can’t get them off? I will have to buy them. But I’m not paying $185 for a pair of pants. I’m struggling, trying not to grunt and I’m sweating profusely. After what feels like an hour, I breathe a sigh of relief and get those expensive things off my body. 

I hear another customer come in; I think to myself I can escape without buying anything. I slowly open the door and try to make a break for it. She cuts me off and stops me. Damn it, I was so close! She says “so are you going to take everything?” I reply “unfortunately not, I'm at the end of my vacation and the clothes are just too expensive. I really love the pants but I just can’t.” She takes me to the till and says, “what if I give you $30 off, that’s 16% off?” I tell her that’s generous but I can’t. She says, “what if I give you 25% off?. I tell her that I appreciate her offer but I have to think about it. 

Now she gets bitchy: “well I can’t give you anymore than that.” I tell her “I appreciate you offering but, like I said, I need to think about it..” I try to walk away but she follows me out of the store. I am ready to snap; this is way too aggressive! She says, “think about how much you spend on other things like food, you just have to decide what’s more important.” I just smile and quickly walk away. I thank my lucky stars I've escaped. 

After that we went to The Montage Hotel (for super rich people) for lunch, a very expensive lunch. My two mojitos and my steak melt sandwich and fries came to $74 with tip, but  worth every penny. They were the best mojitos I have ever tasted. My sandwich was amazing and the atmosphere and view of the ocean were great. Great too that my $74 went to food and not that crazy woman in the store. 

Then on to L.A. Our friend that was with us lives in L.A so we stayed at her place. The first night we went out for the best sushi I ever had, so yummy. My L.A friend ordered mussels – and  nicknamed them car tires, for good reason. They convinced me to try one, I quickly regretted it. My face cringed; I opened my mouth and shoved it in. I immediately wanted to cry. I couldn’t swallow it, I just couldn’t. I spat it out and quickly drank a lot of beer. 

The next day our L.A friend, who is Korean, took us out for Korean barbeque. In the middle of the table is a grill that you cook the various meats on. You get an insane amount of Korean side dishes and condiments. It was delicious, but I ate way too much.  We were walking to the car and I kept rubbing my belly like a pregnant lady. 

We decided to head to Trader Joes to pick up supplies for making mojitos. We get there and all of a sudden my stomach is angry, very angry. I yell I have to poop, now! Trader Joes doesn’t have bathrooms. I run across the street to this fancy burger joint. There is a waitress right there “ Can I seat you?" she asks. I try to casually walk to the washroom, clenching my ass as tight as I can. After I’m done I open the door and try to sneak out, but she is right around the corner.  “Where would you like to sit?” she asks  “Actually I just came in to get a pop.” “A what? Oh sorry, you just want a soda., “Yes that’s all I want”. She totally knows I came in there just to use their toilet. Whatever, the $2.35 was worth it to be able to not shit myself. 

It was a great trip and I am sad it’s over but I am also thankful that I am so fortunate that I get to travel. I had a great time. 

Let’s be clear from the start. My history is one of being an opponent of treatment as prevention (TasP) - and a vocal one at that. But that was then and this is now, a time where the arguments of yore are no longer at all persuasive. So I’ve changed my mind and I now fully support TasP.

To be honest, mine is not a popular stance in Eastern Canada, but I’m in good company elsewhere. I’m referring to endorsement of TasP by the  World Health Organization, the International AIDS Society, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the British Columbia Centre for Excellence in HIV/AIDS, (BC-CfE), the Terrence Higgins Trust, not to mention luminaries like Barack Obama, Hillary Clinton, Bill Clinton and Canada’s own Stephen Lewis.

But those names in themselves do not stir me.  It’s the opportunity that TasP, particularly in the absence of any other current strategy to see an end to AIDS in our lifetime, while improving the health of those with the virus. As Stephen Lewis has said utilizing TasP has become a “moral imperative”, a matter of ethics and of human rights. “What is urgently needed is for the Canadian government to do the right thing and that is to expand HIV testing and treatment nationwide.”

Leading treatment as prevention researcher/advocate Dr. Julio Montaner, a former head of the International AIDS Society, echoes his words, saying  “It is imperative for the Canadian government to mobilize political will and funds to nationally expand testing, treatment and support to people living with HIV/AIDS. This is the moral thing to do if we want to end AIDS and secure the health of our future generations.”

They are both right, of course

All of which leads me to say I was delighted to respond to the British Columbia Centre for Excellence in HIV/AIDS' invitation to endorse their efforts to secure a national AIDS strategy for Canada incorporating TasP.  You’ll find my words quoted in their press release below.

*************************

New study reinforces effect of antiretroviral treatment on prevention of HIV and calls for national action

Study stresses need for political will and funding to implement the made-in-Canada Treatment as Prevention strategy to save lives and prevent new infections 

Vancouver, B.C. [May 14, 2013] — A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) and University of British Columbia shows there is strong and consistent evidence that expanded use of highly active antiretroviral therapy (HAART) decreases HIV transmission across a variety of geographical regions and sub populations. 

Researchers reviewed scientific evidence published in peer-reviewed journals about the benefit of HAART among HIV-positive individuals in preventing HIV transmission. Their analysis of existing literature reinforced the strong relationship between use of HAART and reduced transmission among not only stable heterosexual serodiscordant (where one partner is HIV positive) population, but also high-risk groups such as men who have sex with men (MSM) and injection drugs users (IDU).

“There is no doubt HIV Treatment as Prevention is a game changer,” said Dr. Julio Montaner, director of the BC-CfE and senior author of the study. “It is imperative for the Canadian government to mobilize political will and funds to nationally expand testing, treatment and support to people living with HIV/AIDS. This is the moral thing to do if we want to end AIDS and secure the health of our future generations.”

Study authors noted the effectiveness of abstinence promotion, condom use and needle exchange programs have been limited. In 2010 there were 2.5 million new infections, 1.8 million AIDS-related deaths and 390,000 children infected globally, with disproportionate representation in low-income countries. Only 54 per cent of HIV-infected individuals with severe immunodeficiency are on HAART, and only 20 per cent of people with HIV know their status.

Over the years, scientific evidence has mounted nationally and internationally in favour of HAART’s impact on reducing disease progression to AIDS and death and secondarily decreasing HIV transmission. In B.C., between 1996 and 2009, the number of individuals receiving HAART increased from 837 to 5,413 and the number of new HIV diagnoses fell from 702 to 338 per year (52 per cent decrease). The rates of HIV testing increased throughout the study period. In addition, in 2011, the HIV Prevention Trials Network (HPTN) reported that HAART led to a 96 per cent reduction in HIV transmission among serodiscordant couples.

“I am living proof of the long-term benefits of HIV treatment,” said Bob Leahy, editor of PositiveLite.com, Canada’s online HIV magazine, and someone who has lived with HIV for 20 years. “HAART has allowed me to live a normal and productive lifestyle and this is nothing short of a miracle for people like myself who have been given a second chance. It makes so much sense, and is the right and ethical thing to do, to ensure we quickly scale up testing across Canada so that every HIV-positive person has access to HAART, both to improve their own health and to very significantly reduce the risk of transmission.”

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently reported a 10 per cent drop in HIV/AIDS funding from 2009 to 2010 to support the Universal Access pledge. The U.S.’ budgeted contribution to the Global Health Initiative is projected to fall 10.8 per cent for 2013.

“We have the tools to end HIV/AIDS, and B.C. is a shining example of what can be achieved through universal implementation of Treatment as Prevention,” said Stephen Lewis, co-director of AIDS-Free World and renowned HIV/AIDS activist. “We are talking about human lives and the future health of Canadians. We cannot afford any further debate or more expensive clinical trials to prove what we already know. What is urgently needed is for the Canadian government to do the right thing and that is to expand HIV testing and treatment nationwide.”

The B.C. pioneered Treatment as Prevention strategy has led to the widespread expansion of HAART coverage in British Columbia. It has demonstrated a marked decrease in morbidity, mortality and new HIV cases. As the only province to implement the Treatment as Prevention strategy, B.C. stands alone as the sole province to show a consistent decline in new HIV diagnoses since 1996.

“While expansion of Treatment as Prevention will no doubt be lifesaving, evidence shows the long-term financial benefits can be tremendous,” said Dr. Bohdan Nosyk, lead author of the study and health economist at the BC-CfE. “HAART has evolved beyond individual health benefits to the HIV-positive person to secondary preventive benefits for the community at large. Failing to expand HIV funding can reverse the gains made against the epidemic and undermine the promise of HIV Treatment as Prevention.”

Research by the Canadian AIDS Society suggests the lifetime economic cost of each HIV infection is over $425,000, including health care costs and lost productivity.

Every year, 3,300 men and women in Canada are diagnosed with HIV infection and it is estimated more than 71,000 Canadians are now living with HIV.

The full study authored by several renowned HIV/AIDS experts and published in AIDS, official journal of the International AIDS Society, can be found here.

What is Treatment as Prevention?

The Treatment as Prevention strategy has been pioneered by BC-CfE’s Dr. Julio Montaner. It involves widespread HIV testing and immediate provision of anti-HIV drugs known as HAART to medically eligible people with HIV. The BC-CfE has demonstrated that the benefits of early HAART treatment are twofold: it reduces the level of HIV in the blood to undetectable levels thus improving the health of people with HIV, and decreases the level of HIV in sexual fluids to undetectable levels thus reducing the likelihood of HIV transmission by more than 95 per cent. In 2009, the BC government invested $48 million over four years in the BC-CfE-led Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot project. The intent of the pilot is to expand HIV testing and treatment among hard-to-reach populations such as injection drug users in Vancouver’s inner city and Prince George.

Treatment as Prevention is internationally recognized by organizations such as the World Health Organization, International AIDS Society and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Treatment as Prevention has been endorsed by U.S. President Barack Obama, Secretary of State Hillary Clinton and former U.S. President Bill Clinton as an effective strategy in the fight against HIV/AIDS.