Are There Holes in This Swiss
Theory?
As soon as the announcement came out and,
in turn, posted on www.aidsmap.com, I was bombarded with telephone calls
and emails. In February, an
article published by Switzerland’s Federal Commission for HIV/AIDS stated that “people with
HIV who have undetectable HIV viral load and no sexually transmitted
infections are not sexually infectious for HIV.” I thought this would be
a good time to look at this research and have a discussion of its HIV
health promotion possibilities.
The research that the Swiss research shows
is that you have certain conditions that must be met before you can have
unprotected sex:
• The person must adhere to their HIV
treatment, and the effectiveness of that treatment must be regularly
evaluated by their doctor.
• Their viral load must be undetectable for at least six months.
• The person must have no other sexually transmitted infections (STIs).
I think it’s important to note that some
other expert groups have disagreed with the Swiss group’s conclusions.
The U.S. Centers for Disease Control and Prevention (CDC) issued a brief
statement, saying that the CDC “underscores its recommendation that
people living with HIV who are sexually active use condoms consistently
and correctly with all sex partners”.
So, what exactly did the Swiss experts say?
And why is it controversial?
Based on their review of several medical
studies, the Swiss group concluded that an HIV-infected person who is on
HIV treatment and has a consistently undetectable viral load “is not
sexually infectious, that is, cannot transmit HIV through sexual
contact.”
The Swiss group also acknowledges that
“medical and biologic data available today do not permit proof that HIV
infection during effective antiretroviral therapy is impossible,” but
they believe that the risk is “negligibly small.”
Critics of the Swiss statement have
emphasized that research on HIV transmission and viral load has focused on
heterosexual couples and vaginal intercourse—and does not necessarily
apply to anal intercourse.
A number of people have also pointed out
that, even if the Swiss experts are right, their conclusions about
unprotected sex would apply to only a small number of HIV-infected
persons: people who have excellent adherence to their HIV regimen, a
consistently undetectable viral load, and no other STIs.
Practically speaking, the “no STIs”
restriction could probably be met only within a monogamous relationship in
which both partners were tested for STIs before stopping condom use. STI
testing would be essential, because many people with STIs have no
symptoms.
Several studies have shown that reducing a
person’s HIV viral load tends to reduce their risk of transmitting the
virus. This is very heartening, but it does not mean that people with
undetectable viral loads have no risk of transmitting the virus.
Given the limitations of current data, I
personally believe it would be unwise to endorse a
“no-condoms-needed-if-your-viral-load-is-undetectable” approach.
However, recent studies on viral load and
HIV transmission give reason to hope that, if effective HIV treatment were
widely available worldwide and properly used, the number of new HIV
infections could be substantially reduced.
Universal access to treatment could be an
important element in a comprehensive HIV prevention strategy that would
include widespread access to HIV testing, use of the full range of
existing prevention techniques and technologies, and the continued
research and development of new prevention technologies, including
microbicides and vaccines.
Sal Seeley is Program Director of CAMPsafe, an HIV/AIDS program
funded through a contract with the Delaware Division of Public Health.
E-mail salvatoreseeley@aol.com.
|
Back to Top of Page 