HIV Sex

Better Sex Naturally PictureMost people generally prefer to have sex naturally (without the use of a condom).

For some people with HIV the path of least harm (while still fulfilling your right to intimacy) was to find a partner with the same HIV status.

However given the new scientific evidence that has emerged, people are now incorporating new risk reduction strategies that allow them to have natural sex with their consenting partner/s.

Scientific evidence you are not infectious with an Undetectable Viral Load (i.e. when copies of HIV in the blood are below 20 copies per milliliter)

2008 – Swiss Statement
In January 2008 the “Swiss Statement” redefined what it meant to have sex while successfully on anti-retroviral therapy (ART) swissguidelinesART  referring to people with an undetectable viral load as “non infectious” ( read the guidelines for the qualification which applies)

2011 – HPTN052
August 2011 HIV Prevention Trial Network (HPTN) 052 investigators confirmed that by providing early treatment, HIV transmission was reduced by 96% in pos-neg couples (27 untreated vs 1 treated) . HPTN O52 – New England Journal of Medicine This trial significantly contributed to the momentum for treatment as prevention. The one account of the treated who communicated HIV to their partner, had only recently started treatment and had not yet achieved an undetectable viral load

2013, HIV medication (undetectable viral load) is declared as effective as condoms.
The British HIV Association and the Expert Advisory Group on AIDS Position statement on the use of antiretroviral therapy to reduce HIV transmission January 2013 Take the position that successful HIV medication is as effective as condoms (caution caveats and conditions are the same as the Swiss Statement). I applaud their scientific perspective applied to HIV transmission, and not the moral panic view of some individuals.

2014 PARTNER study
Dramatically, at the 2014 Conference on Retrovirus and Opportunistic Infections, The PARTNER study interim results showed that after 45000 sexual acts between pos-neg couples there were zero transmissions. CROI 2014 PARTNER presentation slides  CROI 2014 PARTNER Question and Answer The authors although cautious with caveat confidence intervals on the data, nonetheless expressed an opinion that they expected zero transmissions when the full study was completed.

2015 Opposites Attract
The zero HIV transmission evideance gathers pace, this time specifically amongst gay man. That’s right more interim results, more zero transmission CROI 2015 Opposites Attract – Abtract

Evidence of STI’s no Impact on undetectable Viral load

2015 British HIV Association Conference
It appears that even with a different STI as long as you maintain an undetectable viral laod, you won’t be passing on HIV (sample size way to small to be conclusive). This was also confirmed in the PARTNER and Opposites Attract studies were some participants had or acquired other STI’s with no impact on HIV transmission. Yay Impact of rectal Gonorrhoea and Chlamydia on HIV Viral Load . Caution, we know for men who are HIV negative having another STI will increase thier risk of HIV if they have exposure to detectable HIV.

Evidence, HIV medication also works as a Before Pill (Pre Exposure Prophylaxis PrEP) for people who do not have HIV

2010 iPrEx Trial
In December 2010 it was reported that if the neg partner actually took daily anti-retroviral drugs (FTC-TDF) there was a relative risk reduction of 95% iPrEx trial – New England Journal of Medicine

Pharmaco kinetic (PK) modelling of daily Truvada (TDF-FTC) provides close to 100% protection. Even two doses of Truvada a week was estimated to reduce the risk by 76%.

2014 iPrex OLE
At the 2014 International AIDS Conference in Melbourne in an extension of the iPrEx trial, reported zero transmissions in the Truvada treated participants, when they took between 4-6 tablets a week of Truvada  2014 AIDS Abtract – iPrEx OLE . Providing strong evidence that having Truvada in the blood correlated with the prevention of HIV transmission.

2015 PROUD and Ipergay Trials
Two studies, cancelled their respective placebo arm participants early, as it became overwhelmingly evident that when a sufficient amount of Truvada is in the blood HIV transmission was prevented. Both studies were presented at CROI PROUD Trial – CROI 2015  Ipergay Trial – 2015 CROI

Access To the Before pills Truvada PreP
Countries around the world are now racing to implement the provision of Truvada for individuals with high risk of HIV exposure. USA has on this occasion lead the world, with the municipality of New York making provision of Truvada free to individuals who fit thier criteria of high risk. Much has also been achieved in the UK and other progressive European Countries. In Australia you may be prescribed a script, however the retail cost is prohibitive and most will purchase a generic online, unless you are part of an Australian PreP trial, which has sites in Sydney Melbourne and Brisbane.

Positive Advocate Opinion
Although all risk reduction strategies have their pitfalls and require nuance to individual circumstances. For many people a reasonable and acceptable pathway to natural sex is now ahead of us.

There will be some individuals who believe that any risk isn’t acceptable. When you consider a zero risk proposition, most people will think of a HIV negative couple in a monogamous relationship. But even this scenario carries a risk as the mutually exclusive sexual arrangement may not hold solid for the entire life of the relationship.

Every individual ultimately decides which hot sex/pleasure/trust/risk/harm equation is acceptable to them. Zero risk (for people who are sexually active) is for the most part a fantasy, constructed to alleviate our anxieties and irrational fears.

Avoiding HIV and therefore people with HIV is still the per-eminent risk reduction strategy for people who embrace irrational fear. Although justified morally under a ” personal choice no risk” mantra, unmasked, it is nothing more than code for sustained ignorance, stigma and discrimination against people with HIV.

If you would like to explore this topic further with your peers, then please see the program section of the PositiveAdvocate.com

More interesting reading and video.

I am on antivirals and undetectable: what about safe sex? 9 Nov 2012

Brief interruption of HIV Antiretroviral Therapy in Patients with Preserved CD4 Counts and Virological Suppression is Safe and Well Tolerated2 Nov 2012

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