Unprotected sex OK for some with HIV'

[Guest guest]

[A CDC Statement Underscores Current Recommendation for Preventing HIV

Transmission follows the main text of the message: Editor, AIeF]

GENEVA: Swiss AIDS experts said on Thursday that some people with HIV who are on

stable treatment can safely have unprotected sex with non-infected partners.

The Swiss National AIDS Commission said patients who meet strict conditions,

including successful antiretroviral treatment to suppress the virus and who do

not have any other sexually transmitted diseases,

do not pose a danger to others.

The proposal, published this week in the Bulletin of Swiss Medicine, astonished

leading AIDS researchers in Europe and North America who have long argued that

safe sex with a condom is the single most effective way of preventing the spread

of the disease — apart

from abstinence.

" Not only is (the Swiss proposal) dangerous, it's misleading and it is not

considering the implications of the biological facts involved with HIV

transmission, " said Jay Levy, director of the Laboratory for Tumor and AIDS

Virus Research at the University of California in San Francisco.

The Swiss scientists took as their starting point a 1999 study by the US Centers

for Disease Control and Prevention, which showed that transmission depends

strongly on the viral load in the blood. The Swiss said other studies had also

found that patients on regular anti-AIDS treatment did not pass on the virus,

and that HIV could not be detected in their genital fluids.

" The most compelling evidence is the absence of any documented transmission from

a patient on antiretroviral therapy, " said Pietro Vernazza, head of infectious

diseases at the cantonal hospital of St

Gallen in eastern Switzerland and one of the authors of the report.

" Let's be clear, the decision has to remain with the HIV-negative partner, " he

said.

The studies cited by the Swiss commission did not themselves definitively

conclude whether people with HIV and on antiretroviral treatment could safely

have unprotected sex without passing on the virus. In practice the

recommendation would affect about a third

of HIV patients in Switzerland, Vernazza said, but added that patients and their

partners would benefit from greatly increased quality of life, such as being

able to have children without fear of passing on the virus.

Levy said there was no safe way of knowing whether a patient with HIV who has no

detectable virus in the blood will not transmit the virus.

More research into the links between viral load in the blood and the presence of

the virus in genital fluid was needed, he said. The World Health Organization

said Switzerland would be the first country in the

world to try this approach.

http://timesofindia.indiatimes.com/HealthSci/Unprotected_sex_OK_for_some_with_HI\

V/articleshow/2749696.cms

_________________________________

CDC Statement, February 1, 2008. CDC National Center for HIV/AIDS, Viral

Hepatitis, STD and TB Prevention, 404-639-8895

CDC Underscores Current Recommendation for Preventing HIV Transmission

An article recently published by Switzerland’s Federal Commission for HIV/AIDS

states that HIV-positive individuals on effective antiretroviral therapy are not

at risk for transmitting HIV to their sexual partners under certain

circumstances. The Commission acknowledges that there are no scientific data

that the risk of transmission in these circumstances is zero. The Centers for

Disease Control and Prevention (CDC) underscores its recommendation that people

living with HIV who are sexually active use condoms consistently and correctly

with all sex partners.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

http://www.cdc.gov/hiv/resources/press/020108.htm

[Guest guest]

No Condoms For The HIV-Infected in Switzerland

February 15, 2008

Sonal Singh Wadhwa

Recently, the national AIDS body in Switzerland proposed that those

HIV positive individuals who have been taking treatment as per the

doctors' orders, do not show the virus in their blood, and have no

other STDs can have sex with their uninfected partners without the

use of condoms.

The objective of this proposal is to " alleviate fears of people

living with or without HIV and this allow the people living with HIV

in Switzerland to have as much as possible a `normal' sexual life. "

In their words:

" The Swiss National AIDS Commission, following a proposal of the

special commission of the Federal Office of Public Health on HIV/Aids

Clinical and Treatment, after a review of the scientific data and

after an extensive discussion, resolves that: An HIV-infected

individual without additional STD and on an anti-retroviral therapy

(ART) with completely suppressed viremia (in the

following: " effective ART " ) is sexually non-infectious, i.e. he/her

cannot pass on the HI-Virus through sexual contact as long as the

following conditions are fulfilled:

• The HIV-infected individual complies with the anti-retroviral

therapy (ART), the effects of which must be evaluated regularly by

the treating physician;

• The viral load (VL) has been non-detectable since at least six

months (i.e. viremia is suppressed);

• There are no additional sexually transmitted diseases (STD)

present. "

I find this incredible!

For a disease on which our understanding is still very grey, and we

have no cure, I find it absurd that experts in the field would

actually give a green signal for HIV positive people to go ahead and

have sex without using a proper form of protection. The implications

of such a proposal will be visible across the world, including in

developing countries like in India where issues like access to HIV

treatment and care, gender equality, and basic awareness of the

disease are of serious concern.

It may be that HIV positive people in Switzerland are much better off

than most living in the rest of world when it comes to access to

antiretroviral treatment (ART) and actually adhering to the treatment

plan set by the doctor. Most people in India have little or NO access

to ART, or they may do the first level of treatment and never be able

to afford / have access to the next level of treatment.

As per NACO, only 20% of the 2.4 million HIV positive adults in India

received ART by December 2007.

Furthermore, gender equality needs to be considered seriously in this

scenario. According to the Swiss National AIDS Commission, the

decision to have unprotected sex must be taken by the HIV negative

partner. It is well documented that women, especially in developing

countries, lack the power to negotiate on safe sex practices.

So where under usual circumstances, Indian rural women who cannot

refuse their husbands from having sexual intercourse with them, will

now be bulldozed by their HIV positive husbands into having

unprotected sex under the pretext that it is safe to do so!

Another challenge that is likely to come up will be the non-

disclosure of HIV status by an HIV positive individual to his/her

partner. The HIV positive person may go ahead and have sex with

his/her HIV negative partner without disclosing their HIV status

thinking that they are not putting their partner at risk. Therefore,

the importance of disclosing a health condition, which attracts the

inevitable stigma and discrimination, falls drastically.

According to the Swiss experts, the risk of transmission of the HIV

Virus depends a great deal on an individual's viral load. Therefore,

my interpretation is that in case the viral load has not been

detected in an individual for over six months, then the risk of that

person passing on the HIV Virus to his/her partner is not there.

The flaw in this proposal is so very simple. Just because a viral

load test is " non-dectable " doesn't mean that the HIV positive person

is cured!!! It may only mean that the level of the HIV virus at this

given point of time is lower than what the test can detect.

I cringe to think how many people who may or may not be HIV positive

will have unprotected sex simply thinking that they are safe since

they follow their doctor's orders and are going through the ART. Most

people, irrespective of education or literacy, will not think even

twice about viral load! All that they will hear is ART and Safe to

have Unprotected Sex!!! So the buzz on the streets will be that it is

absolutely safe to have unprotected sex with an HIV positive person

who is taking treatment.

I can just see yet another myth being added to the universal guide to

HIV facts versus myths. All these years of hard work will be undone

by this one proposal.

Interestingly, even the Swiss experts agree that being on effective

ART does not imply that HIV infection can not be passed. If that is

the case, isn't this proposal misleading, especially when it's so

easy to only hear the key words and not the caveats that the Swiss

National AIDS Commission has put in?

America's Center for Disease Control said in a statement " The

Commission (Switzerland's Federal Commission for HIV/AIDS)

acknowledges that there are no scientific data that the risk of

transmission in these circumstances is zero. [CDC] underscores its

recommendation that people living with HIV who are sexually active

use condoms consistently and correctly with all sex partners. "

The UNAIDS and WHO issued a joint statement in response the proposal

that strongly recommended the " correct and consistent use of condoms "

as a proven and effective HIV prevention method for all people

irrespective of their HIV status.

Yes, this study issued by the Swiss is encouraging and positive,

since this might be the preliminary findings to what may actually

turn out to be a way for HIV infected people to lead normal lives.

But as I said, these are preliminary. Let's wait until it is proven

and experts around the world agree that effective ART, undetectable

viral load, and no STDs equal a normal sex life (aka without the use

of condoms!) without any risk of HIV infection.

______________

Sonal Singh Wadhwa is an Indian writer based in Delhi. She started

her professional writing career with Dow Newswires as a

business reporter. Her work has appeared in international and Indian

publications. Sonal is the CEO of an NGO that works to stop the

spread of HIV/AIDS. She has 6 dogs and hopes that one day she can

have a huge farm that can take care of abandoned and stray dogs.

http://desicritics.org/2008/02/15/061431.php