The past few years have been a rollercoaster for those of us most impacted by HIV. The use of pre-exposure prophylaxis (PrEP) by people who are HIV-negative has gone from being discredited and shamed to become one of the keystones of a renewed and revitalized push to “end the HIV epidemic”. The other life-changing piece of research is the landmark PARTNER study that showed us, once and for all, that the sexual transmission of HIV does not occur in people whose viral loads are undetectable. The joyous global uptake of the U=U message has been nothing short of inspirational.
CATIE recently endorsed the Consensus Statement of the Prevention Access Campaign, celebrating the fact that “undetectable equals untransmittable.” This revolutionary statement, pushed forward by a dedicated group of people living with HIV, has prompted CATIE to reflect on our sexual HIV prevention messaging.
The research on treatment as prevention has been slowly accumulating for many years. As an evidence-based organization, CATIE now recognizes that the evidence on undetectable viral load has reached a point where we are compelled to take our messaging a step further. We can comfortably say that when a person taking antiretroviral treatment has an ongoing undetectable viral load and is engaged in care, they do not transmit HIV to their sexual partners.
Marcus and David have been dating for three years. Marcus is HIV-positive and David is HIV-negative. David was worried when he told his parents that his new partner was HIV-positive, but after they saw how happy Marcus makes him, they have welcomed Marcus into their lives. At the same time, they still worry that their son may become infected.
Faith is living with HIV, and her partner, Scott, is HIV-negative. Faith often finds herself having to educate Scott on what she has to do to manage her condition and Scott has had difficulty understanding because information changes quickly. They fight more often — about sex, about health —and about where they see their relationship going.
These are hypothetical examples of two different types of relationships that involve HIV, yet many other couples have their own, unique experiences. So it is hard to know what kinds of experiences are the most common for people in these relationships.
All of us here at CATIE, and indeed around the world, are celebrating the most significant development in the HIV world since the advent of effective combination therapy 20 years ago – people living with HIV with sustained undetectable viral loads can confidently declare to their sexual partners “I’m not infectious!” The “fabulousness” of this news cannot be overstated. With or without a condom, if you’re undetectable you won’t pass along HIV! This is an absolute game-changer and those who live with HIV can proudly share this information. At the same time, service providers working in HIV must get up to speed fast and share this far and wide with their communities. CATIE will be developing more resources to help share this momentous news so stay tuned! In the meantime, look at the prevention resources on catie.ca and add your organization’s name to the Consensus Statement of the Prevention Access Campaign. Let’s get the word out! Get tested, get on treatment, become undetectable and have lots of great sex!
Laurie Edmiston is executive director of CATIE, Canada’s source for HIV and hepatitis C information.