Saskatchewan has led the country in the rate of new HIV infections and the proportion of people living with HIV since 2009. The HIV epidemic in this province is unique from other jurisdictions in Canada in that more than three-quarters of our new infections occur in people who use injection drugs (the Canadian average is less than 14%).
It’s official! The Government of Canada supports U=U, the consensus statement that a person living with HIV does not transmit the virus sexually if they take treatment and maintain an undetectable viral load (“undetectable = untransmittable”).
The news came on November 30 in a joint statement from Canada’s chief public health officer and the chief medical officers of health of all Canadian provinces and territories.
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.
“What is the risk of HIV transmission through condomless anal sex if I am the receptive partner?” “How low is the risk if my viral load is undetectable?” “What’s the risk if my partner was in the acute phase of HIV infection when we had sex?”
Questions about HIV risk aren’t easy to answer and—with all the recent advancements in our understanding of HIV transmission and prevention—things aren’t getting any easier!
The CATIE Blog is written for people and organizations working and volunteering in Canada’s response to HIV and hepatitis C and hosts the views and opinions of frontline service providers.