Undetectable=Untransmittable – CATIE signs on
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.
Thank you Laurie and CATIE!
Brilliant, the day has finally come , so glad to get this news, CATIE, has delayed the response to U=U, for too long, finally accepting the science, I remember about three yrs ago requesting info from them about treatment as prevention, they sent me a brochure on prep, I remember being outraged, so glad the science is all in we’ve delayed too long, now let’s get to work and end this plague, wow
and thanks Bob
Yes delayed way too long is right forgot what condomless sex is like with my wife
Thank you Laurie and CATIE!!! Thanks for giving me the support and confidence to declare this far and wide.
This statement by Ms. Edmiston is incorrect. It does not adhere to the interpretation of the science by the authors of the most important study on this subject. The PARTNER study has not yet gathered enough data to say that, at least for men who have sex with men, the risk of transmitting HIV with an undetectable viral load is “extremely low”; at this time the authors of the study say they can only say with confidence that the risk is “very low”. They can also say that the risk for heterosexuals is “very low.” They have stated unequivocally that they are not able to say at this time that the risk is zero. See: https://www.poz.com/article/still-new-transmissions-partner-trial
From In an editorial the accompanied the partner trial, Eric S. Daar, MD, and Katya Corado, MD, of the Harbor-University of California, Los Angeles, Medical Center, wrote: “For individuals who want to routinely or intermittently not use condoms with an HIV-infected partner, clinicians can indicate that the risk of HIV transmission appears small in the setting of continued viral suppression, emphasizing that the duration the HIV-infected partner needs to be virologically suppressed before achieving optimal protection is unknown, although appears to be for at least 6 months, based on the best available data.”
They continued: “Moreover, clinicians need to be clear that even though the overall risk for HIV transmission may be small, the risk is not zero and the actual number is not known, especially for higher-risk groups such as MSM. Although more research is needed with larger numbers of couples and longer follow-up, it is not known if or when such data will emerge. Consequently, for now, clinicians and public health officials must share the data that exist in an honest and understandable way so that serodiscordant couples can be fully informed when individualizing their decision making about sexual practices.”
See also: https://www.poz.com/article/published-interim-partner-study-findings-stress-power-hiv-meds-prevent-transmission
Sorry, I miswrote above. I meant to write that the PARTNER authors can say with confidence that the risk for heterosexuals is “extremely low.” –Ben Ryan
It is consistently disappointing to see stigma and homophobia and serophobia being dressed up with the science without any real understanding of what the words actually mean. The risk is never zero in health science, and no reputable journal would publish findings that ever gave an absolute interpretation to the data. CATIE supports the use of condoms. It supports the use of care and judgment when making informed choice around sexual health. What it, and the many other agencies and physicians do NOT SUPPORT is the ongoing witch hunt against responsible, compliant and effectively uninfectious HIV+ people. The risks for transmission, according to the data and in epidemiological terms have never been with those with undetectable viral loads. Your hypothetical transmission possibility is irrelevant to the overall problem. By continuing to raise it, all you do is try once again to shift the burden of responsibility from those who do not know their statuses to those who do, and have been taking care of their health and that of their partners. Shame on you.
How is this incorrect? Even condoms are not 100% [ even says so on the package….] yet many still tout them as the end all and be all of sexual health when it comes to prevention. Scientifically, even if there is less than a 0.0001% chance of something occurring, it must be acknowledged. Yet many in infection control acknowledge that less than 1% means functionally ‘non-transferable’.
There is not been a single, verified case of transmission from someone who is undetectable to a negative person. All of the studies and research support and indication that interrupting the transmission process of the virus is key; that for those on medically supported undetectable status, there seems to be no discernible risk of transmission.
The U=U consensus statement(https://www.preventionaccess.org/consensus) is based on a body of evidence that has been accumulating over many years, including the PARTNER study, HPTN 052 and Opposites Attract. The U=U consensus statement is endorsed by researchers involved with all of these major studies. By endorsing the U=U statement, CATIE agrees with scientific experts in this field.
Finally the science, with the ceaseless effort of Prevention Access Campaign led by Bruce Richman, has become publicized and now the life changing message of U=U, if treatment is maintained, will continue to spread thruout the HIV community in Canada and thanks to IT, hopefully the rest of the world!
LOL – Almost four years later, I’m seeing this comment! Thank you, Dad. 🙂 It was leaders like Laurie Edmiston and organizations like CATIE who really made this movement! And, yes, U=U DID spread to the rest of the world in the four years since CATIE issued this strong statement! CATIE’s unequivocal support brought international attention to the movement, marking the turning point when a groundswell of international organizations began to take notice and sign on. Being a part of this movement has been the most meaningful experience of my life. Very humbled by folks like Laurie, HIV activist Bob Leahy, the folks at Terrence Higgins Trust, and others who joined so early on and continue to share the great news in Canada and around the world.
Once again, this is like the REP pill…. no talk about other communicable STD… so uneducated folks who read this will feel invincible and do away with condoms which may prevent syphilis, which is on the rise amongst gay men, and other STD. I urge you to act more responsibly and qualify your statement when you say… ”have great sex”!
Read the rest of the CATIE website before jumping to conclusions. I assume you are using a condom for oral sex, a dental dam for kissing and other situations where there is any fluid exchange? Most STD’s aside from HIV are transmittable in many, many ways, and this amounts to little more than more shaming and moralizing. When are you people going to be done pointing your fingers at everyone else?
These comments are made in conversation with regards to HIV, not all other existing STI’s. That is why the emphasis is on HIV only. The criminalization of non-disclosure of STI’s does not happen…it only happens with HIV, this is why specific conversations around HIV need to happen.
Yvon
This is a statement about HIV not any other STD. Why are you confusing the issue? I for one will have great sex, knowing that I will not infect anyone. I realize that for us who are long term survivors this may be a bit hard to grasp. We have been told for our entire poz life that we are infectious and that we spread disease. I for one am relieved that science has finally caught up and that the knowledge is finally being shared. Congrats and thank you CATIE and Laurie for helping get the word out.
Thank you for raising this important point. CATIE acknowledges that regular testing and treatment for other sexually transmitted infections (STIs) is an important part of a comprehensive sexual health plan. In our HIV prevention resources, we also acknowledge that having an undetectable viral load will not protect a person from getting or passing other STIs. This brief blog post was intended to speak only about HIV transmission. The CATIE statement on the use of antiretroviral treatment to maintain an undetectable viral load to prevent the sexual transmission of HIV (http://www.catie.ca/en/prevention/statements/tasp) contains more information about STIs in relation to this important prevention strategy.
You make it sound so easy. As a woman living with an AIDS diagnosis the meds have been very hard on my body. Many side effects including a knee replacement, atrophied kidney, mental depression, insomnia to name a few. The meds were never made for women and let’s not start on stigma. It’s just not as easy as undetectable
Thanks Laurie and CATIE from TNTMEN!
As a person living with HIV who’s experienced the discrimination and hardships that disclosure can sometimes bring, this is definitely something that makes the conversation easier to have. Although disclosure is still tough, with it’s own unique challenges, the understanding and acceptance that Undetectable = Untransmittable opens up the door to deeper, more meaningful conversations. Koodo’s to the amazing team at CATIE for paving the way.
I support every single word Laurie said. And I vehemently oppose the overly conservative and discredited opinions of those who think dogmatically – a good example is In this thread – that is is ok to present people living with HIV who are undetectable as a risk when a huge body of evidence going back to 2008 proves that is not only wrong but a hugely stigmatizing position to take that has no place in sexual health messaging . It’s really shameful that a small minority of people continue to have an agenda so thoughtless and so harmful to all people living with HIV and to global efforts to stamp it out. We have been burdened as people living with HIV for decades . We neither need nor deserve attacks like this.
Ben Ryan,
It’s important for me to make a clear statement on this wonderful and important blog in response to another one of your continual attacks on this message since early days of the campaign. Even though you are wrong in both the approach and substance of your argument, some folks might see your name and think you are correct simply because you write with confidence and you’re a journalist.
Once again, here’s the problem with your continual attacks: Your argument is based on the most conservative and intellectually flawed reading of only one study: PARTNER.
CATIE’s endorsement and the U=U conclusion is not based on one study but on the body of clinical research including HPTN 052, PARTNER, and Opposites Attract and two decades of empirical evidence. Readers can have confidence that Laurie and CATIE as well as leaders around the world have read PARTNER’s published results and taken those into account as well as all of the studies and empirical evidence to date before making their public statements.
It is odd that you continue to do whatever possible to discredit this monumental message, and ignore the work and opinions of many of the world’s most caring and brilliant researchers like Dr. Cohen, Dr. Dieffenbach, Dr. Lundgren, and Professor Vernazza.
It’s harmful to the thousands of people living with HIV and their partners who believe they are “still a risk” when they read your work, Ben. It’s wrong and it’s cruel. If that doesn’t move you, then consider how it’s harmful to the field to perpetuate HIV stigma.
I think it’s time you ask yourself “why am I so invested in keeping people with HIV a risk to others?”
Bruce Richman
Executive Director
Prevention Access Campaign
Undetectable = Untransmittable
People who disagree with these statements by focusing in the extremely remote possibility for a transmission to occur are simple enablers for discrimination, criminalization, phobia and simple none sense.
We are living difficult times in this nation (policy and politically speaking). Science will never determined the risk is zero. What is remarkable is the fact and since 2008 when SWISS statement was released is that there a no document transmissions from an undetectable viral load. It’s an accepted fact that an undetectable viral load offers a negligent transmission risk, it’s safer than condom use and for the record than PREP itself (we have documented transmission under PREP).
Nobody is saying abandon protection, there are other STI and by combining prevention methods ones can achieve multiple reassurance. However, it’s imperative and important that the message gets out there without bias and hidden agendas: a prosecutor shouldn’t be able to demonstrate intent when applying an hiv criminalization law on a defendant with undetectable viral load. Let alone, in the realm of public health, everybody is safer when every hiv positive individual is suppressed.
Good to learn Ben Ryan is a journalist with an agenda, as I will be personally writing to Poz maganize complaining on his bias and obvious agenda. I will make sure to take with a grain of salt whatever he writes and simply treat him as any fox news reporter. Very disappointing.
I am excited about this progress as well; however, I am concerned about language and study parameters. Can you please clarify…?
The Partner Study, HPTN 052 and Opposites Attract all recruited serodiscordant couples — people in committed relationships — did they not?
Let’s consider the difference between the life of someone in a committed relationship and someone who is single.
– the committed couple is usually at ease (not always present in a casual encounter)
– the committed couple is more likely to have a certain routine around sex: preparation (i.e. douching), lubrification, etc. are all probably also routine. This is not the same as a casual encounter.
– something as simple as having a committed partner reminding you to take your meds regularly has an impact on adherence. Just knowing you’re in a committed relationship has an impact on one’s life outlook.
– these studies would have also included ongoing counselling from an ethics perspective
Therefore, why are we making this leap? The protocols and controls on the above named studies apply to serodiscordant couples. There has yet to be studies in this regard in the general population when it comes to casual partners.
I want to believe this — be on board with this — fully agree with it and join in this possibly incredibly fantastic statement. However, I’m afraid all we can truly say is: this is what we know when people are in a committed relationships, therefore there is a growing body of evidence that suggests undetectable = uninfectious across the board; however, we don’t know for sure when it comes to casual sex (msm and hetero).
Your statement above: “people living with HIV with sustained undetectable viral loads can confidently declare to their sexual partners “I’m not infectious!”” is possibly incorrect… unless there is evidence that this research also applies to casual relationships.
Am I simply missing something here?
Respectfully,
D
Dear D:
Thank you for your comment. To start, it is interesting to consider why serodiscordant “couples” are included in these studies. In order to be able to assess the risk for HIV transmission, we need to follow HIV-negative people who have some kind of ongoing sexual relationship with an HIV-positive person. It would be incredibly challenging to conduct research on HIV-positive people having casual sex, partly because of the impossibility of following up with every casual partner.
While many of the serodiscordant couples who participated in these studies were likely in stable ongoing relationships, this was not a requirement to participate. There are several reasons why we should not assume that all the partnerships in these studies were stable or committed. First, the eligibility criteria of these studies required simply an existing sexual relationship and an expectation that the relationship would continue. For example, a “couple” enrolling in the PARTNER study needed to meet the following criteria: “(1) the partners reported penetrative sex without using condoms together in the month before enrollment… and (2) the partners expected to have sex together again in the coming months.” Furthermore, the data from these studies shows that couples were not necessarily monogamous, in the number of HIV infections that occurred outside of the main partnership (11 in the PARTNER study and 26 in HPTN 052).
The key issue in getting to undetectable and remaining undetectable is adherence to treatment as prescribed and engagement in regular health care including ongoing viral load monitoring. The evidence is strong enough to suggest that if a person on HIV treatment maintains an undetectable viral load and remains engaged in care, they will not pass HIV sexually regardless of whether their sexual encounters happen within the context of a committed or casual relationship.
Thanks for your response. Much appreciated.
I’m 100% behind u=u awesome
While science can’t ‘prove’ with 100% certainty that someone undetectable can’t transmit HIV, neither can science prove with 100% certainty that the earth won’t be obliterated by a meteor tomorrow, yet respected scientist don’t run around creating hysteria by harping on such a remote possibility.
So why, over a year later, does CATIE’s HIV Basics webpage, still say that treatment “dramatically lower” or “greatly reduce” the risk of transmission rather than that its impossible. Time to walk the talk, Laurie. Stop spreading lies about POZ folk.
Thank you for flagging this old language on our HIV basics page; it has been updated. CATIE strongly and publicly supports U=U. We use language suggested by the U=U campaign in our new resources, and we are continually scanning our existing resources and updating them as necessary.