Everything in life involves some kind of risk. Think of the coffee you drank this morning. I am not sure if you are aware, but drinking coffee is risky business. Drink it too hot and you’ll burn your tongue. If you’re clumsy like me, there’s a good chance you’ll get some on a new white shirt or knock it over on your desk. The reality most probably is that you just drank it and moved on with your day. I will admit that this analogy is a bit farfetched and the benefits of having that coffee far outweigh the risks involved (you don’t want to see me without coffee). However, there are activities we do in our lives where the risks can outweigh the benefits, such as drink driving or having unprotected sex.
Sex is something most of us have come to enjoy and why shouldn’t we, it’s fantastic! As much excitement and pleasure sex can bring us, it also has its own risks. If you have unprotected sex, you will always potentially run the risk of contracting an STI or HIV or maybe even becoming pregnant. Although we have prevention measures available for all of this (condoms) they are not always used or used correctly and therefore transmission of an STI or HIV can occur. So, who is ‘responsible’ for the transmission – the person who transmits or the person who contracts? That’s the million dollar question.
Historically, it’s always been considered the responsibility of the HIV positive person to curb the transmission of the virus to their partners. This is also taught to us in transmission 101, which says that a virus is passed from a person who has the virus to a person who does not have the virus. However, it generally isn’t as simple as that and much of it comes down to a person’s understanding of risk, as well as everyone having an accurate knowledge of their own HIV status.
In Queensland, a person living with HIV (PLHIV) is required by law to disclose their status if they wish to engage in unprotected sex with their partner/s. While it is really important to talk about your status, an accurate discussion can only take place if everyone is aware of their HIV status. So what we need to ask ourselves is ‘when does it become a negative person’s responsibility to remain negative?’ Especially these days when we have biomedical options such as:
- Pre Exposure Prophylaxis (or PrEP). PrEP is the first biomedical HIV prevention strategy that is specifically for HIV negative individuals to maintain their negative status and it is becoming really popular in the US. This is because it gives a HIV negative person more options to protect themselves rather than relying on their partners to truly know their status and to correctly use a condom. PrEP involves a HIV negative person taking a pill of Truvada each day (an HIV treatment containing the drugs Tenofovir and emtricitabine) to prevent HIV from replicating in their body. Therefore, PrEP is a step towards shifting some of the ‘responsibility’ from the HIV positive community to the HIV negative community.
- Treatment as Prevention (TasP). TasP has been a massive benefit for PLHIV and in a nutshell, it is when a HIV positive person on medication has a suppressed or undetectable viral load. The main benefit of TasP is the health benefit for the individual as the virus is supressed and not causing damage to their body and immune system. The secondary benefit is that a person with a suppressed or undetectable viral load has a 96% reduction of passing HIV onto their partners1. Commencing and/or maintaining treatment is still up to the individual, but there is a growing push towards earlier treatment in Australia and across the world. This all means that TasP reduces the chance of HIV transmission from PLHIV on treatment and helps to reduce the emotional burden and the stress of responsibility in ensuring onward transmission does not occur.
So if TasP and PrEP already exist, why do we still have HIV transmission in Australia? Well not everyone with HIV knows that they have the virus. It is estimated that 20% of PLHIV in Australia are undiagnosed2. It is this hard to reach group that HIV prevention and education interventions should be targeting if we want to reach the UN goals of 90-90-90 by 2020 and get rid of HIV once and for all. After all, it’s everyone’s responsibility to know their status and since the release of the 20 minute rapid HIV test, testing has never been easier.
However, to expect the brunt of responsibility in the prevention of HIV transmission to be almost entirely on PLHIV is not justifiable or fair. It is the opinion of this humble blogger that no sole party is responsible for everyone else. Regardless of your HIV status, everyone is responsible for their own choices. Everyone is responsible for their own sexual health. Get educated. Understand the ‘risks’. Know where to go for help or access more information.