In last week’s blog, the Health Promotion & Treatments Officer discussed the PARTNER Study, where interim findings show zero sexual transmissions of HIV with 767 couples over a 2 year period. This is beginning to resurface a debate that has circulated the HIV sector for a few years: will Treatment as Prevention mean that people will stop using condoms as the best form of protection?
What we need to realise is that different prevention strategies will be more appropriate for different people and combination prevention is becoming the way forward. The more options we have to choose from, the more effective we can all be in adhering to our chosen prevention strategies.
Studies like the PARTNER study and the well-known HPTN052, which found that transmission was 96% less likely to occur when the positive partner was on antiretro viral treatment with continued condom use, concentrated on sero-discordant couples (where one person is HIV positive and the other is HIV negative). How then will treatment as prevention work in the real world, where it is estimated that 20-30% of people living with HIV in Queensland do not know they are HIV positive?
Research has shown that a large number of HIV transmissions occur amongst people who do not know their HIV status. If they then use condoms less frequently, or have riskier sex believing they are HIV negative, they may unknowingly transmit the virus to others.
What we need to make everyone aware of, is that there is a great personal benefit to knowing if you are HIV positive, as all people living with HIV in Australia are now eligible for treatment at the time of diagnosis, and an earlier diagnosis greatly improves long term health outcomes. People living with HIV who are aware of their status are also more likely to be having safer sex, due to their own awareness of their HIV status and understanding of HIV transmission. People living with HIV are not to be feared!
The only reason someone may be living with HIV and not know it is because they are not getting their regular HIV and sexual health tests. For gay men (or men who have sex with men) who use mobile apps like Grindr and Scruff or have casual sexual partners, it is recommended to have a sexual health check every 3 months. If all men (and women) are testing regularly, the number of people with an unknown HIV status will decrease, and ultimately decrease the number of new diagnoses every year.
So, if you are telling your sexual partners that you are HIV negative and not using condoms, or someone tells you they are HIV negative and doesn’t want to use a condom, you need to consider these factors:
1. When were you last tested for HIV? What was the result?
2. Did you have ANY unprotected sex the 3 months PRIOR to the test? This is the window period that gets spoken about – it may take up to 3 months after the exposure before HIV can be detected.
3. Have you had ANY unprotected sex since your last test?
One thing that prevents many people from testing for HIV, and even talking about HIV with their partners and friends, is stigma. Stigma remains a significant barrier for people living with HIV, particularly when it comes to their sex lives. Regardless of the advances in treatment and continued condom use, people living with HIV continue to be rejected sexually due to their status and presumably the fear of acquiring the virus.
The best method of preventing stigma is education. If people truly understood the facts around HIV and understood transmission, then we could remove the fear from society and continue the push for all people to be testing regularly.
It is also important to realise that people who are aware of a positive status are not intentionally putting sexual partners at risk. Unfortunately this is a common (false) statement fuelling HIV-related stigma. More than anything else, we need to remember that it is our own responsibility to look after our own health, know our own status and test regularly to ensure overall good health is maintained, whether that is with a positive or negative test result.
With more and more research indicating the benefits of treatment as prevention, it is becoming more exciting for us to reach international goals of reducing the sexual transmission of HIV by 50% by 2015. However, for results of the PARTNER study to be effectively applied to the wider community, it is important that everyone knows their HIV status by regularly testing for HIV. If we are able to reach the undiagnosed people across Queensland by increasing testing, we can work with all people living with HIV, improve treatment uptake and then see a significant drop in HIV diagnoses in Queensland.