What Safe Sex Really Means Now

By David Menadue

Very few HIV-positive people have been spared rejection from potential sexual partners upon revealing their status. I experienced a sexual rejection myself recently, when my potential sex partner got to clothes off stage and then asked, “So what does undetectable mean?” Of course I was happy to educate him, but the moment was lost.

Despite my disappointment, that question, what does undetectable mean is a very good one. The answer is only just beginning to filter through. It needs to be clearer and more resonant, especially among gay and bisexual men.

Nine years ago, HIV-positive people began to hope that having an undetectable viral load of fewer than 20 copies might prevent us passing the virus to others. Backed by global research, The Swiss Statement, said “an HIV-infected person on antiretroviral therapy with completely suppressed viremia (meaning an undetectable viral load for six months) is not sexually infectious”.

In 2011, the HPTN 052 study of 1760 serodiscordant* mainly heterosexual couples showed reduction of transmission from a positive to negative partner was 96%.  And when the study considered those who had six months of effective treatment, transmission was zero.

Zero transmission risk! Yet few seemed to hear this exciting news! Understandably, after the torrid years of the AIDS epidemic, the HIV community was wary of endorsing the concept of treatment as prevention. A great way to maintain your health if you were living with HIV, it was said, but we need more trials and more evidence before we endorse treatment as prevention. Would it apply to gay couples, for instance?

Thankfully, the PARTNER Study answered this question. With a sizeable number of gay male couples among its cohort, in 2014 it found no transmissions among 1,100 serodiscordant couples, despite some 16,400 acts of condom-less sex.

In 2016 the final results of the PARTNER Study, after 58,000 unprotected sex episodes, confirmed that the risk of transmission, if the positive partner is undetectable after six months, was effectively zero. The same results have been found two years into an Australian trial with gay male couples, Opposites Attract. (See www.kirby.unsw.edu.au)

Now HIV organisations around the world are endorsing the U=U statement (i.e. Undetectable Equals Untransmittable”) made by the Prevention Access Campaign, an international committee of researchers, activists and HIV organisation representatives. See www.preventionaccess.org.For an Australian site on treatment as prevention see: https://www.afao.org.au/about-hiv/hiv-prevention/treatment-as-prevention.

Despite this avalanche of evidence, my recent experience seems all too common.  On gay hook-up sites, I still regularly see “Clean and Safe Only” on people’s profiles – a clear sign positive people need not apply!  To such punters, I would ask them to consider who is the safer partner? A positive person with an undetectable viral load for six months or a person who hasn’t tested for more than twelve months and just thinks he is HIV-negative?

The most well-informed people tend to be the HIV-negative partners of positive people who have been having protected condomless sex for years based on the science that has been presented to them. Or the people, mainly gay men, who have casual sex and have enrolled in the PrEP trials, knowing that the HIV antiviral Truvada, or its generic equivalents, will protect them if they have condomless sex.

So if you have read this far, I thank you. And ask, if you are an HIV-negative person who has casual sex, whether you would be happy to have sex with an openly HIV-positive person- with or without condoms? If you like your sex latex-free and believe in science then check out any of the websites mentioned above. We can all live much happier sex lives, if we learn what safe sex really means in the era of effective HIV treatment.

*serodiscordant = where one partner is HIV-positive and the other HIV-negative

David Menadue is a board member of NAPWHA and AFAO.