AIDS & Unprotected sex

[eggbert]

A new report by the Swiss National AIDS Commission says that under certain conditions, people testing positive for the HIV virus can have unprotected sex with HIV negative partners. http://www.msnbc.msn.com/id/22934058/
This seems to me to send a very dangerous message to those people who are looking for any reason to ignore the HIV threat. Any thoughts?

[mimiplastique]

A new report by the Swiss National AIDS Commission says that under certain conditions, people testing positive for the HIV virus can have unprotected sex with HIV negative partners. http://www.msnbc.msn.com/id/22934058/
This seems to me to send a very dangerous message to those people who are looking for any reason to ignore the HIV threat. Any thoughts?

CONSULT YOUR DOCTOR ..... NOT HUNG ANGELS ... IM EAN THATS JUST MY THOUGHT ...
(FORGIVE ME I'M ANTSY ) LOL

[thx1138]

I don't think having unprotected sex with an HIV+ person is a good idea (unless you have a death wish).

[peggygee]

A new report by the Swiss National AIDS Commission says that under certain conditions, people testing positive for the HIV virus can have unprotected sex with HIV negative partners. http://www.msnbc.msn.com/id/22934058/

This seems to me to send a very dangerous message to those people who are looking for any reason to ignore the HIV threat.

Any thoughts?

The science and theory is sound.

A person that has a undectable viral load and very high CD4 count would
be at a very low low risk of passing on the HIV virus to someone else.

However by no means is this to imply that there is NO or zero risk.

Here is the article, and previous discussions that we have had here on the
topic.


AIDS experts: Unprotected sex OK for some
Controversial Swiss proposal says HIV patients must meet strict conditions

GENEVA - Swiss AIDS experts said Thursday that some people with HIV who are on stable treatment can safely have unprotected sex with non-infected partners.

The Swiss National AIDS Commission said patients who meet strict conditions, including successful antiretroviral treatment to suppress the virus and who do not have any other sexually transmitted diseases, do not pose a danger to others.

The proposal, published this week in the Bulletin of Swiss Medicine, astonished leading AIDS researchers in Europe and North America who have long argued that safe sex with a condom is the single most effective way of preventing the spread of the disease — apart from abstinence.

"Not only is (the Swiss proposal) dangerous, it's misleading and it is not considering the implications of the biological facts involved with HIV transmission," said Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco.

Decision up to HIV-negative partner
The Swiss scientists took as their starting point a 1999 study by the U.S. Centers for Disease Control and Prevention, which showed that transmission depends strongly on the viral load in the blood.

The Swiss said other studies had also found that patients on regular anti-AIDS treatment did not pass on the virus, and that HIV could not be detected in their genital fluids.

"The most compelling evidence is the absence of any documented transmission from a patient on antiretroviral therapy," said Pietro Vernazza, head of infectious diseases at the cantonal hospital of St.Gallen in eastern Switzerland and one of the authors of the report.

"Let's be clear, the decision has to remain with the HIV-negative partner," he said.

The studies cited by the Swiss commission did not themselves definitively conclude whether people with HIV and on antiretroviral treatment could safely have unprotected sex without passing on the virus.

In practice the recommendation would affect about a third of HIV patients in Switzerland, Vernazza said, but added that patients and their partners would benefit from greatly increased quality of life, such as being able to have children without fear of passing on the virus.

Levy said there was no safe way of knowing whether a patient with HIV who has no detectable virus in the blood will not transmit the virus. More research into the links between viral load in the blood and the presence of the virus in genital fluid was needed, he said.

'An interesting experiment'
The World Health Organization said Switzerland would be the first country in the world to try this approach.

"There is still some concern that you can never guarantee that somebody will not be infectious, and the evidence I have to say is not conclusive," said Charlie Gilks, director of AIDS treatment and prevention at WHO.

"Many countries in western Europe would regard this as an interesting experiment," he said, adding it was unlikely they would follow suit anytime soon.

"We are not going to be changing in any way our very clear recommendations that people on treatment continue to practice safer sex, including protected sex with a condom, in any relationship," Gilks said.

In any case, of the two million people around the world currently receiving HIV treatment, only a tiny number would receive medical care comparable to that in Switzerland qualifying them to have unprotected sex as suggested by the Swiss, he said.

[peggygee]

Ask Dr. K: He's positive, I'm negative
Dr. Jeffrey Klausner

I'm currently talking to a guy and there's definitely the possibility of a relationship. The thing is, he's HIV-positive and I'm HIV-negative. If this relationship progresses and becomes intimate, I would be the top and he would be the bottom. Now, I know that if we use a condom properly every time, I'm at very low risk of getting HIV from my partner. I'm wondering, though, if his viral load were to increase, do I need to be more concerned about transmission? Or am I safe as long as I continue to use condoms?

There is some risk, albeit small, from topping a man known to be HIV-positive, even if you use a condom. The risk is estimated at about one in 2,500 -- a low risk, but not zero. Without using a condom, the per-contact risk for tops with an HIV-positive partner increases to about one in 1,666.

A high viral load or the presence of an STD (for either partner) increases the amount of virus and/or cells that can get infected, consequently increasing risk of HIV transmission. Even if your potential partner has a low viral load, it only reflects the level of HIV in his blood. The level of HIV in his genital tract where semen is produced can be much higher, particularly if there is an STD (STDs have been proven to increase production of HIV). A recent study has also shown that the amount of HIV in the rectum can be greater than the amount in the blood, even in those people who are on effective medications.

For this reason, a full STD checkup -- including rectal screening for chlamydia and gonorrhea, throat screening for gonorrhea and blood testing for syphilis and herpes -- may be in order for both of you. In general, you can take charge of your health by getting regular STD checkups and using lots of lube and condoms every time you have anal sex. You're doing a great job by thinking about this and doing the research before you start a relationship. Communication with this new man about your preferences and fears will serve you well in friendship, love and satisfying safer sex.

To your health,
Dr. K

[peggygee]

how would screening for other stds help?
all those would do is increase the risk of infection but the simple fact of the matter is that as long as the chance is above 0 sooner or later you will catch the hiv infection

HIV and other STDs can impact upon each other. The presence of STDs in an HIV infected person can increase the risk of HIV transmission. This can be through a genital ulcer which could bleed or through genital discharge.

An HIV negative person who has an STD can be at increased risk of becoming infected with HIV through sex. This can happen if the STD causes breaks in the skin (e.g. syphilis or herpes), or if it stimulates an immune response in the genital area (e.g. chlamydia or gonorrhoea). Nevertheless, HIV transmission is more likely in those with ulcerative STDs than non-ulcerative.

but the simple fact of the matter is that as long as the chance is above 0 sooner or later you will catch the hiv infection

In a serodiscordant relationship (describes couples where one individual is HIV-positive and the other is HIV-negative) is there a a certainty that one of the partners will seroconvert or become HIV positive. Not necessarily if adequate precautions are exercised, thus all due diligence and precautions should be implemented by all parties in a sexual act.

Most HIV+ persons are very concerned about not infecting others and make efforts to prevent transmission.3 Sadly the fact reamains that a significant percentage of HIV+ persons struggle with prevention: from 20-50% of HIV+ persons report unprotected sex with partners who are HIV- or whose HIV status they do not know.4 For many HIV+ persons, the same structural, inter-personal and behavioral challenges that put them at risk for HIV persist beyond their HIV diagnosis and play a role in their inability to prevent HIV transmission.4
http://www.caps.ucsf.edu/pubs/FS/revPwPFS.php

What can HIV+ persons do?

Many HIV+ persons are using strategies that limit HIV transmission. One strategy is having sex mainly with other known HIV+ persons.11 Knowing that your sexual partner is also HIV+ avoids the risk of transmission and allows for sex without consistent condom use. Though there have been recent concerns about superinfection among HIV+ couples, where one HIV+ person might acquire another strain of HIV from their HIV+ partner. However, superinfection among such couples appears to be rare.12

Another strategy is switching from high-risk to lower risk activities. HIV+ persons can avoid high-risk activities such as being an insertive partner (top) during anal and vaginal sex, having sex while menstruating, breastfeeding and sharing syringes. Lower risk activities can be having oral sex and being a receptive partner (bottom).11 However even in these instances it is extremely important to follow safe sex guidelines ie use of condoms, dental dams, etc.

Finally, there is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen. Read more about HIV and circumcision.

http://www.avert.org/circumcision-hiv.htm

[muhmuh]

[quote="peggygee"]

In a serodiscordant relationship (describes couples where one individual is HIV-positive and the other is HIV-negative) is there a a certainty that one of the partners will seroconvert or become HIV positive. Not necessarily if adequate precautions are exercised, thus all due diligence and precautions should be implemented by all parties in a sexual act.

wrong theres no method to bring the probability down to 0 and the law of large numbers will take care of the rest