Words Dr. Verity Sullivan
I’ve asked tens of friends this question and whatever their background or sexual preference, 9 times out of 10 I can predict the reaction: “You’re kidding right..?”
Futuristic as it sounds, this concept is true and it’s something that everyone needs to know about. If you’re HIV positive and taking effective antiretroviral therapy (ART) you will not pass HIV on to a partner. ART suppresses HIV activity in the body, effectively putting it to sleep. Eventually the level of HIV becomes so low that it is “undetectable” and when a person remains undetectable for six months, the risk of passing HIV on is negligible.
The concept’s been coined Undetectable = Untransmittable or “U=U”. Alongside other prevention methods like Pre-exposure Prophylaxis (PrEP) and increased HIV testing, it’s led to a 50% drop in HIV diagnoses reported by London’s busiest sexual health clinics in 2015 – 16. And the U = U consensus statement has been strongly backed by pioneers of HIV prevention like NAM and the Terrence Higgins Trust (THT).
“This is not a position we would come to lightly,” says Dr. Michael Brady, HIV doctor and Medical Director of THT. “The evidence has built over the last decade and with the results of two major studies (HPTN052 and PARTNER) I can confidently advise patients who are on treatment, with a consistently undetectable viral load, that they don’t need to worry about giving the virus to others. It’s a remarkable position to be in just 30-odd years since the start of the HIV epidemic.”
But is there any risk of transmission at all? “In life and in medicine it’s hard to say ‘never’,” says Dr. Brady. “However, the very robust scientific evidence we have means we can confidently say any risk is negligible – i.e. so small to be insignificant and unlikely to happen.”
But how, in a time of relentless bad news and anxiety-inducing politics, has this incredible breakthrough been so overlooked? The sad reality is that the conversation around HIV remains stifled and stigmatised. And continuing the tradition of the last three decades, most still struggle to see HIV as just another chronic, manageable condition and to resist making judgements.
“For many of us, our diagnosis came with strict admonishments that we were a threat to our partners and we are made to feel dirty and dangerous,” says Matthew Hodson, Executive Director of NAM. “The idea of being a risk can become so entwined with your own identity that it’s hard to shake off, even when the evidence is overwhelming that the risk of transmission has passed.”
“For those who can accept it, the understanding is transformative. It gives us hope that we can live our lives without harming those we love and without fear in the moments of greatest intimacy. It also means that pretty much all the fear that HIV-negative people have of HIV positive people is just wasted energy.”
Incredible success has already been seen in San Francisco who reported their lowest ever number of new HIV infections in 2015 thanks to similar prevention efforts. However, there are notable concerns, with the BME population and women not experiencing the same results.
“Overall it’s incredibly positive, but we must remain mindful of other issues,” says Silvia Petretti, Deputy CEO of HIV Charity Positively UK, “Sometimes women really want to wear condoms as they protect against other STIs and pregnancy. Condom negotiation has been a way of shifting sexual health responsibility back to men and so this discussion must not be lost.”
Angelina Nambia, originally from Kenya, is an associate of the Salamander Trust and has lived with HIV for two decades. “There are very low levels of information about HIV transmission in BME communities and that’s what we need to invest in,” she says. “The U = U message is not being conveyed well enough yet. More needs to be done to help the BME community feel empowered around sexual health in general and to understand the positive impact this concept can have on their community.”
This incredible progress in curbing the HIV epidemic remains largely unacknowledged by the UK public. But a new era of HIV prevention is gaining momentum and with it, hope for a future where HIV is no longer met with judgement and fear, but compassion and acceptance.
“Now we have the tools to prevent HIV transmission – we just need to maximise their use and impact.” says Dr. Brady, “U= U, alongside other prevention methods like PrEP and HIV testing, opens the possibility of, if not a world completely without HIV, one where it is dramatically reduced.”