No Condoms For The HIV Infected?

Recently, the national AIDS body in Switzerland proposed that those HIV positive individuals who have been taking treatment as per the doctors’ orders, do not show the virus in their blood, and have no other STDs can have sex with their uninfected partners without the use of condoms.

The objective of this proposal is to “alleviate fears of people living with or without HIV and this allow the people living with HIV in Switzerland to have as much as possible a ‘normal’ sexual life.”

In their words:

“The Swiss National AIDS Commission, following a proposal of the special commission of the Federal Office of Public Health on HIV/Aids Clinical and Treatment, after a review of the scientific data and after an extensive discussion, resolves that: An HIV-infected individual without additional STD and on an anti-retroviral therapy (ART) with completely suppressed viremia (in the following: “effective ART”) is sexually non-infectious, i.e. he/her cannot pass on the HI-Virus through sexual contact as long as the following conditions are fulfilled:

• The HIV-infected individual complies with the anti-retroviral therapy (ART), the effects of which must be evaluated regularly by the treating physician;

• The viral load (VL) has been non-detectable since at least six months (i.e. viremia is suppressed);

• There are no additional sexually transmitted diseases (STD) present.”

I find this incredible!

For a disease on which our understanding is still very grey, and we have no cure, I find it absurd that experts in the field would actually give a green signal for HIV positive people to go ahead and have sex without using a proper form of protection. The implications of such a proposal will be visible across the world, including in developing countries like in India where issues like access to HIV treatment and care, gender equality, and basic awareness of the disease are of serious concern.

It may be that HIV positive people in Switzerland are much better off than most living in the rest of world when it comes to access to antiretroviral treatment (ART) and actually adhering to the treatment plan set by the doctor. Most people in India have little or NO access to ART, or they may do the first level of treatment and never be able to afford / have access to the next level of treatment. As per NACO, only 20% of the 2.4 million HIV positive adults in India received ART by December 2007.

Furthermore, gender equality needs to be considered seriously in this scenario. According to the Swiss National AIDS Commission, the decision to have unprotected sex must be taken by the HIV negative partner. It is well documented that women, especially in developing countries, lack the power to negotiate on safe sex practices. So where under usual circumstances, Indian rural women who cannot refuse their husbands from having sexual intercourse with them, will now be bulldozed by their HIV positive husbands into having unprotected sex under the pretext that it is safe to do so!

Another challenge that is likely to come up will be the non-disclosure of HIV status by an HIV positive individual to his/her partner. The HIV positive person may go ahead and have sex with his/her HIV negative partner without disclosing their HIV status thinking that they are not putting their partner at risk. Therefore, the importance of disclosing a health condition, which attracts the inevitable stigma and discrimination, falls drastically.

According to the Swiss experts, the risk of transmission of the HIV Virus depends a great deal on an individual’s viral load. Therefore, my interpretation is that in case the viral load has not been detected in an individual for over six months, then the risk of that person passing on the HIV Virus to his/her partner is not there.

The flaw in this proposal is so very simple. Just because a viral load test is “non-dectable” doesn’t mean that the HIV positive person is cured!!! It may only mean that the level of the HIV virus at this given point of time is lower than what the test can detect.

I cringe to think how many people who may or may not be HIV positive will have unprotected sex simply thinking that they are safe since they follow their doctor’s orders and are going through the ART. Most people, irrespective of education or literacy, will not think even twice about viral load! All that they will hear is ART and Safe to have Unprotected Sex!!! So the buzz on the streets will be that it is absolutely safe to have unprotected sex with an HIV positive person who is taking treatment.

I can just see yet another myth being added to the universal guide to HIV facts versus myths. All these years of hard work will be undone by this one proposal.

Interestingly, even the Swiss experts agree that being on effective ART does not imply that HIV infection can not be passed. If that is the case, isn’t this proposal misleading, especially when it’s so easy to only hear the key words and not the caveats that the Swiss National AIDS Commission has put in?

America’s Center for Disease Control said in a statement “The Commission (Switzerland’s Federal Commission for HIV/AIDS) acknowledges that there are no scientific data that the risk of transmission in these circumstances is zero. [CDC] underscores its recommendation that people living with HIV who are sexually active use condoms consistently and correctly with all sex partners.”

The UNAIDS and WHO issued a joint statement in response the proposal that strongly recommended the “correct and consistent use of condoms” as a proven and effective HIV prevention method for all people irrespective of their HIV status.

Yes, this study issued by the Swiss is encouraging and positive, since this might be the preliminary findings to what may actually turn out to be a way for HIV infected people to lead normal lives. But as I said, these are preliminary. Let’s wait until it is proven and experts around the world agree that effective ART, undetectable viral load, and no STDs equal a normal sex life (aka without the use of condoms!) without any risk of HIV infection.