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Back to Section One | Back to Arts & Entertainment
posted Friday, August 12, 2011 - Volume 39 Issue 32
Dr. J: HIV: Does undetectable equal safe?
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Dr. J: HIV: Does undetectable equal safe?

by Dr. Joanne Stekler - Special to the SGN

Joanne Stekler, M.D., MPH, is deputy director of community services for the HIV/STD Program at Public Health - Seattle & King County. She is also an internal medicine and infectious disease physician at Harborview Medical Center and assistant professor of medicine and epidemiology at the University of Washington.

This article is part of a series focusing on HIV and other STD prevention and care topics for Gay/Bisexual men and Transgender individuals in Seattle and King County.


If you are HIV-positive and your virus is undetectable, do you ever wonder whether you still need to use condoms? Is it still important to talk with your partners about your HIV status?

For many years, it was thought, but not proven, that being on HIV meds could decrease the chance of giving the virus to someone else. Studies had shown that the virus level (also called the 'viral load') predicts the chance that someone will transmit HIV. The higher the level, the greater the chance. And so if HIV meds decrease the level of HIV in blood and other fluids, it makes sense that the chance of transmission should go down.

Some public health departments and programs believed so strongly that HIV meds can reduce new infections that they recommended all HIV-infected persons go on HIV meds, even if meds didn't have clear benefits for someone's health. In 2008, Swiss HIV experts went so far as to say that HIV-positive individuals could not transmit HIV if they were on meds, were 'undetectable' for six months, and had no STDs. Locally, Public Health - Seattle & King County is committed to making sure, as best we can, that people living with HIV have access to meds if they want to take them. Having greater access to HIV meds will help people live longer, healthier lives. And it should help decrease the number of new infections locally and worldwide.

Earlier this year, results were reported from a study of couples where one partner was HIV-positive and the other was HIV-negative. In the couples where the HIV-positive partner took HIV meds, the HIV-negative partner had a 96% lower chance of getting infected. The couples in this study were almost entirely heterosexual and were not from the U.S. So we don't really know what this will mean for Gay and Bi men in Seattle. But this is the first study to prove without a doubt that HIV meds reduce HIV transmission.

However, 96% is not 100%. Transmission happens when people are on HIV meds. It could happen when people get STDs or go a few days without taking their meds. Or it could be because HIV levels may be undetectable in some people's blood but high in their semen or rectal fluids.

So what does all of this mean?

Being on HIV meds means that there's a much smaller chance of HIV transmission. But the chances aren't zero. So going without condoms means you are taking some risk. You and your partner will really have to trust each other. That neither one of you will get an STD. That whichever one of you is HIV-positive will take their meds every day and see the doctor regularly to check HIV levels. You have to talk about these things with your partners. Don't assume everything is OK because they didn't bring it up.

Of course the best way to decrease the chance that you get or give HIV is to use condoms all the time for anal sex. And remember that it's really easy to get and to give syphilis and other STDs through oral sex. If you or your partner get syphilis, the HIV meds may no longer work as well to prevent transmission. That's another reason why it's important to get tested for STDs on a regular basis.

If you're HIV-positive, make an appointment to see your doctor every three to six months. If you're Gay or Bi and sexually active, you should get tested for HIV/STDs at least once a year. You should get tested every three months if you:

o use meth or poppers, or

o had anal sex without a condom in the last year with someone who was a different HIV status than you, or

o had anal sex without a condom in the last year with someone whose HIV status you didn't know, or

o had sex with more than 10 people in the last year (that's any kind of sex!), or

o had chlamydia, gonorrhea, or syphilis recently.

If you get tested for STDs at your doctor's office, be sure to get a complete screen - that means your mouth, your butt, and your penis. And make sure that you get tested for syphilis, since syphilis is on the rise.

If you're a guy who has sex with other guys, you can get tested for HIV and other STDs at Public Health's STD Clinic, at Gay City, at the baths, or at your doctor's office. For hours and locations, call 206-296-4649 or go to www.kingcounty.gov/health/hiv.

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