Should I Stop Using Condoms And/or Prep If Im With Someone Who Is Undetectable
PrEP and/ or condoms are not necessary to prevent HIV when the sexual partner living with HIV has an undetectable viral load. Having an undetectable viral load, using PrEP, and using condoms are all HIV prevention strategies that people can choose to use alone or in combination. We provide information about the latest science of HIV transmission so people with HIV and their partners can make informed decisions about what works for them. Some people may prefer to use several HIV prevention strategies for a variety of reasons such as to reduce transmission risk anxiety, because they have sex with more than one person, to prevent other STIs, to prevent pregnancy, or if the partner with HIV has challenges with ART adherence. Condoms, when used correctly, are the only method that helps prevent HIV, some STIs, and pregnancy.
It may take time for an HIV-negative person to trust in their partner being truly undetectable and that that will keep them safe from HIV. As the study cited below showed, it can take time, sometimes years. Partners living with HIV can see it as evidence they are not trusted, when it may be that anxiety from the HIV-negative partner is about coming to terms with new information. In the meantime, other strategies are possible including PrEP.
How Is Hiv Spread From Person To Person
HIV can only be spread through specific activities. In the United States, the most common ways are:
- Having vaginal or anal sex with someone who has HIV without using a condom the right way every time or taking medicines to prevent or treat HIV. Anal sex is riskier than vaginal sex for HIV transmission. Learn more about the HIV risk associated with specific sexual activities.
- Sharing injection drug equipment, such as needles,syringes, or other drug injection equipment with someone who has HIV because these items may have blood in them, and blood can carry HIV. People who inject hormones, silicone, or steroids can also get or transmit HIV by sharing needles, syringes, or other injection equipment. Learn more about HIV and injection drug use.
Less common ways are:
- An HIV-positive person transmitting HIV to their baby during pregnancy, birth, or breastfeeding. However, the use of HIV medicines and other strategies have helped lower the risk of perinatal transmission of HIV to less than 1% in the United States. Learn more.
- Being exposed to HIV through a needlestick or sharps injury. This is a risk mainly for health care workers. The risk is very low.
HIV is spread only in extremely rare cases by:
Why Is Viral Load Significant
For the past 20 years, evidence has been building up to show that the likelihood of passing on HIV is linked to the amount of the virus in the blood.
The landmark PARTNER 1 study looked at over 58,000 instances of sex without a condom, where one partner was HIV positive and one was HIV negative. There were zero cases of HIV transmission in couples where the HIV positive partner was on effective treatment .
The statistical certainty of the PARTNER 1 study was slightly lower for receptive anal sex with ejaculation than it was for vaginal sex though. The PARTNER 2 study , which looked only at instances of condomless anal sex, showed zero transmissions for both same-sex male couples and heterosexual couples.
With the results of both those studies, scientists have concluded that the chance of any HIV-positive person with an undetectable viral load transmitting the virus to a sexual partner is scientifically equivalent to zero.
Combined studies PARTNER 1 and PARTNER 2, with 2017s Opposites Attract study, together make up about 126,000 occasions of condomless sex between serodiscordant partners, with no transmissions.
This gives us the robust evidence to say, with confidence, that people on effective HIV treatment cant pass on the virus.
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What Are Viral Load Blips
Even if a person is durably undetectable and taking antiretroviral therapy daily as prescribed, they may experience small, transient increases in viral load called blips followed by a decrease back to undetectable levels. Having a blip is relatively common and does not indicate that antiretroviral therapy has failed to control the virus. Scientists are working to better understand what causes blips.
How Do I Explain This To A Sexual Partner
If you have sexual partners who are not living with HIV, explaining U=U to them is likely to be mutually beneficial. If you had previously relied on other means of preventing HIV transmission , you may jointly decide that these methods are no longer necessary because of U=U.
It may take some time for an HIV-negative partner to accept the U=U message and to rely on it as the sole method of preventing HIV. Some HIV-negative people may reject the message or deny its accuracy. It may be helpful to direct your partner to information resources that explain the accuracy and significance of U=U. NAM has also produced a page for people who dont have HIV to help them understand the impact of an undetectable viral load on HIV transmission.
Another option could be for your partner to hear about U=U from a healthcare worker or another reliable and trusted source.
“For as long as your viral load stays undetectable, your chance of passing on HIV to a sexual partner is zero.”
Despite sharing this information, some people may still not accept that U=U. In this kind of situation, it is important to find a balance between providing your partners with information and taking care of yourself.
Many people find it difficult to talk about sex, even with the person who is closest to them. If this is the case, you might want to discuss your concerns with someone at your HIV clinic, sexual health clinic or a support organisation. This can help you clarify your thoughts and what youd like to say.
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How Often Should Viral Load Testing Be Done
According to the United States Health and Human Services clinical HIV guidelines, patients on a stable, suppressive ARV regimen, viral load should be repeated every 3 to 4 months or as clinically indicated to confirm continuous viral suppression. Clinicians may extend the interval to 6 months for adherent patients whose viral load has been suppressed for more than 2 years and whose clinical and immunologic status is stable. In high-resource countries, providers are increasingly conducting viral load testing on an annual basis.
The World Health Organization guidelines, most often followed in low and middle income countries, however, note on page 148, Routine viral load monitoring for early detection of treatment failure: obtain and review result by 6 months after ART initiation, 12 months after ART initiation and yearly thereafter.
Do Hiv+ People With Undetectable Viral Loads Need To Disclose Their Status
Since the mid-2000s, HIV research has focused on ways to prevent the sexual transmission of HIV as a form of treatment. In September 2017, the Centers for Disease Control and Prevention adopted the widely accepted scientific position that an HIV-positive person with an undetectable viral load in their blood has a low risk of transmitting the virus through unprotected sex. Advancements in HIV treatment has dramatically improved the health, quality of life and life expectancy of people living with HIV. Additionally, these advancements have also transformed the HIV prevention landscape.
Scientists estimate that HIV spread from chimpanzees to humans in the early 1900s. Then, in 1968, the earliest suspected case of AIDS appeared in St. Louis, Missouri. By the 1980s, following the 1981 death of Gaetan Dugas, HIV/AIDS became an epidemic. In the early years, doctors were baffled about the virus that was making gay men in urban areas sick. From the governments slow and counterproductive response to Bayer being responsible for infecting millions of hemophiliacs with HIV, what unfolded throughout the 1980s laid the foundation for the preventative measures and medical advancements seen today.
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Does Hiv Viral Load Affect Getting Or Transmitting Hiv
Yes. Viral load is the amount of HIV in the blood of someone who has HIV. If taken as prescribed, HIV medicine can reduce a persons HIV viral load very low level, which keeps the immune system working and prevents illness. This is called viral suppression, defined as having less than 200 copies of HIV per milliliter of blood.
HIV medicine can also make the viral load so low that a standard lab test cant detect it. This is called having an undetectable level viral load. Almost everyone who takes HIV medicine as prescribed can achieve an undetectable viral load, usually within 6 months after starting treatment.
As noted above, people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIVto their HIV-negative partnersthrough sex.
HIV medicine is a powerful tool for preventing sexual transmission of HIV. But it works only if the HIV-positive partner gets and keeps an undetectable viral load. Not everyone taking HIV medicine has an undetectable viral load. To stay undetectable, people with HIV must take HIV medicine as prescribed and visit their health care provider regularly to get a viral load test. Learn more.
What Does Undetectable Viral Load Mean
Antiretroviral therapy is medication that helps to keep the viral load in the body under control. For many people, HIV treatment can substantially lower viral load levels, sometimes to undetectable levels.
A viral load is considered undetectable if a test cant quantify the HIV particles in 1 milliliter of the blood. If a viral load is considered undetectable, it means the medication is working.
According to the Centers for Disease Control and Prevention , a person with an undetectable viral load has effectively no risk of sexually transmitting HIV. In 2016, the Prevention Access Campaign launched the U=U, or Undetectable = Untransmittable, campaign.
A word of caution: undetectable doesnt mean the virus particles arent there, or that a person no longer has HIV. It simply means that the viral load is so low that the test is unable to measure it.
HIV-positive people should consider continuing on antiretroviral medications to remain healthy and keep their viral loads undetectable.
These increased viral loads may occur between tests, and there may be no symptoms.
Viral load levels in blood or genital fluids or secretions are often similar.
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How Can You Prevent Getting Or Transmitting Hiv Through Sex
There are several ways to prevent getting or transmitting HIV through anal or vaginal sex.
If you have HIV, the most important thing you can do to prevent transmission and stay healthy is to take HIV medicine exactly as prescribed. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex. This is sometimes called HIV treatment as prevention or undetectable = untransmittable . There also are other options to prevent transmitting HIV, below.
Taking Hiv Medicine To Stay Healthy And Prevent Transmission
HIV treatment involves taking highly effective medicine that reduces the amount of HIV in your body. HIV medicine is recommended for everyone with HIV, and people with HIV should start HIV medicine as soon as possible after diagnosis, even on that same day.
People on HIV treatment take a combination of HIV medicines . A person’s initial HIV treatment regimen generally includes three HIV medicines from at least two different HIV drug classes that must be taken every day. Many people with HIV take two or more different HIV medicines combined in one pill. Long-acting injections of HIV medicine, given every two months, are also available if your health care provider determines that you meet certain requirements.
If taken as prescribed, HIV medicine reduces the amount of HIV in your blood to a very low level, which keeps your immune system working and prevents illness. This is called viral suppression, defined as 200 copies of HIV per milliliter of blood.
HIV medicine can also make your viral load so low that a standard lab test cant detect it. This is called having an undetectable viral load. Almost everyone who takes HIV medicine as prescribed can achieve an undetectable viral load, usually within 6 months after starting treatment. Many will bring their viral load to an undetectable level very quickly, but it could take more time for a small portion of people just starting HIV medicine.
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Who Is Most At Risk Of Hiv
The most likely way of getting HIV is having unprotected sex with someone who has HIV and isn’t on treatment. These things increase your risk of getting HIV:
- Having unprotected sex with someone who’s HIV status is unknown
- Having multiple sexual partners
- Being a man who has unprotected sex with other men
- Having rough or intense sex that causes bleeding or friction
- Having certain STIs that make it easier for HIV to enter your blood stream
- Injecting drugs and sharing injecting equipment
- Using drugs to enhance sex this is sometimes called chemsex
- Getting a medical procedure, tattoo or piercing in a country that doesnt have a good screening programme for HIV
If Im Undetectable Is There A Chance My Viral Load Will Become Detectable Again
Being undetectable does not mean that you are cured of HIV. There are three instances when your HIV viral load might come back and be detectable again.
The most common instances are so-called viral blips. Blips are when your HIV levels become slightly detectable, but at a very low level, and then goes back to being undetectable again. People may experience viral blips when they take their HIV medications every day. Viral blips are usually due to issues in the lab, such as some slight error in the test or in the test conditions in the lab. Occasionally they are due to a slight but true increase in the viral load due to a stress such as an illness or a vaccine. Viral blips, in which the viral load goes right back down to undetectable soon, are considered harmless. There is no appreciable chance that a person with a viral blip will transmit HIV to another person.
People also become detectable when they stop taking their HIV medications or take them only partially. It may take between a week to several weeks after stopping HIV treatment for HIV to become detectable again, but people will see the levels of virus in their body go up to detectable levels.
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What Does The Report Conclude On The Criminal Justice Systems Response To Hiv Non
In light of the Public Health Agency of Canadas review of the most recent medical science, Justice Canadas Report on the Criminal Justice Systems Response to Non-Disclosure of HIV draws the following conclusions about the scope of the criminal law addressing HIV non-disclosure cases:
These conclusions concern when the criminal law should impose a duty to disclose HIV positive status before sexual activity, not when there may be an ethical duty to do so.
Viral Load And Being Undetectable
Medical evidence has shown that people on effective HIV treatment cant pass HIV on.
Viral load is the amount of HIV in the blood.
A viral load test shows how much of the virus is in the body by measuring how many particles of HIV are in a blood sample. The results are given as the number of copies of HIV per millilitre of blood for example 200 copies/ml.
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How Is Hiv Not Spread
HIV is not spread by:
- Air or water
- Mosquitoes, ticks, or other insects
- Saliva, tears, sweat, feces, or urine that is not mixed with the blood of a person with HIV
- Shaking hands hugging sharing toilets sharing dishes, silverware, or drinking glasses or engaging in closed-mouth or social kissing with a person with HIV
- Drinking fountains
- Other sexual activities that dont involve the exchange of body fluids .
- Donating blood
Are There Any Side Effects To Being On Hiv Medicines
HIV medicines can cause side effects for some people. Most are manageable. Fortunately, there are numerous HIV medicines available today that people can take without serious side effects. If you do experience any side effects it is important to discuss these with your healthcare provider.
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Viral Load And Hiv Transmission
A low viral load means a person is less likely to transmit HIV. But its important to note that the viral load test only measures the amount of HIV thats in the blood. An undetectable viral load doesnt mean HIV isnt present in the body.
Its also possible to transmit HIV to partners by sharing needles. Its never safe to share needles.
HIV-positive people may also want to consider having an open and honest discussion with their partner. They can ask their healthcare providers to explain viral load and the risks of HIV transmission.