SOURCE: The HIV PLUS Magazine

CDC: “…viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission.”

In a historic letter, the Centers for Disease Control and Prevention unequivocally says
 "Undetectable Equals Untransmittable" for the first time.

After hundreds of other experts and HIV organizations have already signed on to a pledge that recognizes that people living with HIV whose treatment has brought their viral load to an undetectable level — which is nearly half of all HIV-positive people in the U.S. — cannot transmit HIV to any other person, the Centers for Disease Control and Prevention has come out with the definitive statement on the subject. 

In recognition of National Gay Men’s HIV/AIDS Awareness Day, the CDC memo stated,

“On this day, we join together in taking actions to prevent HIV among gay and bisexual men and ensure that all gay and bisexual men living with HIV get the care they need to stay healthy.” Gay and bisexual men, the CDC noted, continue to be disproportionately affected by HIV, with, “more than 26,000 gay and bisexual men received an HIV diagnosis in 2015, representing two-thirds of all new diagnoses in the United States, and diagnoses increased among Hispanic/Latino gay and bisexual men from 2010 to 2014.”

Although these findings are certainly disappointing, the letters key paragraph is not. Noting that research has shown that antiretroviral therapy both keeps people living with HIV healthy and has a preventative effect, the CDC writes,

“When [antiretroviral treatment] results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission.”

In other words, having one’s HIV suppressed to undetectable levels prevents transmission.

“Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP),” the statement continues, “no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”

That is a remarkable statement, as Bruce Richman, executive director of UequalsU.org and the Prevention Access Campaign tells us.

“This is the moment we have been waiting for! The CDC agreed today there is effectively, no risk, of sexually transmitting HIV when on treatment and undetectable.”

NO RISK MEANS ZERO RISK THAT SOMEONE WITH HIV CAN SEXUALLY TRANSMIT THE VIRUS TO THEIR HIV-NEGATIVE PARTNER, EVEN IF THEY ARE NOT USING CONDOMS OR PREP.

Richman says congratulations are in order to

“All the pioneering people and partners in this community and in the city, state, and federal health departments who worked together outside and inside the system to make this change. What a beautiful moment! The CDC’s new and unequivocal language is a result of [the U.S. Department of Health and Human Services’] unprecedented review of transmission risk messaging across departments which will be rolling out core messaging in the coming weeks and months.”

Richman, whose Prevention Access Campaign has led the educational effort around the Undetectable=Untransmittable message, points to the other people living with HIV, who “have been leading the way for this change here in the U.S. and around the world. Our experience as part of the review process and as early as last summer with HHS, [National Institutes of Health], and CDC has been productive and positive even when the gaps in our positions seemed wide. We especially appreciate their integrity, commitment, and decisive action during a time when our health and human rights have been continually under assault.”

At this year’s U.S. Conference on AIDS, Richman notes that Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, “confirmed, the science really does verify and validate U=U (Undetectable = Untransmittable), in follow-up to his statements at [the 2017 International AIDS Society].”

Now, Richman adds, “It’s time to make history and share this news!” He calls on other HIV and LGBT organizations to join “nearly 400 organizations from 56 countries that have signed on as part of a growing and vibrant U=U Community Partner network. Resources on U=U messaging in the U.S. and around the world as well as the related issues of unequal access, social determinants of health, and HIV criminalization are on our website.” 

Scientists Divulge Latest in HIV Prevention

SOURCE: Jamaica Observer

PARIS, France (AFP)— A far cry from the 1990s "ABC" campaign promoting abstinence and monogamy as HIV protection, scientists reported on new approaches Tuesday allowing people to have all the safe sex they want.

ABCDE VS HIV | Infographic by
Rocel Ann Junio for MP-KNN http://sumo.ly/54o0

  

Moving away from the message to "Abstain, Be faithful, Condomise", modern prevention strategies include drug-doused vaginal rings, male circumcision, and taking antiretroviral therapy (ART) medication, experts said at a HIV Science Conference in Paris.  

Thirty-five years of research has yet to yield a cure or vaccine for the virus which has infected more than 76 million people since the early 1980s and killed 35 million.

This means that prevention remains "absolutely critical," according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) in Maryland, who attended the International AIDS Society conference.

There are 19.5 million people on ART today, with another 17.1 million who need it.

"Each year we add about two million to that group," Fauci told AFP. "We must decrease the number of new infections."

Some recent advances:

Circumcision

According to the World HealthOrganization, there is "compelling evidence" that male circumcision reduces the risk of sexual HIV infection in heterosexual men.

On Tuesday, researchers said it also protects their female partners.

In a study with nearly 10,000 people in South Africa, women who reported that their most recent male sexual partner was circumcised were 22 per cent less likely to have HIV and 15 per cent less likely to have genital herpes than women whose last partner was not.

The reason is not clear. Is it simply that fewer men are being infected and infecting others in turn, or does circumcision actively prevent HIV-positive men from passing on the virus?  The research will continue, said Ayesha Kharsany of the CAPRISA Research Centre in South Africa.

"What is certain, however, is that having a circumcised partner can provide women with partial protection against HIV," she told journalists in Paris.

Some 12 million men have been medically circumcised in sub-Saharan Africa to date in an effort to stop the spread of HIV, Kharsany said.

Opposites Attract

A study of gay couples in which one partner had HIV, showed that infected men who achieve virus suppression with ART also protected their uninfected partners.

Add caption

"There were no, zero, HIV transmissions within these couples," said Andrew Grulich of the University of New South Wales in Australia, who took part in the study entitled "Opposites Attract".
Grulich and a team followed 330 couples for about 1.5 years, during which time the participants reported 17,000 acts of condomless, anal sex.

The lack of HIV spread was despite high rates of other sexually-transmissible infections, the team found.

"We think these findings really strongly support the hypothesis that condomless sex, when the viral load is undetectable, is a form of safe sex," said Grulich.

Vaginal Ring

A two-year study of 96 girls aged 15 to 17 in the United States, showed that a vaginal ring treated with the ARV drug dapivirine, was safe and easy to wear.

The ring is worn constantly and replaced monthly.

In previous research involving adult women, the ring reduced the risk of acquiring HIV by about 30 percent, according to the research team. Further study is needed to test whether it also protected girls.

"HIV doesn't distinguish between a 16-year-old and an 18-year-old," said Sharon Hillier of the University of Pittsburgh School of Medicine.

"Young women of all ages deserve to be protected."

Teenage girls and young women aged 15-24 accounted for a fifth of new HIV infections among adults in 2015 — rising to one in four in sub-Saharan Africa where 1,000 are infected daily, according to the study authors.

Injectable Shield

A long-acting, injectable dose of the virus-suppressing drug cabotegravir, given every two months, was well tolerated in trial participants, according to early results.

Cabotegravir is being probed as an alternative to oral ARV as prevention — also known as pre-exposure prophylaxis or PrEP. Forgetting to take a pill can expose one to infection, and is a major complaint of PrEP users.

Further trials are in the pipeline to test the drug's virus-suppressing efficacy, said Raphael Landovitz, an infectious diseases expert from the University of California.

Less Frequent Sex

A drug cocktail that has been shown to protect uninfected gay men who engaged in frequent and "high-risk" sexual behaviour, also shields those who are less active and hence take fewer tablets, another study showed.

The IPERGAY trial is testing the efficacy of the drug cocktail Truvada taken as prevention before and after sex.

No infections were reported among men on PrEP who had sex about five times a month, researchers found. The team had previously measured a near 90-percent drop in infection risk for Truvada-users who had sex on average twice as often.

PrEP