Saturday, May 10, 2014

HIV sex education 404 : some inconvenient truths, not always found in other sex-ed classes

These are some facts that every sexually active gay man should know, and my commentary on the implications of these facts.

HIV Status Unknown for Most “Negative” Men Online . From .
You can never know if someone claiming to be HIV-negative actually tested negative. Many have actually never been tested at all. Others had tested a long time ago and are actually positive and unaware of it. And some men who are aware of their positive status don't disclose their status because of stigma.

HIV test window periods . From San Francisco AIDS foundation
All types of HIV tests have a window period, which varies from 1 to 12 weeks . 3% of HIV infections still show up negative on the most common screening test, the antibody test, after 12 weeks.

This means even if you go get tested today, a negative result doesn't prove you are actually currently negative. It means you were negative as of 1 to 12 weeks ago with 97% confidence. The test can only confirm if you are currently positive, but cannot conclusively prove if you are currently negative.

You can know that you are currently negative based on your own recent sexual history in the last 1-12 weeks. But you can never know for sure about anybody else, even with recent test results, because you don't know their sexual history, only your own.

Thus, gay men who are insisting on meeting only other "HIV-negative" men are only fooling themselves, and are insisting on something that's impossible to prove.

Fast Facts : Acute HIV infection . From UCSF
The acute phase is the early phase in HIV infection. During that period, individuals are more highly infectious due to high HIV viral load. Estimates indicate that up to half of all HIV transmissions may step from acutely infected individuals who are highly infectious and unaware of their disease status.

Unfortunately, this early acute HIV infection phase often coincides with the window period of HIV antibody screening tests. During this period, one may receive a false negative result, but in fact may have been recently infected and be highly infectious to others.

Thus, the knowledge that a potential sex partner has received an HIV negative test in the past provides little comfort that this person is not actually HIV infected and highly infectious.

Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex

The use of antiretroviral therapy to reduce HIV transmission . UK government.

HIV Transmission Risk Essentially 0 if Heterosexual Partner Has Undetectable Viral Load. 3rd International Workshop on HIV & Women

No-one with an undetectable viral load, gay or heterosexual, transmits HIV in first two years of PARTNER study. From AIDSMAP .

These various studies all point to the same finding ; namely that people who are infected with HIV, are on daily HIV antiretroviral medication long-term, and maintain an undetectable HIV viral load, are unable to transmit HIV to others. This remains true even if no other safe sex precautions are taken, such as the use of condoms. Of course, other STIs, if present, can still be transmitted, if condoms are not used.

HIV nPEP, non-occupational post-exposure prophylaxis. From
This is a mouthful, but really important.
If you have had unprotected sex, or if you experienced a condom failure, with someone of unknown HIV status, or someone of confirmed HIV positive status and off-treatment, you can benefit from HIV post-exposure prophylaxis.
This is a 30-day course of HIV medication. It must be started within 72 hours of the exposure in order to be effective.
If this happens, don't panic, but do go to your emergency room as soon as possible to obtain the prescription. Even if you are uninsured, the county should pay for this treatment in most places.

HIV PReP . Pre-exposure prophylaxis . From the CDC .
If you have frequent unprotected sex with multiple partners, or experience a high rate of condom failure; are unable to sustain erections with condoms; or want to utilize every available tool to ensure that you don't contract HIV, then you can benefit from HIV PReP.

PrEP currently consists of taking one daily pill, Truvada, which is a combination of two popular anti-HIV medication. This has been studied and shown to prevent HIV infection, for those who take the pill on a regular basis. This is not a pill you can take on a one-off basis, or just prior to having sex, unlike a condom you can just put on. It only works if the level of the drug is sufficiently high in the blood.

Why isn't every sexually active HIV-negative person on PrEP ? The 2 primary reasons are cost and potential side effects.
Regarding cost, Truvada is a brand-name drug that costs over $1,000 a month. Those who are uninsured, or underinsured, and on high-deductible plans, may not be able to afford the drug.
Regarding side effects : short and long-term side effects of Truvada are well known in HIV positive individuals. Truvada affects kidneys, especially for long-term use. It appears that the side effects may not be as bad in HIV negative individuals. However, PrEP has not been studied long enough as of this writing to know the long-term effects of taking Truvada in HIV-negative individuals.