{"id":59770,"date":"2023-07-25T10:16:38","date_gmt":"2023-07-25T14:16:38","guid":{"rendered":"https:\/\/www.psi.org\/?post_type=news&p=59770"},"modified":"2023-07-25T10:17:36","modified_gmt":"2023-07-25T14:17:36","slug":"undetectable-hiv-poses-zero-risk-of-sexual-transmission-who-says","status":"publish","type":"news","link":"https:\/\/www.psi.org\/fr\/news\/undetectable-hiv-poses-zero-risk-of-sexual-transmission-who-says\/","title":{"rendered":"Undetectable HIV poses \u2018zero risk\u2019 of sexual transmission, WHO says"},"content":{"rendered":"\n

This piece originally ran on Devex.<\/a><\/p>\n\n\n\n

By\u00a0Jenny Lei Ravelo\u00a0<\/em><\/p>\n\n\n\n

Policy documents don\u2019t usually trigger excitement. But at this week\u2019s 12th\u00a0International AIDS Society<\/a>\u00a0Conference on HIV Science, a rare thing happened when the\u00a0World Health Organization<\/a>\u00a0presented its\u00a0latest brief<\/a>.<\/p>\n\n\n\n

\u201cPeople living with HIV who have an undetectable viral load, have zero risk of transmitting HIV to their sexual partners,\u201d Lara Vojnov, technical officer at WHO\u2019s department of global HIV, hepatitis and sexually transmitted infections programs, said before a packed room of delegates who erupted in applause.<\/p>\n\n\n\n

For many people working on HIV\u00a0this information is not new. A campaign that started in 2016, called \u201cU=U,\u201d which is short for \u201cundetectable equals to untransmittable,\u201d was essentially making the same argument and WHO has also included this information in its HIV treatment guidelines.<\/p>\n\n\n\n

But the agency previously didn\u2019t use the term \u201czero risk\u201d and found the message wasn\u2019t getting through to everyone, including policymakers and people living with HIV themselves, with some of them convinced there\u2019s no such thing as zero risk.<\/p>\n\n\n\n

\u201cI think what came out in a lot of conversations that I’ve had with people living with HIV [and] with others is we didn’t realize that we needed to make this statement. We believed in it, we knew the evidence, we were behind U=U or behind any other campaign that said similarly. But we just didn’t understand, frankly, the impact that making this kind of a statement from ourselves will have,\u201d Vojnov told Devex.<\/p>\n\n\n\n

The next step is to disseminate the information to people living with HIV and empower \u201ceveryone across the response to be able to speak to the general public and say, this is what this means,\u201d she said. Many hope that with this information, people living with HIV can find relief and freedom to do what they want \u2014 be it having children or being intimate.<\/p>\n\n\n\n

For Micheal Ighodaro, the director of global policy advocacy of the Prevention Access Campaign, it certainly is liberating.<\/p>\n\n\n\n

\u201cI\u2019m getting married this year to my partner. Just knowing that right now my partner will have zero risk of transmission, we can have sex when we want to have sex, and he has absolutely zero risk of getting infected,\u201d Ighodaro told Devex.<\/p>\n\n\n\n

<\/div>\n\n\n\n
Long overdue<\/h5>\n\n\n\n

For those who knew that someone with an undetectable viral load cannot pass on the virus to their sexual partners this declaration is welcome.<\/p>\n\n\n\n

Melania Mugamu, who is living with an undetectable viral load and works as a peer treatment facilitator for the Queensland Positive People to support other people living with HIV in Australia, said she\u2019s seen it among serodiscordant couples \u2014 couples with one partner living with HIV \u2014 that have been living together for years and have no history of HIV transmission.<\/p>\n\n\n\n

\u201cEven before U=U was formally announced, I was beginning to see it,\u201d she said. But others had doubts, which she said was understandable given the long history of HIV and how, 40 years later, it still doesn\u2019t have a cure.<\/p>\n\n\n\n

\u201cPeople know that it’s not a curable disease. So people are frightened of transmitting it to other people, and therefore they will have to think and they will want assurance,\u201d she said.<\/p>\n\n\n\n

Nina Hasen, Population Services International\u2019s vice president for HIV and TB programs, said she\u2019s known for years that people with low levels of the virus in their blood can no longer sexually transmit the virus, thanks to early research.<\/p>\n\n\n\n

One of them is the\u00a0HIV Prevention\u00a0Trials Network study 052<\/a>,\u00a0which enrolled serodiscordant couples across nine countries to determine if antiretroviral therapy can help prevent sexual transmission of the virus. Initial data from the study published in 2011 showed a 96% reduction of HIV transmission in couples where the partner living with HIV reached viral suppression.<\/p>\n\n\n\n

The study and subsequent others eventually led WHO to change its treatment policy<\/a> to cover everyone with HIV, meaning they started treatment as soon as they tested positive for HIV.<\/p>\n\n\n\n

But these findings didn\u2019t reach people living with HIV for two reasons: There were limited viral load tests in countries, and policymakers and medical professionals such as doctors and nurses who were supposed to be a source of information didn\u2019t believe it, according to Hasen.<\/p>\n\n\n\n

When WHO did come out with the information in 2021, it was \u201cburied\u201d in its guidelines and wasn\u2019t clearly stated, she added.<\/p>\n\n\n\n

Vojnov said when they came out with their 2021 guidelines, they also slightly revised their treatment monitoring algorithm, but didn\u2019t realize that it could lead to misinterpretations. In one change, they defined undetectable viral loads to mean having 50 copies of HIV per milliliter of blood.<\/p>\n\n\n\n

\u201cThat drove countries to think they could only utilize plasma testing for viral load. And it really restricted access to viral load testing, particularly in developing settings, where they can’t get a plasma sample to the lab within 24 hours,\u201d she said.<\/p>\n\n\n\n

\u201cIt just became more and more evident in a lot of those conversations with stakeholders across the board the impact and the need for releasing not just the evidence, but also taking the evidence and turning it into public health messaging that can be really clearly understood by everyone in the HIV response,\u201d she added.<\/p>\n\n\n\n

Scientists also had a hand in the confusion. Hasen said the HIV response is \u201cvery medicalized,\u201d and most often \u201cthey just assume that everybody knows these things.\u201d They also don\u2019t spend enough time listening to people living with HIV about their experience and what\u2019s important to them, and instead focus on handing out treatments with the main benefitting message being that it won\u2019t make them sick.<\/p>\n\n\n\n

\u201cBut when we actually start putting people living with HIV at the center, and asking them \u2026 what’s the biggest problem you face living with HIV? People don’t say that I’m gonna die. People say the biggest problem for me, of living with HIV, it’s [being] socially dead. Nobody will marry me. Nobody will have sex with me. Maybe people won’t hire me. So what do I care about your treatment?\u201d Hasen said.<\/p>\n\n\n\n

\u201cIf we’ve been listening to people living with HIV, we would have been saying this much sooner. But because we weren’t listening, we didn’t realize how important it was,\u201d she added.<\/p>\n\n\n\n

<\/div>\n\n\n\n
A turning point<\/h5>\n\n\n\n

In 2015, one man felt the need to take action.<\/p>\n\n\n\n

Bruce Richman, who had been diagnosed with HIV for more than a decade at that time, founded the Prevention Access Campaign with the main purpose of disseminating the information. He started it a few years after learning that his viral load has reached undetectable levels, and how that meant he can no longer pass the virus.<\/p>\n\n\n\n

\u201cIt totally changed my possibilities of love, of intimacy, of sex, if I could have children that I never thought I could have. It changed everything for me,\u201d he told Devex.<\/p>\n\n\n\n

But he noticed this information isn\u2019t really being communicated in public health, leaving a wide knowledge gap between the science and the people living with HIV.<\/p>\n\n\n\n

So in 2016, he and his team launched the U=U campaign, after consulting with scientists to confirm the science. They then reached out to people and organizations to endorse it. The campaign started to gain traction, receiving support from\u00a0over 1,000 organizations<\/a>\u00a0from 105 countries, and\u00a0endorsements from organizations<\/a>\u00a0such as WHO,\u00a0U.S. President’s Emergency Plan for AIDS Relief<\/a>,\u00a0U.S. Centers for Disease Control and Prevention<\/a>\u00a0and\u00a0UNAIDS<\/a>.<\/p>\n\n\n\n

But they weren\u2019t winning everyone over.<\/p>\n\n\n\n

\u201cIn various countries, we continually hear this pushback and people would be uncomfortable with being definitive and saying undetectable equals untransmittable. They like to say caveats and say, \u2018But use a condom just in case,\u2019\u201d he said.<\/p>\n\n\n\n

\u201cBut now that the WHO is saying zero, there’s no ambiguity with zero. Zero is zero in every language and every culture,\u201d he added.<\/p>\n\n\n\n

It took about a year and half to develop the policy to ensure wide consultation and input from different groups of people, including people living with HIV, said Richman, who was teary eyed when the announcement was finally made this week, saying it\u2019s \u201csuch a relief.\u201d<\/p>\n\n\n\n

\u201cI just realize how many more millions of people are going to be able to experience this joy and freedom of knowing that [they] can’t pass on HIV to anyone,\u201d Richman said, but only if they know about it, which is his cue to get back to work and make sure people with HIV and others such as health care professionals, policymakers, and donor aid agencies understand it and start to see the opportunities to scale up viral load testing.<\/p>\n\n\n\n

<\/div>\n\n\n\n
Getting the word out<\/h5>\n\n\n\n

The job now is to clearly communicate the message to policymakers, health workers and people living with HIV.<\/p>\n\n\n\n

Apart from translating the guidelines to other U.N. languages, WHO is also planning with several partners a series of webinars over the next three months that focuses the messaging on people living with HIV and health care providers, as well as on health ministries and its own country offices.<\/p>\n\n\n\n

Meanwhile, PAC has founded the viral load testing access coalition that mobilizes civil society organizations on equitable access to viral load tests and results.<\/p>\n\n\n\n

Ighodaro believes this new policy brief can be useful as evidence to push governments such as Uganda to overturn its anti-gay law, by saying that the law is making it difficult for LGBTQ+ people in the country to access treatment, and therefore makes it impossible for them to achieve zero risk of transmission.<\/p>\n\n\n\n

Any message however needs to remind people of their responsibilities to remain undetectable, Mugamu said.<\/p>\n\n\n\n

\u201cIf I stopped taking my medication tomorrow, I’ll be detectable. So we need to be able to send a message that says it’s still our responsibility to remain undetectable,\u201d she said. \u201cBeing undetectable once is not enough. You want to be undetectable all the time.\u201d<\/p>\n\n\n\n

<\/p>\n","protected":false},"template":"","related_countries":[],"related_projects":[],"news_category":[1405],"health-area":[],"capabilities-and-cross-cutting":[],"class_list":["post-59770","news","type-news","status-publish","hentry","news_category-news"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t