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CONSENSUS STATEMENT ON THE RISK OF SEXUAL TRANSMISSION OF HIV FROM A PERSON LIVING WITH HIV WHO HAS AN UNDETECTABLE VIRAL LOAD

 A health equity initiative Prevention Access Campaign has published the Consensus statement explaining why PLWH, who have undetectable viral load, are not exposing others to the risk of transmiting HIV. The arguments from the statement can be used as an advocacy tool.

      RISK OF SEXUAL TRANSMISSION OF HIV FROM A PERSON LIVING WITH HIV WHO HAS AN UNDETECTABLE VIRAL LOAD  

      Messaging Primer & Consensus Statement   

There is now evidence-based confirmation that the risk of HIV transmission from a person living with HIV (PLHIV), who is on Antiretroviral Therapy (ART) and has achieved an undetectable viral load in their blood for at least 6 months is negligible to non-existent. (Negligible is defined as: so small or unimportant as to be not worth considering; insignificant.) While HIV is not always transmitted even with a detectable viral load, when the partner with HIV has an undetectable viral load this both protects their own health and prevents new HIV infections.   

However, the majority of PLHIV, medical providers and those potentially at risk of acquiring HIV are not aware of the extent to which successful treatment prevents HIV transmission. Much of the messaging about HIV transmission risk is based on outdated research and is influenced by agency or funding restraints and politics which perpetuate sex-negativity, HIV-related stigma and discrimination.  

The consensus statement below, addressing HIV transmission risk from PLHIV who have an undetectable viral load, is endorsed by principal investigators from each of the leading studies that examined this issue. It is important that PLHIV, their intimate partners and their healthcare providers have accurate information about risks of sexual transmission of HIV from those successfully on ART.   

At the same time, it is important to recognize that many PLHIV may not be in a position to reach an undetectable status because of factors limiting treatment access (e.g., inadequate health systems, poverty, racism, denial, stigma, discrimination, and criminalization), pre-existing ART treatment resulting in resistance or ART toxicities. Some may choose not to be treated or may not be ready to start treatment.  

Understanding that successful ART prevents transmission can help reduce HIV-related stigma and encourage PLHIV to initiate and adhere to a successful treatment regimen.  

The following statement has been endorsed by:  

  • Dr. Michael Brady – Medical Director of Terrence Higgins Trust and Consultant HIV Physician, London, UK
  • Dr. Myron Cohen – Principal Investigator, HPTN 052; Chief, Division of Infectious Diseases, UNC School of Medicine, North Carolina, USA
  • Dr. Demetre C. Daskalakis, MPH – Assistant Commissioner, Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene, New York, USA
  • Dr. Andrew Grulich – Principal Investigator, Opposites Attract; Head of HIV Epidemiology and Prevention Program, Kirby Institute, University of New South Wales, Australia
  • Dr. Jens Lundgren – Co-principal Investigator, PARTNER; Professor, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
  • Dr. Mona Loutfy, MPH – Lead author on Canadian consensus statement on HIV and its transmission in the context of the criminal law; Associate Professor, Division of Infectious Diseases, Women's College Hospital, University of Toronto, Toronto, ON, Canada
  • Dr. Julio Montaner – Director of the British Columbia Centre for Excellence in HIV/AIDS; Director of IDC and Physician Program Director for HIV/AIDS PHC, Vancouver BC, Canada
  • Dr. Pietro Vernazza – Executive Committee, PARTNER; Author, Swiss Statement 2008, Update 2016; Chief of the Infectious Disease Division, Cantonal Hospital in St. Gallen, Switzerland ​

The following statement has also been endorsed by over 400 organizations from 59 countries including:  

  • ACT - AIDS Committee of Toronto - Canada 
  • African and Black Diaspora Global Network on HIV/AIDS - ABDGN - Canada
  • AIDES - France
  • AIDS ACTION NOW - Canada
  • AIDS Alabama - United States
  • AIDS Foundation of Chicago - United States
  • AIDS United - United States APLA Health - United States
  • AIDS Solidarity Movement - Cyprus
  • Australian Federation of AIDS Organizations - Australia
  • Being Positive Foundation - India
  • Black AIDS Institute - United States
  • British Columbia Centre for Excellence in HIV/AIDS - Canada
  • British HIV Association - United Kingdom
  • Canadian AIDS Society - Canada
  • Canadian HIV/AIDS Legal Network - Canada
  • Canadian Positive People Network - Canada
  • Chicago Department of Health - United States
  • CATIE - Canadian AIDS Treatment Information Exchange - Canada
  • Czech AIDS Help Society - Czech Republic
  • Desmond Tutu HIV Foundation - South Africa District of Columbia Department of Health - United States
  • Equitas Health - United States GMHC - United States
  • HIV Medicine Association - United States Housing Works - United States
  • Human Rights Campaign - United States
  • ICASO - International Council of AIDS Service Organizations - Canada
  • INA - Māori, Indigenous & South Pacific HIV/AIDS Foundation - New Zealand
  • International AIDS Society - Switzerland
  • International Association of Providers of AIDS Care -United States
  • International Community of Women Living with HIV - Kenya
  • Latino Commission on AIDS - United States
  • MSMGF (the Global Forum on MSM & HIV) - United States
  • NAM aidsmap - United Kingdom
  • National AIDS Trust - United Kingdom
  • National Alliance of State and Territorial AIDS Directors (NASTAD) - United States
  • National Black Justice Coalition - United States
  • New York City Department of Health and Mental Hygiene - United States
  • New York State Department of Health - United States
  • Positive Women's Network - USA - United States
  • San Francisco AIDS Foundation - United States
  • Sensoa - Belgium Sidaction - France
  • Southern AIDS Coalition - United States
  • Terrence Higgins Trust - United Kingdom
  • Whitman-Walker Health - United States
  • YouthCO HIV & Hep C Society - Canada  

(The full list of organizational endorsements is here.)  

People living with HIV on ART with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV.  Depending on the drugs employed it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.

Please read the full statement with the additional expert quotes, sources and explanations here.

More information in Russian here, in Macedonian here, in Turkish here, in Czech here.

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