In the early years the HIV prevention tool box held a hammer and that hammer was the condom. Today, new technologies, research understanding and treatment options have added to the toolbox beyond the hammer which are changing the realities of HIV transmission and prevention.
Treatment as Prevention (TasP) and Pre Exposure Prophylaxis (PrEP) are two such technologies that are making those in the HIV field reflect upon who may be most at risk for acquiring and/or transmitting HIV and how we target our prevention and education messaging moving forward in future.
TasP is also known as an “HIV prevention intervention” and uses HIV treatment medications known as antiretroviral treatment (ART). ART works to reduce the viral load (level of HIV virus) in an HIV positive person to what is known as an “undetectable” level. Undetectable does not mean cured, but it means the virus is well controlled and at very low levels. The result of effective ART is that a person living with HIV can see improved health outcomes and a future with a normal lifespan.
- Studies and trials have shown that People Living With HIV who are on effective ART are up to 98% less likely to transmit HIV to a partner as a result of their reduced viral load. A lower level of the HIV virus in body fluids means less possibility of HIV transmission.
PreP is the use of ART in HIV negative individuals to prevent acquiring HIV. Currently, the medication Truvada has been approved in the United States to help reduce the risk of acquiring HIV. This use is recommended for adults who are at a high risk of getting HIV and includes HIV-negative men who have sex with men and male-female sex partners when one partner has HIV and the other partner does not.
- Over several years a large body of research has been established indicating that Pre Exposure Prophylaxis or (PrEP) provides an up to 99% level of protection against HIV infection when used as prescribed. Cornerstone projects include iPrEx, Partners PrEP, and TDF2. Clinical trials have involved thousands of participants across multiple continents including Africa, North America, South America, and Asia.
With these two considerations in mind the question raised for many is what the true risks are for transmitting or acquiring HIV if you were a person on TasP or PrEP. It is also important to note that condom use remains a key message for prevention and education regardless of TasP or PrEP.
Many online Gay and MSM meeting sites have begun to take note of these new realities and have begun to make changes on member profile pages, broadening the traditional “positive or negative” definitions of HIV status. Some of these new status options for personal profiles now include: HIV+, HIV+ undetectable, HIV+ on TasP and undetectable, HIV-, HIV- on PrEP, and HIV unknown as examples.
So what does this mean when we speak to “risk”?
If studies have proven that TasP and PrEP are effective at significantly reducing HIV risk to an almost non transmittable reality, what does that mean for persons considering choices for sexual partners? Who is really the higher risk?
Is a person who does not know their HIV status or who has never been tested pose a higher risk for HIV transmission due to their unknown or assumed HIV negative status than a person on TasP with controlled virus or on PreP and known HIV status? These are some of the questions being raised as a result of these new and emerging technologies.