Undetectable = untransmittable, the big change in the lives of couples with HIV

Undetectable = untransmittable. I = I. This acronym has been a real revolution in the field of HIV. And not only from a clinical perspective but, essentially, from the most human: due to the stigma of rejection by the other party, HIV-positive people have always had to deal with the anguish and anxiety of knowing that their sexual and affective relationships would be marked by fear. to infect their partner.

And we are talking about a revolution based both in clinical analysis and in scientific evidence, which shows that an HIV-positive person whose viral load is undetectable – that is, more than 95% of those who correctly follow antiretroviral treatment – cannot transmit the virus. This idea is not really new. As Lucio J. García Fraile, associate physician of the Internal-Infectious Medicine Service of the Hospital de La Princesa (Madrid) and medical coordinator in the organization Apoyo Positivo explains, “there were many studies that suggested this but, as a precaution, it was not said so explicitly. There was always some objection to them, there always seemed to be some bias. Until the evidence was overwhelming. ”

García Fraile refers to international studies that have shown, in serodiscordant couples (also called mixed status couples, in that only one of its members is seropositive), that there has been no transmission of HIV to the seronegative when the viral load of the positive was undetectable for six months or more (it is considered that a viral load is not detects when the number of HIV particles in a milliliter of blood is below 50).

“At first they were small jobs, but now the evidence is very solid, with thousands of people being followed for years,” explains Dr. María Jesús Pérez Elías, Section Chief of the HIV Unit at the Ramón y Cajal Hospital in Madrid . “This evidence indicates that there have been no cases of HIV transmission in sex without a condom, even in practices that we consider especially risky.” García Fraile, from Apoyo Positivo, confirms this: “It is no longer possible to object to the results. The studies have been done in real life, in real couples, in all kinds of relationships and with all kinds of sexual practices. And we can say that undetectable is equal to untransmissible. ”

How to make the seronegative couple understand

But this The information has not yet had an echo or social dissemination, laments Marina Hispán Alonso, mediator of Sexual Health in Positive Support. And that is where the I = I campaign comes into play, which began in the US five years ago and has become a growing global community, bringing together activists and researchers and spanning more than 100 countries. Its purpose is, based on this scientific evidence, to guide and reassure people with HIV (and, by extension, their friends, partners and relatives) that they can live without worrying about transmitting the infection. Always, yes, that they are in treatment and with an undetectable viral load. For Hispán, it is about “raising awareness that, thanks to medication, you can have sex without fear of transmission. It is very important for the external view, but also for the internal one: an HIV diagnosis involves a process of mourning and acceptance, in which it causes a lot of discomfort to think that one could be a danger to their partners. For this reason, antiretroviral treatment is not only good for physical health, but also for mental and emotional health. ”

Marina is an HIV carrier. Through her work as an activist and her work in Positive Support, she soon learned of the studies that were being carried out and that she, thanks to her undetectable viral load, could not transmit the virus to her partners. “I have lived through many unpleasant situations. But, when I met my current partner, I was over my grief and had the correct information. I informed him of what it is to live with HIV and what it is to be undetectable. With affection and love, we have moved on and supported each other. ”

But the fear, in many cases, is still there. Pedro, for example, is seronegative and has not been able to have unprotected sex, even though Miguel, his partner and HIV positive, has already had an undetectable viral load for years. “It only reports stress and anxiety, it’s not worth it. The condom is not something that limits me; It gives us security ”, explains Pedro. He also says that both were greatly surprised when the doctor informed them that, if they wanted, they could do without the condom. “So many years hearing the opposite… that you have ended up internalizing it and it is difficult for you to accept it”, recognizes Miguel.

No guarantee before the rest of ITS

It has also cost the doctors, recognizes Dr. Pérez Elías: “For those of us who carry 30 Years of instilling in our patients the importance of having sex with a condom, changing the message has not been easy. And the same thing happens to them: they have it burned into their brains. But it is important to admit that I = I, and take your time to transmit it well. ”

Dr. García Fraile points out: “The message, from the biomedical and social point of view, is positive. Allow these people to have a calm, pleasant and fulfilling sex life. Many times they live in fear of what will happen if a condom breaks. We often have the profile of an irresponsible HIV-positive person in our heads, but it is a very minority. Most of the community is very sensitized. ”

The message of being undetectable only refers to HIV , not to the rest of sexually transmitted infections

This change in the message is experienced, therefore, individually, as a couple and socially. The I = I movement insists that it is an opportunity to transform the lives of people with HIV: transforms their social, sexual and reproductive lives; strikes stigma and strengthens empowerment, and reduces anxiety and encourages continued treatment.

This last aspect, that of continuing with treatment, is crucial. Because not following it well means that the viral load goes back up and, consequently, the ability to transmit the virus again. And another crucial aspect is the message that being undetectable only refers to HIV. “We spread a message that was not known, that I = I, and that antiretroviral treatment exclusively guarantees that we will not transmit HIV, but not the rest of the infections of sexual transmission ”, warns Marina Hispán, referring to hepatitis C, syphilis or gonorrhea, among others.

For more information about the studies mentioned, click on the following links (all in English): ‘ HTPN 052 ‘, from 2011; ‘Partner 1 ′ , from 2016; ‘Opposites Attract’, from 2017; and ‘Partner 2 ′ , from 2018.

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