HIV positive people with an undetectable viral load cannot sexually transmit HIV. That’s the unequivocal conclusion from one of the leading health agencies in the US.

Researchers from the National Institute of Allergy and Infectious Diseases (NIAID) undertook a review of recent research. Their conclusion is simple: Undetectable = Untransmittable (U=U). It’s the same message now backed by over 300 health agencies all around the world.

The results of the NIAID review were published yesterday in the Journal of the American Medical Association (JAMA). One of the reports co-authors is NIAID Director, Dr Anthony Fauci. He is widely regarded as one of the world’s leading HIV experts.

‘Overwhelming evidence’

In a statement, NIAID called evidence for Undetectable = Untransmittable ‘overwhelming’. Not only does getting those diagnosed with HIV on to Antiretroviral Therapy (ART) ensure their long term health. But it also significantly reduces HIV transmission rates. This is because those with the virus suppressed in their body cannot pass it on.

The authors pointed to research that looked at over 77,000 examples of condomless sex between serodiscordant male couples. One half of the couple had HIV and the other did not. There was not a single transmission of the virus from the HIV positive person to the negative person.

The NIAID report notes several important factors

Those taking medication must stick to their medication regimes.

It can take up to six months of ART treatment to bring viral load down to undetectable levels (less than 200 copies of HIV per ml of blood).

Those with HIV should have their viral load tested every 3-4 months for the first two years of treatment. If their viral levels remain suppressed, this can extended to every six months.

They noted that adhering to medication was essential. ‘When ART is stopped, viral rebound usually occurs within 2 to 3 weeks.’

‘The Centers for Disease Control and Prevention (CDC) reported that of the individuals with HIV in the United States in HIV clinical care in 2015, approximately 20% had not achieved viral suppression at their last test.

‘CDC also noted that 40% of the individuals in HIV clinical care that same year did not maintain viral suppression for more than 12 months.’

They say lack of access to consistent healthcare, among other factors, can impact viral load.

‘In summary, even though the clinical data underpinning the concept of U = U have been accumulating for well over a decade, it is only recently that an overwhelming body of evidence has emerged to provide the firm basis to now accept this concept as scientifically sound.’

It says U=U has implications on prevention. There are also legal implications. Currently, more than 20 states in the US make it a crime for someone with HIV to have sex without informing their partner they have the virus.

They also think promoting the U=U message may remove, ‘the sense of fear and guilt that a person may be harming someone else, as well as the feeling of self-imposed and external stigma that many people with HIV experience.’

‘Huge news’

Among those to welcome the report was Bruce Richman, Founder of Prevention Access.

🌐 THANK YOU! This is huge news and validation of #UequalsU from the greatest minds In the field and the world’s #3 medical journal! https://t.co/NaqArTEIcD — Bruce Richman (@BR999) January 10, 2019

Richman tweeted, ‘This is huge news and validation of #UequalsU from the greatest minds In the field and the world’s #3 medical journal!’

Matthew Hodson, Executive Director of NAM/AIDSmap told Gay Star News, ‘Dr Anthony Fauci is the most senior American scientist working on HIV. His unequivocal support of the U=U message is welcome.

‘HIV stigma remains a public health crisis resulting – in extreme cases – in murder and suicide. The understanding that someone with HIV on effective treatment does not pose a transmission risk has the power to dispel much of the fear that results in stigma.

‘It should now be a public health duty to inform all of us who are living with the virus, and all of those whom we may encounter, that effective treatment prevents transmission.’

See also

Top US doctor on HIV undetectable sex: ‘From a practical standpoint, the risk is zero’

HIV: When will it sink in that undetectable = untransmissible?