Testing, Treatment Translate to Reduced Chance of Giving Partners HIV

It may seem like a no-brainer: Get tested, get treated, and the chances of infecting a HIV-negative partner are slashed. But 1 in 5 HIV+ people may not know that that they carry the disease.

Early treatment is crucial for maximum effectiveness and minimal damage to the body of a HIV+ person. But a new study indicates that getting treatment as soon as possible after infection also has a benefit for others by drastically reducing the chances of spreading HIV to an uninfected partner, a May 13 U.S. News & World Report article said.

The new study, underwritten by the National Institutes of Health, "could convince doctors and healthcare policymakers to offer medication sooner," the article said. "In a trial of 1,763 couples with one infected partner, those who started oral antiretroviral drugs immediately upon diagnosis were 96 percent less likely to transmit the AIDS-causing virus to their uninfected partner than those who started therapy later, according to preliminary findings announced [May 14]."

The study was initially supposed to run through 2012, "but the results were so clear that researchers stopped four years ahead of schedule," the article added, noting that the expense of the drug cocktail used to manage HIV is costly, and can lead to liver damage and other side effects. For those reasons the article said, many HIV+ people do not start treatment regimens right away. But the study results have such important implications for public health that the standard approach to HIV management might well adapt.

"It has less to do with a decision about what's good for you from a personal health standpoint than what is the extra added benefit from starting earlier, i.e., transmission, especially if you have a partner who's uninfected," said Dr. Anthony Fauci of the National Institutes of Health, a May 13 Associated Press article said.

"This breakthrough is a serious game changer and will drive the prevention revolution forward," said a media release from the executive director of the UN's Program on HIV/AIDS, Michel Sidib�. "It makes HIV treatment a new priority prevention option."

The study's findings are "a crucial development," said the director general of the World Health Organization, Margaret Chan, "because we know that sexual transmission accounts for about 80 per cent of all new infections."

The two organizations issued a joint statement on the importance of adopting every available means of preventing the spread of HIV.

"No single method is fully protective against HIV," the media release noted. "Treatment for prevention needs to be used in combination with other HIV prevention options. These include correct and consistent use of male and female condoms, waiting longer before having sex for the first time, having fewer partners, male circumcision, and avoiding penetrative sex."

Also crucial: Outreach and education initiatives, so that people have fact-based information on the disease and know what it is, how it is spread, and how to protect themselves and others.

With the study results in hand, "now we need to make sure that couples have the option to choose treatment for prevention and have access to it," said Sidib�.

But popular myths and unhelpful attitudes toward HIV can hinder efforts to contain the pandemic--and so can anti-gay laws and social messages that tell people that HIV is a "gay disease" and promote the idea that even getting tested for the disease is suspect. Such messages reinforce the untrue idea that only gays, prostitutes, and drug users are at risk.

Moreover, men who have sex with men (MSM)s--many of whom identify as heterosexual despite their same-sex encounters--may fall into a mindset of denial due to a false reassurance that even though they practice sex with others of the same gender they are immune because they are not gay. Moreover, gays, bisexuals, and MSMs may shun testing in political and social climates hostile to gays, allowing the virus greater opportunity to spread.

Even where there is less open hostility toward gays and people with HIV, the disease carries a stigma that invites denial. A Dec. 1, 2010, U.S. News and World Report article on "10 HIV/AIDS Beliefs" notes that denial, fear, and ignorance help perpetuate a number of false--and dangerous--myths about HIV, including the idea that people who look and feel healthy must be HIV- or the rationalization that once a person is HIV+ safer sex practices are no longer important.

In fact, safer sex is still crucial to a HIV+ person's health because different strains of the virus exist. A person who becomes infected with two or more strains is "superinfected," and faces even graver health dangers.

Another myth: That a HIV+ sex partner on a regimen of anti-retrovirals whose viral load is undetectable is safe for unprotected sex. Not so. HIV tests that look at the blood's viral load do not account for a possible higher concentration of the virus in semen or vaginal fluid. Similarly, the belief that oral sex does not transmit the virus is fallacious: Any exposure to the blood, semen, breast milk, or vaginal fluid of a HIV+ person carries a risk of infection, though the risk is much smaller if the virus is kept in check with the proper treatment regimen.

But there are upsides to dispelling HIV myths. For instance, one canard has it that HIV can be communicated simply through kissing or shaking hands. This is untrue--HIV is not spread through casual contact. But it has taken years, sometimes decades, for the law to take this into account. Hence, until just last year, the United States, among other nations, continued to turn HIV+ travelers away from its borders.