In 2008 Swiss clinicians published a brave conclusion, now known as the ‘Swiss statement’. It stated that the risk of acquiring HIV from someone who was on effective antiretroviral therapy (ART) and achieving viral suppression for at least six months was “negligible”.
At the time, this was thought to be a provocative consensus and came under fire from a range of critics who felt the evidence was yet to come or prove compelling.
Reflecting on the furore eight years later in the recent Swiss Medical Weekly (29 Jan 2016), with no documented HIV transmission on ART and after extensive research based mainly on the HPTN 052 Study and the PARTNER Study, the authors state “… that the true risk is close to if not zero” for the sexual transmission of HIV with viral control.
Right or wrong, for a long time the burden and responsibility of the onward transmission of HIV was placed squarely at our feet. The experience of living and loving with HIV had deep lasting effects on our minds as we negotiated our way through this space of obligation, blame and accountability of living with HIV and we carried the weight of this charge alone for many years. Today, with over 90% of people living with HIV in NSW on combination ART, we have good reason to celebrate and acknowledge the HIV positive community for their part in controlling the onward transmission of HIV and protecting the health of our sexual partners.
Despite this reality, the tapestry of liability woven into our minds with steel-like threads was the thought “I could still pass on HIV.” This fear remains etched into the mentality of many people living with HIV today. Unpicking the fault-lines of risk and responsibility remains a challenge for the positive community, despite the compelling evidence that speaks so solidly now.
With the evidence from the ‘Strategic Timing of Antiretroviral Treatment’ (START) research, which recommends the immediate commencement of treatment, along with today’s range of effective prevention strategies and the broad selection of effective treatments with improved tolerability profile, we can acknowledge that people who are on treatment are less likely than ever to pass on HIV.
As people living with HIV, today we can be confident we are part of the solution of ending the transmission of HIV. There is immense pride in this reality and good reason to celebrate. We also have new ‘bedfellows’ to share the burden of transmission – HIV negative people on PrEP as well as gay men who know their status and consistently use condoms.
All people at risk of HIV are now in a position to be part of the effort to end the transmission of HIV. What is needed is for everyone to know their HIV status and test regularly for HIV. Today, both people living with HIV and people who know their HIV status can celebrate their role in ending HIV together.
The START Study https://kirby.unsw.edu.au/content/start-hiv-treatment-study-q
The Swiss Statement – eight years later http://www.smw.ch/content/smw-2016-14246/