Should HIV-Serodiscordant Couples Always Take Preventive Measures? Experts Debate

  • Posted by a hidden member.
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    Sep 06, 2014 10:19 PM GMT
    Since this site can not conduct a meaningful discussion on HIV/Undetectable without immediate name calling, insults and disinformation.....I found a reasonable discussion between two doctors. Both were fellows at Mass General.

    http://www.thebodypro.com/content/73528/should-hiv-serodiscordant-couples-always-take-prev.html?getPage=2
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    Sep 07, 2014 1:00 AM GMT
    I should add this was before the Partner's Study. I think more people might agree with the second opinion, now.
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    Sep 09, 2014 5:15 AM GMT
    The PARTNER Study isn't over yet. It's second phase has only just started and is expected to end in 2017 only.
    This is what the PARTNER Study team has to say about all this:

    uKjSRmP.jpg
    0g69r2w.jpg
    DWFECwY.jpg
    WDrFNiv.jpg

    http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_QA.pdf
    http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_slides.pdf
    http://www.cphiv.dk/portals/0/files/PARTNER2.pdf

    Undetectable is NOT the "new negative".
    Unprotected sex with an undetectable partner is NOT safe
  • Svnw688

    Posts: 3350

    Sep 10, 2014 5:44 PM GMT
    My feeling is that the question could be better worded. "Should" seems to be some normative public-policy stance. If you're asking for my opinion from a public-policy standpoint I would urge condom use and/or PrEP.

    If you're asking from an individual perspective, then there are as many answers as there are people. These are just facts:

    (1). If a neg/neg couple chooses monogamy and to go bare, then you are taking the calculated risk your partner won't cheat, or if he cheats he'll bag it up, or if he cheats and doesn't bag it up that he won't catch HIV. "Should" you put your faith in your boyfriend or husband? Depends on the specific guy, his track record, and various circumstances.

    (2). If a neg/poz couple is together, and the poz guy is undetectable, then that's great and it seems the risk of transmission is low without condom or PrEP. But nonetheless we're not gambling this month's rent in Vegas. The person is gambling their long-term health. Even if HIV isn't a death sentence like it was in the 80s, and even if AIDS never develops, taking those potent drugs cannot be healthy, and let's not get started on advanced complications when you factor in other medical issues (diabetes, liver problems, hypertension, high blood pressure, etc) OR the issue of equality in that not everyone has access to life saving HIV treatments. So I personally would use a condom and/or PrEP if I was with a poz partner, and I'd use condom and/or PrEP if I was with any normal "hookup." The only instance I'd even consider no condom or PrEP is with a monogamous neg partner who I, literally, TRUSTED WITH MY LIFE.

    At the end of the day, HIV is still HIV. It's not a mere inconvenience. It's a serious health issue that, while we shouldn't stigmatize those with it or those who associate with positive persons, we shouldn't act like it's a scraped elbow. Treatment is not a cure. Each person has to weigh their own cost/benefits.
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    Sep 11, 2014 10:19 PM GMT
    AaronH20P saidThe PARTNER Study isn't over yet. It's second phase has only just started and is expected to end in 2017 only.
    This is what the PARTNER Study team has to say about all this:

    uKjSRmP.jpg
    0g69r2w.jpg
    DWFECwY.jpg
    WDrFNiv.jpg

    http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_QA.pdf
    http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_slides.pdf
    http://www.cphiv.dk/portals/0/files/PARTNER2.pdf

    Undetectable is NOT the "new negative".
    Unprotected sex with an undetectable partner is NOT safe


    "Given the latest data showing that effective HIV treatment dramatically reduces the chances of sexual transmission—potentially to zero—we need new ways of talking about HIV before hooking up. To make informed decisions about risk today, it’s not enough to know whether someone is HIV positive or HIV negative (or thinks he is) but also what he’s doing about treatment, if positive, or biomedical prevention, if negative."


    "It’s all about harm reduction, said panelist David Waggoner. “We have to negotiate our own levels of comfort, and we’re all going to come to different conclusions about what we’re comfortable with and not comfortable with.”

    http://betablog.org/undetectable-new-negative/

    Is undetectable the new negative? That is the question. For some, who worry about the actual transmission rate, it is. For many who point out "But you're still POSITIVE!...."(followed by some epithet) it is all about the stigma of being POZ.

    Never mind that the CDC, amongst MANY others say: "Treatment as prevention (TasP) for people with HIV.
    Treating people with HIV lowers the amount of virus in
    their body and can dramatically reduce their risk of
    transmitting HIV to others, underscoring the importance
    of HIV testing and access to medical care and treatment.
    In fact, a landmark clinical trial in 2011 showed that
    people with HIV who began taking anti-HIV medications
    early (before their immune systems were significantly
    weakened) experienced a 96 percent reduction in their
    risk of transmitting HIV to their sexual partners."
    (also pre-Partners, which reinforce those, and other findings to probably "ZERO")
    http://www.cdc.gov/nchhstp/newsroom/docs/HIVFactSheets/Methods-508.pdf

    True, it's not safe sex. I don't think there is such a thing as safe sex. It's safer and what is comfortable to the people involved. Condoms should not be thrown away, there are still STDs and it's yet another barrier. With condom use down in the US and S Africa, with TasP HIV rates have dropped 30 and 41% respectively. But in Botswana, where condom use is UP and TasP is also used rates are down 71%
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    Sep 14, 2014 3:48 AM GMT
    AaronH20P saidThe PARTNER Study isn't over yet. It's second phase has only just started and is expected to end in 2017 only.
    This is what the PARTNER Study team has to say about all this:

    uKjSRmP.jpg
    0g69r2w.jpg
    DWFECwY.jpg
    WDrFNiv.jpg

    http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_QA.pdf
    http://www.cphiv.dk/portals/0/files/CROI_2014_PARTNER_slides.pdf
    http://www.cphiv.dk/portals/0/files/PARTNER2.pdf

    Undetectable is NOT the "new negative".
    Unprotected sex with an undetectable partner is NOT safe



    Thank you.
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    Sep 18, 2014 8:10 PM GMT
    News Flash!

    CDC's press release shows new protocol for HIV/Undetectable---Treatment as Prevention.

    HIV Treatment Works highlights benefits for those with HIV and their partners

    “Today, not only can HIV treatment save lives, it can help stop a national epidemic in its tracks,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “Our goal is to help everyone with HIV know the tremendous health benefits treatment offers to them and the protection it provides to their partners.”

    In addition to the positive impact it can have on a person’s health and well-being, people who start and continue treatment are 96 percent less likely to transmit HIV to others. Treatment for health and prevention is a key element in CDC’s HIV prevention toolkit.

    HIV Treatment Works is the latest campaign of CDC’s Act Against AIDS initiative, a national communication campaign to combat complacency about HIV in the United States. The campaign also advances the National HIV/AIDS Strategy, which includes decreasing the number of new infections, reducing stigma and discrimination against people living with HIV, and educating Americans about the threat of HIV and how to prevent it.

    http://www.cdc.gov/nchhstp/newsroom/2014/HIV-Treatment-Works-press-release.html

    Note there is no mention of condoms, the CDC obviously still recommends them. But TasP is an additional, and very important strategy. As is PrEP. The pro-condom community doesn't need to get in a tizzy, it's use is certainly valid as another layer of HIV protection (and especially STDs) for both ART and PrEP.
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    Sep 18, 2014 8:19 PM GMT
    AaronH20P saidThe PARTNER Study isn't over yet. It's second phase has only just started and is expected to end in 2017 only.
    This is what the PARTNER Study team has to say about all this:



    Of course it isn't over yet. it's an ongoing study. The straight group is completed. They have an additional 450 Gays. Not sure what you meant by "only". If the results change it'll only be by increments, fine tuning.

    There have been several studies, all say essentially the same thing. Virtually (as in ZERO) no transmissions from HIV undetectable. That's science and that's the new CDC stance. CDC is being very cautious with saying 96%.