With ART, the deadly virus can’t be transmitted to other people through sexual activity.

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    Jul 24, 2015 7:52 PM GMT
    IMHO it's hardly groundbreaking, the Swiss statement said the same thing in 2008. "An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”



    "The landmark study, financed with more than $100 million in federal research grants, confirmed initial results reported in 2011 and demonstrated that AIDS medications known as antiretroviral therapy, or ART, can suppress the virus for years. The virus can reemerge if the patient stops taking the medicine, but as long as it’s suppressed, the virus essentially is harmless and most patients can lead normal, healthy lives.


    “If people are taking their pills reliably and they’re taking them for some period of time, the probability of transmission in this study is actually zero,”

    "However, researchers are not endorsing unprotected sexual activity." <<<
    The study, conducted by the HIV Prevention Trials Network, took precautions to assure that patients were using condoms as an extra safety barrier against sexual transmission of the virus. All study participants received free condoms, risk-reduction counseling, primary medical care and other health services.
    No guarantee

    Still, Cohen said condoms are not always reliable, or not always used, as documented by the numerous pregnancies recorded during the study.



    Read more here: http://www.newsobserver.com/news/business/health-care/article27928615.html#storylink=cpy


    Again, as per ACON, condoms are essential if you don't know the status of partner:

    There are now at least five strategies that reasonably constitute‘safe sex’, provided that certain parameters are met.
    They are:
    1.The use of Condoms during casual encounters between men of unknown or discordant serostatus.
    2.HIV negative men taking effective pre-exposure prophylaxis (PrEP).
    3.Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL) and in the absence of sexually transmissible infections (STIs).
    4.Effective use of serosorting between HIV positive men.
    5.Effective negotiated safety agreements.

    http://www.acon.org.au/sites/default/files/What-is-Safe-Sex-Position-2014.pdf
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    Jul 25, 2015 5:29 PM GMT
    So much remains unknown about this deadly disease that caution - read, safe sex - remains the order of the day.
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    Jul 25, 2015 6:43 PM GMT
    MGINSD saidSo much remains unknown about this deadly disease that caution - read, safe sex - remains the order of the day.


    So much IS KNOWN, I wrote to the journalist:


    Quote from article: "However, researchers are not endorsing unprotected sexual activity."
    The CDC reclassified not using condoms from "unprotected sex" to simply "condomless sex" last year. TasP IS protection.
    http://rhrealitycheck.org/article/2014/02/24/cdc-stopped-calling-sex-without-condom-unprotected-sex/



    Why the CDC Stopped Calling Sex Without a Condom ‘Unprotected Sex’

    He replied:
    Tim,

    I applaud your gimlet eye. I do hope our house style long favors unprotected over condomless, a most graphic designation that would cause our readers to react with pearl-clutching horror.


    John Murawski
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    Reread what ACON says is 'safe sex'. (IMHO there is no such thing, safer sex, yes.)

    If your only solution is to use condoms, and ignoring PrEP and TasP, you are compromising your risk reductions.



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    Jul 25, 2015 8:16 PM GMT
    timmm55 saidIf your only solution is to use condoms, and ignoring PrEP and TasP, you are compromising your risk reductions.
    I couldn't agree more. It's the equivalent of taking off the seat belt and expecting the airbag save you in an auto accident.
  • Oceans_of_Flo...

    Posts: 393

    Jul 25, 2015 10:16 PM GMT

    While reading this I could only think of one thing.

    ..................


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    Jul 26, 2015 7:38 PM GMT
    anotherphil said
    timmm55 said...
    If your only solution is to use condoms, and ignoring PrEP and TasP, you are compromising your risk reductions.


    Unless I'm even further behind the game than I thought, if you think those are the only two options available to you, you are still compromising your risk reductions.


    i.e., while I think it is ...misguided... for a number of RJers to lash out at you and a few others for trying to explain the updated science of risk mitigation, I think that buying into the whole condoms-only-vs.-PrEP oversimplification is nearly as bad as the condoms-only oversimplification was. The emerging realization IMO seems to be that as with any agent with potential for pandemic knowing all available methods of risk management, and how they interact, is critical to successful reduction of HIV risk population-wide.

    Not that I disagree. As I understand it, what you stated is just as true in the following sense:

    * If your only solution is to use condoms, you are compromising your risk reductions (PrEP/TasP notwithstanding -- there are lots of complex factors in HIV transmission risk).

    * If you ignore/oppose PrEP and TasP entirely (as opposed to knowing them not to be relevant to your particular patterns of sexual activity), then you probably are operating based on outdated medical science (having more to do with disease control in general rather than condoms in particular) and may not be making the most effective decisions.

    How far off am I?


    Spot on I think, if I understand you. For some though the ubiquitous condom IS the only choice due to economics, fear of drugs, lack of access to medications, and other reasons.

    So it can be a logical and reasonable choice.
    Per ACON : 1.The use of Condoms during casual encounters between men of unknown or discordant serostatus.

    If you are negative and need protection NOW, it's available 24/7 at you nearest 7/11. And it prevents many (if not all) STDs. Condoms will always be the first line of prevention. But, mostly due to human error, they have a relatively high rate of failure.

    2.HIV negative men taking effective pre-exposure prophylaxis (PrEP).

    So now you have a choice: using condom with a 20-30% failure rate with anal sex, or combining it, or solo, with PrEP. PrEP is 96% or better taken as prescribed. If you can't roll on a condom, wilt with one on, or it affects you negatively PrEP may be for you. But if you can't take 1 pill a day it isn't for you.

    If you can't do either: a condom or PrEP, you shouldn't be having anal sex. Stick to other more effective ways of prevention: oral, masturbation, massage, rubbing.

    Comments on TasP and HIV/undetectable after ABBA.

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    Jul 26, 2015 8:22 PM GMT
    Oceans_of_Flowers said
    While reading this I could only think of one thing.

    ..................




    That can be taken several ways.
    "Take a Chance On Me" implies risk. Emotional and physical risk. There is always risk.

    It could imply desperation. If you think a person who adheres to TasP (the concept) and is HIV positive and undetectable is begging to be dating as a normal person...we are not.

    As per ACON:
    2.HIV negative men taking effective pre-exposure prophylaxis (PrEP).

    3.Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL)

    4.Effective use of serosorting between HIV positive men.

    (I will add: with condoms to prevent typical STDs)

    I don't want anyone to 'take a chance on me' if they don't understand the above. If you are (or think you are) Negative and only date guys who are Negative (or think they are) YOU are taking the biggest 'chance' of all.

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    Jul 26, 2015 9:37 PM GMT
    directly relating to this study:

    Dr Joel

    Question
    I'm years into undetectable, my partner is neg. His doc learned my status and told him to use condoms with me, reminding him "undetectable doesn't mean cured" as if to suggest there is a significant chance of transmission. Other disturbing statements were made. She practices in a gayish neighborhood in Cleveland, part of a Large National Clinic. I find it alarming a physician is spreading fear and misrepresenting risk in this neighborhood, in a state with so much stigma. Any suggestions?

    Answer

    Undetectable may not mean cured, but as prevention goes, it’s about as good as it gets. This was a major theme from last week’s IAS Conference in Vancouver, but maybe the word hasn’t spread to Cleveland yet.

    I certainly understand that a doctor may not want to tell patients that it’s completely safe to abandon condoms. We’ve all had patients whose viral load was undetectable at one visit and then rebounded before the next visit (almost always because they stopped taking their meds). But this discussion should be held as a dialogue about pros and cons rather than a blanket statement that everyone must use condoms.

    In a monogamous serodiscordant relationship, where sexually transmitted diseases aren’t an issue and the positive partner’s virus has been consistently suppressed for a long time, the risk of transmission is extremely low: probably too close to zero to be measured. When risks are this low, there’s no room for dogma. It’s about letting the individuals involved make educated choices.


    http://hivforum.tumblr.com/
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    Jul 26, 2015 11:07 PM GMT
    anotherphil said
    timmm55 said
    anotherphil said

    I think we're mostly on the same page, but here again there is the implication that you have two and only two choices:

    1. Condoms for every situation

    2. PrEP (-slash-TasP) for every situation

    But you've also implied here, and in your following response, that you're fully aware that context and scope are extremely important. I think you do this because *you* know better; however, it's confusing to people like the trolls (who are looking for someone to hate and an excuse to do so) and people like me (who are trying to figure out a sustainable pattern of behaviors and choices above and beyond which one form of protection is THE one right form of prevention.

    As far as I can tell, my assumptions are compatible with the emerging science:

    1. Casual encounters with total strangers should probably involve condom use as a secondary supplement to PrEP, but always at least one of the two.

    2. PrEP is far better than not PrEP (irrespective of condom use) for somebody who is single and dating (i.e., forming new trust relationships not based on a history of monogamy) or possibly in a sero-discordant LTR.

    3. TasP is effective as you cite, but as it is essentially unverifiable outside of a relationship of trust, does not absolve the (assumed) negative partner of some measure of protection, which might mean insisting on condom use, a strict PrEP regimen, and/or forms of intimacy which convey much lower risk of transmission.

    I'm intentionally *not* distinguishing between HIV prevention in particular and STD prevention in general.

    My first time with another man was only last year icon_redface.gif and he was positive. Despite his sustained UVL status he was very self-conscious about it (he implied that he had not been with anyone for a while due to his status, though he did not say whether it was by his choice or not) but we agreed we could find a way to enjoy a night together without having to take any unnecessary risks. I keep moving around the country so I have a difficult time getting situated with a long-term medical provider (and similarly with a viable dating pool), but until I can assess the cost and availability of PrEP moving forward I feel like the most important thing is to improve my understanding of what risks are best mitigated by what strategies and not assume that I'm going to find a magic bullet that makes all situations equally (especially 100%) safe.

    That's why I find it frustrating to see condom use and PrEP set forth as mutually opposed and mutually exclusive options.


    "I think we're mostly on the same page, but here again there is the implication that you have two and only two choices:"


    No, there are at least 5. Your UVL friend is a #3 below.

    There are now at least five strategies that reasonably constitute‘safe sex’, provided that certain parameters are met.
    They are:
    1.The use of Condoms during casual encounters between men of unknown or discordant serostatus.
    2.HIV negative men taking effective pre-exposure prophylaxis (PrEP).
    3.Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL) and in the absence of sexually transmissible infections (STIs).
    4.Effective use of serosorting between HIV positive men.
    5.Effective negotiated safety agreements.

    http://www.acon.org.au/sites/default/files/What-is-Safe-Sex-Position-2014.pdf

    I, for example, typically use #3 and #4 (undetectable and serosort with other POZ/undetectable men). #1 I use condoms for STDs, not so much for HIV protection, I don't play with Negative men unless they grasp fully what 'undetectable" is. If someone insists on a condom, I figure they are are worried about something they have done! Even if they do understand, I have to wonder why they aren't on PrEP. So #2 is an option, but I've not done that with any frequency.
    #5 is the wild card.....whatever "effective negotiated" is. It may be for future treatments not covered yet.

    So there are plenty of options for Negative and POZ alike. Some even cross over (to which some will say 'the hell it will!").

    Two strategies that DON'T work are:
    1) sex between a POZ man (not on treatment/not fully suppressed) and a Negative man w/o condoms. 2) Serosorting between Negative men, it is really sero-guessing and is not reliable in the least.

    ACON again!:

    "Given the substantial risk of HIV infection for men who use condoms intermittently in casual settings, ACON believes that the promotion of condom use alone will not be sufficient to deliver the desired outcome of Ending HIV by 2020.

    ACON does not endorse serosorting in casual sexual encounters as an effective HIV prevention
    strategy for HIV negative men, on the grounds that ascertaining the current HIV negative status of
    even a familiar casual partner is inherently unreliable
    "

    http://www.acon.org.au/wp-content/uploads/2015/04/What-is-Safe-Sex-Position-2014.pdf

    I don't think "That...condom use and PrEP set forth as mutually opposed and mutually exclusive options."

    They certainly can be used together, it's additional reinforcement. Overkill for some situations, but that's for them to decide what is 'safe(r)" sex, and their comfort level.
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    Jul 27, 2015 1:54 AM GMT
    New research is showing that PrEP can easily taken intermittently and still be effective. Men take a double dose on the day of sexual activity and a single dose for 2 days after. Cheaper and as effective.
    The trick is knowing when you're getting lucky.
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    Jul 27, 2015 8:50 PM GMT
    Wyndahoi saidNew research is showing that PrEP can easily taken intermittently and still be effective. Men take a double dose on the day of sexual activity and a single dose for 2 days after. Cheaper and as effective.
    The trick is knowing when you're getting lucky.


    Promising, but risky as of yet.

    The CDC is still advocating daily use for full coverage. They say it takes 7 days to build up enough medication to be effective.

    http://betablog.org/demand-prep-shows-high-efficacy-ipergay-trial/
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    Jul 27, 2015 9:58 PM GMT
    anotherphil saidThanks. I'm pretty sure #5 refers to relationships where the risks on all parts are well-known and well-communicated, and mitigating strategies are strictly adhered to (simplest case being the monogomous relationship between negatives who regularly share test results, but also more complicated situations).

    Hypothetically speaking (I haven't really gotten too deep into the hookup scene, for better or worse) if I met someone as a total stranger in what I thought was a higher-risk social situation and found they were adamantly opposed to condom use I would probably assume they didn't care about other STD risks, had ulterior motives for claiming UVL status, or both, and either way probably wouldn't go through with much. My loss, I'm sure, but it's basically another example of #5 in action: if both parties don't feel safe about something, don't do it.



    "if I....found they were adamantly opposed to condom use I would probably assume they didn't care about other STD risks, had ulterior motives for claiming UVL status, or both,"

    That's a lot of negatives based on presumption. A lot of people don't use condoms, a majority in fact. Certainly that doesn't mean you should acquiesce. It is ultimately your determination and the final word.

    "Ulterior motives" to do what? Infect you? That's groundless criminalizing based on an assumption. You should just pass him by, without passing judgement. If he has a UVL he may simply be used to other UVL or PrEP partners where HIV transmission isn't an issue. (3.Men living with HIV who only have sex without condoms when they have a sustained undetectable viral load (UVL) and in the absence of sexually transmissible infections (STIs). AND
    4.Effective use of serosorting between HIV positive men.)


    As for STDs I get tested every 3-4 months for them too.

    Stick to your guns about condoms, you are negative. That is for you to decide how to stay that way. But I find it unlikely that a truly UVL person would try to bully you into condomless sex. Which brings us back to #1...The use of Condoms during casual encounters between men of unknown or discordant serostatus. Since you can not really know at that point.

    As aside: the bottom condom http://www.himprogram.org/printme/bottomcondomPF.html

    For me, as someone who has been undetectable for a decade +, I wouldn't have sex with someone who was negative....even with a condom. The laws still play into the negative stereotype of the sinister HIV person wantonly infecting innocent people.

    See the video I posted about the PROUD study. Actual PrEP users talk about their reasoning for going on it. The wall between POZ and NEG dissolves and PrEP user's anxiety is greatly reduced. They take proactive responsibility for their negative status.