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SWISS REPORT
Feb 5, 2008

Dear Dr. Bob,

Thanks for your prompt response. I understand your caution about such a "controversial" consensus statement by The Swiss Federal Commission for HIV/AIDS. However, this latest international news about HIV/AIDS is especially significant for people like me, which happen to be in a consensual serodiscordant relationship. Not for the sake of letting go of safer sex practices during intercourse, but so we can feel a little more comfortable during foreplay and the occasional unprotected nibbling during oral sex. During my 20 years of surviving AIDS I have had a couple of consensual monogamous relationships with HIV negative men and met several serodiscordant couples that have been together for 10, 15 and even up to 20 years, without the HIV negative partner ever testing positive. Like the article clearly states: "The situation is analogous to 1986, when the statement HIV cannot be transmitted by kissing was publicized. This statement has not been proven, but after 22 years of experience its accuracy appears highly plausible.

I am aware this fact has been well known for years by the scientific community working on HIV research, as well as many Physicians specializing on HIV/AIDS & Infectious Diseases in big "gay meccas" like New York City and San Francisco and their respective AIDS Service Organizations, but fear of controversy and loosing essential federal founding (most specially during this past 8 years of republican dictatorship) has kept this information in the dark in the United States. I do agree more studies are needed in the US to better understand this subject, but to label the conclusions of the Swiss expert researchers as "premature" is condescending and naive from our part, to say the least. Lets not forget that historically, the USA has not been on the forefront of HIV research (even though we will like to believe so) the Europeans are. In the US, we have been successful at developing treatments (through our money hungry Pharma-Industry), but not at researching the cause and effects of HIV itself.

I think this new information should be taken into account, most specially when providing testing and face-to-face counseling to people with questions about serodiscordant relationships and safer sex practices.

Mahalo for your time and efforts working to understand and serve our HIV+ community.

Much aloha,

Fernando

Response from Dr. Frascino

Hello Fernando,

I disagree with your statement that "fear of controversy and losing essential federal founding has kept this information in the dark in the United States." What???? As an HIV/AIDS physician, educator and activist, I can assure you we are not afraid of controversy in either the medical or activist communities! Federal funding for some excellent HIV-prevention programs has been cut to help fund Bush's wrong-minded abstinence-only programs, but that has nothing to do with the information in the Swiss report. That report is nothing more than a review of four previously published and readily available studies resulting in a consensus statement from one group. Within hours of the group posting their statement, I and many other HIV experts were flooded with questions about it. There is no cover-up or suppression of this data or information.

Regarding my opinion of the Swiss report, I expressed concern, because the research focused heavily on heterosexual couples and vaginal sex as opposed to anal sex. Consequently, to make a definitive statement that "positive people on effective HIV meds aren't sexually infectious" is, in my opinion, premature. I stand by my opinion and assure you it is not based on fear of controversy or fear of losing federal funding (or, as you call it, "federal founding").

Fernando, be reasonable. We are all on the same side here. I too am HIV-positive and in a serodiscordant relationship.

Below I will print some "hot off the press" reactions to the Swiss report from several international HIV/AIDS groups (UNAIDS and WHO). I agree with them. (Or should I say their just-published opinions agree with my previously stated position?)

Dr. Bob

UNAIDS, WHO React to Swiss Claim About Antiretrovirals, HIV Transmission

February 4, 2008

UNAIDS and the World Health Organization last week responded to a claim by a Swiss state commission that HIV-positive people taking antiretroviral drugs cannot transmit the virus during sex under certain circumstances, AFP/Google.com reports. The organizations said that they "strongly recommend a comprehensive package of HIV prevention approaches, including correct and consistent use of condoms" (AFP/Google.com, 2/1).

The Swiss AIDS Commission on Wednesday in a report based on four studies said that couples with one HIV-positive partner do not need to use condoms to prevent HIV transmission provided that the HIV-positive partners are adhering to their treatment regimens, have suppressed HIV viral loads for at least six months and do not have any other sexually transmitted infections. Several HIV/AIDS advocacy groups and scientists expressed concern following the release of the report, noting that the research was focused on heterosexual couples and vaginal intercourse rather than anal sex (Kaiser Daily HIV/AIDS Report, 1/31).

UNAIDS and WHO in a joint release said that HIV-positive people "who are following an effective antiretroviral therapy regimen can achieve undetectable viral loads" at certain points during treatment and that research "suggests that when the viral load is undetectable in blood, the risk of HIV transmission is significantly reduced." The organizations added that despite these findings, "it has not been proven" that suppressed viral loads "completely eliminate the risk of transmitting the virus. More research is needed to determine the degree to which the viral load in blood predicts the risk of HIV transmission and to determine the association between the viral load in blood and the viral load in semen and vaginal secretions." In addition, further research should "consider other related factors that contribute to HIV transmission," including coinfection with other STIs, UNAIDS and WHO said.

According to the groups, a comprehensive HIV prevention strategy also includes:

Delaying first sexual activity;

Fidelity;

Decreased number of sexual partners;

Avoiding penetration;

Safer-sex practices, including the use of male and female condoms; and

Early and effective STI treatment (UNAIDS/WHO release, 2/1).



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