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"Undetectable": Safe or Not?

August 28, 2013

Dave R.

Dave R.

This article originally appeared on PositiveLite.com, Canada's Online HIV Magazine.

Positive people, on effective treatment, with an undetectable viral load and healthy immune system, still don't know if they can or can't pass on the virus to their partners. New UK developments suggest that official conclusions may already have been reached.

Recently, the idea that people on HIV medication who are also undetectable (where your viral load is measured at less than 40-50 copies of HIV in every milliliter of blood) might also be non-infectious to others with similar tested levels and a healthy immune system, has naturally got everybody in that situation very excited. There is however, still no definitive proof and although we're assured that proof either way is being worked on, it's going to be some time before that news emerges from behind the locked doors of the research labs.

In the meantime, people with an undetectable status see proven non-infectiousness as a possible, instant solution to many sorts of stigma. If, after indisputable proof, it is widely reported that people on successful treatment are not in danger of passing on the virus, then there is no reason for every sexually active person on the planet not to get tested and if necessary treated because treatment will make you a safe person to have sex with. This is discounting other STDs of course but then you're just as much at risk as any sexual partner of contracting those. If successfully proved, people living with HIV will be seen as living with a chronic illness that is no danger to their partners, pretty much like diabetes patients, cancer patients and others. The world will change overnight, not only for positive people but for LGBT society as a whole. They won't be able to point accusing fingers at us anymore, claiming we're "unclean," "disease spreaders" and a "danger to society."

It's almost a utopian idea but it may well be only a large-scale research study away. Doctors, scientists and HIV-specialists are already giving the idea some credence; politicians and other social groups ... not so much. The idea that people living with HIV can safely have sex with anyone in the community again, sticks in many a craw, including, astonishingly enough, many HIV organizations, who see it as subversive to all the work they've been doing to promote condom use and safe sex!

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The word "undetectable" has already been abused and misused to the point where many claim it to be meaningless. Proof that undetectable means non-infectious, or even proof that undetectable means the possibility of transmission still exists, is essential and you have to ask why research groups across the world aren't moving heaven and earth to get an answer one way or the other. Maybe they are but nobody's telling us.

That all said, there has been a breakthrough in the UK this month which gives a remarkable insight into the way health authorities and government ministries there are currently thinking.

The current ban on health workers in the UK who have HIV, carrying out certain procedures involving possible exposure to blood and fluids, has been lifted! It even hit the breakfast news and made national headlines the same day but it is the reasons behind the decision that have enormous implications for all people living with HIV.

So why has the ban on HIV+ health workers working normally with patients been scrapped?

Remember, this means that HIV positive health workers can deal with contact situations in the same way as all their colleagues and this includes surgery and dentistry. It's a decision that can't have been taken lightly because the ramifications of an HIV transmission from nurse to patient are enormous. You might reasonably assume that they must be sure of their facts.

Both on television and in the press, Professor Dame Sally Davies, England's chief medical officer (second only to the minister responsible for health) explained the decision in refreshing detail, stating that science had moved on and "outdated rules" should be scrapped. She went on to say that modern treatment means that HIV is mostly a chronic condition where people can live long and normal lives. Nothing new so far you might think; but the revolution in thinking is in the details and as she explained:

"At the moment we bar totally safe health care workers who are on treatment with HIV from performing many surgical treatments, and that includes dentists."

Professor Davies continued in a more HIV-friendly tone than we may be used to:

"What we want to do -- and want to get over -- is how society needs to move from thinking about HIV as positive or negative and thinking about HIV as a death sentence, to thinking about whether they're infectious or not infectious."

People with HIV "... are leading lives that are normal in quality and length. With effective treatment, they are not infectious."

The new rules are very straightforward. HIV positive people with a job in health care must have an undetectable viral load; be on an effective combination therapy and must be regularly monitored by their own specialists (every three months). There is a non-obligatory responsibility for medical carers to get themselves more frequently tested if they feel that have been once again exposed to the virus but again, the professional is being trusted to do the right thing. There will be a confidential (barring memory sticks being left in taxis!) register of infected workers lodged with Public Health England but this registered proof of status is as much to protect the health worker as the patient. No excessive government control or checks; no unreasonable demands and no uncertainty as to what the ruling actually means ... refreshing or what!

It was also pointed out that there have only been 4 cases worldwide of health carers infecting patients, with none in the UK and to hammer home the point, it was suggested that people have more chance of winning the state lottery than being infected by an HIV+ medical health worker.

Professor Davies went even further to educate the public:

"Many of the UK's HIV policies were designed to combat the perceived threat at the height of HIV concerns in the 1980s and have now been left behind by scientific advances and effective treatments ... It is time we changed these outdated rules which are sometimes counterproductive and limit people's choices on how to get tested or treated early for HIV. ... What we need is a simpler system that continues to protect the public through encouraging people to get tested for HIV as early as possible and that does not hold back some of our best health care workers because of a risk that is more remote than being struck by lightning. The risk is absolutely negligible, we are talking about people being treated so they are not infectious."

How often do we hear such sensible conclusions from government, or health organizational sources? Little wonder that this decision has been welcomed by LGBT and HIV groups and more importantly, the umbrella organizations of surgery and dentistry.

Are there any further implications for undetectable people living with HIV?

Well, let's put this in context. There's still no definitive proof that being undetectable, on treatment and immune-healthy means no risk of transmission. In world terms, this is also a small step to benefit a relatively small number of people in the UK but it suggests that health authorities are beginning to think differently about the issue.

If health workers are deemed to be no risk to their patients, with all the possibilities of cross infection via blood and bodily fluids, then by definition, non-health workers with the same HIV profile must also be of no risk to their partners. Or is that an assumption too far and wishful thinking? Am I missing something? You can't imagine that the top health experts in the UK are taking a risk here, based on a mistaken premise; so when will the rest of the world, including HIV organizations and the media, put two and two together and come up with four, instead of five, six, or seven!

Once again, it can't be stressed enough; you can't escape the fact that there's no official, scientific proof. The studies so far have been grasped at by many as being suggestive of proof but they are few and far between and hardly large scale and none have been directed at gay men having gay sex.

So it seems reasonable to surmise; what do the health authorities in the UK know that the rest of us don't?

Send Dave an e-mail.

Read Dave's blog, HIV, Neuropathy and More: Avoiding Becoming a Nervous Wreck.

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