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Position Paper
Statement Regarding Findings of the Swiss Government on the Transmissibility of HIV Infection by HIV-Positive People Receiving Antiretroviral Treatment

March 12, 2008

In February 2008, the Swiss AIDS Commission reported on the results of studies suggesting that HIV positive individuals receiving effective antiretroviral treatment do not appear to be at significant risk of transmitting the virus to their HIV-negative partners in the absence of condom use during sex. The Swiss report reviewed data from four studies conducted among heterosexual couples. One study involving 393 couples of mixed HIV status concluded that when an HIV-positive individual adhered to treatment with approved HIV antiretrovirals, had an undetectable viral load for at least six months, and did not suffer from any other sexually transmitted infections, the HIV-negative partner did not become infected as a result of unprotected sexual intercourse. However, another study found that 6 out of 43 HIV-negative partners did become infected with HIV as a result of sexual activity; apparently because their HIV-positive partners were not completely adherent to an antiretroviral treatment regimen.

Concern has been raised that the results of the Swiss report will be taken to mean that HIV-positive people receiving antiretroviral therapy can discontinue the practice of safe sex or condom use. Project Inform welcomes the opportunity presented by the report to talk with the community about the interrelatedness of HIV testing, treatment for HIV infection and the prevention of HIV transmission.

The Swiss report supports what have long been considered to be the dual benefits of antiretroviral treatment. First, effective therapy is likely to significantly increase longevity and quality of life for people living with HIV. Second, by reducing the amount of virus present in blood, semen, vaginal secretions and other sexual fluids, antiretroviral therapy helps to reduce the potential for HIV-positive individuals to transmit HIV to their partners during sexual intercourse.

Project Inform does not encourage HIV-positive people receiving treatment for their infection to dispense with safe sex or condom use. Drawing on the Swiss report and other data:

We encourage all individuals who have been sexually active within the past ten years to learn their HIV status if they have not already done so, and to be tested for HIV at least once a year if they continue to be sexually active. Knowing one's HIV status is the vital first step we must all take to preserve our own health and, if HIV-positive, fulfill our desire to avoid transmitting the virus to others.

We encourage all people who know that they are HIV-positive to consult with qualified medical providers and our National HIV/AIDS Treatment Hotline in order to make well-informed decisions about when to enter treatment with HIV antiretrovirals. While current Federal guidelines strongly encourage treatment for HIV-positive people whose CD4 (T cell) counts are at or below 350, substantial evidence suggests that the earlier HIV-positive people enter treatment, the better the outcomes of their treatment may be. And as the Swiss report suggests, being adherent to effective HIV treatment can reduce the transmission of HIV to others.

We encourage HIV-positive people, whether receiving treatment or not, to continue to engage in safe sex and condom use with HIV-negative individuals and individuals of unknown HIV status. Neither HIV treatment or safe sex practices alone have been shown to be 100% effective in preventing the transmission of HIV infection. But in combination with one another, the two strategies provide a strong means of preventing the further spread of HIV in our communities.

Finally, data indicate that it is possible for HIV-positive people to be re-infected with HIV as a result of having sex with one another. Data are inconclusive, however, about the extent to which re-infection actually occurs. Project Inform encourages HIV-positive people to consider the use of condoms during intercourse with other HIV-positive people in order to avoid potential re-infection and, as importantly, to avoid receiving or transmitting sexually transmitted infections other than HIV during sexual intercourse.

For more information, or to reach Project Inform's National HIV/AIDS Treatment Hotline, please call toll-free at 1-800-822-7422.

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