HIV Treatment as Prevention (TasP)

Another significant change in 2015 is acceptance for how ART reduces the chance of transmitting HIV.

With an undetectable viral load, in many cases this risk is close to zero.

Although this has been known for many years, there is now much better evidence, including for gay men as well as heterosexual couples.

  • The European PARTNER study reported no transmissions from the positive partner with an undetectable viral load. This was after 44,500 times that people had vaginal or anal sex without condoms.
  • This study is still ongoing for gay men because there were more heterosexual couples in the first part of the study.
  • Condoms are still important if you want to protect against pregnancy and some STIs.

The HPTN-052 study -- also in couples where one person was positive and the other was negative -- showed that this protection for ART continues for years when viral load is undetectable.

These facts should improve the quality of life both for anyone who is worried about HIV.

It should reduce any anxiety for couples where one partner is positive and the other is negative, even if they still chose to use condoms.

ART as Prevention

UK guidelines recommend that all HIV doctors should talk about how ART reduces the risk of transmission.

Taking ART will benefit your own health and reduce the risk of sexually transmitting HIV.

Public Health and Personal Choice

TasP is changing the approach to HIV treatment.

But it is important to understand the difference between public and personal benefits of ART. Your decision to use ART should always be your personal choice.

If you do not want to take ART for your own health, you should not be under pressure to take ART for TasP.

  • Many HIV positive people do not put others at risk. This relates to their choice of sexual activity including condom use or they have partners who are also positive.
  • Most new infections are likely to currently come from people who are not yet diagnosed. This is related to people being most infectious in early infection, or having a high viral load in later infection.
  • An undetectable viral load can reduce the anxiety and worry even when you are using condoms.
  • Many HIV positive people on ART like the feeling they are not infectious. Many people stop having sex after they are diagnosed because of this fear. ART makes it easier to continue to date and have full relationships.

We are both HIV positive and not using condoms is a special part of our relationship. We are both on treatment and have no resistance.

We don't usually have other partners, but agree to use condoms if this happens, so that we would reduce the risk of STIs ...

-- Steve, Manchester.

I am positive and so is my partner.

I am happier to continue using condoms.

This is because I feel better to be in control of this part of my life.

At least I don't have to worry about my health if he decides to have other partners ...

-- Paula, London.