Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER)

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study

The Lancet, Published Online May 2, 2019

Background

The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships.
Findings
Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1–3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33–46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4–2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up).

Interpretation

Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV.

 

Healthcare providers should discuss U=U with all their HIV-positive patients

aidsmap/nam, 18/03/2019

Healthcare providers should inform all patients with HIV they cannot transmit HIV to a sexual partner when their viral load is undetectable, argue the authors of  a strongly worded comment in The Lancet HIV.

The authors note that despite overwhelming scientific data supporting the undetectable = untransmittable (U=U) message, significant numbers of healthcare providers do not educate their patients about U=U when telling them their viral load is undetectable.

 

 

 

Changing attitudes to and engagement with biomedical HIV prevention by gay and bisexual men

Centre for Social Research in Health, UNSW, 2017

The latest findings from the PrEPARE Project have now been published. The  PrEPARE Project is a longitudinal study of Australian gay and bisexual men’s attitudes to biomedical HIV prevention, particularly PrEP and treatment as prevention (TasP).

With the unprecedented scaling up of PrEP access in many states over the last few years, we have observed a surge in PrEP use, and increasing levels of support for PrEP in the community. Belief in the effectiveness of TasP has also increased, although many men remain skeptical about it. The report includes national summary data. it is hoped that the report will be useful in assessing community readiness for biomedical prevention and potential issues in implementation.

Key findings:

» Nearly a quarter of gay and bisexual men (24%) reported they had ever used PrEP. This was a large increase from the 2015 survey (3%).

» Most current PrEP users were accessing it from a research study or demonstration project (82%) and the majority (74%) reported increased sexual confidence and reduced concern about acquiring HIV as a result of PrEP.

» Nearly all participants (95%) had heard of PrEP and two-thirds of participants (66%) knew someone who had taken PrEP; substantial increases from the 2015 survey. Knowledge of PrEP also improved between 2015 and 2017.

» Willingness to use PrEP has increased among HIV-negative and untested men (to 37% in 2017) and concern about using it has fallen (to 36%).

» Support for gay and bisexual men using PrEP increased to 75% in 2017, as did willingness to have sex with someone using PrEP (47%).

» Belief that HIV treatment prevents transmission increased to 20% in 2017; the increase was primarily among HIV-negative and untested men.

» Agreement that early HIV treatment is necessary increased to 79% in 2017; this increase was concentrated among HIV-positive men

The Evidence for U=U: Why Negligible Risk Is Zero Risk

August 10, 2017

Over the last year, hundreds of HIV organisations have joined a new campaign to endorse the statement that HIV transmission does not occur when viral load is undetectable on ART.

And while the dramatic impact of ART on reducing HIV transmission has been known for a long time, it is new to say ART stops transmission completely.

NASTAD Releases Statement of HIV Risk When Undetectable

Poz, USA, March 2017

The National Alliance of State & Territorial AIDS Directors (NASTAD) released its own statement regarding the risk of sexual transmission of HIV from people who are virally suppressed.

The statement affirms that “durably virally suppressed people living with HIV on antiretroviral therapy do not sexually transmit the virus.” It describes virally suppressed as “having a consistent viral load of less than < 200 copies/ml.”

Antiretroviral sex: the transformation of safe sex?

February 2017

This free, public lecture, given by Associate Professor Martin Holt of the UNSW Centre for Social Research in Health, considers the radical shifts in HIV prevention associated with the use of HIV treatment and pre-exposure prophylaxis (PrEP).

These prevention strategies provide new ways to safely avoid HIV, but also pose challenges to the ways communities understand, and potentially practice, ‘safe sex’. As safe sex transforms to accommodate the new possibilities provided by ‘antiretroviral sex’, what are the effects on sexual and social relations, identities and HIV-related stigma?

These prevention strategies provide new ways to safely avoid HIV, but also pose challenges to the ways communities understand, and potentially practice, ‘safe sex’. As safe sex transforms to accommodate the new possibilities provided by ‘antiretroviral sex’, what are the effects on sexual and social relations, identities and HIV-related stigma?

With n treatintroduction by The Hon Michael Kirby AC CMG, and moderated by Dr Bridget Haire, AFAO President. The “Sex Lecture” is part of the 2017 Sydney Gay and Lesbian Mardi Gras Festival.

  • Watch video (57 minutes) below