USA - Treatment as Prevention

posted: 10/12/2009

The USA has joined the list of countries producing national statements about how effective HIV treatment can make passing on HIV during sex very unlikely. 

The USA statement uses much the same evidence as the earlier Swiss, French and German statements on HIV treatment as prevention that we have reported. However, it is a lot more cautious, urging continued consistent condom use.

"In summary, for couples in which one member is HIV-infected, treatment of the infected partner with effective ART and suppression of viral load to undetectable levels should greatly reduce the risk of transmission to the uninfected partner. However, this risk is not eliminated and it may not be maximally reduced at all times due to some of the factors discussed above. Moreover, the likelihood of transmission may be expected to increase with repeated exposures over time."

"In a model which estimated transmission risk in the setting of suppressed viral load (<50 copies/mL) without intercurrent STIs, the number of expected transmission events occurring within a population of 10,000 serodiscordant couples over 10 years was estimated to be 215 for female-to-male transmission, 425 for male-to-female transmission, and 3,524 for male-to male transmissions [31]."

"In a meta-analysis of data from 11 cohorts including 5,021 heterosexual couples observed no transmissions among persons receiving ART with a viral load of <400 copies/mL; however, analysis of the data was compatible with the possibility of one event per 70 person-years [32]. For this reason, it is important that individual couples recognize the risk, and use additional preventive methods (e.g., condoms) in order to further minimize the chance of transmission."

So they advise condoms for heterosexual couples to prevent a 1 in 70 person years possibility of transmission.

This statement and advice comes from the US Centers for Disease Control.

Effective HIV treatment where the viral load is undetectable reduces the risk of HIV transmission but some slight risk remains. The risk is higher for gay men than most heterosexual people, and sexually transmitted infections especially raise the risk of transmission.

US Centers for Disease Control statement Effect of Antiretroviral Therapy on Risk of Sexual Transmission of HIV Infection and Superinfection [read on webpage] OR download it as a pdf

French statement

German statement

Swiss statement

German HIV Campaign - Positive Protests

posted: 08/09/2009

People living with HIV are furious about a new German HIV awareness campaign. It features Hitler, Stalin and Saddam Hussein with the message AIDS is a Mass Murderer. It seems to say people with HIV are mass murderers for having sex. It does not even advise people to use condoms.
 

The campaign will run in German cinemas, TV, radio and on posters until December 1st, World AIDS Day. It is creating an international outcry. It's being promoted by the German HIV awareness organisation, Regenbogen e.V (Rainbow Association) whose web address is stopaids.de.

They are a regional community organisation based in Bavaria (capital Munich) in the SE Germany. Rainbow Association are funded by the district of Upper Bavaria, as well as by charitable bodies such as Rotary International and the Munich-Keferloh Lions Club .

The campaign has an English version on their website (try that link if you can't reach their website if that has crashed) and you can see everything there for yourself. You can view their TV / cinema advert video here. It is sexually graphic. Scroll down that page for the posters, radio MP3 and a music video - all part of the campaign.
 

The creators of the campaign defended it, amid growing criticism.

Das Comitee, an advertising agency in the city of Hamburg, in North Germany, said the advert's shock value was aimed at highlighting the dangers of unprotected sex, at a time when public awareness about the risks was diminishing. "We knew the face we gave to the illness could not be a pretty one," said Dirk Silz, the creative director. The advert was trying to "show the ugliness of the illness, not of AIDS victims", he added. 
 

Das Comitee said it had worked for nothing on the film, and had received a positive response so far. "If it wakes people up to the dangers of unprotected sex, we've been effective," Silz said.

People with HIV are outraged: the campaign shows people with HIV = mass murderers

But organisations representing people living with HIV across Europe have condemned it, saying it only adds to the stigma they already suffer by appearing to put them on a par with mass murderers.
 

The agency explain their campaign in English on their press page

HIV organisations condemn

But organisations representing people living with HIV across Europe have condemned it, saying it only adds to the stigma they already suffer by appearing to put them on a par with mass murderers.
 

Others criticised the campaign for failing to offer any prevention advice, such as to use condoms.

George House Trust comment

The campaign is wrong-headed for so many reasons, and we strongly suspect that the advertising agency who did a great deal of work for free, have set out to deliberately provoke, simply to get themselves publicity and business during the recession. Bennetton's advertisements have used this provoking tactic repeatedly.

The Rainbow Association has been foolish in the extreme.

Anti-HIV Stigma and discrimination is reinforced to an intense degree. If AIDS is a mass murderer was part of a British newspaper headline, we'd be complaining immediately to the Press Council, and for these adverts, to the Advertising Standards Authority.

AIDS as a cause of death is now uncommon in Germany and the UK. In North West England in 2008 31 people died an AIDS-related death. 24 died of other causes out of 5767 people diagnosed with HIV in this region.

With modern HIV treatments most people with HIV in the West will not die of AIDS or even get an AIDS diagnosis. (AIDS means having one of an official list of illnesses that can follow HIV infection at a late stage).

The advertising campaign should be about avoiding HIV and avoiding passing that on.

The advertising agency says that the advert was trying to "show the ugliness of the illness, not of AIDS victims" and this is simply nonsense. Using 'AIDS' rather than 'HIV' raises fear and stigma; the word victim makes people with HIV the murderers, and implies there is nothing the victims can or should do to protect themselves. 'The ugliness of the illness' makes people with HIV feel bad about themselves, and takes us back to the really unhelpful and wrong idea that you can tell, by looking, that someone has HIV.

There's no prevention message or advice on what to do, whether you are positive, negative, or don't know.
 

The campaign perversely ignores the German reality and statistics - most people with HIV and becoming HIV positive in Germany are gay men. Between 50 and 60%. But all the images are of heterosexual sex and the target for the message that is shown are white heterosexual German women. 

Showing white German women as the victims of history's mass-murderers does nothing to help the uninfected German gay men who are at the most risk.

This is one of the worst campaigns we can remember. It takes us back to the AIDS hysteria and clumsy government campaigns of the 1980s, see our report on the hospital detention in Manchester of a man with AIDS in Manchester, in 1985, for an example - the AIDS tombstone campaign.

Have a look yourself at their campaign and then tell them what you think, on their English message page.

Here's an improved version of google's automatic translation of what they say on their front page about their "AIDS is a mass murderer" campaign for World AIDS Day 2009.
 

"For the World AIDS Day campaign of Rainbow Association, our Advertising Agency 'The Committee', went back to basics. There will be additions to the comprehensive campaign in the coming weeks. Elements of the campaign leading up to World AIDS Day 2009 include TV and cinema commercials, viral adverts, a music video, radio adverts and posters.
Because of the alarmingly high numbers of people with HIV, our World AIDS Day campaign has a clear message: "AIDS is a mass murderer," which is the new slogan.
The greatest mass murderers of recent history are shown having sex. The campaign aims to shake people up, make HIV a central issue and stop the rise in unprotected sex. Because anyone can become infected. Visit the campaign here."
 

Based on Source with additional material

Elizabeth Pisani's comments in The Guardian speaks a lot of sense. Her blog is The Wisdom of Whores and is worth watching.

German Risk Statement

posted: 27/04/2009

We have had the Swiss Statement, now their neighbours, the Germans, have issued their own on the risks of HIV transmission from people taking HIV treatment successfully.

The Swiss told us last year that people on HIV treatment, if they meet certain conditions, can be considered uninfectious. Now the largest HIV voluntary sector organisation in Germany, Deutsche AIDS-Hilfe, has issued a paper largely supporting this statement.
 

The German paper describes sexual transmission, where the HIV-positive partner is

• adhering to effective combination therapy,
• has had an undetectable viral load for the last six months and
• has no sexually transmitted infections,

as ‘unlikely’ and describe this as being as effective as using condoms. They add that it is also important that there is no other damage to either person’s mucous membranes.

Stable, long-term different-HIV-status relationships
Both the German and Swiss organisations say their statements are relevant to stable, long-term relationships where one partner has HIV. After the couple has made a decision, based on good information and advice, regular viral load testing and sexual health check-ups are recommended.
 

HIV is sometimes found in semen even though it is undetectable in blood.

However, Deutsche AIDS-Hilfe argues that relying on effective treatment as a means of HIV transmission prevention is a realistic HIV prevention approach, and that individual couples already  make decisions about the level of risk they take.

Read the English language version of the German statement

Swiss statement report