Treatment Protects Partners

posted: 13/05/2011

There’s been a lot of publicity in the last day or so about HIV treatment helping stop the spread of HIV. 96% of HIV transmissions among couples are blocked by early treatment of the partner with HIV, was the headline result from a multinational study.

The results were so striking that the study was stopped three years early and everyone with HIV who was not already on HIV treatment was immediately offered HIV treatment.

The results show that treating people living with HIV is at least as good as using condoms to prevent HIV transmission.
 

Universal access to treatment goal
This treatment for prevention success offers an extra reason for pushing the world to achieve the internationally agreed World Health Organisation goal of universal access to HIV treatment, prevention and care. The goal was to reach universal access by 2010, but better late than never. Millennium Development Goal 6 includes halting and beginning to reverse the spread of HIV/AIDS by 2015.
 

Gay men too?
The study included hardly any gay couples (only 3% were gay), so the results don’t prove a 96% reduction in transmission in gay couples. Other evidence already strongly suggests gay men living with HIV on successful treatment are also much less likely to transmit HIV, but probably not by the same amount. (Anal sex is riskier than vaginal sex for passing on HIV, gay men tend to have more partners than heterosexual couples, and other sexually transmitted infections also raise the risks).
 

What they found
The study began in 2005 of 1763 couples where one partner has HIV and the other did not (97% were heterosexual couples). They wanted to find out whether HIV treatment prevented the uninfected partner from getting HIV. It was an international study at 13 sites in Botswana, Brazil, India, Kenya, Malawi, S Africa, Thailand, USA (only one couple were from the USA), and Zimbabwe.
 

They split the couples in half randomly and half the partners with HIV immediately started HIV treatment (with CD4 counts higher than normal for starting treatment at between 350 and 550). The other half of positive partners only started treatment when their CD4 count fell to 250 or less, or they developed an AIDS defining illness.
 

• 39 (2.2%) of the negative partners out of 1763 got HIV
• Up to 11 of the 39 got HIV from someone else, not their partner in the study
• 28 (1.5%) got HIV from their partner in the study, and all but one of those were infected by positive partners who were in the delayed treatment half of the study.

That result was so stark they stopped the study and offered immediate treatment to everyone with HIV not already on treatment because the prevention effect of early treatment was so clear. Early treatment also prevented partners from getting tuberculosis (TB) with only 3 of the people treated early getting TB, compared with 17 of those treated after their CD4 count fell below 250. There were slightly more deaths among the deferred treatment group, but the difference was not statistically significant.
 

You can read the report from the US National Institute of Allergy and Infectious Diseases here  and their Q&A page about the study here
 

Aidsmap’s report

Gay Couples HIV Campaign

posted: 29/06/2010

Gay men in relationships are the focus of a new HIV prevention campaign by Terrence Higgins Trust. Men in couples are left out of many HIV prevention campaigns, which focus more on HIV risks in casual sexual encounters. But a good number of HIV transmissions happen in couples.

Condoms, talking and testing

This new campaign reminds men of two things they can do to protect themselves and their boyfriend – carry on using condoms with each other or, if they want to ditch condoms, both test for HIV first.
 

Toothbrush talk

The poster has two toothbrushes in a glass to show a relationship, and asks men to think about the question 'When you find a boyfriend, can you lose the condoms?' The ad advises 'Use condoms unless you’ve both tested. And keep using them if you’re having risky sex with others.' The campaign knows that not all couples are monogamous (even if they think they are), and that sex outside the relationship is how HIV joins some relationships.

Talking matters

The idea is to get men talking about one of the most important aspects of their relationship: their sex life. The message to couples is a clear one: condoms are one of the best ways to protect against HIV and testing is the only sure way to know both your status and your partner’s. So before you have unprotected sex, why not talk first?
 

Alan Wardle, Head of Health Promotion at THT said: “We know that for some men in a relationship, condoms can be one of the first things to go. Why do you need them if you’re in a relationship? Yet the fact is, if you’ve not talked to your partner about their sexual history and yours before you ditch the condoms, you could be at risk. We know that some men may find it difficult to discuss their past sex life with their partner, but if you don’t talk about it how will you know?”
 

Outside of London, men are more likely to see the campaign on gaydar. Mostly the campaign will be seen in ads in the London gay press, and in posters and postcards in London bars, saunas, STI clinics and community centres, because it is funded by and for London.

Positive and negative couples?

The campaign assumes neither man is diagnosed with HIV. Where one man has HIV and the other doesn’t, or the other man hasn’t tested recently, help is definitely available and the choices can be different.

George House Trust is happy to advise in confidence and tell you about the support we and other HIV services in NW England offer.

Find out more by email

or telephone 0161 274 4499

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