Thursday 14 August
2008, San José, Costa Rica
HEALTH:
Safe Sex With HIV - and
Without a Condom?
By Daniela Estrada*
MEXICO CITY (Tierramérica)
- The Swiss Federal
Commission for HIV/AIDS
set off a small
firestorm of debate by
asserting that people
living with the virus
can have sexual
relations without a
condom and without
endangering their
uninfected partners,
under certain
conditions.
People living with HIV
who are free of other
sexually transmitted
diseases and are under
effective antiretroviral
therapy do not transmit
HIV, the AIDS virus,
through sexual contact,
says the Swiss
governmental entity in a
text signed by four
renowned experts,
professors Pietro
Vernazza (chairman of
the Commission) and
Bernard Hirschel, and
doctors Enos Bernasconi
and Markus Flepp.
To achieve these
conditions, an
HIV-positive individual
must follow
antiretroviral therapy
to the letter, remain
under regular medical
testing, and have no
other sexually
transmitted diseases,
and his or her viral
load must be
undetectable (less than
40 copies of the virus
per millilitre of blood)
for more than six
months.
Because of the risks
posed by additional
sexually transmitted
diseases, the couple
should understand the
need to define rules
about sexual contact
outside the stable
relationship, states the
text in a sidebar about
the advice that doctors
should provide their
patients and the
patients' partners.
Furthermore, the
decision to stop using a
condom should be made by
the partner who is free
of HIV.
Under these conditions,
the risk of becoming
infected with AIDS is
less than one in
100,000, say the Swiss
experts in their
statement, published in
January by the Bulletin
des Médicins Suisses.
This proposal became a
hot topic at the XVII
International AIDS
Conference, held Aug.
3-8 in Mexico City.
The Swiss statement
upset some in the
community dedicated to
fighting AIDS, who are
concerned about a new
threat: the decline of
prevention measures,
like condom use.
"They are important and
interesting conclusions,
but they take place
within a very controlled
context and are not
necessarily applicable
in all countries," César
Núñez, director of the
Joint United Nations
Programme on HIV/AIDS (UNAIDS)
for Latin America and
the Caribbean, told
Tierramérica.
Rick Jones, coordinator
of the Global Network of
People Living with
HIV/AIDS, said his group
had not yet had the
opportunity to discuss
the new findings with
its membership.
For Nikos Dedes, of the
non-governmental
European AIDS Treatment
Group, the report is
good news, which will
help people with HIV to
overcome constant fear
and to learn to enjoy
their sex lives.
The recommendations of
the Commission were
based on epidemiological
and biological data from
26 international
studies.
One of the studies,
conducted in Spain with
393 heterosexual couples
in which one partner was
living with HIV, found
that there were no
transmissions of the
virus to the uninfected
partners of people
undergoing
antiretroviral therapy
for 14 years, while the
percentage of
transmission in couples
without ARV treatment
was 8.6 percent.
"The evidence is quite
sound, but it is, in a
way, indirect. There are
practical, political and
ethical difficulties for
doing this type of
study," one of the
authors, Professor
Hirschel of the Geneva
University Hospital's
infectious disease
division, told
Tierramérica.
It is a situation
comparable to that of
1986 when the
affirmation that
"kissing does not
transmit HIV" was
published and
disseminated, despite
the fact that it was not
scientifically proven at
the time, although it
has been upheld by 20
years of experience, say
the Swiss experts.
Although ARV therapy
considerably reduces the
risk of transmission of
HIV, many believe the
Swiss pronouncement
could undermine the AIDS
prevention campaigns
that are based on condom
use.
Furthermore, said the
president-elect of the
International AIDS
Society, Julio Montaner,
it shifts attention away
from the core issue:
universal coverage of
ARV treatment, which can
save lives and prevent
infection.
In a Tierramérica
interview, Montaner, an
Argentine physician
working in Canada, noted
that it is a difficult
message to manage for
the general public.
"You have to explain to
people all of the
details. Also, if
antiretroviral treatment
stops working in the
infected individual
because it generates
resistance, that person
is going to start to
transmit the virus," he
warned.
"And if your spouse
cheats on you? How are
you going to know? Is he
going to tell you,
'Honey, I have to
confess that I cheated,
and now I'm going to use
a condom'?" Montaner
said with a note of
irony.
"In Latin America not
all health services are
equally advanced, and
not all people living
with HIV are undergoing
treatment or undergo
constant monitoring of
their viral load," said
UNAIDS's Núñez.
"We are not
disqualifying the
declaration, but the
buzzword at the
conference is combined
prevention," which
consists of ARV therapy,
condom use, male
circumcision and
awareness-raising
campaigns, he said.
Condom use should not
stop, because "the
susceptibility of each
person to HIV is
different," 25-year-old
Panamanian activist José
Rafael Olmedo, a member
of the Global Youth
Coalition on HIV/AIDS,
told Tierramérica.
"I don't see it as being
very feasible in Latin
America," said Olmedo,
agreeing with Spanish
activist Carmen Tarrades
of the International
Community of Women
Living with HIV/AIDS,
who believes the ideal
scenario put forth by
the Swiss experts is a
long way from the
reality of regions like
Africa.
The Swiss health
authorities laid out the
repercussions of the
resolution for their
country's legal system,
whose penal code
punishes the intent to
spread a serious
infectious disease.
People with HIV who meet
the indicated conditions
cannot be accused of
that crime, they said.
In other countries, this
aspect would require
action in the political
sphere, said Tarrades.
To implement the Swiss
policy, each country
would have to reform
legislation that
otherwise treats people
who transmit the virus
as criminals, she said.
(*Originally published
by Latin American
newspapers that are part
of the Tierramérica
network. Tierramérica is
a specialised news
service produced by IPS
with the backing of the
United Nations
Development Programme,
United Nations
Environment Programme
and the World Bank.)
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