That Swiss statement

Once again it's in the news. I'm sure you're all aware of the gist of it: that someone with HIV who is adherent to antiretroviral therapy (ART) and has an undetectable amount of virus in the blood is basically very unlikely to transmit the virus to a partner via vaginal sex, as long as neither of them have genital infections, The Australians disagree, but frankly not by a whole load. Although I agree we must be careful about the message, there's a couple of points that rarely seem to get aired.

Dr. Ayie (who works with young mostly male HIV-infected drug users in Bogor) makes the point that this gives us a great tool to encourage adherence, as well as the urge to start ART. We can also use it to encourage both partners to avoid catching nasty sexually-transmitted bugs by using condoms at all other times.

When I meet with groups of people with HIV here, almost always the first question is 'how can I have children?' A surprising number have uninfected partners, and want to know how they can impregnate them without infecting them. We talk about timing sex without a condom at the time their partner is most fertile, but they often still worry about the risk of infecting her. The Swiss statement makes them much more comfortable.

As Eli puts it, "we should lay out the risks as accurately as we know how, and let people decide for themselves if the rewards of sex without a condom are worth the risk of becoming infected by a partner who is on appropriate and well-monitored treatment.' At worst, the Australians tell us a woman with an infected husband and having sex twice a week without a condom has a 425 in 10,000 chance of infection over ten years. The risk once or twice to make a baby is infinitesimally small.

This is really fantastic news for many kids here...

Babé