December 1, 2017
Ask the Doc: World AIDS Day 2017
Dr. Peter Meacher READ TIME: 5 MIN.
For World AIDS Day, EDGE's resident expert Dr. Peter Meacher
looks at Undetectable = Untransmittable and how it will help end the AIDS epidemic by 2030.
The doc tackles issues including whether it's safer to have sex with someone who is HIV-positive but has an undetectable viral load, or who is on PrEP than someone who doesn't know their serostatus.
He also takes a look at how UNAIDS will work with the global community to end the AIDS epidemic by 2030, with increased testing and access to treatment.
Is U=U Safest?
Q: I recently read that the CDC said people with an undetectable viral load can't pass HIV on to others, i.e. Undetectable = Untransmittable. Does that mean it's safer to have sex with someone undetectable than someone who doesn't know their status, or is on PrEP?
A: A viral load -- a term to describe the amount of HIV in your blood -- is one determining factor for how likely it is for an HIV-infected person to pass HIV on to someone else. If you don't know your status, it's possible to be infected with a very high viral load and pass it onto others. If you know your status and are on HIV medication to suppress the virus, you can have a viral load which is undetectable -- meaning there is almost none of the virus present in your bloodstream -- making it very difficult to pass it onto others. Hence the term "Undetectable = Untransmittable," or U=U.
For people living with HIV/AIDS, the U=U concept is life-changing. The PARTNER study -- the largest ever study of HIV positive and negative (serodiscordant) couples -- demonstrated that people living with HIV/AIDS who are undetectable have no risk of transmitting HIV through sexual contact. The study enrolled over 1,100 couples who engaged in over 58,000 reported sexual acts over the course of four years. There were zero HIV transmissions between them.
Of course, it is always safest to use a combination of prevention methods, like condoms and PrEP, if you're negative, or condoms and HIV medication, if you're positive.
If you're HIV-negative, PrEP is a terrific option to stay negative, and reduce the risk of transmission to and from others. However, PrEP alone does not prevent STDs and so regular STD screening is important if condoms are not used. When on PrEP, you must also be tested for HIV every 3 months. Regular visits to your healthcare provider also ensure you'll stay on top of other health screenings that will keep you healthy.
If you're HIV-positive and on medication, regular checkups with your doctor including scheduled labs will make sure your HIV is well controlled.
PrEP and the U=U concept are both enormous leaps in helping to end stigma, and the epidemic.
Can We End AIDS by 2030?
Q: The theme of this year's World AIDS Day in "My Health, My Right." UNAIDS says that we can end the AIDS epidemic by 2030. But new infections are not declining among adults. How will they do that?
A: In 2016, the UN adopted a political declaration to fight against HIV and end the AIDS epidemic by 2030. To be certain, it is an ambitious goal -- but new infections are, in fact, declining worldwide. According to the UN AIDS 2017 fact sheet, in 2016, there were roughly 1.8 million new HIV infections, compared to 2.1 million in 2015.
In order to accomplish this goal, there are a number of specific guidelines and recommendations, including:
What is not outlined are the innumerable factors that create barriers to care: stigma, poverty, housing, healthcare, racism, and all of the societal indicators that turn HIV from a manageable chronic illness into a death sentence.
As we have seen in New York State with the Governor's Ending the Epidemic initiative, the pathways created by science do work, if they have the opportunity to flourish. In a new report released on Wednesday, HIV infections in NYC reached an all-time low -- with 2,279 new infections in 2016, down 8.6 percent from 2015, according to city data. This decrease is attributed to many of the same factors as the global guidelines, including access to PrEP, and "treatment as prevention," another term for U=U.
So while it is possible to end the epidemic globally, challenges remain. Addressing the systemic factors that create new infections and barriers to care will be the ultimate challenge to fighting HIV, and ending AIDS.
Peter Meacher MD is a Board Certified Family Physician and credentialed as an American Academy of HIV Specialist (AAHIVS). He has been the Chief Medical Officer of Callen-Lorde Community Health Center since 2013.He completed residency at Montefiore's Department of Family Medicine where he was then Chief Resident and Faculty Development Fellow. He worked for 14 years as an HIV and Primary Care Provider, becoming the Medical Director of a federal qualified health center in the South Bronx developing programs in HIV & transgender care before joining Callen-Lorde.
He was on the NY/NJ Board of AAHIVM, works with NYSDOH AIDS Institute Clinical Guidelines Program, serves on the AIDS Institute Mental Health Guidelines Committee and chairs the HIV/HCV/STD QI sub-committee of CHCANYS.
This story is part of our special report: "Ask the Doc". Want to read more? Here's the full list.
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