While there is no denying the proven science that an HIV positive person whose HIV viral load cannot be detected cannot transmit it to an HIV negative person, it is how that message is packaged and delivered to the public that is proving to be a difficulty.
This is according to the Chief Executive Officer of the Botswana Harvard AIDS Institute Partnership (BHP) Dr Joseph Makhema.Internationally, the Undetectable equals Untransmittable (U=U) campaign, has gained ground as scientific consensus has united around the concept that being undetectable means being unable to transmit HIV. The campaign has been endorsed by more than 350 HIV organisations from 34 countries, including leading scientific and medical organisations such as the International AIDS Society (IAS), UNAIDS, and the British HIV Association (BHIVA).
By taking HIV treatment consistently and on time, the HIV virus in the blood (also known as viral load) and other bodily fluids gets to undetectable levels. The drugs work by controlling the replication of HIV in the body by reducing the virus’ ability to make copies of itself.
“The drugs slow down the damage that the virus does to the immune system and allow people to live long, productive lives like everyone else without succumbing to the disease. These drugs are tremendously valuable in giving an excellent quality of life and preventing HIV transmission. There is absolutely no doubt that HIV treatment has revolutionised AIDS,” Dr Makhema explained.
However, he said for now BHP and the Health Ministry are still looking at the context and messaging of U=U and how to package it for the public. This, he explained is because, there are situations whether of illness, for example if someone has flu, they can get an exacerbation of viral rebound.
Or somebody gets a gastro intestinal disorder and they have diarrhoea or vomiting, they cannot keep the medication in their system. This would mean they are not fully able to keep the virus fully supressed and they can rebound.
“So we really don’t know at this point in time, we really need to have research done so that we are able to know how we are going to package and share the U=U messaging with the general public,” stated Dr Makhema.
According to Dr Makhema, the only time he would ever give anyone the go ahead to have unprotected sex is only if there was a test where before each sexual act, a person can check their viral load.
Until then he insists on condom use even with the other HIV prevention tools currently available like Safe Male Circumcision and more recently, Pre-Exposure Prophylaxis (PrEP).
“While we have got the tools to not only end the fear of HIV, but to end it as an epidemic, it’s important how we package that information so that our people really understand how they work,” Dr Makhema said.
Citing the condom as an example, Dr Makhema said that new infections are still high even though condoms are cheap, readily available and have been proven to be over 99 percent effective if used correctly at not only preventing HIV infection but also other sexually transmitted diseases and unwanted pregnancies.
Overall, Dr Makhema said there was need for clear guidance on how individuals should be advised on using “treatment as prevention” as a safer sex option and this should be combined with renewed efforts to encourage condom use.