CDC: Undetectable HIV Cannot Be Transmitted
In a surprise announcement for National Gay Men’s HIV and AIDS Awareness Day (September 27, 2017), the Centers for Disease Control and Prevention (CDC) made an announcement that people who are HIV-positive and on ART, and who maintain an undetectable HIV viral load, have no risk of transmitting the virus to their sexual partners. This announcement is important as we move into the newest stages of the epidemic with Treatment as Prevention (TasP) and the uptick in PrEP prescriptions to prevent infection.
The official wording from the CDC states: “When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission. Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed. This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”
With this statement, the CDC also acknowledged a bigger issue that still remains within the marginalized LGBTQ HIV community, which is that there are still not enough people on treatment, or in treatment at all.
“Among gay and bisexual men living with diagnosed HIV, 61% have achieved viral suppression, more than in previous years, but well short of where we want to be. More work is needed to close this gap and to address the barriers that make it more difficult for some gay and bisexual men, including African American and Hispanic/Latino men, to get HIV care and treatment. For example, socioeconomic factors such as lower income and educational levels and cultural factors such as stigma and discrimination may affect whether some gay and bisexual men seek and are able to receive HIV treatment and prevention services.”
Barriers to getting into care within the Black community are still some of the biggest problems we are facing as we attempt to fight the epidemic within our communities. Some of these barriers are included in a report from the National Institutes of Health (NIH), which listed 12 different factors that prevent people from getting into care, and from staying in care once they get in. They included:
Inconsistent, unstable, or inadequate housing
Unstable housing was a barrier mentioned by both patients retained and not retained in care. For some participants, housing insecurity caused significant stress and created obstacles for daily living that affected appointment adherence. Without a stable phone number, participants were unable to receive reminder phone calls and maintain contact with their provider. Also, without a place to shower and bathe, participants were self-conscious about visiting the clinic. In addition, frequent address changes sometimes prevented patients from completing the necessary paperwork required to maintain their health insurance.
Stigma was a barrier in the high tertile for patients not retained in care and a barrier in the medium tertile for those retained in care. Many participants reported hesitancy to disclose their status to family, friends, and acquaintances. Uncertainty about how family, friends, or the public would respond to their status made some patients anxious and affected their ability to attend appointments. Attempting to avoid disclosure in the waiting room, laboratory, and pharmacy created additional obstacles for these participants and discouraged regular clinic attendance.
Depression and mental illness
Participants in both groups commonly (high tertile) identified symptoms of depression and other mental illnesses (e.g. post-traumatic stress disorder, schizophrenia, anxiety, and bipolar disorder) as barriers. Participants experiencing depression described sleeping through appointments and sometimes not wanting to “bother” with traveling to a clinic. In addition, depressed participants felt apathetic about their ’health care, with some stating that they did not care whether they lived or died.
Negative experiences with clinic space and processes
Participants in both groups sometimes (medium tertile) referenced negative experiences at their clinic. Several participants mentioned frustration about clinic wait times that can extend to several hours; some also mentioned frustration that being 15 minutes late could result in a cancelled appointment. Many participants disliked the waiting room experience for a range of reasons including fear of unintentional disclosures and conflict with other patients. Challenges with referral paperwork and long waits for laboratory testing were also mentioned as barriers to appointment adherence.
The CDC’s announcement is a step forward for those who are HIV-positive who deal with constant discrimination that spans from the criminal justice system to their bedroom. However, communities must be more vigilant in not only creating access to these services, but encouraging utilization of the services if we are ever going to get to a place with no new HIV infections.