In a letter issued yesterday in recognition of National Gay Men’s HIV/AIDS Awareness Day, the federal Centers for Disease Control cites several studies in acknowledging that HIV-positive people who take their antiretroviral medication as prescribed and have an undetectable viral load “have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”
“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,” said a joint letter from Dr. Eugene McCray and Dr. Jonathan Mermin, leaders of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.
The letter cited recent trends that indicate efforts to prevent HIV prevention “are slowing the spread of HIV among some gay and bisexual men. From 2010 to 2014, HIV diagnoses fell among white gay and bisexual men and remained stable among African American gay and bisexual men after years of increases,” it said.
However McCray and Mermin noted that many gay and bisexual men are not getting treatment. “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,” said their letter. “More work is needed to close this gap andto 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.”
The use of pre-exposure prophylaxis (PrEP), an pill regimen that radically reduces one’s ability to become infected by HIV, is another factor cited in the reduction of HIV infections. However, studies are showing that gay men using PrEP (delivered with a pill called Truvada), are more likely to become infected with sexually transmitted diseases, likely because they do not then use condoms.
In a study published in the journal “AIDS,” researchers analyzed 18 studies where new sexually transmitted disease infections were discovered in gay and bisexual men. Five of the studies included men given PrEP, and 14 were conducted with men who were not given PrEP.
Men on PrEP were 44.6 times more likely to contract syphilis, 25.3 times more likely to contract gonorrhea and 11.2 times more likely to be infected with for chlamydia than were men who had sex with men and were not on PrEP.
The researchers attributed the higher rate to several possible factors. One is that people taking PrEP are required to be tested more often for STIs, which means the infection is more likely to be discovered. Another is that those on PrEP may be less likely to use condoms. And also they may have more sexual partners.