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Some interesting information on risk of HIV transmission

Author: May 30, 2014 0 Comments

From: HIV Update <bulletins@bulletins.aidsmap.com>
Date: Thu, May 29, 2014 at 9:04 AM
Subject: Long-term HIV transmission risks – HIV update, 29 May 2014

Long-term HIV transmission risks

A group of American researchers have published an analysis which attempts to estimate the long-term risks of HIV being passed on within a couple.

This was a mathematical modelling study – in other words, it does not report new findings from a study of couples in the real world. Instead, modelling studies use previous research findings, assumptions and mathematical techniques to simulate a sequence of likely future events.

Their findings show that even if the risk of HIV being passed on during one sexual act is relatively small, the risk can accumulate over time for a couple who have sex regularly for a number of years.

The researchers wanted to get a rough idea of the long-term benefits and risks of using different methods to reduce the likelihood of HIV transmission. They were interested in couples where one person is HIV-positive and the other person HIV-negative, who were assumed to have penetrative sex six times a month.

For example, for an HIV-positive woman and HIV-negative man, who only have vaginal sex:

  • If no protective measures are taken, 6% risk of transmission after one year, which adds up to 44% after ten years.
  • If the negative partner takes pre-exposure prophylaxis (PrEP), 2% risk after one year, 15% after ten years.
  • If condoms are used, 1% risk after one year, 11% after ten years.
  • If the positive partner takes HIV treatment, 0.2% after one year, 2% after ten years.
  • If condoms and PrEP are used, 0.3% after one year, 3% after ten years.
  • If condoms and HIV treatment are used, 0.05% after one year, 0.5% after ten years.
  • If condoms and PrEP and HIV treatment are used, 0.01% after one year, 0.1% after ten years.

The risks are much greater for couples who practise anal sex, whether they are heterosexual or gay. (The risk of HIV transmission during receptive anal sex is 18 times greaterthan that during vaginal sex).

For a gay male couple:

  • If no protective measures are taken, 52% risk after one year, which adds up to 99.9% after ten years.
  • If the negative man takes PrEP, 34% risk after one year, 98% after ten years.
  • If condoms are used, 13% risk after one year, 76% after ten years.
  • If the positive man takes HIV treatment, 3% after one year, 25% after ten years.
  • If condoms and PrEP are used, 8% after one year, 59% after ten years.
  • If condoms and HIV treatment are used, 1% after one year, 6% after ten years.
  • If condoms and PrEP and HIV treatment are used, 0.3% after one year, 3% after ten years.

Some mathematical models that we have reported on in the past could be criticised for being based on unrealistically optimistic assumptions. This one can be criticised for including some rather pessimistic assumptions.

In particular, the estimates for pre-exposure prophylaxis (PrEP) and condoms assume that people who plan to use them don’t always manage to. Both PrEP and condoms are likely to be much more effective when they genuinely are used consistently.

The figures produced are rough estimates and there is much that scientists can debate. Nonetheless, the study brings to light four key points:

  • A small risk of transmission in a single act of sex translates into a much larger risk during a sexual relationship that lasts several years.
  • The risks of transmission through anal sex, especially in the long term, are much greater than through vaginal sex.
  • Current research shows that effective HIV treatment provides more protection than other strategies, including condoms.
  • The safest strategy is to use several prevention methods in combination, such as HIV treatment, PrEP and condoms.

HIV STI info

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Help for gay guys to decide when to have bareback sex

Author: March 7, 2012 0 Comments

 

 

Sex between guys can be very complex.  Often when guys begin a sexual encounter they do not know how it will unfold, will it include: sucking, ropes, handcuffs, fucking, rimming, piss, electricity, alcohol, drugs, lots of alcohol, sounds, scat, tit play, other guys, fisting and many others.  The creative play between two guys exploring where their sex will go it part of the fun.

 

Reducing safe sex messaging to a simple prescription of “use condoms” is not very helpful, because we already know that message but who helps us to make the decisions in a complex playful experience of having sex.  The medicalization of safe sex messaging has not served us well.  Almost all new HIV infections now have emotional and psychological reasons as a main cause for lack of condom use.  The medical professional is not trained to integrate the emotional and psychological causes of problems, they are trained to look for medical causes.  Where is the messaging that helps us make the decisions we are comfortable with?

 

Let me give an example of how a psychosocial messaging may be more helpful for guys

 

A while ago a guy asked me, if he as poz bottom with long standing undetectable viral load could be fucked without condoms by his boyfriend who was negative.

 

I, as a person trained in psychology, made a few suggestions as follows:

 

1.         Consider how upset would your boyfriend be if he became poz.

 

2.         Also consider how upset you would be if your boyfriend became poz.

 

3.         Some people think that if either you or he have an STI that HIV transmission is more likely, so you could decide to not have unprotected sex outside the relationship.

 

4.         Some people think that if he cums and/or pees after fucking it will clean out the urethra and reduce the chances of getting HIV.

 

5.         If you (the poz guy) get a cold or some other infection your viral load MAY go up; you may wish to be more careful at these times.

 

6.         The spectrum Health website (the largest group of doctors treating gay men and HIV poz guys in BC, suggests that without an undetectable viral load there is 1 in 1,666 chance of getting infected as a top for each fuck.  (6.5/10,000) We can assume that with an undetectable viral load these odds are much less.  The exact chance of getting infected is not known but it may be 1 in 10,000 or maybe 1 in 100,000.  (BC is spending $50 million to reduce HIV poz guys viral load in an effort to reduce transmission; so they must believe that this will have a big effect in reducing the number of new infections.)  (The cynic in me thinks that it is not $50 million being spent because they care about the welfare of poz gay guys, or other poz persons.)

 

So by using the complex information above they can make decisions about the kind of sex they choose to have.

 

Notice that none of the above are “shoulds” but only things to consider when making decisions.  Medicine is good at “shoulds” and “musts” – at prescribing – a behaviour.  He did not want a prescription, but he really wanted to know was “what do I need to consider if we proceed with not using condoms” (if that is our choice).  He knows the normal message of use a condom, that is not what he is looking for and if no one helps him to know what to consider and give him an understanding of what are the risks and  how to reduce those risks of transmission he/they will be “fucking in the dark” – so to speak

 

What is interesting about this question is why he did not go to a medically trained person to ask this question.  I believe that he would have gotten a medical response that is prescriptive and not really useful for their decision making.  The medical profession has done wonders at supporting, treating and educating all of us on HIV.   But, the medicalization of HIV safe sex messaging has run it course.

 

It is time for medicine to step aside with the less than useful messages.  We need a psychosocial approach that will help us makes decisions that fit in our complex lived sexual experiences. What is needed is to understand that only pushing condoms is not effective.  What we need instead is messages to help guys to make informed decisions around their complex sexual decisions.

 

If there was more space I would add the following:

 

We need help to understand when and how we find ourselves vulnerable to take risks that are outside our comfort level.  For some it may be when drinking, for others it may be when depressed, for others it may be when horny, or lonely, or he is hot, or any number of things that we all need to understand more about how we put ourselves in situations where we are not comfortable afterwards.  In my experience the general pattern is when a person feels their life is falling apart, (job loss, boyfriend break up, money problems etc.) then they may do things that later they wish they had not done.

HIV STI info, Interesting stuff for gay guys, Stuff that did not make it in the newspaper

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