The Swiss National AIDS Commission (EKAF)  has determined that if you're taking anti-HIV drugs, you always take the drugs on schedule, your HIV blood tests come back "undetectable" for greater than six months in a row and you don't have any other sexually transmitted diseases, it is next to impossible that you could transmit HIV during unprotected sex. Their report, released on January 30, 2008, has ignited international response and concern from HIV/AIDS advocacy groups and scientists.

 The report, based on four studies, said that couples with one HIV-positive partner do not need to use condoms to prevent HIV transmission provided the above conditions are met. One of the studies -- published in the Swiss Bulletin of Medicine -- was conducted in Spain between 1990 and 2003 among 393 heterosexual couples with an HIV-positive person. The study found that none of the HIV-negative partners contracted the virus from an HIV-positive person taking antiretrovirals. Another study conducted in Brazil found that out of 93 couples, 43 with an HIV-positive partner, six people became HIV-positive. All six of the new HIV cases in the Brazil study were attributed to the HIV-positive partners not following their treatment regimens, AFP/Yahoo! News reports. The two other studies -- one conducted in Uganda and the other conducted among pregnant women -- had similar results, Bernard Hirschel, co-author of the Swiss report and an HIV/AIDS specialist at University Hospital in Geneva, said.

EKAF acknowledges they are fully aware that the medical and biological data available today cannot prove, on strictly scientific grounds, that HIV transmission on effective and stable [antiretroviral therapy] is not possible,  as it is impossible to prove the non-occurrence of an improbable event. They have likened this situation to the statement, “HIV cannot be transmitted through kissing” which was published and communicated in 1986. This statement could not be proven then, and now, after 20 years of experience with HIV, its high plausibility has been ascertained. EKAF has stated that the scientific data and evidence are much better than what was available in 1986, and strong enough to support their conclusion. Others disagree.

 There are considerable concerns about the report and its findings. Some of them are:

 - The studies, which took place in Spain and Brazil over the past decade focused on vaginal intercourse between serodivergent (one person is HIV-positive, the other is HIV-negative),presumably monogamous heterosexual couples. The findings do not account for the risk of transmission through anal sex. The level of risk associated with anal sex between an HIV-positive person with an undetectable viral load and an HIV-negative partner remains unclear.

 -Approximately 10-15%[1] of men and 25% of women[2] who adhere to antiretroviral treatments and have undetectable viral loads in their blood continue to have detectable viral loads in their semen/vaginal fluids and are at risk of transmitting HIV to their sexual partners during unprotected sex.

 -No one can be sure of their own, or their sexual partner’s viral load at all times. There is always a level of risk associated with unprotected sex. In fact, one of the studies that was a part of the Swiss report found that 6 out of 43 HIV-negative partners did become infected—a rate of nearly 14%—due to the fact that the HIV-positive partner was not always faithful to a treatment regimen.  

 -HIV positive people with apparently undetectable viral loads do sometimes experience transient spikes in viral load.

 -Some HIV-positive people, regardless of level of adherence, may develop resistance to the medications and experience a rise in viral load.

 -Many people with STIs are unaware of it because they do not have any symptoms.

 In short, HIV-positive people cannot be entirely certain that they meet these criteria or that the criteria themselves are an indication of safety.

Because of all of these issues, advocacy groups from around the world have stressed that all people should continue to practice safer sex, including those who are in a serodivergent relationships or who have multiple partners.  Groups expressing caution and concern include: Public Health Agency of Canada, Canadian AIDS Society, UK’s Terrence Higgins Trust, France’s National AIDS Council, US Center for Disease Control, San Francisco AIDS Foundation, among others.

The AIDS Committee of Guelph/Wellington County is adding its name to the growing list of groups that are urging caution over this report and its conclusions and are continuing to endorse appropriate, evidence-based measures to prevent HIV transmission.