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Author Topic: Is anyone following the swiss suggestion about sex between UD and neg plp?  (Read 2981 times)

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Offline Pek

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I was diagnosed 45 days ago. I have read a lot so Im not really worried about my health. Im already receiving treatment. But there is one thing that really scares me. It is to infect someone(like my girlfriend who is still with me but shes not sure about coz she is really paranoid about been infected). I will not  have unprotected sex with her ever.

I think most of you know what swiss experts said but I ll remember just in case.

The statement’s headline statement says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

It goes on to say that this statement is valid as long as:

the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
the viral load has been suppressed (< 40 copies/ml) for at least six months, and
there are no other sexually transmitted infections.

Implications for HIV-positive people

The Commission states that an HIV-positive person in a stable relationship with an HIV-negative partner, who follows their antiretroviral treatment consistently and as prescribed and who does not have an STI, is "not putting their partner at risk of transmission by sexual contact."

"Couples must understand," they write, "that adherence will become omnipresent in their relationship when they decide not to use protection, and due to the importance of STIs, rules must be defined for sexual contacts outside of relationship."

"The same goes for people who are not in a stable relationship," they add. However due to the importance of STIs, use of condoms is still recommended.

They add that heterosexual women will have to consider eventual interactions between contraceptives and antiretrovirals before considering stopping using condoms.

They also say that insemination via sperm washing is no longer indicated when "antiretroviral treatment is efficient."

the full article is http://www.aidsmap.com/page/1429357/

It is almost 5 years since that article was wrote. So I think there is at least someone following that(maybe just in switzerland). I would like to find a research about magnetic couples doing that. Or someone here who does that.  If there is no research going on They should consider to do one. It would help a lot to prove that for the world( I think this is alredy proved in switzerland)
I really wanna believe on that.
If someone knows something about that post here

Thanks a lot


« Last Edit: September 10, 2012, 10:09:20 PM by Pek »

Offline buginme2

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #1 on: September 10, 2012, 10:32:46 PM »
Since the Swiss statement was made, there was a lage multi-national clinic trial studying the transmission between couples in stable heterosexual relationships.  It was called the "HPTN 052" study.  You can google that and there is a ton of info written about it. 

Long story short.  If the positive person in a serodiscordant couple is on effective antiretroviral therapy the risk of transmission was reduced by 96%.  (Interestingly, the one case of transmission occured in a couple where the positive person had not yet reached an undetectable viral load, amongst those with an undetectable viral load there were no transmissions.)

There have been some studies since then amongst gay men that showed even with an undetectable viral load, there were occasions (mostly in men who had another sexually transmitted infection) where there was detection of the virus in semen. 

Online mecch

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #2 on: September 10, 2012, 11:00:32 PM »
Pek the Swiss Statement was REALLY BIG NEWS for most HIV+ people.  It has a lot of influence and led to a lot of changes in behavior.   

ON the other hand, it hasn't had much impact on what HIV- people know about living with HIV.  I live in Switzerland and very few people know about the Swiss Statement unless they have an HIV+ friend or lover.

Sounds like you understood it pretty well so I hope eventually you can take advantage of this knowledge, for example when you are in that long relationship, you are long undetectable, and maybe you want to make babies. :)   Good news, right? 

You asked in another thread where in the Eurozone is a good place to be HIV+ and receive treatment.  As far as I know, all European countries have universal health insurance.  However, may countries are in very tight crisis and I personally do not know if all countries are the same about providing every resident "a good life" regardless of their citizenship. 

I have always believed what is important in life is a getting the best job, with the best future, and being near friends and family, and where there is safety, and good leisure.  If all European countries have medical care, than I don't see why you would consider medical care to be a reason to move to another country.   You have a job, diplomas, that make it so easy to set up shop in another country?  I'm an expat and I can tell you it takes a LONG time to adjust and build a new life in a new country.  That's probably something I wouldn't want to do if I just found out I was HIV+ and just starting treatment.   
« Last Edit: September 10, 2012, 11:02:49 PM by mecch »
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline jkinatl2

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #3 on: September 10, 2012, 11:30:17 PM »
Just a question for anyone who has recently perused the studies.

These breakthroughs in semen viral load - what were they? Were they significant? Were they at a level that, say, five years ago would have been considered undetectable?

Just wondering if this particular caveat is for academic interest, and how much equates to a real life health risk?

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline Dr.Strangelove

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #4 on: September 11, 2012, 12:06:18 AM »
Quote
the one case of transmission occured in a couple where the positive person had not yet reached an undetectable viral load
Quote
in men who had another sexually transmitted infection
These two conditions are explicitly excluded from the Swiss conclusion.

I am aware of two scientifically verified cases of transmission of a UD partner (free of other STDs) to his neg partner. However, you have to keep in mind that these are two cases out of millions of poz people on treatment. My opinion is that if this was a common route of transmission, we'd see many more cases. (Similar to the debate around oral sex being safe)

Now, the whole HIV story is not just a medical issue, it is also a political issue. To reduce the number of new transmissions the authorities have been hammering the "No sex without condoms" rule into the mind of the public for decades (for good reason). Understandably, they won't want to undermine this mantra by acknowledging that sex without a condom with an otherwise STD-free undetectable poz guy is just as safe as sex with a condom with a person of unknown HIV status.

What I find very interesting though is how the data of those scientific studies and the Swiss statement are interpreted very differently.
Correct me if I am wrong but as far as I see, the situation (guidelines as well as the courts) in US has been mostly unaffected by the Swiss statement and the studies that show that undetectable viral load makes transmission virtually impossible.
But the situation in Switzerland and its German speaking neighbors (not sure about the rest of Europe) seems to have somewhat changed since the Swiss statement came out four years ago.
It's not uncommon that HIV-specialized doctors tell their UD patients that they can have sex without a condom again.

Here is a recent case of a poz woman that was UD and apparently didn't tell her husband about it. She was acquitted by the court after her doctor testified that she is not infectious and the court saw no intend of her trying to endanger others:
Process: acquittal for HIV-positive despite having unprotected sex with several men

This ruling by the court is not the only of it's kind although it's still rather the exception than the rule.

Sorry, I drifted a little apart from the topic. My point is, that there are different views about how safe it is. But certainly this is something that one can discuss with his negative partner and then come to a conclusion about whether to use a condom or not.

@jkinatl2
The semen study doesn't invalidate the results of the previous studies. Despite the fact that some men that are UD in blood might have a low detectable viral load in semen (80-2560 copies/mL), transmission still doesn't seem to take place (with very few exception). It's not like the new findings about the semen VL suddenly changes the previous findings and make transmission more likely.
« Last Edit: September 11, 2012, 12:09:27 AM by Dr.Strangelove »

Offline jkinatl2

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #5 on: September 11, 2012, 12:23:53 AM »
Thanks, Dr. Strangelglove. That was a bit of the study a little over my pay grade. Yet a bit of the study often quoted by naysayers.

My partner and I have elected to have unprotected sex so long as I am UD in my blood supply. The reason? I am basically a bottom, and that level seems directly proportional to the (extreme unlikelihood) possibility of infection.  As for oral, we have not crossed that bridge yet, but I have few qualms about even a blip being of any significance.

Like oral sex, when dealing with transmission statistics and likelihoods, it's imperative, however embarrassing, to be explicit as regards whose fluids are going in which direction.


"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline surf18

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #6 on: September 11, 2012, 08:06:22 AM »
My bf and I had unprotected sex for the two or so years i didn't know I had it and thankfully he remained neg. Then when I was dx'd we did the condom thing but he didn't want to use condom's anymore so we did the swiss thing for about two years now and again thank god thus far he is still negative. I am the bottom.
I m not sure Id top him without a rubber though to be honest. Also he does finish me off orally every time too.

Offline Rockin

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #7 on: September 11, 2012, 01:11:30 PM »
As for oral, we have not crossed that bridge yet, but I have few qualms about even a blip being of any significance.

Like oral sex, when dealing with transmission statistics and likelihoods, it's imperative, however embarrassing, to be explicit as regards whose fluids are going in which direction.

I`m curious about this jk. Is it a mutual decision, not doing oral? Is it something you're afraid of or is it your partner?

Offline newt

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #8 on: September 11, 2012, 02:49:51 PM »
Oral between men with condoms is boring, life is for living, and in the HIV transmission context only of interest when viral load is massive and throat health poor. Ah yes, backrooms etc, the buff bloke who don't know he's positive with that extra massive must eat knob...

That condoms off treatment = no condoms on treatment in terms of prevention is a paradigm shift and loads of people haven't got their heads (or mouths) round it yet.

Plus, good question, is treated HIV in the genital tract infectious? I think we should be told.

One small study says it is 0-something odd % replication competent, less than normal, so prob not/less likely. The +1 log difference usually seen in genital viral load is neither here nor there unless you have genital inflammation, it's still too low for man-woman or woman-man transmission according to the studies to date. Man-man, hmmm, maybe not... 30 years on we's still waiting for THE STUDY (can we have it please?)

It is fair for people to feel cautious, but also fair to be confident. Different couples will reach different conclusions. At some point, on treatment, with regular partners, under most circumstances, HIV becomes non-transmissible except in rare cases (like with untreated HIV and condoms then).

I note, in my experience of positive/negative couples, the anxiety around transmission is not related to the actual risk, one is always higher than the other, and it's not always the neg person who is most anxious ... none are consistent in their condom use, but some are consistent in taking their meds.

- matt
"The object is to be a well patient, not a good patient"

Offline jkinatl2

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #9 on: September 11, 2012, 03:02:51 PM »
I`m curious about this jk. Is it a mutual decision, not doing oral? Is it something you're afraid of or is it your partner?

Neither one is afraid. My partner has been deathly ill for the last six months. Haven't had any kind of sex for the last three. We had only started the conversation (and started the practice) of UP sex when he started getting sick.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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Offline surf18

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #10 on: September 11, 2012, 09:43:30 PM »
In the beginning my bf performed oral sex on me with a rubber and it was terrible. Terrible for both of us. We even tried the flavored rubbers and it was horrible. Would rather have just jerked off.

Offline atlanta05

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #11 on: September 17, 2012, 07:15:26 AM »
I'm poz, my wife is neg. We talked about having a baby and looked into sperm washing; sought advice from my doctor and got introduced to a clinic...and then decided to go with the Swiss study.

Our daughter is ten months old and an utter joy - we couldn't be happier with the decision. All is well.

Offline Pek

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #12 on: September 25, 2012, 07:43:15 PM »
Thanks for all replies. I didnt log on forum lately coz Im having bad days. My girlfriend broke up with me just because I have HIV( I know its a good reason for many people) but anyway I love her and she loves me. I have been suffering a lot. But today I had good news, My first exam after 3 weeks of treatment and viral load went to undectable from 9,500 and CD4 went to 348 from 281 . So Im kinda happy with that and could came here to write a little bit.

Online mecch

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #13 on: September 26, 2012, 08:34:20 PM »
Hey Pek good to hear that about the treatment success.
SORRY really to hear about the break up.  :-\
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Anqueetas

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #14 on: October 09, 2012, 10:41:18 PM »
One thing guys, UD in your blood doesn't mean that your viral load is UD in your semen, vaginal fluid, pre-cum. Those places is a virus harbor. Condom for sexual intercourse is the best idea but again it entirely up to a person how much risk you willing to take. For my opinion is not worth it.

ARS, hospitalized for very high fever-July 2011
diagnosed HIV positive - October 16 2011
CD4 460 19.5% VL 49000 - late October 2011
CD4 625 19.5% VL 50030 - January 2012
CD4 369 19% VL 69000 - March 2012
Start Sustiva+ Truvada - April 17 2012
CD4 524 24.5% VL UD - August 22 2012
Switch to Nevirapine+Truvada
CD4 490 26% VL UD - November 2012
CD4 539 29% VL UD - February 2013
CD4 621 28% VL UD - May 2013

Offline jkinatl2

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Re: Is anyone following the swiss suggestion about sex between UD and neg plp?
« Reply #15 on: October 10, 2012, 01:03:18 AM »
One thing guys, UD in your blood doesn't mean that your viral load is UD in your semen, vaginal fluid, pre-cum. Those places is a virus harbor. Condom for sexual intercourse is the best idea but again it entirely up to a person how much risk you willing to take. For my opinion is not worth it.



Many of us have done fairly exhausting research. The blips in semen seem relegated to very low level VL, and the only vaginal fluids that are even infectious in the first place are the thick mucousal fluids isolated close to the cervix. Can you point me to the study or studies that show that these fluids exhibit blips in viral load after an UD VL in the blood?

I don't go into the women's forum, but perhaps someone there can enlighten us as to roughly how many couples are having unprotected vaginal sex (in order to procreate or recreationally) and if so, how many infections have occurred despite an UD VL?

As for oral, of course, even a blip in viral load shouldn't have any impact, as except for extreme circumstances (meth mouth + huge viral load) the chance of infection through receptive fellatio (sucking someone) is too low to even be studied. Of course the other three oral sex methods (giving and receiving cunnilingus, insertive fellatio) are not considered risks to begin with.

All my research tells me that the ONLY potential for infection is if the HIV negative partner is receptive in anal or vaginal sex, if the positive partner is HIV positive and male.  And even then, the Swiss study - while not definitive - is certainly compelling.

Given the expense of sperm washing and IVF, not to mention the risk of no pregnancy despite these options, I totally understand couples making the decision to conceive naturally. I also doubt that all these couples go back to condom use after pregnancy is achieved.

Obvious everyone needs to do what's right for them in the context of their relationship. Hidden/withheld fears and uncertainties can certainly kill a relationship the same as any other deception.

I think that if two people ( or four or seventeen) make this choice out of informed and educated consent (i.e. reading and comprehending the studies instead of just headlines or abstracts) then more power to them. Seems like that's the very definition of a mature, responsible, and mutually respectful relationship.

It's fairly obvious even in the fay community that we are moving towards a new paradigm. I wonder how many committed serodiscordant couples, straight AND gay, practice this yet are afraid to discuss it openly for fear of judgment and condemnation.





"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

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