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Clarification needed on U=U

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Mindless:
I asked my hiv dr to talk to my wife about U=U: we’re willing to try to “rebuild” our sexual life after years (but that’s another story). She’s the negative one btw.

To my surprise he was quite cautious and advised that, even if I’ve been UD for 2 years, we should have only protected intercourse (my personal expectation was that the dr would have approved unprotected sex).

I asked what about U=U and he said that, despite the studies say “zero transmissions etc.“, those are only the results of medical/scientific studies and there isn’t actually any official guideline from any governmental health body to his knowledge (his words not mine).
His point was that “in real life” shit happens: for example you may become detectable between your 6 months blood check without being aware and/or become resistant.

I’m sure he was partially trying to protect himself avoiding taking the responsibility of the decision, which being him a Thai (I live in Thailand) is quite understandable but I’d like to understand if he’s really correct: my understanding was that U=U is a definitely proven scientific fact but maybe I misunderstood a part of the message.

Note that I’m only reporting what I’ve been said and not personally trying to challenge anyone or anything.

Hugs

Jim Allen:
Sounds like your Doctor belongs to the "never say never" brigade, ;) I had a Doctor once try to claim shaking hands was an HIV transmission risk under this logic, it's the same kind of logic the paranoid use about sneezing because HIV could in theory mutate and become airborne one day ...  ::)

Anyhow, my two cents on U=U and your doctor's reply, would be to find a new doctor or choose to educate this one for the greater good.


--- Quote ---I asked what about U=U and he said that, despite the studies say “zero transmissions etc.“, those are only the results of medical/scientific studies and there isn’t actually any official guideline from any governmental health body to his knowledge (his words not mine).
--- End quote ---

Firstly the consensus statement has been endorsed by over 940 organizations from nearly 100 countries including the CDC. No joke but I would be happy to send him an old fashioned letter with the list of endorsements and materials.

At this stage there is nearly 22+ years of evidence on TaSP both through observational data and controlled studies, that consistently has confirmed its effectiveness leading to the the Swiss statement and later the refined consensus statement, although the news/media act as if it's something new it's not.

In this time there have been 0 sexual transmission recorded when someone living with HIV was and remained adherent to treatment for 6+ months and virally suppressed defined as lower than 200 copies. 

The Swiss statement was made more than a decade ago and, since then more large scale studies and case reporting has continued to confirm this and allowed for the further refinement of that statement leading to empowering the U=U movement & supported consensus statement.

Now the scientific part, yes never say never, although, with the 22+ years of data and evidence behind TaSP at this stage the foot is not the other foot i.e It's the excepted consensus until proven otherwise and ill add that if it does ever go amiss in the future than we will all know about it will be the one famous exception that otherwise simply confirms the rule, worrying about being that exception at this stage is paranoid from your doctor if you ask me.

BTW The lowest ever recorded threshold of sexual transmission occurred in early 2000's at a suspected viral load of 362 copies/ml, the key point was the individual was not on ART above 200 copies/ml in blood and the VL in other uncontrolled transmissible fluids could have been even higher.


--- Quote ---His point was that “in real life” shit happens: for example you may become detectable between your 6 months blood check without being aware and/or become resistant.
--- End quote ---

In the real world, condoms can and do break from time to time etc,  in the real world TaSP has a far more impressive track record then condoms in terms of HIV prevention.  ;)

Keep taking your meds. If you have been UD like you said for 2 years without issues and continue to consistently & correctly adhere to your medication this is simply not a real-world concern.


--- Quote ---To my surprise he was quite cautious and advised that, even if I’ve been UD for 2 years, we should have only protected intercourse (my personal expectation was that the dr would have approved unprotected sex).

--- End quote ---

I doubt if I asked Doctors here many would approve either simply because of increased STI risks and sex is still viewed as a taboo subject (Catholic nation, so-called morals etc, etc) Since I don't need their approval to have sex unless it was with them I don't ask.

Could it theoretically one day happen, sure just like tones of stuff could in life theoretically happen like getting hit in the head by a meteorite but worrying about such things or wearing steal hats for what theoretically could happen would be a disproportionate response if you ask me.

Hope this helps

Best, Jim


Castilla J et al. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. J Acquir Immune Defic Syndr 40: 96-101, 2005

http://i-base.info/htb/32308

Vernazza P et al. Bulletin des médecins suisses 89 (5), 30 January 2008

https://www.preventionaccess.org/consensus

P.S

If I don't mention this I will get messages about it so "Use condoms to reduce your exposure to STI's and remember to test at least yearly out of routine and more frequently should condomless intercourse occur"

Jim Allen:
BTW

End of the day it all depends on your comfort level and that of your partners. 
If your partner wants additional peace of mind then perhaps PrEP would be an option to discuss. 

Expat1:
Mindless, maybe take her to Dr Phillipe, in Pattaya, I know that he has counseled other couples before on this issue.
 

daveR:
As soon as the CDC backed it my Doctor discussed it with me. Said there was no issue for me and my wife. My wife still has concerns though.
Good luck with normalizing your relationship.

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