HIV Transmission Risks POZ interactive lesson

[xman]

i am very shocked about this new hiv transmission risk interactive lesson page and the related links. it is sad the poz.com share this infos.
the survey lists a lot of risk situations ignoring treatment as prevention or the fact that positive persons on successful treatment are no more a threat for negatives. Furthermore it lists several links with misleading and confusional informations. 
Here's a link of the many listed after the survey containing terrible outdated informations about the risks, in particular regarding intercourse between a poz and a neg. partner where the pos. partner is on treatment.

https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/48/the-basics-of-hiv-prevention/

it cites:

To protect your partner, use condoms correctly every time you have sex. Even someone who is taking HIV medicines and has an undetectable viral load can still potentially transmit HIV to a partner. So even if you are taking HIV medicines, it’s still important to use condoms.

What ?

More of concern the fact this is a government page and shared by this site. what do administrators think of this? is poz.com not supporting the u = u consensus?

this informations are wrong and are confusional.

[Jim Allen]

Now I think you mean the module from d’Vinci Interactive and the NLM.  Well I am happy to pass the comment you had on to them, however you could also feedback this by yourself of course. 

The NLM also have this page on the topic: broken link removed

I personally know for a fact POZ.com covered extensively TaSP, HTPN and Partner studies and there are several lessons pages on the topic.  Most recently updated last week, few examples:

Reducing STI & HIV risks:
https://www.poz.com/basics/hiv-basics/safer-sex
Transmission risks:
https://www.poz.com/basics/hiv-basics/hiv-transmission-risks
When Undetectable…
https://www.poz.com/article/undetectable
-   Covers the consensus statement (UD = Negligible)

The list goes on and on, but in short ill personally pass your comment on about the NLM site, however I must ask you to please don’t post in this area of the forum again.

Thank you for your cooperation. 

Jim

What do administrators think of this?

What, me personally?? You really want to know...

Well strictly personally speaking and since you ask I’m fine with condoms. Wording on NLM page is a bit crude at times but looking at the several studies on TaSP its shown a reduced risk, the consensus statement is it’s a negligible risk.

Now would the U=U campaign mean I am or others should stop educating on safer sex or stop telling HIV negative persons not to reduce transmission risks from HIV or STI’s and just go ahead and do it bare with people??

-   Not on your life. ill explain why.

Safer sex involves a combination of approaches to reduce HIV and STI risks, this includes TaSP, PrEP, Condoms, or any combination of proven risk reduction methods to reduce risk. In the case of couples, it’s a personal thing that couples must decide for themselves together, what level of risk are they happy to accept and this could also vary on several things including lifestyle.

People are people, and some do go off meds, or have Treatment failure/virologic failure from things like poor adherence, drug resistance, poor absorption of medications, and drug-drug interactions etc. etc. now of course technically U=Negligible idea in the way i seeing it pushed is unaffected by this as if/when treatment failure does happen or someone just stops the meds, any transmission is I would than suspect because the person was no longer UD or only UD for a too short of a time frame.

The final report on HTPN showed transmissions, some of them because of treatment failure. In short U = Negligible risk and just like any other prevention method it comes with "if's" & "but's" so in good faith I could not push U=U to someone who is HIV negative. https://hptn.org/sites/default/files/inline-files/1002_Fogel.pdf

We have seen plenty of people crying that they trusted someone and was infected, partner study did not change human behavior or how HIV is transmitted - like it or not.

In short TaSP reduces HIV transmission risk, however if’s and but’s remain, the HIV negative person is relying on partners or peoples TaSP (UD status) alone would be putting a great deal of trust and faith in the HIV positive person. – Up to them of course.

However, personally like i said the NLM wording might be a bit crude, I just give HIV negative people asking that question the consensus statement and warn them of STI’s of course and other safer sex methods that can be used.  Than poeple can make up their own minds.

People living with HIV on ART with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV.  Depending on the drugs employed it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.

NOTE:   An undetectable HIV viral load only prevents HIV transmission to sexual partners. Condoms also help prevent HIV transmission as well as other STIs and pregnancy. The choice of HIV prevention method may be different depending upon a person’s sexual practices, circumstances and relationships. For instance, if someone is having sex with multiple partners or in a non-monogamous relationship, they might consider using condoms to prevent other STIs.
“NEGLIGIBLE” = so small or unimportant as to be not worth considering; insignificant.
https://www.preventionaccess.org/consensus

Virologic outcomes in early antiretroviral treatment: HPTN 052
https://www.ncbi.nlm.nih.gov/pubmed/28385131
http://www.croiconference.org/sessions/virologic-outcomes-when-antiretroviral-therapy-used-prevention-hptn-052

Jim

[xman]

well, at first thanks for replying and for the clarification.

more in detail i think it is quite obvious that the u=u consensus applies only to couples where the pos. partner is on successful therapy and with a consistent ud viral load. now if's and but's are always present in life. however, excluding cases of people going off meds, with poor adherence or a not working therapy, the actual science tells us clearly that risk is negligibile and practically zero if your vl is consistently ud and very unlikely if under at least 150 copies/ml.

telling to pos. people that despite an ud viral load the use of condoms is recommended is absolutely misleading and represent a poor prevention message, (not considering the stigma attached).

it is important for ppl to know they are no more infectious if on therapy.

i am glad you'r happy with condoms. i am not and like me many others. i think we deserve a sense of normality and peace of mind when it comes to sex after decades of strict condoms only rules.

[Jim Allen]

As said i am happy to send you feedback to the owners of the pages in question.
However I also asked you not to post here.

more in detail i think it is quite obvious that the u=u consensus applies only to couples where the pos. partner is on successful therapy and with a consistent ud viral load. now if's and but's are always present in life. 

Its not obvious in a lot of the messaging I have seen and it should not be pushed to the back to make someone else feel better ...

it is important for ppl to know they are no more infectious if on therapy.

i am glad you'r happy with condoms. i am not and like me many others. i think we deserve a sense of normality and peace of mind when it comes to sex after decades of strict condoms only rules.

Yeah, I am ... Look you asked for it and you got my answer. I'm not even sure why you asked, bit pointless to ask if you ask me.

My own choices are simple when it comes to sex and risk reduction I don't give in to peer pressure so use condoms to give me additional protection, I got HIV from not doing it that way the first time. Hard lesson to learn and I am not looking for a 2nd STI anytime soon.

Normality aha, well personally l feel normal is when talking to people to make them aware of the "if's and buts" and that there are risks around sex. What you feel is obvious and needs not mentioning as a risk/concern or a manner of reducing risks is not so to others. There is no harm in providing people with information so they are empowered to make their own informed choices and sure in some cases or for some people that will include a condom. You might not feel any of that is normal, that is entirely up to you. You do what you want to do and same goes for other people.

I think the consensus statement is pretty good example actually and I'm sorry if we disagree on that.

Anyhow like I said your feedback has been passed on, but please refrain from posting here.

Jim