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Author Topic: Clarification needed on U=U  (Read 578 times)

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Offline Mindless

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Clarification needed on U=U
« on: November 30, 2019, 02:29:37 am »
I asked my hiv dr to talk to my wife about U=U: weíre willing to try to ďrebuildĒ our sexual life after years (but thatís another story). Sheís the negative one btw.

To my surprise he was quite cautious and advised that, even if Iíve 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 ďzero transmissions etc.ď, those are only the results of medical/scientific studies and there isnít actually any official guideline from any governmental health body to his knowledge (his words not mine).
His point was that ďin real lifeĒ shit happens: for example you may become detectable between your 6 months blood check without being aware and/or become resistant.

Iím 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 Iíd like to understand if heís 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 Iím only reporting what Iíve been said and not personally trying to challenge anyone or anything.

Hugs

Offline Jim Allen

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Re: Clarification needed on U=U
« Reply #1 on: November 30, 2019, 03:32:43 am »
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 ďzero transmissions etc.ď, those are only the results of medical/scientific studies and there isnít actually any official guideline from any governmental health body to his knowledge (his words not mine).

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 ďin real lifeĒ shit happens: for example you may become detectable between your 6 months blood check without being aware and/or become resistant.

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 Iíve been UD for 2 years, we should have only protected intercourse (my personal expectation was that the dr would have approved unprotected sex).

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 mťdecins 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"

« Last Edit: November 30, 2019, 12:45:22 pm by Jim Allen »
HIV 101 - Everything you need to know
HIV 101
Transmission and Risks:
HIV Transmission and Risks
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Jim Allen

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Re: Clarification needed on U=U
« Reply #2 on: November 30, 2019, 03:49:58 am »
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. 

HIV 101 - Everything you need to know
HIV 101
Transmission and Risks:
HIV Transmission and Risks
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline Expat1

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Re: Clarification needed on U=U
« Reply #3 on: November 30, 2019, 06:19:07 pm »
Mindless, maybe take her to Dr Phillipe, in Pattaya, I know that he has counseled other couples before on this issue.
 

Offline daveR

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Re: Clarification needed on U=U
« Reply #4 on: November 30, 2019, 07:15:45 pm »
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.

Offline Mindless

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Re: Clarification needed on U=U
« Reply #5 on: December 02, 2019, 10:20:33 am »
Thanks for all the information Jim, Iíll take my time to go through it and will discuss with the Doc, I think is a nice and valuable dr after all. Iíd like to discuss further with him before give up and change.

Hugs

Offline Mindless

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Re: Clarification needed on U=U
« Reply #6 on: December 02, 2019, 10:33:11 am »
Mindless, maybe take her to Dr Phillipe, in Pattaya, I know that he has counseled other couples before on this issue.

Thanks a lot, I will consider this option in case wify is interested: for the moment she seems more prone to avoid intimacy. With or without condoms. Over the years itís become an habit and I have to admit I looked elsewhere to satisfy my needs. Which is the main reason I got infected by the way. Iím still ashamed and feel guilty about all this.

We still love and respect each other but... no sex. I know itís a weird situation but I still didnít find a solution or maybe the courage to face it and make a change. She also seems to accept things as they are and is maybe scared to face reality as I am. Itís  long story.

Thanks again

Offline Mindless

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Re: Clarification needed on U=U
« Reply #7 on: December 02, 2019, 10:35:04 am »
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.

So, youíre not using condoms or PreP if I can ask? Thanks for the feedback.

Offline daveR

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Re: Clarification needed on U=U
« Reply #8 on: December 02, 2019, 10:45:06 am »
So, youíre not using condoms or PreP if I can ask? Thanks for the feedback.

My wife insisted on condoms. She has now also gone off the idea of sex again. There has been so much negative information put out by governments in the past based on whst was known in the day that i think U=U is going to take a long time to become accepted. It is a complete U turn on the original message concerning HIV.

Offline Jim Allen

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Re: Clarification needed on U=U
« Reply #9 on: December 02, 2019, 11:36:10 am »
Thanks for all the information Jim, Iíll take my time to go through it and will discuss with the Doc, I think is a nice and valuable dr after all. Iíd like to discuss further with him before give up and change.

Hugs

Cool. Look I've had to educate Doctors on all sorts over the years particularly regarding HIV transmission & prevention. Except for 1 most of them were genuinely just out of date and unaware of risks, studies and updates. Hardly surprising given how much has changed over the past 25 years or even the last 10.

Let me know if you need additional resources or references
HIV 101 - Everything you need to know
HIV 101
Transmission and Risks:
HIV Transmission and Risks
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

 


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