Therapy as protection
If you are HIV-positive and in successful treatment, with an undetectable viral load, you cannot pass the virus on sexually. Effective HIV therapy thus protects against transmission.
How do HIV drugs offer protection?
HIV drugs prevent the virus replicating in the body of someone with HIV. If the therapy is working well, after a certain time it will not be possible to detect HIV in the person's blood. This is referred to as a viral load which is below the detection threshold. There will be very little – if any – of the virus detectable in sperm, vaginal secretions, other bodily fluids or in the body's mucous membranes either. At this stage, it is highly unlikely that HIV will be passed on to sexual partners.
How reliable is the protection the drugs offer?
Studies have shown that HIV therapy that is working well provides protection against infection that is at least as reliable as condoms. There is no such thing as 100% reliability in either case, however, as things can go wrong even if you use condoms, but both methods offer a very high level of protection.
What conditions must be met to ensure that therapies offer protection?
The viral load must have remained below the detection threshold for at least six months, and the person with HIV must be taking their medication regularly. Blood tests must be done every three months at a medical practice specialising in HIV to check that these conditions continue to be met.
Can I really feel safe if the conditions are met?
The crucial question here is whether or not the conditions really are met. If you are HIV-positive, you can discuss this with your doctor.
If you are HIV-negative, or if you have not been tested, you must talk about things with your HIV-positive partner. Then it is up to the individual to decide for themselves whether or not they trust their partner, and whether they might want to have sex without a condom. Couples should have unprotected sex only if both are well informed and comfortable with their joint decision.
The decision is more difficult where casual sex is concerned, because in most cases, there will not be the same relationship of trust. The Swiss AIDS Federation recommends using condoms if you are at all unsure.
Can the viral load rise again, so that it is possible for the virus to be passed on?
This can happen above all if the drugs are not taken regularly. There are other reasons that the effectiveness of therapies may decline after a certain time. That is why it is important to check the viral load regularly, generally every three months.
Can the viral load rise if someone with HIV also has syphilis or another sexually-transmitted infection?
That is possible, but therapy will keep the increase to a minimum, so that HIV transmission can still be virtually ruled out.
Isn't it safer to continue using condoms in addition to the protection given by the therapy?
This is, indeed, the safest option. Added together, the two methods offer maximum protection, although the protective effect of condoms and HIV therapy in themselves is already very high.
What are the arguments for continuing to use condoms?
Condoms reduce the risk of contracting another sexually transmitted infection, such as syphilis, gonorrhea or chlamydia.