CDC on HIV: 'Undetectable' Equals 'Untransmittable'

ATLANTA—In a "Dear Colleague" letter dated September 27, Dr. Eugene McCray, Director of the Division of HIV/AIDS Prevention for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, as well as Dr. Jonathan H. Mermin, Assistant Surgeon General, USPHS, both of the Centers for Disease Control, announced that "We ... have strong evidence of the prevention effectiveness of [antiretroviral therapy (ART)]. When ART results in viral suppression, defined as less than 200 copies/ml or undetectable levels, it prevents sexual HIV transmission." "Across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed," the letter continued. "This means that people who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner." Although there has been not one single on-set HIV transmission among hetero adult performers over the past dozen-plus years, the possibility of such transmission remains worrisome to some performers, despite the industry's excellent STD/HIV testing program and the increasing use of the pre-exposure prophylaxis (PrEP) drug Truvada. But the news of the untransmissibility of the virus if a person's viral load is less than 200 copies/ml should be a welcome relief, though it is unlikely to encourage performers to be willing to work with HIV-positive individuals no matter what their viral load, since that viral load may vary depending on how faithfully they follow their prescribed anti-retroviral treatment—a fact that an international consortium of physicians and treatment organizations made clear in a recent statement. "People living with HIV on ART with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV," the group of eight physicians and 400 organizations from 58 countries stated. "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." The news caused widespread celebration across the HIV treatment community, as well as with many LGBT groups. "This is the moment we have been waiting for," said Bruce Richman, executive director of the Prevention Access Campaign's Undetectable=Untransmittable initiative, in an interview with HIV Plus magazine. "The CDC agreed ... there is 'effectively no risk' of sexually transmitting HIV when on treatment and undetectable. The overwhelming data clearly shows that taking our medication daily protects our health and our partners." "The implications of the CDC acknowledging that there is 'effectively no risk' are massive in terms of both politics and policy," noted Zack Ford of ThinkProgress.com. "As HIV Plus Magazine notes, nearly half of all HIV-positive people in the U.S. have brought their viral load to an undetectable level through treatment, so it’s significant to recognize that they are not contributing to the epidemic." However, the site also reported that, "Unfortunately, President Trump has proposed massive cuts to the funding that helps supply 11.5 million people worldwide with antiretroviral drugs, and the health care policies he supports also make it harder for people with HIV to afford the care they need." But while an undetectable viral load means that unprotected sex will not transmit HIV, the website Avert.org has posted some warnings and recommendations, including, "It’s recommended that you should be taking treatment for at least six months, and then have your viral load monitored every 2-4 months by a healthcare professional to know that you are undetectable." The site also notes that, "Not everyone living with HIV can achieve an undetectable viral load and this is usually down to factors out of someone’s control," and that, "If you aren’t able to get your viral load monitored regularly, it’s important not to assume that you are undetectable." Just what this news will mean for the adult content production community remains to be seen, but it's damned good news for those already infected.