Treatment as Prevention (TASP) | Undetectable Viral Load
When people living with HIV have access to appropriate HIV medication (also known as antiretroviral therapy), they can achieve an undetectable viral load. In Canada, this means that the amount of HIV in their bloodstream is so low (below 40 copies per ml of blood) that it cannot be detected by the most sensitive HIV viral load test we use regularly in Canada. We have known for quite some time that when a person living with HIV achieves and maintains an undetectable viral load, the “risk” that they will pass on HIV to their sexual partners dramatically decreases. Most recently, however, the science has become even clearer.
On that note, the Positive Voices Caucus, alongside many of the leading organizations and medical professionals working in HIV across the globe, wholeheartedly endorses the Prevention Access Campaign consensus statement on the “Risk of Sexual Transmission from a Person Living with HIV who has an Undetectable Viral Load”:
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.
In simpler terms, this means that people who are undetectable will not transmit HIV to their partners sexually. Or in the words of the “U=U” campaign, “Undetectable=Untransmittable.”
This shift in understanding regarding the impact of an undetectable viral load on the sexual transmission of HIV is significant in that it helps to combat HIV stigma by declaring that people who are undetectable no longer pose a “risk” of transmitting HIV to their partners sexually. It also alleviates the stress experienced by many people living with HIV by clearly stating that if they take their medication as prescribed and achieve and maintain an undetectable viral load, they are in control of their HIV and can stop it from being passed on to others sexually. Recently, Canada became the first country to officially endorse U-U!
There are some caveats to this, however:
As the Prevention Access Campaign notes, an undetectable viral load only prevents transmission of HIV to sexual partners and may not be effective at preventing transmission through other means, such as sharing injection equipment (i.e. needles).
A viral load test only measures a person’s viral load at the time their blood was taken.
Once people achieve an undetectable viral load, if they continue to take their HIV medication as prescribed, they should maintain an undetectable viral load. However, if someone was stop taking their medication, their viral load could increase above an undetectable viral load, meaning that the risk of transmitting HIV to others sexually would increase.
An undetectable viral load only protects against the transmission of HIV. People should still consider the potential risk of transmission of other STIs and take precautions as deemed necessary, such as the use of barrier methods such as internal or external condoms.
Finally, the Positive Voices Caucus recognizes the many structural barriers which make obtaining an undetectable viral load more difficult for some people living with HIV. Although we celebrate the wide embrace of the science proving that undetectable individuals will not transmit HIV to their partners sexually, we also encourage all stakeholders engaged in HIV work to continue to work to remove barriers which discourage people from HIV testing, treatment, and obtaining an undetectable viral load and all of the associated health and prevention benefits that come with that.
Post-Exposure Prophylaxis (PEP)
PEP is the use of HIV medication by someone who is HIV negative, after a potential exposure to HIV, to prevent HIV infection. PEP can be accessed in both occupational and non-occupational settings. If you are involved in an occupation where you are at an increased risk of being exposed to HIV (i.e. a member of the police force or a healthcare provider) please speak with your employer about protocol for accessing PEP in the case of a workplace exposure. The remainder of this section will focus on accessing PEP in relation to a potential exposure to HIV outside of the workplace.
If someone feels as though they may have been exposed to HIV (perhaps due to experiencing sexual assault, a condom breaking, or various other circumstances) they may wish to access PEP. The ease of accessing PEP can differ depending on where an individual is located. As PEP must be started no later than 72 hours after a potential exposure to HIV (and ideally earlier), your nearest emergency department or STI clinic should be contacted as soon as possible.
In order to access PEP, a physician will assess you to determine if you meet the criteria to receive publicly funded PEP. If so, you will be started on PEP free of charge. If the assessing physician determines that you do not meet the criteria for publicly funded PEP, it may be possible for you to access the medication by paying out-of-pocket or going through your private insurance plan.
If you are successful in accessing PEP, you will be placed on a 28 day regimen. PEP should be taken as prescribed and should not be interrupted. When taken as prescribed PEP is highly effective at preventing HIV infection. Some people who are on PEP may experience unwanted side effects. If this occurs, please contact the prescribing physician.
There are a lot of new, exciting HIV prevention options available these days. However, when used correctly, barrier methods remain one of the most effective ways to prevent HIV infection.
There are different types of barrier methods that can be used in different situations, depending on the type of sex being had and the anatomy of the individuals involved. Some examples of barrier methods are:
Often referred to simply as “condoms,” external condoms (or “male” condoms) are placed over an appendage such as a penis or a sex toy like a dildo or vibrator. To learn the correct method for using an internal condom, click here.
Often referred to as “female” condoms, internal condoms are generally placed inside of a bodily cavity such as a vagina, anus, or front hole. To learn the correct method for using an internal condom, click here.
Dental dams are often used for oral sex as a barrier between someone’s mouth and another individual’s genitals or anus. To learn the correct method for using a dental dam please click here.
We understand that barrier methods can be associated by some with decreased pleasure and intimacy. However, there are some added benefits to consistent condoms use that other HIV prevention methods do not provide. For example, while PrEP and Treatment as Prevention (or Undetectable Viral Load) are extremely effective at preventing HIV infection, they do not prevent the transmission of additional STIs such as chlamydia, gonorrhea, and syphilis. Barrier methods, on the other hand, not only prevent HIV transmission but also help lower the chance of transmitting many other STIs as well.
If cost is a barrier to you or your partner(s) accessing barrier methods, many AIDS Service Organizations (ASOs) in Alberta provide access to free safer sex supplies. Check out our Get Access section to find your nearest ASO and stock up today!
Pre-Exposure Prophylaxis (PrEP)
PrEP is the use of the HIV medication most commonly known as Truvada (emtricitabine and tenofovir disoproxil fumarate or TDF/FTC) by someone who is HIV negative to prevent the sexual transmission of HIV. There is a wealth of evidence that demonstrates that when PrEP is taken daily as prescribed, it is nearly 100% effective at preventing the sexual transmission of HIV.
Historically, accessing PrEP in Alberta was very challenging – primarily due to the significant cost of PrEP and the lack of public PrEP coverage. This meant that many individuals had to try to find coverage for PrEP through their private ensurer – with mixed success – or pay out-of-pocket. Recently, however, Alberta Health announced full PrEP coverage for eligible Albertans. Additionally, Non-Insured Health Benefits provides full PrEP coverage for eligible First Nations and Inuit. You can learn more about these coverage options here.
However, even with these changes, sometimes it can be challenging to know if PrEP is right for you, how to access it, how to find coverage if you don’t qualify for Alberta Health or Non-Insured Health Benefits, and what you need to do to keep yourself safe and healthy while on PrEP. All of this information can be found at PrEPAlberta.ca, developed by the Edmonton Men’s Health Collective. They also have a section specifically for healthcare providers interested in prescribing PrEP. For more information, check them out below: