Prevention of HIV: Undetectable = Untransmittable

While there is currently no effective cure for HIV,  this World AIDS Day, The Pioneer connects to a few experts who shares with us ways to prevent HIV, can AIDS-infected persons conceive safely, and much more.

Shikha Duggal

There is currently no effective cure, when it comes to HIV. Once people get HIV, they have it for life. As soon as one hears this, they are not just discouraged but are frightened to no boundaries.

HIV infection in humans came from a type of chimpanzee in Africa and studies show that HIV may have jumped from chimpanzees to humans as far back as the late 1800s. But what are we doing about it today? Only, trying to control the disease to a point? Many of our readers ask us about the mental stigma attached to it too, because the lack of awareness dispirited them. While there are a number of ways to prevent the spread of AIDS, safe sex, when done correctly, is undoubtedly the best way to prevent sexually transmitted infections.

Dr. Monalisa Sahu, from Yashoda Hospitals who specialises in infectious diseases confirms to us, and says, “Safer sexual practices can go a long way in preventing transmission of HIV, and it’s true. Certain health conditions, which may become serious and have many complications without appropriate diagnosis and treatment can be transmitted from one person to another through sexual route! But, safer sexual practices can combat the risks of acquiring and transmitting other STIs to a great extent. Having other STIs like syphilis, gonorrhea, chlamydia, increases the chances of transmission of HIV.

These STIs need to be diagnosed early and managed  appropriately to prevent the transmission of HIV. So, safer sexual practices include certain actions like using barrier contraceptives: a condom (male and female), that prevents person-to-person sharing of bodily fluids and secretions.”

For people living with HIV, safer sexual practices can be rather more important as it can decrease the chances of getting other STIs, which may lead to infection with other STIs, that may further weaken their immune system.

“ In case of individuals where both the partners are having HIV, safer sex can decrease the chances of acquiring another strain of HIV that may be resistant to the HIV drugs the person may be already on. Being compliant with the medications and taking the HIV medications regularly is also a safer sexual practice, as the person on medications will have his HIV viral load suppressed, and this decreases the chances of transmission of HIV to his/her partners to a great extent! Having access to the correct information on the methods of transmission of HIV and other STIs, ways by which the chances of transmission can be reduced, and methods of decreasing the high risk activities can help in a great extent in preventing the transmission of these infections.

Other infections like Hepatitis B and C can also be transmitted through unprotected sexual activities and unsafe sexual practices. Several bodily secretions involving blood, vaginal secretions, semen, and even anal fluids can transmit HIV and other STIs. The risk of transmission of HIV is negligible in a person on anti-HIV drugs, who is virally suppressed.”

She further states, “The WHO has come up with the Slogan of U=U, which means undetectable is equal to untransmittable which means that, a HIV positive patient who is on medications and his/her viral load is undetectable, then, the chances of transmission of HIV to his/her partner by sexual route is negligible. However, the other STIs if present can still be transmitted by them.

For individuals who are HIV-negative, and have a high risk of exposure to unsafe sexual practices and chances of acquiring HIV, then, they can go for options called pre-exposure prophylaxis and post-exposure prophylaxis. The PrEP implies to the usage of anti-HIV drugs prior to the sexual exposure, and PEP implies taking taking the anti-HIV drugs after the exposure to the virus. The PrEP and PEP are highly effective in decreasing the chances of acquiring HIV,  if they are exposed to the virus.

PrEP is a very helpful method that women can use, without even their partners’ knowledge or cooperation to prevent transmitting HIV! PrEP is as simple as like taking birth control pills. PEP refers to taking anti-HIV drugs for about four weeks immediately after a possible exposure to prevent HIV acquisition. Repeated vaginal, anal, and oral sexual activities can cause micro-abrasions and damage to the linings of these areas.Damage of these protective mucosal linings causes decreased protection against HIV and the STIs. Having any lesions in the genital area in sexually active individuals should call for medical attention.”

Our next exploration was whether it is possible for an AIDS-infected person to conceive safely? Dr. M. Niharika, Senior fertility expert from Kamineni Fertility Centre, said “Advances in HIV treatment and preventions allow HIV-positive couples to become pregnant without fear of transmitting the virus to their children. Women living with HIV have been taking the anti-HIV drug safely throughout pregnancy for years in order to protect their children from HIV. However, with new medical advances and careful planning, it is now possible to have a safe and successful pregnancy while preventing HIV from passing to an HIV-negative partner or the baby.

Invitro fertilization and intrauterine insemination, both of which involve a technique known as sperm washing, has been the gold standard for assisting so-called discordant couples to conceive, but PrEP has become an enticing alternative for some in recent years. However, you can pass HIV to your baby during pregnancy, labour, delivery, or breastfeeding! In an effort to provide the world with an HIV-free generation, the National AIDS Control Organization has established integrated counseling and testing centers, as well as a programme for the prevention of parent-to-child transmission.

Primordial prevention in adolescents and women of childbearing age through health education, primary prevention of HIV in pregnancy through counselling on safe sexual health practises, routine HIV screening in pregnancy, early detection and use of antiretroviral therapy as soon as it is diagnosed, and safe delivery practises are all important PPTCT strategies.”

Another facet: conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. And here, women become vulnerable. The men start mounting more challenges and the statistics shows there are innumerable suicides because of this reason amongst the men, they are higher.

Dr. Preeti Singh, Sr. Consultant Clinical Psychology from Lissun aware us, “Risk for suicide in people living with HIV also increase with other psychiatric conditions like post traumatic stress disorder, mood disorders like bipolar affective disorder, substance harmful use  disorder and insomnia.”

She went on, “Some kinds of antiviral therapies particularly efavirenz is associated with increased risk for suicide as documented! Also if some one has a psychiatric condition and is diagnosed with HIV will also increase the risk of suicide in them.

So, it’s important to identify this feeling which we call as ‘survivors feeling’ in our fraternity after being diagnosed with HIV. One very powerful tool that we can use to overcome this is by practicing mindfulness based cognitive behaviour therapy and also acceptance commitment therapy.”

“While the prevalence of HIV AIDS has seen a down-surge since 2000, on a national scale, I personally believe there is an exponential increase in the number of males and females intimately getting involved into unethical sex which further increases the chances of getting the incurable disease amongst the younger population. I must admit, the rural parts of India are ignorantly unaware when it comes to the holistic sexual measures and practices. In the remaining urban parts, HIV cases are on the low.

In my experience, unprotected intercourse is a commonality — especially when its unprotected sex under the consumption of alcohol or even anal sex! I have personally witnessed a sexual pattern of men known to be more affected by HIV as compared to women, coming with its own mental roadblocks like depression, anxiety, perpetually fearful, isolation practices — being more prone to suicidal tendencies,” concludes Dr Chirag Bhandari, founder of Institute of Andrology and Sexual Health!