As I understand it, large studies of couples where one partner has HIV with an undetectable viral load and the other does not have HIV have not recorded any cases of transmission through sexual activity. The question of whether it's "impossible" or "extremely unlikely" comes down more to philosophy than anything pragmatic at this point.
Transmission through sharing needles we have less confidence around, because illegal drug use is harder to study.
IIRC not everyone reaches an undetectable viral load through antiretroviral medication, so you do need to make sure that's the case. Pre-exposure prophylaxis and general safe sex practices like condoms can mitigate the risk for people with low-but-detectable viral load and their partners.
I grew up in the 1990s with an overwhelming fear of HIV as a teenager. It still feels incredible that the virus is now undetectable and non-transmissible with medication that’s not much of a burden in one’s daily life. A cure for AIDS was much closer than anyone imagined in 1993.
When everything seems dark and hopeless, this is one of the examples that always lifts my spirits. Humankind can achieve incredible things together.
10,000 people a year die of AIDS in the US. Not even remotely close to "winning."
I suspect a large portion of those deaths are due to poor sexual education thanks to christofascists, and people who don't get tested regularly because of poor access to family planning and reproductive health, again thanks to christofascists. All because Magical Sky God Said Abortion Bad.
That and people who lose their healthcare and can't afford the meds because this country is the only developed nation in the world which does not treat healthcare like a universal human right, because corporations want to keep using health coverage to keep workers from switching jobs more freely, because they don't want a free labor market.
Isn’t that like a third of gun deaths in the USA? Personally for me this idea of trust that it’s undetectable and therefore non jtransmissible is not a risk I would recommend anyone to take, but at the same time we have to put things into relation no?
Even these days, when cops accidently pike themselves with needles when dealing with addicts, they go to HIV center for preventative drugs. So that they, a cop who got piked exactly once, do not get HIV.
Um, no? Unlike with toilet seats, tons of people got it this way. There were even cases of hospital outbreaks due to insufficient sterilization of reusable syringes.
About 270 patients, mostly children, were nosocomially infected with HIV subtype G in seventeen hospitals in 1988–1989. The infection was mainly transmitted between children through contaminated catheters and needles, and from children to mothers through breast-feeding.
I once spoke to a primary-care doctor about the risks of getting HIV through sex. The doctor told me that the risk of getting HIV the "typical way" (receiving anal sex) is about 1/72. Thus, for every 72 exposures, the recipient would contract HIV one time. This assumes that condoms are not used, and that the transmitter has an untreated HIV infection, which presumably has a high viral load.
Transmission risk goes down by orders of magnitude for other forms of sex, until we get to receiving blowjobs, where the risk is literally nil. There are zero recorded cases of HIV caused by receiving a blowjob.
In other words, HIV is actually kind of hard to get. You have to be very active, and not using protection, in order to get it. Or just be very, very unlucky. And that's with respect to untreated cases, which likely have high viral loads.
This suggests to me that, for practical purposes, undetectable levels are impossible to transmit. Or as the Prep marketing executives would say, "U means U" - undetectable means untransmittable.
Whether or not you're comfortable having sex with someone who is HIV+ but claims to have an undetectable viral load is a separate question entirely.
Sorry to rant a little, but as someone who grew up with HIV in the family, this odd pressure against people who might be hesitant to sleep with someone U=U always feels uncomfortable and manipulative to me. I see it a lot around the internet.
The way I was raised, I'm the only person I trust with my sexual health. I would never trust someones word they're tested recently and have unprotected sex with them. I wouldn't trust someone saying they're on PrEP and have unprotected sex with them either. I can only trust myself. U=U is exactly the same situation.
In a zero trust mindset like that, someone telling me they're U=U only tells me they have HIV. I have HIV+ friends who struggle to take their meds at the right time every day, or forget. And I also know people who have lied about when they last took their STI screening to hookups.
I'm also sure a bunch of people would get angry if you asked a U=U person to show you their latest CD4 count or viral load proof too - so what am I to do, just trust that, unlike everyone else, U=U people are perfectly honest, and never screw up taking their meds?
The response to this is often "anyone COULD have HIV, U=U people are actually safer because they have it locked down", but again to me this is about as trustworthy as "anyone COULD have HIV, but people on PrEP have it locked down". It all relies on the trust the other person is on top of their shit.
I read this entire thread under the assumption that we are talking about long term partners here. Completely disregarding HIV, there are enough other STIs that say unprotected sex is a bad idea, so if we are talking about hookups, the person can tell me whatever they want, condom is mandatory.
Of course long term relationships don't magically shield you against STI, but I'd hope there is enough trust to share test results of any kind that are relevant to this matter if you are having the discussion about going fluid bond. And you probably know the person well enough to know if they are reliable with taking their meds on time.
Unfortunately, consistent self-care isn't easy for many people struggling with mental health issues.
Since you don't immediately feel worse after not taking your pill once, it's very easy to slip up if you aren't the most organized / functioning person.
It’s interesting. I never really thought to ask about the chances with anal given that going on prep wasn’t really even a question.
I knew it wasn’t one exposure and you would get it, but I honestly kinda figured the chances were higher than that.
Regarding oral, I was under the impression that the important caveat there was assuming you had no major sores in your mouth (like, maybe don’t do it after getting dental surgery). Since the reason it’s nil is due to the acids in your saliva and stomach, at least that is what my doctor told me.
