The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review
The risk of sexual transmission of HIV from individuals with low-level HIV viraemia receiving antiretroviral therapy (ART) has important public health implications, especially in resource-limited settings that use alternatives to plasma-based viral load testing. This Article summarises the evidence related to sexual transmission of HIV at varying HIV viral load levels to inform messaging for people living with HIV, their partners, their health-care providers, and the wider public.
The role of HIV viral suppression in improving individual health and reducing transmission
This policy brief describes key HIV viral load thresholds and the available viral load testing approaches for monitoring how well antiretroviral therapy is working for people living with HIV.
Key messages include:
- HIV viral suppression is critical to improve health, prevent sexual transmission, and reduce perinatal transmission.
- There are three key categories for HIV viral load measurements: unsuppressed (>1000 copies/mL), suppressed (detected but ≤1000 copies/mL) and undetectable (viral load not detected by test used).
- People living with HIV who have an undetectable viral load using any WHO-prequalified combination of sample and testing platform, including dried blood spot samples, and continue taking medication as prescribed have zero risk of transmitting HIV to their sexual partner(s).
- People living with HIV who have a suppressed but detectable viral load and are taking medication as prescribed have almost zero or negligible risk of transmitting HIV to their sexual partner(s).
GNP+ and THT. Criminalisation of HIV transmission in Europe: A rapid scan (2005)
This paper, prepared by Moono Nyambe at GNP+, and managed by Julian Hows (GNP+) and Lisa Power (Terrence Higgins Trust) comprised a synthesis of input from several different sources, pubished in April 2005 as a draft document open to comments. The statements and information provided in this document are based on replies to a questionnaire and have not been independently confirmed. The views expressed in this document do not necessarily reflect the official position of UNAIDS which partly funded its production.
Respondents from 41 out of 45 countries provided information for the study. Of the respondents from the 41 countries that were able to provide information, it was reported that in at least 36 countries the actual or potential transmission of HIV can constitute a criminal offence. This supported anecdotal evidence that increasingly the law is seen as a tool for regulating conduct that can lead to HIV transmission. In 21 of these countries, it was reported that at least one person has been prosecuted.
Per-contact risk of human immunodeficiency virus transmission between male sexual partners
Reports on follow up from prospective cohort study of gay and bisexual men. Findings include estimates of risk from unprotected anal intercourse and oral sex.
The problem of ‘significant risk’: Exploring the public health impact of criminalizing HIV non-disclosure
Emphasizes that the concept of significant risk undermines communication about transmission risk during HIV counselling and contributes to contradictory advice about disclosure obligations. Criminalization discourages openness about HIV non-disclosure in counselling relationships. The recontextualization of public health interpretations of significant risk in criminal proceedings can intensify criminalization.