The PARTNER study doesn’t just tell us that HIV-positive gay guys on treatment are pretty safe. It tells us that they’re safer than a lot of ‘HIV negative’ guys.
The big news at last week’s HIV conference in Boston was a thing that didn’t happen. A trial, the PARTNER study, found that no one, gay or straight, who had HIV but was on successful treatment transmitted the virus to their partner over the two years the trial has so far lasted. And that’s in people largely not using condoms. As Tyler Curry writes in his blog, this is big news.
One of the researchers said that they’d have expected 86 transmissions between partners, or thereabouts, if none of the HIV positive people was on treatment. It was no big surprise that instead they saw none, since successful HIV treatment reduces the amount of HIV in your system ten-thousandfold or more.
To those less acquainted with the workings of HIV, and more surprised by the news, you’d think this would be cause for celebration. In the gay community, however, the news was received by many with disbelief ("This is bullshit science" said one) or downright fear.
Take someone Tyler Curry quotes. "HIV undetectable (people) will use it as excuse to bareback" [Yes, but terms solely of HIV risk, the PARTNER study is telling us it won’t matter if they bareback] "or skip their daily antiviral meds" [Why in God’s name would they want to do that?] "Then become re-infected creating a super bug of HIV that current meds can’t treat" [Run for the hills].
A couple of ‘Yes, But’s. Firstly, the reason the trial does need to be continued in gay men is because so far we only have relatively few people in it.
A proper scientist, unlike me, would say something like this: "Seeing zero transmissions allows us to estimate that the true risk of transmission lies somewhere between zero and 1% a year" – not that comforting if taken over ten years.
But that caveat is about the fuzziness of the picture we have, and not about the thing it shows, namely nothing. Researchers expect that with more people and time, and barring nasty surprises, the maximum estimate of risk will probably edge ever closer to zero.
A bigger ‘Yes, But’ is this: the PARTNER scientists are keeping another figure close to their chest: the number of HIV infections the negative guys actually got. They hinted there were quite a few, and probably a lot of other STIs too. A smidgeon of HIV may come from the 5% or so of positive partners who were unlucky enough to have treatment failure. But the vast majority will come from sex with guys outside the main relationship. Mainly, probably, guys who thought they were HIV negative.
And here we get to the heart of the meaning of the PARTNER study. It confirms that we gay men have to change our ideas about infectiousness and HIV radically if we are to stand a chance of reducing HIV infection in our community.
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