Sexual transmission of HIV and use of undetectable viral load as a means to prevent transmission of the virus depends on maintaining an undetectable viral load. It is worth remembering this when we mention it as a “strategy that has gained space nthe past few years, within the HIV prevention toolbox which has expanded significantly.
IThis is due to the rapid growth in our knowledge of effective approaches that help prevent HIV transmission. However, to maximize the impact of these approaches on the HIV epidemic, we must effectively increase awareness, understanding and appropriate use of them.
Three approaches to help prevent sexual transmission of HIV.
These statements are designed to help service providers in Canada adapt their programs and incorporate this evidence into their messages.
There are three highly effective strategies to help prevent the risk of sexual transmission of HIV:
- The consistent and correct use of antiretroviral treatment (ART) by people living with HIV to maintain an undetectable viral load
- The consistent and correct use of oral pre-exposure prophylaxis (PrEP)
- The consistent and correct use of Condoms
When any highly effective strategy is used consistently and correctly, the risk of sexual transmission of HIV ranges from zero to very low.
The following statement focuses on the use of antiretroviral treatment (ART) by people living with HIV to maintain an undetectable viral load. It starts with a simple key message, followed by recommendations for service providers and a list of available tools and resources. It also provides a review of the evidence that service providers can use for more specific discussions with customers. See the accompanying statements for more information on the other two highly effective strategies.
Sexual transmission of HIV is the means of greatest impact
The consistent and correct use of antiretroviral treatment (ART) by people living with HIV to maintain an undetectable viral load is a highly effective strategy to prevent sexual transmission of HIV. When this strategy is used consistently and correctly, there is no risk of sexual transmission of HIV.
For more information, see adas revisionevidences at the end of this statement.
What are the gains with these means of combating HIV contagion?
In addition to improving the health of people living with HIV, ART has important benefits in preventing HIV when it is used to maintain an undetectable viral load. People working with communities at risk or living with HIV have an important role to play in promoting this approach as a highly effective prevention strategy.
Below are recommendations on how you can better integrate the use of ART for prevention into your schedule.
- Increase awareness of the use of ART to maintain an undetectable viral load as a highly effective HIV prevention strategy, including the important factors to maximize its effectiveness. Any educational and counseling activities provided to HIV-positive and HIV-negative clients should include information about the prevention benefits of ART and an undetectable viral load and how to use it consistently and correctly.
Education and counseling activities should also include the discussion of other prevention strategies, such as, but not limited to, condoms and pre-exposure prophylaxis (PrEP). Encourage customers to choose the combination of strategies that will work most effectively for them.
It is important that clients - whether people living with HIV or at risk of HIV - receive information and advice on using ART to maintain an undetectable viral load as a highly effective strategy for preventing sexual transmission of HIV. When talking to clients, you can explain to them that a body of evidence shows that people on ART who maintain an undetectable viral load and are involved in care do not transmit HIV through sex. Discussions should include the factors necessary to maximize the effectiveness of this strategy.
Points to emphasize in the use of ART as a means of decreasing risks of HIV transmission?
- Adherence to ART is essential for obtaining and maintaining an undetectable viral load (generally defined in Canada as less than 40 or 50 copies of the virus per milliliter of blood).
- It usually takes three to six months to achieve an undetectable viral load. A viral load test is the only way to know if your viral load has reached undetectable levels.
- Maintaining a sustained undetectable viral load for at least six months is necessary for this approach to be effective. Regular viral load testing is the only way to monitor a sustained undetectable viral load.
- Regular medical visits are necessary for ongoing care, including monitoring of viral load.
When discussing with a client the use of ART to maintain an undetectable viral load, it is important to recognize that each client has the right to decide whether or not to take ART based on their own assessment of what is best for their health and well-being. .
You can also lead or support efforts to raise awareness of the use of ART to maintain an undetectable viral load as a preventive approach among a variety of service providers in your area, including doctors, nurses, pharmacists and non-clinical staff in organizations. community activities.
- Facilitate and support the use of ART to maintain an undetectable viral load as a prevention strategy. Treatment guidelines now recommend offering ART to all people living with HIV, regardless of their CD4 count. This recommendation is based on the health benefits of starting ART early on for people living with HIV, although an important secondary benefit is HIV prevention. If your client is HIV positive, you should help to link him to HIV care, if he doesn't already. The client's decision to start ART should be well informed. ART requires a lifelong commitment to the daily intake of pills and regular visits to a healthcare professional. Facilitating informed decision-making for clients may require the provision of services that support the doctor-patient relationship.
Emphasize the correct use of HAART in combating HIV infection
Support clients who are using ART with education on its consistent and correct use to maintain an undetectable viral load as a prevention strategy. You may have to provide, or link clients to, interventions to support medication adherence and continued involvement in medical care. Encourage customers to take regular viral load tests if they want to use undetectable viral load for prevention, in addition to the benefit for their own health. They should also discuss the results of the viral load test with the partner (s) regularly, if possible.
Encourage and support clients to communicate openly with their sexual partner (s). Clients may need support to reveal their HIV status to a sexual partner. If a client is in a serodiscordant relationship, important discussion topics for the couple may also include whether there are sexual partners outside the relationship and the results of monitoring viral load and testing for sexually transmitted infections (STDs). Educating HIV-negative clients about HIV viral load and what it means to be undetectable can give them a better understanding of the concept of treatment as prevention.
- Encourage a comprehensive sexual health plan. Discuss how using ART to maintain an undetectable viral load fits into a comprehensive sexual health plan, including regular STD tests and safer sexual practices.
Inform that ART and Undetectable Viral Load May Fail to Combat HIV Transmission
There are circumstances in which HIV transmission can occur when a person living with HIV is on ART. There is a risk of HIV transmission right after starting ART, before the viral load becomes undetectable. There is also a risk of HIV transmission if treatment fails to maintain the viral load of the positive partner at undetectable levels.
This usually occurs due to low adherence to treatment, but it can also occur due to drug resistance. If this occurs, the person should discuss the options with their doctor. However, studies show that the main risk of transmission to an HIV-negative partner comes from sexual partners outside the serodiscordant relationship, where highly effective prevention strategies cannot be used.
It is important for clients to understand these risks and the options available so that they can decide in an informed and conscious way about the use of ART as part of a comprehensive personal care and care plan for sexual health, in order to minimize the risk of transmission long-term HIV. A comprehensive sexual health plan also helps protect against STDs, as ART does not offer any protection against STDs.
Guide the Fight of the Adjacent Risk of Contagion with Condom
- Approach the underlying risk of HIV transmission. HIV prevention counseling offers an opportunity to involve individuals in additional services. You can help your clients deal with the underlying factors that can increase their risk of HIV, such as depression or the use of alcohol and other substances; reinforcing safe sex strategies; and facilitate the growing use of all prevention strategies appropriate. You may find that counseling alone is not enough. It may be necessary to provide - or link customers to - appropriate and relevant support services.
- Offer comprehensive couples-based counseling. For couples, you may want to advise both partners at the same time, couples-based counseling, as this can be more effective than advising partners individually. Couples-based counseling can create a supportive space where clients can reach a consensus agreement on how to reduce the risk of HIV transmission, develop ways to support each other in using HIV prevention strategies consistently and correctly . As well as discussing potentially sensitive issues relevant to HIV prevention.
Talking about Sex, pleasure and sexuality is necessary to fight Pandemic
HIV / AIDS
Be prepared to discuss issues such as what a couple wants from sex and the way of making love that they like best; the desire for pleasure, intimacy, the concept of monogamy or not monogamy and even polyamory, as well as the need to reveal the occurrence of sex outside the relationship. This counseling can also support non-monogamous clients to develop strategies or agreements to help prevent HIV or STDs from external partners, such as the consistent and correct use of condoms for sex outside the relationship.
- Incorporate information on the use of ART to maintain an undetectable viral load in all prevention programs to increase its impact. Personal counseling is a way of transmitting information about ART as a highly effective prevention strategy. However, this information can be integrated into several other communication channels, such as print publications, websites and campaigns to increase its reach and impact.
7. Be prepared to discuss the legal issues surrounding HIV disclosure. Canadian law requires people to tell their sexual partners that they have HIV in certain circumstances. However, the law and its applications are evolving. For the most up-to-date information on when people with HIV have a legal duty to disclose their HIV status, contact Canadian HIV/AIDS Legal Network.
Reading Suggestions in Combating HIV
- Undetectable Viral Load Gives Negative Test?
- HIV Infection: Medication Against HIV Prevents HIV Infection
- Undetectable Viral Load gives No Reagent?
- Undetectable Viral Load and HIV-negative transmission
- Viral Rebound and Chemical Dependence
- Viral charge! What is it, and what are viral load tests for?
- HIV viral load tests why take them?
- Antiretroviral therapy. ART or “the Cocktail”
- HIV for Bisexual and Heterosexual Lesbians. “O Caminho das Pedras”!
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