Massive transmission-rate study debunks the justification for punishing people with HIV

With an undetectable viral load, HIV-positive men are not transmitting the virus to others.

CREDIT: iStockPhoto/jasam_io
CREDIT: iStockPhoto/jasam_io

For the second time in two years, a massive study has found that for men who have managed their viral load to undetectable levels, it’s virtually impossible for them to transfer HIV to their male sexual partners.

Unlike last year’s study (“PARTNER”), which involved both different-sex and same-sex couples, the new study (“Opposites Attract”) focused entirely on same-sex male couples from Thailand, Brazil, and Australia with mixed HIV statuses. When one partner is HIV-positive and the other is HIV-negative, they’re referred to as a serodiscordant couple.

Over the four years these couples were followed, the study captured about 12,000 condomless sex acts between an HIV-positive partner with an undetectable viral load and an HIV-negative partner who was not taking PrEP, medication that helps protect people from contracting the virus. There were zero HIV transmissions.

An additional 5,000 condomless sex acts took place between a partner with an undetectable viral load and a partner who was taking PrEP. There were zero HIV transmissions.

Of the 343 couples in the study, only three of the HIV-negative men contracted the virus, and genetic testing determined in all three cases that they didn’t actually get it from their partner.

“Opposites Attract” is only the latest study to show how invaluable it is to fighting the epidemic to make sure people get tested, diagnosed, and started on treatment. So long as the treatment is effective and they stick to it, the risk they will pose to others will be “vanishingly small” or “even negligible,” according to Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

The robust findings in the culmination of these studies has significant implications for the 30 states and 72 countries that still have laws criminalizing the nondisclosure of HIV status in sexual encounters. Not only do these laws do nothing to change anybody’s sexual behavior, but they’ve been also found to discourage HIV testing and may even contribute to sexual behavior that is more risky for transmission.

Given the evidence that a person in effective treatment poses no threat of transmission to others, it becomes increasingly clear that laws punishing people for not disclosing their status do nothing to actually protect their partners from HIV — but instead simply punish people for having HIV.