Not long ago, it was common for gay and bisexual men and others at high risk for human immunodeficiency virus, or HIV, to engage in “serosorting,” or choosing a romantic partner based on shared HIV status. “Someone who was HIV positive had to live in fear that they would infect their partner,” says Richard Greene, M.D., an HIV researcher and associate professor of medicine at the New York University School of Medicine. Meanwhile, HIV-negative individuals had to trust that their partner was being honest about their HIV status.
But much of that is in the past, Greene says. Thanks to advancements in HIV treatment, serodiscordant couples can have sex without risk of transmitting HIV. While one of these drugs is for HIV-negative individuals, the other is for those who have HIV.
Pre-Exposure Prophylaxis (PrEP)
PrEP is a prescription drug that contains two antiviral medicines used to treat HIV. “PrEP is one pill, once a day, that someone who is HIV-negative can take to protect themselves from transmission,” Dr Greene says.
While PrEP isn’t a guarantee, it does lower the risk of transmission by up to 92 per cent, according to the CDC. When combined with condoms, the risk of HIV transmission drops almost to zero, Dr Greene says.
He says insurance typically covers the cost of PrEP for people at high risk for HIV, which includes those in a sexual relationship with an HIV-positive partner. “It’s not protection against any other STDs,” Greene adds. (A condom is still the best protection against gonorrhea, chlamydia, and other sexually transmitted diseases.)
But if you’re diligent about taking your PrEP pill every day, it’s an effective way to protect yourself from HIV.
Antiretroviral Therapy (ART)
HIV is a type of virus known as a “retrovirus.” And since the 1990s, prescription antiretroviral therapies (ART) have helped those with HIV keep the virus from progressing to AIDS.
But while ART has been around for decades, these antiviral drugs have become far more effective, Dr Greene says. Not only can they allow someone who is HIV positive to live a normal, symptom-free life for decades, but they can also eliminate the risk that an HIV-positive individual will transmit the virus to a partner or offspring, he says.
He mentions the U=U campaign, which stands for “undetectable equals untransmissible.” During the past decade, three landmark studies have shown that HIV-positive individuals on ART who have an “undetectable viral load” cannot transmit the virus to a partner.
“These studies followed couples for years and found no incidence of transmission,” Dr Greene says. He points out that, just last year, the CDC backed both these findings and the U=U campaign. “We used to have these stigmas about what it means to have HIV in the body, and all that’s changing,” he says.
To be clear, someone who is HIV positive must be on ART meds and showing an undetectable viral load for at least six months before they can safely have sex without fear of transmission, Dr Greene says. He explains that viral load is measured every three months via a blood test and that current ART therapies are usually a single prescription pill taken once a day.
The Bottom-Line For Couples
If one partner has HIV, ART and PrEP allow both people in the relationship to take steps to safeguard the HIV-negative individual’s health status. “Now someone who is HIV positive no longer has to live in fear that they’re going to pass this virus on,” Dr. Greene says.