by: VICTOR EBOH ESQ (LEGAL/REPRODUCTIVE RIGHT OFFICER) LAWYERS ALERT
1st day of December of every year is designated as WORLD AIDS DAY, an international day dedicated to raising awareness of the Aids pandemic caused by the spread of HIV infection and mourning those who have died of the disease.
There is no known cure for HIV/AIDS in the world today. However, treatment for
HIV, offers hope for people living with the virus. According to the UNAIDS Fact Sheet (2019), there are 37.9 million people living with HIV, globally.
Out of this number, 24.5 million people are accessing HIV treatment.
In Nigeria, UNAIDS (2018) estimated that 1.9 million people in Nigeria were living with HIV, however, in 2019 statistics indicate a 1.4% HIV prevalence rate among adults aged 15-49 years in Nigeria. Consistent and effective HIV treatment leads to improved health outcomes for people living with HIV.
Scientific evidence holds that people living with HIV who have an undetectable viral load cannot transmit HIV via unprotected sex to their partners. This is the basis for the undetectable equals untransmittable (U=U) concept.
CONCEPT OF UNTRANSMITTABLE (U = U)
The U=U Campaign was started by PREVENTION ACCESS, an organization in
the United States which seeks to raise awareness and ensure universal access to
treatment for people living with HIV. It is beneficial for people who are diagnosed
with HIV to start treatment early and adhere, by remaining on treatment. This
reduces the amount of HIV in the blood stream to an undetectable level. In simpler
terms, an undetectable HIV viral load means that the amount of HIV in the blood is
negligible.
The Centre for Disease Control, CDC (2019) holds that most people on
HIV treatment achieve an undetectable viral load within six (6) months of initiating
HIV treatment. This occurs as long as they consistently take the medication as
prescribed. After, the initial six (6) month period, adherence to HIV treatment is
advised to ensure that the HIV viral load stays undetectable. While the CDC (2019)
defines an undetectable viral load as having less than 200 copies of HIV per mililitre
of blood, the Canada AIDS Treatment Information Exchange, CATIE (2018) notes
that, HIV viral load is undetectable when it is less than 40 to 50 copies of HIV per
mililitre of blood.
The U=U concept is supported around the world by renowned organizations. The
World Health Organization, WHO (2019) cites an empirical study to the effect that,
the risk of HIV transmission through sex, where condoms are not used, in sero-discordant couples is effectively zero when HIV viral load is suppressed through
ART treatment. The WHO recommendation to initiate ART in all people living with HIV will contribute significantly to reducing HIV transmission.
From the foregoing, there is no risk of HIV transmission through unprotected sexual
intercourse from a person living with HIV to a negative partner as long as the former
is on HIV treatment and has achieved an undetectable viral load. This finding has far
reaching implications on the relationships and interactions between people living
with HIV and those who are HIV negative, especially surrounding stigma and
discrimination.
People living with HIV often suffer stigma from other members of the public when they know the HIV status of the former. Thus, scientific evidence such as U=U which supports the fact that people living with HIV who consistently adhere to HIV treatment, and become undetectable, cannot transmit HIV through unprotected sex, “strikes down” the reason for the stigma and discrimination against people living with HIV.
In addition, UNAIDS (2018) lends credence to the U=U concept with its submission
that, there is a strong scientific consensus that people living with HIV who are taking effective antiretroviral therapy and whose level of HIV is suppressed to undetectable levels, will not transmit HIV sexually.
This evidence from UNAIDS (2018) is borne from twenty (20) years of research
which demonstrates that effective treatment of HIV reduces the risk of HIV
transmission. Due to this fact, the U=U concept validates previous concepts such as
Treatment as Prevention (TasP). The reasoning is logical. If HIV treatment reduces
the risk of HIV transmission, then it simply means that HIV treatment is an effective
strategy at preventing the transmission of HIV from one person to another. However,
it is important to reiterate the conditions necessary for which transmission of HIV
will not occur. The person living with HIV, has to adhere to HIV treatment and consistently maintain an undetectable HIV viral load.
In Nigeria, (and indeed most countries of the world) HIV treatment services are free and viral load tests are conducted once every six (6) months. There is a persistent need to ensure that user fees are not charged to encourage access and uptake of HIV treatment.
Strict adherence to HIV treatment is advised for people living with the virus. This is
necessary because consistent HIV treatment ensures that the virus remains
undetectable over a long period and reduces the risk of transmission via unprotected
sex to zero (0). Thus, people with effective HIV treatment cannot transmit the
virus through unprotected sex. This has far reaching implications on public health
and should re-configure popular perception about HIV especially the way people
living with HIV are treated in society.
Evidence for further validation of the U=U concept is provided by findings from
other empirical studies. Three (3) large studies (undertaken between 2007 and 2016)
were cited by Cohen, Chen, McCauley et al (2011), Roger, Cambiano, Bruun et al
(2016), and Grulich et al (2015). In each of these studies, the researchers investigated
sexual transmission of HIV among thousands of couples. With each of these couples,
one partner was living with HIV and the other was not, i.e. sero-discordant.
Findings from these studies show that there was not a single case of HIV transmission from the partner living with HIV (who had achieved undetectable levels of HIV) to their HIV negative partner. (Source: Rural Renewal & community Health Development Initiative)
Conversations as well as public enlightenment about the U=U concept are necessary
In the society to combat the stigma and discrimination which people living with HIV
face, especially regarding inter-personal relationships, family and even in the work
place. With the empirical evidence presented on U=U, people living with HIV
should not be barred from marriages and romantic relationships with others who are
HIV negative. They pose no risk because they cannot transmit the HIV virus through
unprotected sex. Sero-discordant couples have the potential of raising children
without the risk of transmitting HIV. Also, marital disharmony owing to HIV
diagnosis of one partner should not arise.
CONCLUSION
The concept of U=U offers hope to people living with HIV because HIV treatment
affords dignity, inclusion and acceptance in society. With effective public
enlightenment via relevant communication channels, notions of HIV/AIDS as a
deadly epidemic can be replaced with the U=U concept which demonstrates how
HIV transmission can be stopped. The hope and benefits from maintaining
undetectable levels of HIV will encourage people living with HIV to access HIV treatment services because it is a means to an end. Families, relatives and partners will be more accepting and supportive to persons living with HIV because they are no longer threatened by HIV transmission and treatment holds greater promise for better health outcomes.
Furthermore, countries and legal systems which impose travel bans as well as
criminalize people living with HIV on account of disclosure and so called “intended
HIV transmission,” need to revise these laws via necessary steps in the judicial
process. The scientific evidence from existing research is sufficient basis for judicial
reform in this respect. Also, the police, vigilante and other security agencies require
education and enlightenment on the U=U concept in order to guide the
administration of justice when complaints and disputes regarding HIV transmission
are brought before them.
References:
1. Three (3) large studies (undertaken between 2007 and 2016)
were cited by Cohen, Chen, McCauley et al (2011), Roger, Cambiano, Bruun et al
(2016), and Grulich et al (2015)
2. UNAIDS (2018) is borne from twenty (20) years of research
which demonstrates that effective treatment of HIV reduces the risk of HIV
transmission.
3. The World Health Organization, WHO (2019)
4. Canada AIDS Treatment Information Exchange, CATIE (2018)
5. The Centre for Disease Control, CDC (2019)
CAVEAT
Lawyers Alert hereby puts our readers on notice that this article is based on the writers opinion and do not necessarily represent the views of the organization except otherwise stated.