You are here

Stigma is so yesterday

Dr Michael Brady reveals that, although medical science has provided huge advances in the treatment of HIV, many people still face unfounded prejudice.

When I meet patients who have recently been diagnosed with HIV, their most common concerns are about transmission, having sex and disclosing their status to others. The three letters are so loaded with fear around infectiousness that many mistakenly believe they have to give up on the idea of love, a healthy sex life and a family for ever.

It’s great to be able to dispel these concerns with a simple medical fact: effective HIV treatment stops you from being able to pass the virus on to others. Once treatment has reduced the amount of virus in the blood to such low levels that it can no longer be detected, you become un-infectious.

The scientific evidence has been building for years, but medical advice began shifting to the more definitive “can’t pass it on” when the ground-breaking PARTNER study published its findings. Out of 58,000 instances of condomless sex reported in the study — where one partner was HIV positive and on effective treatment, and the other was HIV negative — there were zero HIV transmissions.

This was demonstrated again when Opposites Attract — an Australian study of more than 350 gay male couples — showed zero HIV transmissions when the positive partner was taking HIV treatment, with researchers confirming an undetectable viral load was “completely effective” at preventing HIV. I’ve seen first-hand the relief and the weight being lifted, once people living with HIV hear this message for the first time. It changes everything.

A huge amount of the stigma and discrimination around HIV is rooted in ignorance and a fear of being infected. I am still shocked to hear people sharing examples of abusive messages they’ve received on dating apps, for example, after being open about their HIV status. This kind of thing is unacceptable and unfounded.

Thanks to science, people don’t have to put up with that anymore. People diagnosed with HIV on effective treatment are undetectable and, therefore, not infectious. The greatest risk of HIV transmission is from people who haven’t had a test and may have undiagnosed HIV — not those who have taken the proactive steps to get tested, get on to treatment and are now un-infectious.

This requires a shift in how we think and talk about HIV. The old approach, of treating someone living with HIV as an infection risk and of people being told to disclose their HIV status to every potential partner, is no longer justifiable. People living with HIV still have concerns about being prosecuted for passing it on, a practice called “reckless transmission”.

In the era of effective HIV therapy — where an undetectable viral load means no risk of transmission — these fears should be a thing of the past. People on effective treatment can have the confidence that they don’t need to disclose their HIV status until they feel ready and comfortable to do so because they are responsibly preventing transmission to their partners.

However, increasingly I find people saying that being un-infectious, in fact, makes it easier for them to have open discussions with new partners about their HIV status, and to talk more confidently about sexual health more generally. It can be liberating.

We still have much to do to spread the word. We need to say, in no uncertain terms, that people on effective HIV treatment cannot pass on the virus. But we won’t unravel decades of fear overnight. Even among some healthcare professionals the message has not completely got through. There is continued use of unnecessary caveats such as “extremely unlikely” or “very low risk”. This may come from a well-intentioned place, but it is unhelpful and outdated.

Far from being irresponsible, it’s a very simple HIV-prevention message: get tested, know your status and, if you’re positive, start treatment as soon as possible. It will keep you well and protect your partners. Only when this becomes common knowledge can we start to bring an end to HIV transmission and the stigma that surrounds it.

 

latest news

May 9, 2018
The federal government's budget details were released last night. Here's a community response.
March 29, 2018
We’re not talking about recovery parties here, but the post-recovery recovery when the festivities have ended.
March 21, 2018
The world has lost one of the most respected scientists in the field of HIV/AIDS, Professor David Cooper.
March 21, 2018
The cost of PrEP (pre-exposure prophylaxis) is to be drastically reduced from 1 April
February 12, 2018
The annual awareness day on 9 March is aimed at encouraging women to test for HIV.
January 22, 2018
Once again, 9 March commemorates the National Day of Women Living with HIV Australia. 
November 30, 2017
On a trip to Bali, David Menadue discovered that it pays to be clued up about travel insurance.
November 30, 2017
Armistead Maupin talks to Steven Petrow about 1970s San Francisco, AIDS and ageing.
November 30, 2017
This year marks the 30th anniversary of the AIDS Memorial Quilt. Read the story behind the icon.
November 29, 2017
They are the all-too forgotten minority: heterosexual men with HIV. Here are their stories.
November 29, 2017
In 2018, researchers will explore a number of approaches that might bring an end to the need for treatment.
November 29, 2017
As people with HIV get older and live longer, they become vulnerable to cardiovascular disease. 
August 22, 2017
A decision to subsidise PrEP has been deferred, much to the disappointment and frustration of HIV advocates.
July 26, 2017
Results from an Australian study show that HIV-positive men on treatment cannot transmit the virus.
June 22, 2017
Why is an easily curable disease once believed to be on the wane in Australia out of control?