With access and adherence to antiretroviral therapy (ART) and comprehensive health care, it is not only possible but very likely that people living with HIV (PLWH) will live long and relatively healthy lives. As HIV has transformed from an acute infection and guaranteed death sentence into a chronic disease that can be managed, so have the lives of PLWH.

 

Many PLWH want and have the right to healthy relationships, marriages, children, and many of them will have intimate relationships with people who do not have HIV. These HIV-negative partners are not doomed to contract the virus; in fact, under the right conditions, it is very unlikely for them to become infected.

 

The Swiss Consensus Statement (English summary) outlined the criteria that make transmission nearly impossible. For example, if an HIV-positive person is on ART with strict adherence, has had a suppressed viral load (<40 copies/ml) for the past six months, and has no other sexually transmitted infections, it is unlikely that person will transmit the virus during unprotected heterosexual intercourse. It is impossible to prove that this event will never happen, but research has not been able to document transmission under these conditions.

 

In a session, titled “Sero-different: Experiences about Sex and Relationships,”at the XVIII International AIDS Conference in Vienna, presenters and participants discussed both the science of HIV sero-different relationships, including the risk of transmission, and the psychosocial elements, including fear of becoming infected, fear of infecting, disclosure to friends and family, stigma and discrimination, and the constant struggle to find information.

 

Presenters emphasized that there are limited resources and information for people in sero-different relationships, as well as for their care providers and counselors. People in sero-different relationships must make informed decisions about using protection, disclosing their status to family and friends, and whether or not to have children in a complex personal and socio-cultural context. However, the role of counselors and providers remains very important; they must provide their patients with the best tools available so that they are able to make the best decisions in their contexts. Counselors and providers have a responsibility to encourage communication about these issues, provide as much information as possible, and refrain from judging the decisions of their patients, whatever they may be.

 

Due to a lack of resources and information available, I will be researching this topic in the upcoming weeks to find and disseminate the information that does exist. I invite you all to contribute resources that you are aware of by emailing me at cmickish@jhuccp.org. 

 

Healthy, safe, and mutually satisfying relationships are an important component of sexual and reproductive health and a fulfilling life. With high quality up-to-date information, we can give sero-different couples the tools they need to advance their relationships and their overall well being.