Deutsche AIDS-Hilfe statement

Deutsche AIDS-Hilfe, the largest HIV voluntary sector organisation in Germany issued a position paper in April 2009 which broadly echoed the Swiss statement. They said that if the following conditions are met, the sexual transmission of HIV is unlikely:

• The HIV-positive partner’s viral load has been undetectable for at least six months.
• There is good adherence to antiretroviral treatment.
• There is no damage to mucous membranes.

Whereas the Swiss had stated in definitive terms that in these circumstances people cannot sexually transmit HIV, the German paper describes transmission as “improbable”. They say that the transmission risk is comparable to that when using condoms consistently. If an individual combines condom use with controlled viral load, then the transmission risk is described as close to zero.

Deutsche AIDS-Hilfe draw attention not only to sexually transmitted infections like syphilis and herpes, but also to other causes of damage to mucosal surfaces in the vagina, penis, anus and gut. Damage may also be caused by conditions which cause inflammation of the gut like ulcerative colitis and Crohn’s disease, or by fistulas (abnormal passages, for example between the vagina and the bladder).

The paper mentions cases where HIV has been detected in semen although it was undetectable in the same person’s blood, and also highlights the case of the German man who transmitted HIV to his regular partner while undetectable on combination therapy.¹

Nonetheless Deutsche AIDS-Hilfe argue for a 'realistic' HIV prevention approach which recognises that individuals do not necessarily aim to completely eliminate all risks, but balance risk reduction against sexual desires. They emphasise that individuals will make their own decisions according to their own priorities.

Moreover, although they acknowledge that there is very little evidence available on the effect of viral load on infections between gay men, they suggest that such evidence is unlikely to be produced in the foreseeable future. They argue that it is logical to assume that gay men on effective treatment also experience dramatic reductions in their infectiousness.²