Guidelines from BHIVA, BASHH and FSRH

British guidelines on the sexual and reproductive health of people with HIV include some discussion of the issues first raised in the Swiss Statement. The guidelines were produced in 2008 by the British HIV Association (BHIVA), the British Association of Sexual Health and HIV (BASHH) and the Faculty of Sexual and Reproductive Health of the Royal College of Obstetricians and Gynaecologists (FSRH).¹

The guidelines acknowledge the “compelling evidence” concerning virally suppressive treatment and vaginal or oral sex, but the authors say they “cannot fully endorse the Swiss consensus statement”.

A number of concerns are raised:

• Gaps in the evidence on anal sex.
• Individuals making decisions based on incorrect assumptions.
• The limited period of time that people remain undetectable.²

The key points are:

• HAART reduces the risk of HIV sexual transmission and for individuals with chronically suppressed viral loads the transmission risk may be negligible in the absence of STIs .
• In most circumstances, counselling and advice should continue to promote the use of condoms to reduce the transmission risk of HIV and other STIs.
• Detailed individual counselling including the use of harm reduction should be available for individuals in sero-different and sero-same long-term relationships who wish to consider unprotected sexual intercourse.