A recent Swiss AIDS Commission report demonstrated that some HIV-positive people who met several criteria did not transmit the virus to their partners, even when condoms weren't used. The finding sparked a joint statement critical of the report from the San Francisco AIDS Foundation and the San Francisco Department of Public Health.
The statement said the report offered "insufficient evidence to abandon safer sex practices."
According to the joint statement, the Swiss report was based on four studies that used only heterosexual couples. One study found that HIV-negative partners did not become infected when the HIV-positive partner followed his treatment regimen, had at least six months where his viral load couldn't be detected, and he didn't have other sexually transmitted diseases. That study involved 393 couples.
Another study that the report was based on found that almost 14 percent of 43 HIV-negative partners became infected if the HIV-positive partner sometimes strayed from his treatment regimen, according to the joint statement.
Mark Cloutier, executive director of the San Francisco AIDS Foundation, said, "I think there's a little hazard of them putting this out and not adequately explaining what was not known and the unpredictability of abandoning condoms."
The two San Francisco entities took issue with the report for several reasons. One was that only heterosexual intercourse was studied. Other reasons included the possibility of viral load spikes, and resistance developing to treatment drugs.
The Bay Area Reporter sent a copy of the statement to Bernard Hirschel, a co-author of the Swiss report. Hirschel responded by e-mailing a frequently asked questions sheet that didn't directly address the statement.
However, the sheet did purport that the chance of viral load spikes are small. The sheet also states, "There is really no good biological reason why vaginal transmission should be any different from rectal transmission."
Dana Van Gorder, executive director of Project Inform, which operates an HIV/AIDS hotline, said the Swiss report reaffirms something important – adherence to treatment can lead to reduced viral replications, which can help avoid transmission.
"I think we have to treat people like adults with regard to this kind of data," Van Gorder said. "Medical strategies like effective HIV treatment, combined with the practice of safe sex is ... in their interest."
Cloutier agreed the fact that treatment can reduce the risk of infection is well known, but said this was a separate matter, since the Swiss report doesn't just talk about effective treatment.
Longtime AIDS activist Michael Petrelis blogged about Hirschel's work in December, before the report was released. He wonders why others didn't catch on, and said there should have been a public meeting locally before the statement was put out.
"The basic modus operandi is experts in ivory towers make a pronouncement for the rest of us, and we weren't invited to sit at the table," Petrelis said.
Dr. Grant Colfax, the health department's director of HIV prevention, said, "This response was done in collaboration with a well-respected community-based organization ... We thought it was important to get this information out into the community. "He was referring to SFAF's participation in the joint statement.
Colfax said with the exception of Petrelis, response has been "almost uniformly positive."
Cloutier said the report didn't get a lot of traction among the public. He said he hasn't heard of anyone calling the organization's hotline or Magnet, the gay men's health center in the Castro that merged with SFAF last year. Van Gorder said he wasn't aware of calls to Project Inform about the report.