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Awareness of treatment’s impact on transmission is transforming the lives of couples of mixed HIV status
Roger Pebody, 2015-09-21 10:20:00

A greater understanding of the impact of HIV treatment on prevention is changing the experience of being in a relationship with a partner of a different HIV status, according to a qualitative Australian study published last week in the Sociology of Health and Illness. A biomedical intervention appears to be having unexpected effects – loosening the association of serodiscordant relationships with ‘risk’ and helping couples to experience their relationships as normal and safe.

Asha Persson of the University of New South Wales reports that people’s views about treatment as prevention have changed significantly in recent years. She previously researched the topic in 2009, soon after the ‘Swiss Statement’ was issued. At that time, people in a relationship with a partner of a different HIV status often expressed scepticism or uncertainty about the idea that HIV treatment could make a person non-infectious. They did not always see the relevance of the information to their own lives.

But in her more recent interviews, conducted in 2013 and 2014, couples readily discussed the implications of having an undetectable viral load. HIV treatment appears to be transforming the social and sexual lives of people living with HIV and their partners.

The research specifically focuses on so-called ‘serodiscordant couples’, in other words those in which one person has HIV and the other does not. The public health literature on serodiscordant relationships typically focuses on the risk of HIV transmission and tends to see such a relationship as inherently problematic. In contrast, Persson found that her interviewees wanted to stress how normal and positive their relationships were, with HIV being seen as ‘no big deal’.

She interviewed 38 people who were in a relationship with a person of a different HIV status in Australia. Members of 25 couples were interviewed, including 13 couples in which both partners were interviewed. As well as 16 gay couples, there were seven heterosexual couples and two which included transgender people. Of the 25 HIV-positive partners, 20 were taking HIV treatment and had an undetectable viral load, and three were about to start. Half were diagnosed before their current relationship and half were diagnosed while in it.

About half the couples had sex without a condom. Typically, heterosexual couples were monogamous and did not use condoms. Gay couples were more likely to have open relationships, and also more likely to use condoms together.

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