advice specific to the prevention of sexual transmission of HIV infection
Advice to people living with HIV, their sexual partners and those from groups with higher incidence of HIV infection should include:
- taking effective antiretroviral therapy and having a quantitative plasma viral load below the limit of detection of currently available assays significantly reduces the risk of HIV transmission
- despite routine undetectable plasma viral load measurements a residual risk of transmission is likely to exist
- a negative plasma viral load cannot always be considered as a marker of an undetectable seminal viral load and there are reports of HIV transmission with undetectable plasma viral load. The residual transmission risk is likely to be higher for anal sex than for vaginal sex
- the risks are increased with reduced antiretroviral therapy adherence or the presence of STIs in either partner. The risks can be reduced by using condoms and having regular STI screens
- serodiscordant (also known as mixed-status, is one in which one partner is infected by HIV and the other is not ) couples should receive detailed expert counselling and support on the transmission risks and other relevant issues
- discussion regarding the early initiation of antiretroviral therapy to reduce the risk of HIV transmission should be considered as part of safer sex counselling for some people living with HIV
Seroadaptive behaviours including negotiated safety, serosorting and seropositioning
- seroadaptation includes
- serosorting - choosing partners with concordant HIV status
- "strategic positioning ", also interchangeably termed "seropositioning" - choosing the position taken during sexual practices according to HIV status
- negotiated safety - usually refers to the use or non-use of condoms according to a partner's HIV status
- these strategies have mainly been described in men who have sex with men (MSM), in whom 14-44% report serosorting and 6-35% seropositioning, but also in heterosexual populations, and may be more common and better adhered to than consistent condom use
- negotiated safety and serosorting should be discussed with those who are known or suspected to be unable or unwilling to maintain 100% condom use
- MSM should be advised that serosorting is less effective than consistent condom use but more effective than non selective nonuse in preventing HIV acquisition or transmission
- HIV positive MSM should be advised of the risk of acquiring other STIs, in particular Lymphogranuloma venereum and Hepatitis C, through unprotected sex with other HIV positive men
Post-exposure prophylaxis following sexual intercourse and preexposure prophylaxis:
- all individuals at increased risk of HIV acquisition (including those in serodiscordant relationships, MSM and those from, or with partners from, populations with high HIV seroprevalence) and those at risk of transmitting HIV should receive verbal and written advice on the indications for and availability of PEPSE (Post-Exposure Prophylaxis Following Sexual Exposure) (1)
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