Should I wear a condom if my HIV viral load is undetectable?

This seemingly simple question was recently debated at IDWeek 2016 held in New Orleans. Compelling evidence was presented on both sides of the argument along with significant statistical data supporting the argument that condoms are not necessary. For example, a study conducted in Uganda of 400 serodiscordant couples (one being HIV positive and the other negative) found no cases of HIV transmission when viral load was below 1500 copies/ml. Further, a Canadian meta-analysis of six cohort studies of over 7000 serodiscordant couples again found no new HIV cases when the HIV positive partner had a confirmed undetectable viral load. So, with such compelling evidence why not just stop wearing condoms?

Well, following the debate most of the attendees came down in favour of regular condom use. Their reasoning was based on three main points. The first is that condom use prevents not only the transmission of HIV but of many other STI’s as well. Rates of Chlamydia, Gonorrhoea and Syphilis are reaching all-time highs and Gonorrhoea is becoming worryingly hard to treat successfully. Also, there are new and emerging STI’s which need to be controlled such as the Zika virus, for which there is increasing evidence of serious harm not only to developing foetuses but to adults as well.

Secondly, undetectable viral loads can become detectable. All it might take is a few forgotten doses of medication and the person who was earlier not infectious could now pass on the virus. And even if the possibility of this is remote, is it worth the risk?

Finally, whilst there has been no evidence of HIV transmission when the positive partner’s viral load was undetectable, there is still a theoretical risk. We know that the virus is still present in the person’s body, so there should still exist a theoretical chance of the infection being passed on. Again, should we really be taking this risk?

The balance of opinion at the end of the debate was just under 70% in favour of continued condom use even where the viral load was undetectable. Certainly not a unanimous view but a clear majority opinion.

Our personal views and decisions on matters such as this must start with a test to know our own status. Have you tested recently? If not, contact Better2Know on the number above, get tested and no matter what the results remain informed and behave responsibly towards yourself and others.