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Risk of HIV transmission going down

Health By Gatonye Gathura
The study reported not a single infection from a virally suppressed partner to their mate (Photo: Shutterstock)

Muhia and his wife have two children. The wife is living with HIV, they do not use any protection and are happily planning for a third child.

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But the eight-year marriage has not always been a breeze considering that Mary secretly but religiously swallowed ARVs until she was busted one day.

When Muhia eventually found the pills, Mary could no longer hide her condition. “I am HIV-positive,” she had told him.

This true story is told by Geoffrey Njenga, a communications officer with the charity group Jhpiego in their official blog.

Immediately, Muhia went to the health facility to check his HIV status. The HIV-testing counselor there was more curious than respectful: “Is this your wife, or someone you picked from the streets?” Yes, Mary was his wife, Muhia replied, and they had lived together for seven years in Murang’a County.

The man had tested negative, much to Mary’s relief and surprise. But she had offered to leave the marriage nonetheless, fearing the stigma that couples often face if a partner has been diagnosed with HIV.

Muhia had however, reassured her, saying: “We cannot separate because of a disease.”

Mary is among 1.3 million Kenyans living with HIV, and among the 96 per cent who are on ARVs medication.

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Because she takes her medication as prescribed without failure, she is also among the majority of infected Kenya who have managed to suppress the virus to undetectable and untransmissible levels.

The Kenya Population-based HIV Impact Assessment (KENPHIA) 2018 report released in February showed 90.6 percent of infected adults on medication have achieved viral load suppression.

This means, these people though positive cannot infect their sexual partners, a concept HIV programmes have been promoting in the last four years.

This campaign, called Undetectable = Untransmittable or simply U=U followed four large studies conducted from 2007 to 2016.

They studied among thousands of serodiscordant couples (where one partner is living with HIV) reported not a single infection from a virally suppressed partner to their mate.

This, medical experts say, has several benefits including reduced stigma toward infected people, increased demand for testing and use, and adherence to medication.

“This is a message of hope to those living positively. It is the success that comes along with adherence. The victory after all those days you feel like the drugs were a burden,” says the NGO Aidsmap.

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Warranted skepticism?

But not everybody is taken in by this U=U message including the infected, their partners, and even health workers.

“I don’t believe in that; even if they have undetectable viruses …… we have never told them that they should stop using protection,” said a female peer educator at the Coast.

“After testing him, I was told his viruses were low, like dead. And so, the health workers told me that he could not infect me with HIV … I don’t believe it because I know that he can infect me regardless of his viral load,” said a female HIV negative partner.

These discussions were reported recently by researchers from Kenya Medical Research Institute (Kemri), Jomo Kenyatta University of Agriculture and Technology (JKUAT) and University of Washington, US.

The study appearing in the Journal of the International AIDS Society in February was exploring HIV elimination through the U=U concept in Kenya.

Led by Dr Kenneth Ngure of JKUAT, the researchers had involved 61 HIV negative women whose partners were positive and using protection. They had also involved 83 health workers from 30 health facilities.

The authors say they found most of the health providers, including nurses and clinicians to have little confidence in the U=U concept.

“Many lacked confidence in U = U and counseled on consistent condom use even after viral suppression. Others expressed concerns that the message would encourage infected people to engage in multiple sexual relationships,” says the study.

Still, other health workers said they did not tell HIV positive persons about the reduced risk of transmission for fear of being blamed if infection occurred.

While the U=U campaign managers recommend virally suppressed people be told they have no risk of infecting others at all, the report says that bolder health workers are only likely to talk of low or reduced risk.

“Most health providers used words such as ‘very low,’ ‘minimal’ ‘like zero’ and ‘close to zero’ to describe the risk of HIV transmission after viral suppression. Very few used the words “no risk.”

A founding member of the U=U campaign Dr Carrie Foote, of Indiana University, US, and herself living with the virus says this language is not good enough.

“Instead of using phrases such as ‘greatly reduces’, ‘close to zero’, or ‘extremely unlikely’, it is important to definitively state that those who have an undetectable viral load cannot pass on the virus and that successful treatment eliminates onward transmission.”

The general consensus, however, is that there is still a long way to go before most Kenyans take to the new message. But still may answer the curiosity why many partners in a serodiscordant relationship remain uninfected.

NB: Names have been changed to protect identity.

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