The main headline “Loyal Lovers Live Longer” on the cover of The May 8, 2019 Issue of SFGN obscures the importance of a recent HIV study. The study did not show that “loyal lovers lived longer.” It showed that Undetectable equals Untransmissible (U=U). When antiretrovirals suppress HIV, current health is maintained, and transmission becomes impossible. The study said nothing about “loyalty,” or monogamy. The problem lies in the main headline not in the story.
The SFGN article referred to a Lancet article about a two-phased study. The first phase, PARTNER 1 enrolled gay male and het couples. All couples had mixed-HIV statuses. The second phase, PARTNER 2, only enrolled gay male couples. PARTNER 1 study had too few gay male couples to provide precise estimates of risk.
The PARTNER 2 had the goal “to provide precise estimates of transmission risk" in mixed-status gay couples. That Lancet article concluded “that the risk of HIV transmission through anal sex when HIV viral load is suppressed is effectively zero.” It said nothing about partner loyalty or monogamy.
In this eight-year study of 782 mixed-status gay male couples, 15 HIV-negative partners did acquire HIV. Researchers compared strains of HIV between the partners. They found no evidence of HIV transmission within the relationship. They inferred sexual contact outside the relationship.
The article had no data about whether the couple had an open or closed relationship. If they had an open relationship, "loyalty" becomes an irrelevant concept.
More importantly, 288 (37%) of all HIV negative men in the study reported condomless anal sex outside of the relationship. That would mean that 273 men (94.8%) had anal sex outside their relationship without acquiring HIV. Only 15 men (5.2%) acquired HIV outside their relationship. The study proved nothing about the side issues of “loyalty” or monogamy.
This study provided more strong support for the Undetectable = Untransmissible (U=U) movement. The larger headline stressed a side issue that the study did not address.
If anyone would like to read the full Lancet study, they can visit http://bit.ly/2wef6sp
– Sean McShee
SFGN HIV Editor