How HIV-discordant couples can enjoy unprotected sex life
With sex, the foremost intention of the couple is to experience pleasure. As young people, we worry about what will happen if the condom bursts, for instance.
By AGGREY OMBOKI
Joyce Auma is passionate and outspoken about the need for HIV-discordant couples to have a healthy sex life.
This, she says, is primarily because sex feels good. However, the pleasurable sensations also come with the inevitable burden of worry for youthful partners.
“With sex, the foremost intention of the couple is to experience pleasure. As young people, we worry about what will happen if the condom bursts, for instance,” the former AVAC fellow and HIV treatment advocate says.
In a HIV discordant couple, one of the partners tests positive for the virus while the other does not.
Previously, medics used to advise such couples to use consistently and correctly use condoms except that fertile time for the woman when they wished to get a child.
According to the community development undergraduate, the reluctance of male partners to use condoms has been an extra hurdle on the youthful couples’ path to enjoying comfortable, worry-free sex.
“It is difficult to negotiate condom use while in relationships as young people. Most men want to hit it raw, and this can be a source of worry and discomfort to us,” she says.
Thanks to science, Ms Auma and other partners in discordant relationships can now enjoy those special moments.
“PLHIVs are now viewed as non-contagious as a result of this science,” she says.
According to Dr Lazarus Momanyi of the Ministry of Health, a viral load of more than 200 copies per millilitre is indicative of the person being capable of spreading the virus.
“When the viral load is more than 200 copies per millilitre, it means there is a risk of transmitting the virus during sexual intercourse. If diagnosed at this level we encourage the person to immediately begin treatment.
Scientific findings tabled by experts and ratified by the World Health Organization, CDC and Unaids show that a virally suppressed individual on treatment cannot transmit the virus through sexual activity.
“When we begun treatment, we were encouraged to take medication so that we do not infect others,” she told the Woman’s Newsroom.
“This is because consistently and correctly taking medication can reduce the viral load,” adds Ms Auma.
In Kenya, 1,250,134 people representing 83 percent of the 1,508,405 people living with HIV are on antiretroviral (ARV) treatment.
Approximately 257,000 or 17 percent of those living with HIV are yet to be put on ARV treatment.
Dr Momanyi says the challenge remains locating and encouraging the remaining PLWHIVs to be put on treatment.
A total of are said to overall suppressed. This represents 78 percent of the people living with HIV and 94 percent of those on treatment.
According to Dr Momanyi, the virus was initially perceived as the result of irresponsible sexual behavior. These previous and long held prejudices and stigma against PLWHIVs as contagious and terminally ill are however fast fading away.
“It is hard to imagine that stigma against PLWHIVs still exists in this day and age. Science has shown there is absolutely no need to stigmatize such individuals,” he says.
Dr Momanyi says the ARV medication has improved the quality of life for people living positively to the level where they can actively participate in productive activities.
“People living with HIV are not patients. They need medication to boost their immune system so that they do not frequently fall ill due to opportunistic infections. This will improve their quality of life and enable them fulfill their potential,” said the medic.
The regimen consists of TLD, made up of Tenofovir, Lamivudine and Dolutegravir
Taken consistently and correctly with a balanced diet and plenty of water and exercise, the ARV regimen can result in a reduced viral load of less than 150 copies. At this level, the virus is undetectable in conventional tests and is untransmittable through unprotected sex.
The science has come as a relief to discordant couples.
“U=U improves confidence, especially for discordant couples. I am dating a HIV-negative person and can talk about it with confidence,” says the bubbly 23 year old Auma.
As a young person, she understands and appreciates the fact that relationships are at that fun stage in life, packed with the heady rush of emotions and sensations that characterize an active sex life.
“Sex is spontaneous for young people. Now with U=U, we cannot only have sex as discordant couples but also enjoy it. It improves our treatment options and encourages us to be virally suppressed,” adds Judy.
“As a sero-discordant couple, it gives us the chance to live and enjoy our lives as normally as other HIV-negative couples do,” she said.
Ms Auma says the science is reassuring for discordant couples, but does not mean that other risks associated with unprotected sex are out of the picture.
“It is important to note that U=U only applies to sexual transmission of HIV. Other risks including pregnancy and STIs remain,” she says.
“If you are a mother and breastfeeding, there is still a chance that you can transmit HIV to your child,” she says.
Not all people have achieved viral suppression, and sometimes the U=U may have the effect of putting pressure on them or cast doubts on their confidence in the treatment.
She notes that the science has also come with its fair share of pressure on the partners living positively in discordant relationships.
“Depending on the way the message is coined, U=U places the burden of HIV prevention on the person living with HIV, she says.
Overall, she remains convinced that U=U still a good thing for many people living positively.
“The science has given us autonomy and the ability to enjoy sex. I have been undetectable for 10 years and looking forward to many more years of the same. We still have the unspoken few, who are yet to achieve viral suppression, which means the journey is not yet over for all the people living positively and undergoing treatment,” she says.
She is however emphatic that measures against new HIV infections, unplanned pregnancies and STIs must continue using existing tools as well as new ones.
“In addition to existing measures, other new strategies are needed to combat the threat of new HIV infections, STIs and unplanned pregnancies.
“Apart from increasing our HIV viral load, we also don’t want to get pregnant or get sexually transmitted infections (STIs).
She also pointed out the uncertain times the COVID-19 pandemic had placed ARV treatment clients.
“When I go to the facility to collect my medicines this morning, I found all the young clients at the facility being lectured by a medic as to why they should not be failing to attend their clinic sessions. Accessing youth friendly services in our health facilities is still a problem,” she said.
She also pointed out that viral load testing seems to have stagnated.
“I have not been tested for viral load for a whole year, and our facility has not indicated when we can expect to get tested and given the results. This has also been a source of concern for us in the ARV treatment program as we are not able to regularly track our progress,” she said.
