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The TasP approach is playing an increasingly important role in the prevention of HIV infections. These four letters stand for “treatment as prevention,” i.e., HIV protection through treatment. In practical terms, this refers to the attempt to treat HIV-positive individuals and reduce the virus to undetectable levels. If the viral load is no longer detectable, infection during sex is virtually impossible. You could then have sexual intercourse with an infected person without contracting HIV yourself. We will explain how this works, how safe TasP is, and what you need to bear in mind.
How does TasP work in practice?
We have long known that HIV is not an immediate death sentence and that the onset of AIDS can be delayed for decades with effective therapy. Nevertheless, contact with an HIV-positive person still causes fear and concern, especially when it comes to sex.
If a condom breaks, post-exposure prophylaxis is quickly administered at the clinic to prevent infection. Although this is reliable, it is an enormous burden. TasP takes a different approach. The aim here is not to react in an emergency, but to prevent infection from occurring in the first place.
Taking antiretroviral drugs significantly reduces and inhibits the replication of HI viruses in the body. If you take your medication reliably and regularly, the viral load in your blood may no longer be detectable. From this point on, HIV is no longer considered transmissible. Sexual contact without a condom is then even possible, but TasP only protects against HIV, not other sexually transmitted diseases.
The role of “U” in TasP
When discussing TasP, you will repeatedly encounter the letter “U,” which plays an important role. “U = U” stands for “undetectable = untransmittable.” This means: “What cannot be detected cannot be transmitted.”
Deutsche Aidshilfe reports that over 550 HIV organizations worldwide have signed this statement and that even the US CDC considers “U = U” to be a given.
The Deutsche Aidshilfe magazine gives the topic controversial significance. It points out that the statement is considered remarkable. There is no scientific evidence that infection does not occur.
However, studies conducted in recent years up to 2018 have repeatedly shown that undetectable HI viruses are not transmitted to other people.
Aidshilfe has recorded milestones from the past decades, dating back to 1998:
● In 1998, it was observed for the first time that triple antiviral therapy reduced the transmission rate. The first expert opinion stating that therapy inhibits the risk of transmission dates from the same year.
● Between 2000 and 2005, there were several research and observational studies on the topic, and in 2008, new expert opinions and reviews of the data collected so far were added.
● In 2011, randomized studies led to verifiable data for the first time.
● In 2017, observational studies continued, and the first data on the risk for gay men became available. In the same year, more intensive “U = U” campaigns were launched.
PARTNER study proved safety for gay couples for the first time
For many gay men, the fear of HIV infection was a constant companion during sex for decades. Two international studies (PARTNER and Opposites Attract) followed couples in which one partner was HIV-positive and the other was not over a period of several years. The decisive factor was that the HIV-positive men were receiving effective therapy and their viral load was below the detection limit.
What is remarkable is that despite tens of thousands of instances of unprotected sex, there was not a single case of HIV transmission. Neither the 91 homosexual PARTNER couples with other STIs nor the 358 gay couples from Opposites Attract showed any evidence of transmission.
For the gay community, this clearly shows that “U = U” is not just a theory, but reality. This breakthrough is particularly important for gay men, as fear of HIV in the community makes spontaneous sexual encounters difficult. Stable therapy builds trust among HIV-positive men and reduces stigma and fear.
How does infection protection work in practice?
If an HIV-positive person takes their HIV medication reliably, it prevents the HI virus from multiplying in the body. After a period of consistent therapy, HIV can no longer be detected. Doctors refer to this as a viral load that is below the detection limit.
The test is performed on blood, but the effect is also transferable to other bodily fluids such as ejaculate.
According to current findings and study results, TasP is just as effective or even more effective than condoms. However, it is important to mention once again that other STIs can still be transmitted. Protection through therapy is now a recognized method for safer sex, if we only look at HIV.
How long does TasP work?
Protection does not begin immediately with the start of antiviral therapy, but only after six months at the earliest, when the viral load is no longer detectable. The infected patient must take their medication reliably and consistently. If you cannot verify this with your partner or do not believe them, TasP is not safe.
It is also important that the HIV-positive person has a blood test every three months at an HIV clinic or an experienced specialist practice. The result is verified here so that TasP remains safe in the long term.
Although the medication does not have to be taken at exactly the same time every day, continuity is important. According to the FAQ of Aidshilfe Konstanz, forgetting to take the medication once does not jeopardize the success of the therapy. If several doses are missed, this can affect the viral load. A resurgence cannot be ruled out with certainty.
In principle, the effect of TasP can diminish over the years. There are various possible reasons for this. For this reason, the “contraceptive method” is only considered complete if blood tests are carried out once a quarter.
Can you really do without condoms with TasP?
In stable, trusting relationships, protection through therapy is an effective method of preventing HIV transmission. You must always ask yourself how sure you are about the conditions. Do you know for certain whether your partner is taking their medication on time and reliably? Have all medical check-ups been carried out on time?
You should only do without condoms if you are 100 percent sure. If you don’t know much about your partner and it’s casual sex, realistic condoms, for example, offer better protection than TasP because you can control them. You also need to bear in mind that effective protection against HIV does not automatically mean effective protection against gonorrhea, chlamydia, and many other STIs.