Risk of HIV transmission from patients on antiretroviral therapy: A position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy

Albert, Jan; Berglund, Torsten; Gisslén, Magnus; Gröön, Peter; Sönnerborg, Anders; Tegnell, Anders; Alexandersson, Anders; Berggren, Ingela; Blaxhult, Anders; Brytting, Maria; Carlander, Christina; Carlson, Johan E.; Flamholc, Leo; Follin, Per; Haggar, Axana; Hansdotter, Frida; Josephson, Filip; Karlström, Olle; Liljeros, Fredrik; Navér, Lars; Pettersson, Karin; Johansson, Veronica Svedhem; Svennerholm, Bo; Widgren, Katarina

doi:10.3109/00365548.2014.926565

Cited by 28 publications

(24 citation statements)

References 15 publications

(13 reference statements)

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“…Although the legislation relating to the legal obligation to inform a partner about HIV changed in 2013 in Sweden (Albert et al, 2014; SMI, 2013), the regulations were often experienced in our findings as repressive and old-fashioned compared to those of other countries; for example, Switzerland (Hasse et al, 2010), where the law differs from Sweden in relation to the legal obligation to use a condom (Vernazza, Hirschel, Bernasconi, & Flepp, 2008). Several countries, similar to Sweden, have legal statutes relating to HIV-positive individuals about HIV non-disclosure, HIV exposure and/or HIV transmission (UNAIDS, 2012, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…As a mother, a woman must not breastfeed her baby (SMI, 2013). In 2013–2014, due to the new knowledge about low risk of sexual transmission, the interpretation of the Swedish law changed, which made it possible for the treating physician to remove the HIV-positive person’s duty to inform about HIV in sexual encounters in instances where they have not been diagnosed with other sexually transmitted diseases, they demonstrate good adherence to ART, and they have undetectable plasma viral load (HIV RNA < 50 copies/ml) (Albert et al, 2014; SMI, 2013). …”

Section: Introductionmentioning

confidence: 99%

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Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Carlsson-Lalloo

Berg

Mellgren

et al. 2018

International Journal of Qualitative Studies on Health and Well

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The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Carlsson-Lalloo

Berg

Mellgren

et al. 2018

International Journal of Qualitative Studies on Health and Well

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“…Mono-therapy with Zidovudine (AZT) and combined antiretroviral therapy (ART) are effective in reducing vertical HIV transmission from mother to child [1–7]. Lifelong ART decreases morbidity and mortality in adults across all CD4 counts [8, 9], protects the foetus from HIV infection from the time of conception in subsequent pregnancies and reduces the risk of transmission to partners [10–12]. In 2013, the WHO recommended the use of lifelong ART in all pregnant and breastfeeding women at the time of HIV diagnosis regardless of CD4 count, known then as prevention of mother to child transmission (PMTCT) option B+ (PMTCTB+) [13].…”

Section: Introductionmentioning

confidence: 99%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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BackgroundUniversal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland.MethodsLifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses.ResultsOf 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+.ConclusionsPMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.

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“…Consequently, although sexual transmission is a common form of HIV transmission at a global population level, this Consensus Statement recognizes that the possibility of HIV transmission during a single sexual encounter ranges from no possibility to low possibility, while it ranges from no possibility to negligible possibility in cases of spitting or biting. This approach to the science of HIV in the context of criminal law is similar to that used in national scientific consensus statements from Australia , Canada , Sweden and Switzerland .…”

Section: Discussionmentioning

confidence: 99%

Expert consensus statement on the science of HIV in the context of criminal law

et al. 2018

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IntroductionGlobally, prosecutions for non‐disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence.DiscussionTwenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV‐negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant.ConclusionsThe application of up‐to‐date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.

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Risk of HIV transmission from patients on antiretroviral therapy: A position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy

Cited by 28 publications

References 15 publications

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Expert consensus statement on the science of HIV in the context of criminal law

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