AIDS Action Committee’s Blog

Comment by dsaklad@gnu.org

February 4, 2007 @ 1:05 am

Here’s a better strategy… How about considering
the phenomenon of the strategy of
potential sex partners getting tested TOGETHER for
A VARIETY of sexually transmitted infections BEFORE having
sex. A thought experiment. Any ideas? suggestions? A few of
us with personal experiences have been discussing a thought
experiment the strategy of potential sex partners getting
tested TOGETHER for a VARIETY of sexually transmitted
infections and revealing their results to one another
BEFORE having sex. Public health officials have not been
observing the phenomenon of this strategy. Informally,
clinicians for example like those at Dartmouth College
Health Service student medical services have seen same sex
and heterosexual couples who say we haven’t had sex yet and
we want to know more about what could happen before we
begin the sexual part of our relationship. Journalists have
not observed the phenomenon other than the syndicated
Ann Landers’ columns recommending the strategy for
potential couples concerned about their sexual histories.
Here’s a collaborative blog http://notb4weknow.blogspot.com
Questions. How widespread is the phenomenon going on of the
strategy of let’s get tested TOGETHER for a VARIETY of STDs
BEFORE we have sex? Besides reducing ambiguity for the
respective sex partners doing the strategy, what would be
the effects on the epidemic? the effects on transmissions
of human immunodeficiency virus? if 1% of the population
did the strategy? if 10% of the population did the
strategy? If some percentage of the population did the
strategy, at what level could the course of the acquired
immune deficiency human immunodeficiency virus epidemic
change? What related studies are going on now or proposed?
What related reports have come out? What media have covered
or mentioned the strategy? Have you or anybody you know
actually tried the strategy?

Comment by Emily

February 4, 2007 @ 11:19 am

You make it pretty clear that you think the strategy of partner testing before becoming sexually involved makes sense. I agree! That in fact would be a gold standard in HIV prevention and I can say that I have met with people who intend to use that strategy to keep them and their sexual partners safe. I cannot give you a statistic, and I’m not sure what scale you were thinking (U.S.? North America? Global?), but I would say it’s more than rare but less than common in Western countries. That’s just my estimate.

This column was about microbicides, so I’ll reframe from wandering too far from this topic here (though there’s a lot of places we could go with it). The very need for microbicides (a gel people could use during sex to reduce the likelihood of HIV transmission) exists because not everyone everywhere is able to advocate for themselves and their partners to get tested and share that information. You might imagine the difficulty some people have disclosing that they have HIV to someone they’d like to have sex with. In order for both members of a couple to engage in the strategy you suggested, there has to be no threat of violence or other threats to a person’s safety or well-being, a comfort in talking about sex (which is not the norm in many countries and for many people) and enough knowledge, information and resources to know when/how/where to get tested.

Thinking epidemiologically for a second, a crux of the strategy you brought up in what we call “the window period” - the time it takes for the body to develop enough HIV antibodies to be detected by an HIV antibody test. It can take six weeks to six months for that to happen, depending on who you ask. Here in Massachusetts, we feel confident that our testing can detect at six weeks. Federally, our public health service says three to six months. So picture this: Two people beginning a relationship decide they’d like to have sex and want to be sure neither has any STD, including HIV, before they do. One partner ended their last relationship a month ago and last had unprotected sex three weeks ago. The newly formed couple go and get tested a week later. It is possible that the partner who had sex “in the window period” will not yet have a positive HIV result as it is too early in that infection for it to show up. Also please keep in mind that it can take two weeks or more for the results to return. So for the couple who chooses this method, a period of up to eight weeks or more of abstaining from all sexual activities that put one at risk for HIV is necessary.

This is just one of many challenges in the strategy you suggested and, although ideal, because it has not and in all reality will not be the strategy chosen by people who are not already practicing it, we need other strategies and new technologies like microbicides, vaccines, pre-exposure prophylaxis and other barrier devices like diaphragms to be developed and made available as soon as possible for those folks not in a position to negotiate testing before intercourse.

Comment by Judy

February 4, 2007 @ 12:14 pm

It’s imperative that other safe options, I emphasize SAFE options, be available to prevent HIV/STD transmission. Microbicides sound like an alternative that would be easy to use (very important), and hopefully, without side effects (tests should identify if there are any). Who can be contacted to advocate on their behalf? Are the family planning offices, clinics etc. mounting a national effort to contact congressmen and women now?
Thanks for keeping us informed about the benefits and status of microbicides. Spreading the word is imperative.

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