• We recommend that ART is offered to all PLWH for the prevention of onward transmission 
  • We recommend the evidence that treatment with ART substantially lowers the risk of transmission is discussed with all PLWH 
  • An assessment of the risk of transmission to others should be made at diagnosis and subsequent visits  

The discussion should include the following:

  • If the decision to start ART is being driven primarily by transmission risk it should be the HIV-positive individual’s choice and must not be due to pressure from partners or others.
  • The clinical benefits of ART at all CD4 cell counts should be emphasised.
  • Individuals should be reassured about the relatively low risk of tolerability and toxicity issues with modern ART, and the option to switch ART if problems occur.
  • Condoms, both male and female, continue to be recommended as protection from other sexually transmitted infections and unplanned pregnancy.
  • There are risks associated with interrupting ART, and once started, it should generally be continued
  • Much of the evidence that ART lowers the risk of transmission mainly relates to vaginal sex. Recent data also show that ART greatly reduces the risk of transmission for anal sex, although the upper estimates for risk for anal sex are higher, and more data are needed; therefore, other prevention strategies, including condoms, should be discussed.
  • High and consistent adherence to ART is required to maintain viral suppression and minimise transmission risk.
  • Taking ART does not result in immediate complete viral suppression; it usually takes several months to achieve an undetectable viral load (VL) in blood.