No. A person living with HIV on antiretroviral therapy (ART) with an undetectable HIV viral load in their blood for at least six months has a zero risk of transmitting HIV to a sexual partner.

Viral load refers to the amount of HIV in a blood sample of a person living with HIV. Generally, the higher the viral load, the more likely you are to transmit HIV. ART can reduce a person’s viral load to the point where it is so low that it cannot be detected by measurements. This is called ‘having an ‘undetectable viral load,’ which prevents the sexual transmission of HIV while simultaneously improving the health of a person living with HIV. Your Viral Load is considered undetectable when it is less that 200 copies/ml. It does not fully clear the virus from the body or cure someone of HIV. Excellence adherence, or taking ART as prescribed, is important to maintain an undetectable viral load.

The conclusion is based on the force of real world and research experience including PARTNER, HPTN 052, Opposites Attract, and the Swiss Statement. For instance, in the most recent study called PARTNER, there were ZERO transmissions out of 58,000 condomless sex acts between people with HIV with undetectable viral loads and their partners who are HIV negative. There have been no confirmed reports of anyone with an undetectable viral load sexually transmitting HIV in these studies.

Viral blips have not been shown to increase the transmission of HIV. Small transient increases in viral load (between 50 and 1000 copies) known as ‘blips’ sometimes result on effective ART when people are adherent, but typically return to undetectable levels without any change in treatment. Unless the viral blips start to increase in frequency, they do not mean treatment isn’t working and are normally not of concern to providers.

Having an STI is not significant to HIV transmission when the partner with HIV has an undetectable viral load. An STI in the presence of a detectable viral load may increase the risk of HIV transmission.

Regular viral load testing for health benefits is normally recommended about 2-4 times a year for people who have a stable undetectable viral load. People with HIV who are using an undetectable viral load as an HIV prevention strategy should talk to their providers to see if increased viral load testing is recommended.

Yes, when ART suppresses a person's viral load to anything less than 200 copies/ml they are considered virally suppressed or Undetectable. The sensitivity of the viral load test is constantly improving, as such it is able to detect the virus in smaller and smaller amounts, but for the purpose of transmission risk, anything under 200 means you cannot transmit HIV to sexual partners. Being virally suppressed prevents the sexual transmission of HIV while simultaneously improving the health of a person living with HIV. Excellence adherence, or taking ART as prescribed, is important to maintain viral suppression.

Yes, you can have sex and conceive children with no risk of transmission between partners or to the baby.

The risk of a mother who has an undetectable viral load passing HIV on to their unborn baby is practically zero (0.1%) while engaged in antenatal care. U=U does not apply to breastfeeding.

Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) are not needed if an HIV negative individual has sex with someone who is HIV positive, is on treatment and has an undetectable viral load.

HIV negative individuals only need PEP or PrEP if they have condomless sex with somebody who does not know their HIV status or who is HIV positive but has a detectable viral load.

People living with HIV are entitled to an active, healthy sex life. You do not have to tell a sexual partner that you have HIV, as long as you take appropriate precautions to prevent sexually transmitting HIV.

In New Zealand, what is considered 'appropriate precautions' is using a condom for vaginal or anal sex. While adhering to treatment so you maintain an undetectable viral load offers more protection than condom use, undetectable has yet to be recognised under NZ law. You can find more information on disclosing your status to others here.

It's important not to stigmatise or marginalise people who, for whatever reason, do not achieve an undetectable viral load. We must ensure we do everything we can to support them to do so while respecting their choices. This includes addressing social, psychological and stigma-related barriers to engagement in care and adherence to treatment.