A new paper published in The International Journal of STD and AIDS by University of Otago researchers reports that the number of gay and bisexual men diagnosed with HIV in 1999 – 2009, the decade following the widespread introduction of subsidised antiretroviral drugs (ARVs), increased by a 137%.

Shaun Robinson, New Zealand AIDS Foundation (NZAF) executive director, says “The effectiveness of new combination ARV treatment introduced in 1996 has substantially reduced the number of people who are dying from AIDS and HIV-related conditions. This is an excellent outcome. However, it also means there are more than double the number of gay and bisexual men in the community now who can transmit HIV if they’re not using condoms and lube.”

Other research that is starting to come to the fore points to the failure of previously promising interventions for gay and bisexual men. Robinson says, “The latest research into the preventive effects of having an undetectable viral load shows that HIV levels are very low in the blood that’s taken for the test. Unfortunately, the levels of HIV in rectal mucosa and semen – the fluids that transmit HIV during anal sex – are much higher.”

The invasive and difficult procedures required to regularly test rectal mucosa and semen have led to delays in research being undertaken and thus information being available.

Robinson says, “In light of the trends over the recent decade, and the unreliability of viral load being an accurate indicator for the risk of sexual transmission, we’re strongly advocating that universal condom use is still the way forward. Relying on knowledge about HIV status and HIV treatment alone doesn’t work to prevent HIV transmission. If they did then there wouldn’t have been a 137% increase in HIV in the communities that we’re serving. Luckily, there’s still one intervention that will prevent HIV and that’s condoms and lube.”