Safer Sex can work in different ways

Zum Europäischen Tag des mehrsprachigen Bloggens am 15. November 2013 veröffentlichen wir einen Beitrag von Holger Wicht, der im Rahmen der Kampagne „Wussten Sie eigentlich?“ anlässlich des 30-jährigen Bestehens der Deutschen AIDS-Hilfe im September 2013 in deutscher Sprache erschienen ist. Darin geht es um eine Schweizer Familie, die den lebenden Beweis liefert, dass eine gut wirkende HIV-Therapie genauso zuverlässig schützt wie Kondome. Viel Spaß beim Lesen!

Michèle and Mic enjoy their little disagreements. This is often the case with couples who have been happy together for a long time. There are one or two issues that always lead to a debate. When exactly they decided to stop using condoms is one question on which they don’t exactly see eye to eye, for example. „We talked about it in bed“, Michèle recalls. „Sometimes we didn’t use one, then we did …“

„We did talk about it in bed“, Mic emphasises. But then, as far as he remembers, the matter was resolved: condoms are no longer required. For him, the HIV-negative husband of an HIV-positive wife, there was no longer any doubt: he trusts in the protective properties of Michèle’s medication (see information below). He has never been afraid, he says, „or maybe just a tiny bit.“

„It just feels good an right“

Michèle is now also certain about it: „It just feels good and right.“ The 48-year-old has been with the 54-year-old Mic for ten years and they live with their daughters Sofia and Mona in a small town near Basel. But it was a long journey before they found happiness in their married and family lives.

A little under twenty years ago: Michèle wants nothing more desperately than a child. Her boyfriend at the time is HIV-positive, but he is the father of two HIV-negative children – why shouldn’t that work again? The two of them take the chance.

And everything goes wrong: Michèle loses the child, her HIV test a few weeks later is positive. The relationship falls apart. There are still no effective treatments for HIV. „I thought I would grow old with the burning desire for children, but don’t ask how old“, Michèle recalls.

Ten years later: Michèle comes across an ex-boyfriend, her childhood sweetheart. She knows that her HIV treatment reduces the risk of infection massively, but she does not feel comfortable relying on that. He is the one who wants to do without condoms. She refuses, but eventually lets herself be won over – and falls pregnant. The ex disappears again, but Sofia is born. Drugs prevent HIV infection of the child and to be on the safe side Sofia is given the agent AZT after birth.

For Mic, Michèle’s infection is not a problem

The dream of having a child has been fulfilled, the yearning for a fulfilled relationship remains. Until Michèle meets Mic via a ridiculously expensive text message chat service. When they meet for the first time a week later, she is scared to tell him that she is HIV-positive. But Mic has already googled the busy activist and is fully in the picture.

The surprise: for Mic, Michèle’s infection is not a problem. „I said to her: tell me what we have to be careful about. I trusted her, but at the same time I felt responsible for myself and found out everything I needed to know.“

At that time, sex without condoms was out of the question for the couple. „Even after the business with my ex, I was worried for three months that I might have infected him“, says Michèle, „I didn’t want to go through that again.“

They put their shared desire to have another child on ice for financial reasons. Not long after, Michèle becomes pregnant. Despite safer sex. There is no such thing as complete certainty in life. „We have no idea how we made Mona“, says Michèle with a laugh, „it must have happened during foreplay somehow.“

A chat with her doctor changes everything. „If you like, you can have the child without a Caesarian“, says the doctor. At that moment, the penny drops. „I thought: during a birth there is pressure, friction, a lot of blood. If nothing can happen then, I’m really not infectious any more.

Natural birth despite HIV – everything suddenly became clear

After Mona was born, Michèle and Mic decided not to use condoms any longer. This fulfils a deep need for both of them, which they had denied themselves in the past: sexuality without anything „technical“ coming between them. „It’s just wonderful to be able to feel each other completely, without any barriers“, says Michèle. „And it was a huge relief for me finally not to feel I was a danger any more.“

It takes a little while before the fear goes away completely, until the knowledge of the protective effect of the treatment becomes a tangible reality. Above all, one question preoccupies her: „I wanted to know if Mic still loved me if I did infect him after all.“

Mic protests immediately: „It wouldn’t be the case that you had infected me! I am in full possession of my intellectual faculties and I take full responsibility.“

How can Mic remain so calm in the face of a virus that makes other people panic? „I can count“, he says, in laconic reference to studies on the subject. „The risk is so small, that mathematically it’s safe to say it is zero. If it happened, it would be an extremely improbable accident. I drive a car, even though something could happen to me when I do so – and with far greater probability.“

Sex without condoms is now part of everyday life for them

Then a grin spreads over his face: „Anyway, I’m already scared enough of lung cancer and heart attacks. I don’t need anything else to worry about.“ A hypochondriac who is not afraid of HIV? „I can count“, he repeats with a twinkle in his eye. In the meantime, he has even stopped having himself tested for HIV. Sex without condoms is now part of everyday life for them, as it is for other couples.

Few couples speak as openly as Michèle and Mic about the fact that they do not use condoms despite HIV. As president of the self-help organisation LHIVE, Michèle has insisted on speaking openly in the Federal Commission for Aids Issues (Eidgenössische Kommission für Aids-Fragen – EKAF). In 2008, after a long battle, the committee published a paper that said: people who are HIV-positive are not sexually infectious if they have undergone successful treatment. This statement has been discussed throughout the world ever since then. That’s how Michèle and Mic ended up with their family story on stern TV and answered Günter Jauch’s questions. The children were playing quietly in the next room. They know – as Mona puts it – that „mum has a virus, but it can’t hurt dad because she takes medication.“

It takes time for knowledge to become tangible reality

Adults sometimes have difficulty believing this. A few years ago, a French Aids activist even accused Michèle of being a murderer, even though Mic is obviously alive and kicking.

In Michèle’s experience, it is people who are HIV-positive in particular who have difficulty trusting in the protection given by the treatment. Many people have said: we are not allowed to do that. That’s why we talk about it in public. Not everyone should have to go through this process alone and the issue should not be locked away behind four walls. It is a great relief to know that nothing can happen!“

Michèle knows these moments of uncertainty herself. „I had internalised the idea at a deep level that as someone who is HIV-positive I am a danger and bear more responsibility.“ „Such rubbish“, Mic counters, „we took the decision together.“ They do enjoy their little arguments.

Protection through treatment

A properly effective HIV treatment provides just as much protection against infection with HIV as a condom. The medication prevents the virus from replicating in the body. After a while, there are very few viruses, if any, in the body fluids and mucous membranes. HIV transmission during sex without a condom is therefore virtually impossible. Only one case in which a partner was infected has been documented worldwide.

In 2011, the study HPTN 052 provided scientific evidence of the high degree of protection offered by HIV treatment. The prerequisites for protection through treatment are that no viruses have been found in the blood of the HIV-positive partner for at least six months, that the viral load and other blood parameters are checked every three months and that he or she takes the medication regularly, so that virus replication is continuously blocked.