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HIV-positive people with undetectable viral load pose ‘almost zero’ risk to sexual partners



People living with HIV who maintain low – but still detectible – levels of the virus and adhere to their antiretroviral regimen have almost zero risk of transmitting it to their sexual partners, according to an analysis published in The Lancet. The study’s findings will be presented at an official satellite session ahead of the 12th International AIDS Society Conference on HIV Science (IAS 2023).

Findings from the systematic review indicate the risk of sexual transmission of HIV is almost zero at viral loads of less than 1,000 copies of the virus per millilitre of blood-;also commonly referred to as having a suppressed viral load. The systematic review also confirms that people living with HIV who have an undetectable viral load (not detected by the test used) have zero risk of transmitting HIV to their sexual partners.

A new policy brief from the World Health Organization (WHO), published alongside the research paper, provides updated sexual transmission prevention and viral load testing guidance to policymakers, public health professionals, and people living with HIV based on this analysis. This guidance aims to further prevent the transmission of HIV and ultimately support global efforts to achieve undetectable viral loads through antiretroviral therapy for all people living with HIV and to prevent onward transmission to their sexual partner(s) and children.

Previous research has shown people living with HIV with viral loads below 200 copies/mL have zero risk of sexually transmitting the virus. However, until now, the risk of transmission at viral loads between 200 and 1000 copies/mL was less well defined.


The authors filled this knowledge gap by searching databases for all research studies published between January 2000 and November 2022 on sexual transmission of HIV at varying viral loads. In total, eight studies were included in the systematic review, providing data on 7,762 serodiscordant couples – in which one partner was living with HIV – across 25 countries.

These findings are important as they indicate that it is extremely rare for people who maintain low levels of HIV to transmit it to their sexual partners. Crucially, this conclusion can promote the expansion of alternative viral load testing modalities that are more feasible in resource-limited settings. Improving access to routine viral load testing could ultimately help people with HIV live healthier lives and reduce transmission of the virus.”

Laura Broyles, MD, Lead Author, Global Health Impact Group (Atlanta, USA)

Taking daily medicine to treat HIV – antiretroviral therapy, or ART – lowers the amount of the virus in the body which preserves immune function and reduces morbidity and mortality associated with the virus and helps reduce HIV progression. Without ART, people living with HIV can have a viral load of 30,000 to more than 500,000 copies/mL, depending on the stage of infection.

While using lab-based plasma sample methods provides the most sensitive viral load test results, such tests are not feasible in many parts of the world. However, the new findings support the greater use of simpler testing approaches, such as using dried blood spot samples, as they are effective at categorising viral loads for necessary clinical decision-making.

Of the 323 sexual transmissions of HIV detected across all eight studies, only two involved a partner with a viral load of less than 1000 copies/mL. In both cases, the viral load test was performed at least 50 days before transmission, suggesting individuals’ viral load may have risen in the period following the test. In studies that provided the full range of viral loads in partners with HIV, at least 80% of transmissions involved viral loads greater than 10,000 copies/mL.

Co-author Dr Lara Vojnov, of WHO, said: “The ultimate goal of antiretroviral therapy for people living with HIV is to maintain undetectable viral loads, which will improve their own health and prevent transmission to their sexual partners and children. But these new findings are also significant as they indicate that the risk of sexual transmission of HIV at low viral loads is almost zero. This provides a powerful opportunity to help destigmatise HIV, promote the benefits of adhering to antiretroviral therapy, and support people living with HIV.”

The authors acknowledge some limitations to their study. Some of the data analysed were imprecise due to variations across the studies in the definitions of ‘low viral load’, and in the timing and frequency of viral load testing and patient follow-up. Today, HIV treatment is recommended for everyone living with HIV and very large sample sizes would be needed to develop more precise estimates given the extremely low number of transmissions.

Further, the findings do not apply to HIV transmission from mother to child, as the duration and intensity of exposure – during pregnancy, childbirth, and breastfeeding – is much higher. Differences also exist in the way the virus is passed from mother to child as compared with sexual transmission. Ensuring pregnant and breastfeeding women have undetectable viral loads throughout the entire exposure period is key to preventing new childhood HIV infections.

Writing in a linked Comment, co-authors Linda-Gail Bekker, Philip Smith, and Ntobeko A B Ntusi (who were not involved in the study) said, “Laura N Broyles and colleagues’ systematic review in The Lancet further supports the almost zero risk for sexual transmission of HIV at levels less than 1000 copies per mL…This evidence is relevant for at least three important reasons. First, it highlights the need for viral load testing scale-up in all settings where people are living with HIV and taking ART…Second, as pointed out by Broyles and colleagues, these data are probably the best that we will ever have. Standard of care now requires that individuals are offered life-saving ART regardless of viral load…Third, and most importantly, this study provides strong support for the global undetectable equals untransmittable (U=U) campaign. This campaign seeks to popularise the concept that individuals with undetectable viral loads are not infectious to sexual partners, thereby reducing stigma and improving quality of life.”


Journal reference:

Broyles, L. N., et al. (2023) The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review. The Lancet.



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The Key Role of Trustworthy Babysitters in Balancing Work and Family Life




Are you a busy parent in constant pursuit of the elusive work-life balance? We know firsthand how overwhelming and challenging it can be to juggle professional commitments while still having quality time with your children.

That’s why we’re here to discuss an essential ingredient that unlocks the secret to harmony: trustworthy babysitters.

What Characteristics Parents Should Look for When Choosing a Babysitter?

Parents should look for a few key characteristics when choosing a babysitter. A good babysitter should be patient, responsible, and reliable. They should also be comfortable with children and have prior experience caring for them.

Besides, the babysitter must be able to communicate effectively and follow directions well. The babysitter should be someone the parents can trust to care for their children in their absence.


Strategies for Parents to Establish Reasonable Anticipations

As a parent, finding babysitters you can trust to care for your children is vital. However, it is also important to establish reasonable expectations for your babysitters.

Some tips for establishing reasonable expectations for babysitters include:

  1. Set clear expectations: Sit down with your babysitter to discuss bedtime routines, dietary preferences, and any necessary medications.
  2. Allow flexibility: While clarity is vital, also provide room for your babysitter to use their judgment and feel comfortable in their role.
  3. Trust their expertise: Once expectations are set, trust your babysitter’s judgment as a professional caregiver to avoid undermining their authority and creating discomfort in their role.

Determining a Fair Payment Plan

Determine your babysitting budget, factoring in your income and family size, while researching local rates. Account for the babysitter’s experience and qualifications, giving preference to those recommended by trusted sources.

Engage in open negotiations with your chosen babysitter. This aims to find a mutually agreeable arrangement that accommodates both your budget and their needs.

Tips on Finding Trustworthy and Compassionate Caregivers

When seeking a caregiver for your child, to ensure you find the right fit:

  • Seek recommendations from trusted sources such as friends, family, and neighbours who may have suggestions for caregivers in your area.
  • Conduct online research to review feedback and check references to gauge candidates’ qualifications and experience.
  • Request references and contact details from the caregivers’ previous employers or families they have worked with.
  • Trust your instincts and ensure you feel at ease with the caregiver, ensuring they are someone you can entrust with your child’s well-being.


Being able to trust your babysitter means you can have peace of mind knowing your child is safe and cared for.

Spending some time researching online reviews or asking friends and family for recommendations will help you find the perfect fit so you can feel more at ease while juggling work commitments in today’s hectic world.

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Facility-wide COVID-19 outbreak at Bethammi Nursing Home



THUNDER BAY — St. Joseph’s Care Group and the Thunder Bay District Health Unit have declared a facility-wide COVID-19 outbreak at Bethammi Nursing Home, part of the St. Joseph’s Heritage complex on Carrie Street near Red River Road.

The respiratory outbreak at the 112-bed facility was declared effective Sept. 15 but only announced publicly on Monday.

No details were provided with regard to the number of people affected to date.

Restrictions are now in place for admissions, transfers, discharges, social activities and visitation until further notice.




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Alberta COVID hospitalizations up 73% since July: health minister



Three weeks after the start of the school year, Alberta’s health minister provided an update on the spread of airborne viruses in the province.

Adriana LaGrange also said more information about flu and next-generation COVID-19 vaccines will soon be released.

“Now that we will be spending more time indoors, we need to make doubly sure we are following proper hygiene protocols like handwashing and staying home when sick,” LaGrange said. “It also means respecting those who choose to wear a mask.”


Global News previously reported that influenza vaccines will be available on Oct. 16 with the new Moderna vaccine formulated to target the XBB.1.5 variant likely to be available at around the same time. On Sept. 12, Health Canada approved the use of the Moderna vaccine.

“More information on immunizations against respiratory viruses including influenza and COVID-19 will be available shortly,” the health minister said.

LaGrange said there have been 28 cases of influenza and five lab-confirmed cases of respiratory syncytial virus (RSV) since Aug. 28.

“This is consistent activity for this time of the year,” the health minister said in a statement.

The end of August or the beginning of September has typically marked the beginning of flu season for provincial health authorities.

LaGrange also provided an update on the ongoing COVID-19 pandemic in the province.

From Aug. 28 to Sept. 8, there were a total 92 new hospitalizations and three ICU admissions, bringing the total to 417 in hospital and seven in ICU, a 73 per cent increase of COVID hospitalizations from the last reported info.

On July 24 – the last update to the province’s COVID data dashboard – there were only 242 in hospital.

“Sadly, five Albertans died during that period due to COVID-19,” LaGrange said.

LaGrange said the reporting dashboard is being refreshed to include RSV, influenza and COVID-19 data, work that was originally expected to be completed on Aug. 30. The latest data on the province’s influenza statistics dashboard is dated July 22.

“This work is currently underway and will be available in the coming weeks,” LaGrange said.

She said data for the dates between July 24 and Aug. 27 will be available when the new dashboard goes online.

Amid more hospitals continent-wide reinstating masking requirements in the face of increased hospitalizations, the health minister made no mention of any such moves for Alberta hospitals. Acute care COVID-19 outbreaks in Alberta jumped from Sept. 5 to 12, with 146 per cent more healthcare workers and 55 per cent more patients testing positive for COVID.

LaGrange stressed the “collective responsibility” to prevent the spread of airborne viruses like COVID and influenza.

“As a mother and grandmother, I understand the anxiety that comes with sending your children back to school. I want to reassure you that Alberta’s government has the health and well-being of all young Albertans top of mind,” the health minister said.

–with files from Meghan Cobb, Global News



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