+LIFE: Turning Positive into a PlusCAN WOMEN TRANSMIT HIV?

It’s long been a misconception that women cannot transmit HIV. Karl sits with Dr. Charlene Flash to find out the risks, facts, and misconceptions about women living with HIV.

The following is a transcript of the conversation between Karl and. Dr. Flash.

DR. FLASH

We’ve known this since the nineties.

KARL

Can women transmit HIV Well, that’s what we’re talking about today and joining me to have that conversation is Dr. Charlene Flash. She is the president and CEO of Avenue 360 Health and Wellness in Houston. Dr. Flash, lovely to see you.

DR. FLASH

Hi there,

KARL

Dr. Flash. Look, we know that HIV transmissions are, you know, male to male, male to female. That’s, that’s the dominant way sexually people are, you know, being infected with HIV I think there are people out there who believe that females, cisgendered females are not able to transmit the HIV virus. I’ve recently seen statements on the internet, like it’s not like our partners got it from another woman. They got it from a man. Those men are going to the gay community. That’s where this is coming from. Or another statement I saw was why is the gay community just focusing on the risk, which is super low to pull us in and make it appear that we are contributing to the spread when in reality we are not. You are a physician, you’re a scientist, you’re a nationally recognized expert in the field of HIV. How do you respond to those kind of statements?

DR. FLASH

What I would share is that HIV can be transmitted between men and they can be transmitted between men and women. It is true that it is much easier for a man to give HIV to a woman or for a woman to contract it from a man than the other way around. I would say that the risk, it’s a twofold difference. Risk, right? So if two people are having intercourse and the woman is living with HIV versus if they’re, if the man is living with HIV, if the man’s living with HIV, he’s two times as likely to give it to the partner so that it’s true that it’s less risky. But I said two times not zero. Right.

KARL

Right.

DR. FLASH

Yeah. And so I feel like I’m always telling you it depends, but it depends.

KARL

Have there been studies done? ’cause as, again, again, we talk about this a lot and it’s, it’s seems to be constantly, the focus is always male to female transmission or it’s, it’s always coming from us blokes, as we say in Australia. But have there actually been any studies done that specifically look at the risk of cisgendered vaginal sex with a cisgendered male where it shows, I mean, is there data out there that exists?

DR. FLASH

Absolutely. And this is not recent data either. I mean, these studies were done, their studies as old as back in 1992 or so, where they looked at heterosexual couples. And that’s where the data came from to determine not only how much more risky it was for male to female as compared to female to male, but what are the things that made transmission more likely? Hmm. So for example, if the person living with HIV has advanced aids, for example, then transmission was much more likely if the woman was on her menstrual cycle that made transmission much more likely. If they were inconsistent in their condom use, that made transmission more likely. So this is not new news. We’ve been, we’ve we’ve known this since the nineties. I think sometimes with all of the new data, people forget.

KARL

Yeah. But bottom line is even though the risk is extremely low, it is possible is what you’re saying.

DR. FLASH

Absolutely.

KARL

So what are some of the factors, and we touched on this a little bit, but what are some of the factors that con contribute to a cisgendered female transmitting the virus to a sexual partner?

DR. FLASH

Okay, so first she has to have detectable viral load, right? So if she is not taking her medication or not taking her medication reliably or not on medication or her medication or not working for her, that’s gonna create an increased risk because a higher viral load is gonna be easier to transmit If she has advanced aids, that’s also going to make it easier to transmit if she has an, a sexually transmitted infection or he has a sexually transmitted infection, especially one of the ulcerative. So translation, so things that give you a lesion like I feel like I’m on, on jeopardy. What are things that give you a lesion? So that would be herpes or syphilis with a, with a Shanker or even gonorrhea because there’s some inflammation there. So those are things that will make it easier for her to transmit. Also, of course, if they’re not using condoms, right? Because if you’re using condoms then you know, condoms offer really robust protection. Yeah, we talk about PrEP, we talk about all this other stuff, but condoms work.

KARL

Well, I I, I’ve seen some studies and some headlines recently in, in, in the press talking about male circumcision, uncircumcision. If, if, if you’re a cisgendered female who’s living with HIV and not undetectable and you are engaging in condomless sex with your negative male partner who is uncircumcised, does that also present more of a risk?

DR. FLASH

If the man is circumcised there, his risk goes down 60%.

KARL

Wow.

DR. FLASH

Six zero. So circumcision really changes the, the, the risk. Now, I’m not saying that every uncircumcised man has to run out immediately and go find a urologist or someone. Thank you.

KARL

That’s very, that’s very comforting to me, Dr. Flash without oversharing with our audience.

DR. FLASH

Exactly.

KARL

We should also remind people out there that, you know, sexual intercourse is just one of the ways that HIV is transmitted, right? But there are others, there are also men who were born with HIV or who contracted it via blood transfusion back in the day before we had all those tests. You know, who, who may not be undetectable when you’re engaging with them. So it’s not just men who are having sex with men who are thus causing women to become HIV positive.

DR. FLASH

You know, blame is, blame is hardly useful. Right? The virus actually doesn’t know if you’re a man or a woman doesn’t know if you’re trans or you’re straight. Okay? So humans that have HIV ideally should work to with their clinician to get their virus undetectable. Male, female, trans, or whoever you are. Let’s get this thing under control for your own health, but also to decrease transmission. If you’re not there yet, then condoms are ways that you can take control of this or PrEP.

KARL

Well, and I think also it’s about having it, and I know it’s not always possible, but sort of taking responsibility for your own sexual health. And if you are choosing to engage in condomless sex with a partner, I think one has to at some degree say, I am, I guess rolling the dice here if I don’t know what my sexual health is. Right?

DR. FLASH

That’s true. And, you know, conversation and communication. Did you know that it’s actually like an STD prevention device? Yeah. Yeah. You’re about to do the most intimate thing on earth, right? Let’s have a conversation.
Yeah, Let’s have a conversation about what we’re gonna do, what we’re not gonna do. Because as we’re thinking about layers of risk, right? There’s also, am I gonna have Anal sex this time? Am I going to use a condom this time? Am I going to, maybe I’ll wait till you get your lab work so we can see where things are, right? And so being able to have the conversation, I mean, you can’t always, but that being able to have that conversation could solve a lot of problems.

KARL

Yeah. We’ve talked about prep before. Is prep recommended for cisgendered heterosexual females who to engage in condomless sex with partners? And how can that help?

DR. FLASH

Yes. PrEP can be used effectively by people who were born female. However, not all prep is created equal. Okay. And so the newer form of by mouth prep just doesn’t have the data for us to say that it works for women. And so there’s an injectable available and there is the original formulation of oral prep, but yes, women can use utilize prep.

KARL

And lastly, you know, what advice, what’s your advice to folks to, to ensure that they are really taking the maximum precautions to protect themselves and their partners regardless of their gender.

DR. FLASH

One, can you please have a conversation with this person that you’re gonna have sex with? I just, I’m just saying it’s like a pet peeve of mine, right? And so, one, two, take care of yourself, whether it is knowing your status and getting HIV test, whether it’s getting tested for other STDs and making sure that you get treatment, like get that result and get treated as soon as possible. Whether it is, if you have HIV and you’re living with HIV, making sure that you’re engaging in care and that the medication is being tolerated well and your viral load is undetectable, these are all things that you can do. And take the power into your own hands now. Forget about even what your partner’s doing. Is your partner viral load undetectable? And are they on prep or are you on prep? These are all things that you can do and take the power into your own hands.

KARL

Dr. Flash, this has been really insightful. Thank you as always for joining us. Thanks for making the time to chat with me today.

DR. FLASH

Absolutely. Anytime.

KARL

That is gonna do it for this episode of Plus Talk. If you want more information, check out our website plus life media.com. And remember, you can like, follow, share across our social platforms. We are at plus Life media. Until next time, be nice to one another. And remember, just have that conversation with your partner. It’s not that difficult. See ya.

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