To the Editor: In their Commentary, Drs Dieffenbach and Fauci1 were optimistic that universally available HIV testing and treatment with ART could significantly curtail HIV epidemics. Trials are currently investigating the potential efficacy of this approach. Unfortunately, it seems that the behavioral ramifications of ART for prevention were not fully appreciated by Dieffenbach and Fauci.
While the authors noted the possibility for behavioral disinhibition (or risk compensation) to diminish the preventive effects of ART, there is compelling evidence that people whose HIV viral load is undetectable believe that they are no longer infectious, significantly increase their sexual risk behaviors, and reduce their protective actions.2 Uninfected sex partners of people living with HIV/AIDS may believe that their partners who have undetectable viral loads are not infectious. Modeling the effects of patients who believe they are noninfectious and reduce their condom use shows substantial risks for increasing HIV incidence.3
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