menshealth.com – Some of what we learned today about Charlie Sheen was not surprising.
It was surprising to learn that he had the HIV virus, and that he was first diagnosed four years ago.
What wasn’t so surprising is that, allegedly, he hasn’t always shared this information with his sexual partners.
If that sounds cynical, it’s because this is a guy who once claimed he cured his drug addictions with willpower—“I blinked and I cured my brain,” he said—and frequently described himself as a warlock with tiger’s blood.
Bree Olson, Sheen’s ex-girlfriend, was on Howard Stern’s SiriusXM radio show this morning, talking about the announcement, and her claims that Sheen never told her about his HIV diagnosis.
She had sex with Sheen, she told Stern, “almost every day for a year”—sometimes with no protection whatsoever, and sometimes while Sheen was wearing lambskin condoms.
Now, while “lambskin condoms”—officially known as natural membrane condoms, which are made from a thin layer of lamb intestines—are effective at preventing pregnancy, they’re not recommended for HIV prevention.
That’s because the pores on natural membrane condoms are large enough for the HIV virus to pass through them, says Antonio Urbina, M.D., an associate professor of medicine in the infectious diseases department at Mount Sinai Hospital.
Latex condoms, on the other hand, are less permeable, so the HIV virus remains trapped.
Olson also revealed to Stern that she is HIV free. To prove it, she shared her latest HIV rest results live on the show.
How, you might be wondering, is that possible?
How could this woman have unprotected or badly protected sex with Charlie Sheen, a man carrying the HIV virus, for an entire year, maybe as often as once a day, and not have contracted the virus?
Is she just the luckiest person in the universe? She somehow had 365 sexual encounters with a man carrying HIV and dodged 365 bullets?
Sheen’s physician, Dr. Robert Huizenga—who appeared with Sheen this morning for a Today show interview—explained that thanks to a regular treatment of “strong antiviral drugs,” the virus is now “undetectable” in Sheen’s blood.
Even if you consider yourself well informed about HIV, this might be the first time you’ve heard the virus described as “undetectable.”
And what are these magical drugs that make patients, or at least Charlie Sheen, capable of having unprotected sex without infecting anybody?
The treatment is called antiretroviral therapy (ART), a combination of drugs that slows the progression of the virus in your body.
Ideally, ART will knock your viral load down to an undetectable level, as it reportedly has with Sheen. This just means that the amount of HIV in your blood is too low to be picked up by the lab testing it, says Dr. Urbina.
And what that means is that your risk of transmitting it is very, very low.
“It’s almost like you’d have more of a chance of getting struck by lightning,” he says.
Benjamin Young, M.D., Ph.D., the Senior Vice President and Chief Medical Officer at the International Association of Providers of AIDS Care, takes it even further.
“What we’ve done for years, for decades, is accept the belief that safe sex is protected sex, which is sex with a condom,” he says. “But the scientific evidence is very, very clear. If somebody is on ART treatment, and has an undetectable virus, the risk of transmission of HIV, with or without a condom, is essentially zero.”
But to be clear: “Essentially” zero doesn’t mean “literally” zero.
According to a 2014 CDC study published in the journal AIDS, an HIV positive man on ART has just a 0.2 percent chance of passing on the virus to his female partner over the course of one year.
And if he adds condoms to the mix, that risk drops to 0.05 percent.
However, even if the virus remains undetectable, the HIV still exists in your body.
And it’s possible that you can test as “undetectable” in your blood, but still have higher levels in your semen.
In fact, according to a 2014 study from France, HIV was detected in 8 percent of semen samples given from HIV-positive men, even though their blood tested clear of it.
“Whether or not that can lead to transmission is still unknown,” Dr. Urbina says.
It’s also possible that your viral loads can fluctuate slightly from when you’ve taken the test. For instance, if you don’t take your meds for a few days, your viral load can go up, he says.
Plus, battling an infection—whether it’s something like the flu or a sexually transmitted disease—can increase your viral loads. So can getting a vaccine.
But again, the research hasn’t yet been done to determine what these little viral load blips mean for HIV transmission, says Dr. Urbina.
And that’s why sticking with a latex condom is still critical.
“Latex condoms are important to use because there is still a lot we don’t know,” he says. “And even though we have this data that shows the risk is really, really low, at least in certain populations, we still don’t know completely what factors can play into transmission at the individual level.”
What’s the ultimate lesson here?
For starters, if you haven’t already, get yourself tested for HIV.
It’s still a terrifying diagnosis, but with access to the right medication, HIV can be managed far more effectively now than during the 90s or even a decade ago.
“With treatments today, people living with HIV can and should live normal, healthy lives, with normal life expectancy,” Young says.
It’s important to note that costs can range up to several thousand dollars a month out of pocket for each medication, and often a combination of three or more drugs is necessary. Which may be one reason the disease hasn’t been eradicated yet.
In fact, while Sheen appears to be receiving very good care, even many Americans living with HIV are not: Less than 40% are on antiretroviral treatment and only 30% have achieved very low or “undetectable” levels of the virus, according to the CDC.
But secondly, if you have HIV, or any sexually transmitted disease, tell your partner.
Young’s general advice to his patients with HIV is “to expose their status to potential partners, but in the context of an informed conversation, which includes information around what being on treatment means, in terms of risk.”
Even if you think you can’t infect them—“Hey, I used a condom” or “I don’t have any visible sores, it’ll be fine”—they need to know.
It’s their right to know.
As for Olson, she expressed shock at just now discovering that Sheen was HIV positive, at the same time as the rest of the world.
“He doesn’t even value my life,” she told Stern.