How can we harness the power of U=U?

What is this story about?

People with HIV who are on effective treatment cannot pass the virus on through sex. This is called ‘undetectable = untransmittable’, or U=U. A blood test is used to see if someone has an undetectable viral load.

Why is this important?

Many people with HIV experience rejection from partners or potential partners because they have HIV. And many people with HIV think they should not have sex or be in long-term relationships because they might pass HIV on. Both are a form of HIV stigma and can have a terrible effect on people’s lives.

People with HIV can have sex and relationships. Condoms and PrEP are two ways to prevent HIV being passed on through sex. U=U is another.

What are the main issues?

One of the big issues surrounding U=U is awareness. Lots of people know that condoms prevent HIV transmission, for example. Far fewer people have heard of U=U.

In 2016, the Prevention Access Campaign began the U=U campaign. Although U=U is now a global movement supported by over 1,000 organisations in 105 countries, a lot of people still do not know about it.

Many people with HIV are not told about U=U by a healthcare professional when they are diagnosed. One of the reasons for this is that not all healthcare professionals are HIV experts, so many are unaware of U=U themselves.

Most countries have not run public health campaign about U=U, so general awareness is also low. Vietnam is one of the countries that has run a public U=U campaign, which in the country is known as K=K. The campaign reached one-third of the Vietnamese population. The things that helped it succeed include:

• partnering with the Ministry of Health
• being led by people with HIV
• K=K information being included in national HIV health guidelines and strategies
• getting health provider buy-in through mentoring and education
• raising awareness of K=K with community-led organisations
• funding community-led advocacy on K=K
• providing media training for journalists
• using different types of media and social media to spread the message to different audiences.

What does this mean for HIV services?

It is important that healthcare professionals provide clear and accurate information about U=U to people with HIV and their partners. The Terrence Higgins Trust has developed a free and adaptable training resource designed to support non-specialist healthcare professionals understand and communicate about U=U.

If public health campaigns on U=U are done well, they can reduce HIV stigma and enable many people with HIV to live fuller lives. But it is important to understand what elements are needed to make a public U=U campaign succeed. This video explains more about how the K=K campaign worked in Vietnam.

The message of U=U could cause people to stop using condoms, even if the sex they are having puts them at high risk of other sexually transmitted infections. This is important to address in any U=U campaign. It is also important to understand how easy or difficult it is for people with HIV to have regular viral load monitoring. Without this, people with HIV will not know if they have an undetectable viral load or not.