Understanding U=U can be life-changing

Knowing you cannot pass HIV on through sex if you are virally suppressed can be life changing. So why is the message of undetectable = untransmissible (U=U) not being widely shared with young people?  

What is the research about? 

The WHO surveyed 388 adolescents and young people with HIV (ages 10–24) from 45 countries to hear their views on U=U. Focus groups were also held with 60 survey participants (ages 14-24). 

Why is this research important? 

Where U=U has been promoted, mainly among gay men with HIV in high-income countries, it has improved people’s mental health and their engagement with antiretroviral treatment (ART).  

But so far, U=U has not been promoted to young people. There are many reasons for this, including the fear that young people with HIV might stop using condoms if they know about U=U, even if they are not taking their treatment properly. (Although this has not happened in studies with adults who are made aware of U=U.) 

What did they find out? 

Most young people consulted had little knowledge about HIV viral loads. 

Most did not know about the benefits of viral suppression. They were unaware that if someone is virally suppressed (or undetectable) they cannot pass HIV on.  

Most had little experience of viral load counselling and support. One young person from India said: “…they are just handed results and the healthcare worker says there is ‘no problem’, and so they misinterpret what suppression means.” 

The few young people who did know about the benefits of viral suppression, including U=U, said it had changed how they felt about having HIV and improved their well-being and self-esteem.  

A young man from Chile summed this up when he said: “When they …explained to me what it [U=U] meant, my mind was dancing. I was very happy.” 

Young people felt that viral load tests should be used to help young people start and stay on ART. One young person in Zimbabwe said: “If one is aiming for an undetectable viral load, it will be a goal…the adolescent will really work hard to achieve the goal knowing that the virus, though it’s in my blood, it can never control me.” 

What does this mean for HIV services? 

There is a need to advocate for young people to have access to viral load monitoring so they can know whether they are undetectable or not.  

Young people with HIV also need clear and accurate information so they can fully understand what their viral load means for their health. This should be a key part of the adherence support. 

This information should be age-appropriate and explain what being virally suppressed means for things like their energy levels, sporting ability, skin, growth and height and school attendance. But it should also include discussion about U=U in relation to current or future partners so that young people with HIV understand that they can have a fulfilling life, which includes being sexually active, either now (if they are ready) or in the future. Community-based youth-led HIV support programmes have a vital role to play in this. 

Wider understanding of U=U may also help to reduce HIV-related stigma. This means the U=U message should be shared widely among people whether they have HIV or not.