Also known as U=U
This is what HIV looks like in 2021. A person living with HIV can take antiretroviral therapy (ART) to limit the replication cycle of the virus so much that it barely takes hold of the body. HIV is still present, but the amount of virus is so low it is undetectable by a blood test and is, therefore, untransmittable, meaning that it is unable to be passed on to others through sexual contact.
Spreading the word about U=U not only helps people understand the science behind the treatment of HIV, but it also debunks fear that seronegative people may have and reduces the stigma for people living with HIV, particularly when seeking intimate relationships.
The evidence behind U=U
Since 2005, there have been three major studies published, all of which gave resounding support to the statement “that if someone takes ART daily, as prescribed, and achieves and maintains an undetectable viral load there is effectively no risk of sexually transmitting the virus to a HIV-negative partner.”
These studies featured heterosexual and same-sex couples from all over the world, and collectively over 93,000 reported condomless sexual encounters. Of all those encounters, not one HIV-positive person passed the virus on to their HIV-negative partner through sexual contact.
What is an undetectable viral load?
The viral load is how many copies of the virus are present per millilitre of blood.
For the virus to be undetectable, there must be less than 200 copies per mL. This can be achieved by keeping to an ART treatment plan which includes regular blood tests to monitor the viral load.
U=U and the law
Taking ART and having an undetectable viral load is actually considered a preventive measure. Western Australian law states that so long as you are taking preventative measures to stop transmission if you are HIV-positive, then you do not have to disclose your status.
U=U and STI’s
Having an undetectable viral load is great, but it doesn’t protect from catching or passing on other STIs. We recommend regular screening and condom use regardless of your status.
U=U + PrEP + PEP
Looking for that extra, extra peace of mind? Well, clinically, a person is not considered at any risk of acquiring HIV if they have sexual contact with someone with an undetectable viral load, and therefore do not meet the eligibility requirements for PrEP. Same goes for PEP.
Why is U=U so important?
Because people who aren’t directly involved with HIV don’t tend to discuss it, there is still some anxiety and misinformation lingering from the HIV epidemic of the last century. By educating the community about U=U and the advancement of ART we can reduce stigma and take down barriers for people living with HIV, who would otherwise lead long, healthy and fulfilling lives.
So, what can you do personally to end stigma for people living with HIV?
1. Normalise HIV as part of conversation (whether asking about HIV status before sex, talking about it as a health professional) and encourage regular HIV testing for all people!
2. When people talk about HIV, plug U=U. What do they know about it? Do they believe in the facts?
3. Reframe HIV as a chronic condition rather than a life-threatening illness, where people can lead lives equivalent to their HIV negative counterparts.
To learn more about U=U go to the ASHM website.