We need to keep talking about U=U

When U=U launched 7 years ago, it was a game changer. Definitively knowing that you could not pass on HIV if you were on medication and maintained an undetectable viral load meant a sense of newfound freedom and relief for so many people living with HIV (PLHIV) who lived in fear of passing on the virus to others.

Today, we take a look back at the journey so far and what challenges we still have to overcome in the future.

What is U=U?

Courtesy of 'I Can Give You'

U=U stands for Undetectable = Untransmittable.

If a person living with HIV is taking their medication as prescribed, they can reduce the amount of virus in their blood to a point where it’s so low that it cannot be detected.

This is called an Undetectable Viral Load (UVL).

If a person is undetectable, there is ZERO risk of passing on the virus to another person.

Undetectable Viral Load equals Untransmittable HIV.

Numerous scientific studies conducted have determined that U=U is FACT. In total, around 89,000 acts of condomless sex between serodifferent partners have been studied and of all those encounters, not one person living with HIV passed on the virus to their HIV negative partner through sexual contact.

What did U=U do for people living with HIV?

Photo: LifePlus.org

The gay community in particular has a lot of trauma surrounding HIV. Even those who weren’t around in the 80’s and 90’s are haunted by the stories and images of young, healthy men dying from AIDS related illnesses depicted in the media.

That fear has persisted for decades, and as a result, PLHIV have often been rejected, ostracised and outcast. U=U meant that people who were HIV negative no longer had to fear contracting HIV from a person living with HIV if they had an undetectable viral load. And through addressing the fear, we’re breaking down the stigma.

Ruan Uys, BGF’s Health & Wellbeing Programs Manager said, “U=U is empowering for us. It helps us fight the stigma and proves to the rest of the world that we’re not dangerous or a threat. It’s made us feel like we’re more in control and protecting everyone because our biggest fear has always been passing it on. That we don’t have to be afraid of that anymore is very empowering.”

For Matt, who’s been living with HIV for the past 12 years, U=U has been life changing. U=U helped heal the self-stigma he had been living with and find love with a partner in a serodifferent relationship.

Matt said, “Back when I was diagnosed with HIV in 2011, U=U wasn’t a thing. I had resigned myself to the fact that I was probably going to spend the rest of my life alone, never to find love again. And I was so scared of passing the virus on to someone. I was so relieved to learn that being undetectable meant that I couldn’t pass on the virus. I no longer felt dirty, toxic and unloveable. For the first time, it opened up the possibility of living a normal life and finding a lover whether they were positive or negative.”

Bobby Goldsmith Foundation's CEO, Nick Lawson agrees. He said, “If HIV can’t be transmitted, then it is no longer any different from so many other pathologies that people live their daily lives with very comfortably. And I think U=U certainly contributed very importantly to that.”

The challenges U=U faces now and in the future

Photo: Living Positive Victoria

Reaching wider audiences

Whilst we’ve made huge progress in spreading the message of U=U, we still have a long way to go, even in the LGBTQIA+ community.

In a recent Italian study, around three quarters of PLHIV surveyed had heard of U=U yet only just under half of the HIV negative people had knowledge of it.

In the western world, HIV transmissions are on the rise amongst heterosexuals, culturally diverse populations and first nations people. And people from these communities who contract HIV are getting diagnosed much later.

On this, Nick Lawson said, “For a lot of people, HIV doesn’t impact on their lives, so they don’t really take on this information. Trying to figure out how to get those messages into broader society is really important.”

U=U can help these communities understand that HIV is no longer something to fear. It’s not a death sentence. And it can’t be passed on with an UVL. It’s a completely manageable condition that can have very little impact on day to day life. But getting tested and starting treatment early is the key.

Resistance, disbelief and doubt

U=U was evidence for the first time that there was more chance of contracting HIV from someone who says they’re negative and hasn’t been tested for some time than from a person living with HIV that is on medication and has an undetectable viral load.

Despite this, as well as the consensus amongst the global medical community that U=U as a science is completely accurate, there are still some who are choosing stigma over the science.

In a 2018 Australian study, only 18% of HIV negative men surveyed agreed that a person with an undetectable viral load cannot pass on HIV. And a large US study found that nearly half of the HIV negative gay respondents did not believe U=U is accurate.

U=U doesn’t happen for everyone

It also needs to be remembered that not everyone can reach undetectable status. On this, Ruan said, “They (PLHIV with a detectable viral load) still live with the old fear, the old stigma because they can never tell anyone that they are undetectable. So, there’s some work needs to be done there.”

U=U is key to ending HIV by 2025

Whilst the medication and the science has advanced so dramatically over the past 40 years, we’ve still got a long way to go in addressing how society views HIV.

If we really want to ‘End HIV by 2025’, then we need to address the stigma. U=U has proven to be one of the clearest and most effective ways to do that.

And this is why now, more than ever, we need to keep talking about U=U and spreading the message. Please share this article or the resources below.

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