U=U: Setbacks and Strides

On World AIDS Day, we reflect upon the most recent tools – and progress – in the fight against HIV/AIDS. PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis), and most recently, using HIV treatment as a prevention tool, colloquially known as TasP or U=U, have made great strides in decreasing HIV transmission rates, particularly in areas where rates have remained stagnant.

Callen-Lorde has joined over 475 organizations around the world – including the Centers for Disease Control – in declaring that “Undetectable = Untransmittable”—that is, a person with an undetectable viral load cannot transmit HIV through sexual contact.

A person who is undetectable has fewer than 200 copies of the HIV virus per milliliter of blood in their system. Results from the largest ever study of serodiscordant (when one partner is HIV-positive and the other partner is HIV-negative) couples, the PARTNER study, demonstrated that people living with HIV/AIDS (PLWHA) who are undetectable have no risk of transmitting HIV through sexual contact. The study enrolled over 1,100 serodiscordant couples who engaged in over 58,000 reported sexual acts over the course of four years. There were zero transmissions between undetectable HIV positive individuals and their HIV negative partners. The PARTNER study proves that treatment is prevention for HIV, and a fundamental part of ending the HIV epidemic.

For PLWHA, the U=U message is life-changing. Due to stigma, shame, and intersecting oppressions, PLWHA have for decades received the false message that they are sources of risk—a message that has negatively impacted some PLWHA’s ability to forge romantic and sexual relationships. U=U is the first step to ending stigma around HIV status, and empowers everyone to pursue pleasure and intimacy in whatever way feels best—whether that’s condomless sex, sex with multiple partners, or any other intimate behavior.

Additionally, for couples seeking to get pregnant, U=U opens up a world of family building possibilities. For years, PLWHA were told that they would have to seek Assisted Reproductive Technologies, like IVF, in order to get pregnant and keep their negative partner safe from HIV. However, countless serodiscordant couples are attempting to and succeeding in getting pregnant without a concern of HIV transmission.

Although U=U is scientifically proven, not everyone is on board with the message yet. Unfortunately, many medical providers remain either ignorant or skeptical of U=U, and still provide inaccurate information about HIV risk through sexual contact when someone is undetectable. This is why education at every level—providers, consumers, and other stakeholders—is crucial.

U=U alone cannot end the epidemic. First, being undetectable does not stop transmissions through other breastfeeding and needle sharing. Also, while being undetectable does prevent HIV transmission through sexual contact, it does not stop the spread of other sexually-transmitted infections, which can increase a person’s susceptibility to HIV from people with detectable viral loads. This is why U=U must be a part of a comprehensive range of prevention methods, including condoms, PrEP, access to clean needles and syringes, and routine HIV testing.

People who have access to medical care and medication, housing, and employment are more likely to become undetectable, and in a shorter period of time than those who don’t. HIV prevention is as much about ending systematic oppression, poverty, and prejudice as it is about getting people tested and into medical care. U=U is one big step on the road to ending the epidemic, starting with ending stigma and empowering people to celebrate their lives, relationships, and sexualities.