U=U: The New Normal
It was on September 27, 2017, that the CDC would make an announcement potentially changing the narrative on how stigma plagues the HIV community. It was on that day—which just so happened to be National Gay Men’s HIV/AIDS Awareness Day—that the CDC made the official statement that "People who take ART daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner."
This was probably one of the largest announcements and confirmations of scientific data that was very well known but not officially validated. For those living with HIV, stigma is one of the biggest issues many of us deal with. HIV-positive people deal with the shaming that correlates the virus with being “sexually deviant.” Stigma creates the fear that many HIV-negative people hold of contracting the virus by having a relationship with someone who is HIV-positive. This statement from the CDC would finally change the narrative around fears for those who thought they were at risk from contracting HIV.
So what does U=U mean?
Undetectable=Untransmittable. It is that simple.
The more refined definition from the U=U Campaign looks like this:
"An undetectable viral load is typically under 40 copies/ml depending on the diagnostic tests. However, studies show a person living with HIV on antiretroviral therapy (ART) with a viral load of 200 copies/ml or less also cannot sexually transmit HIV. This is called being 'virally suppressed.' For the purposes of the U=U campaign and any Prevention Access Campaign materials, the term 'undetectable' is used synonymously with the term 'virally suppressed,' meaning a person living with HIV with a viral load of 200 copies/ml or less cannot transmit HIV."
The HIV community has a goal of ending the epidemic through various methods. For people who are positive, treatment through the use of ART is the primary tool. ART for most people is a once-a-day pill treatment that suppresses the virility of HIV in the bloodstream—with the goal of reducing the copies of HIV to less than 200ml per copy. Getting people who are HIV-positive to a undetectable/virally suppressed means a significant reduction in the transmission of the virus.
Why is this messaging important?
As stated earlier, having HIV comes with the burden of stigma and shaming from others based on lack of education and views of the virus trapped in the time period when it was most dangerous. There are still many people in this world who are unaware of how HIV is transmitted and whose communities or countries lack the resources to get the proper messaging out to them.
U=U offers freedom and hope. For many people living with HIV and their partners,
U=U opens up social, sexual, and reproductive choices they never thought would be possible.
U=U is an unprecedented opportunity to transform the lives of people with HIV and the field:
· Reduces the shame and fear of sexual transmission and opens up possibilities for conceiving children without alternative means of insemination.
· Dismantles HIV stigma on the community, clinical, and personal level.
· Encourages people living with HIV to start and stay on treatment to keep them and their partners healthy.
· Offers a strong public health argument for universal access to diagnostics, treatment, and care to save lives and bring us closer to ending the epidemic.
However, the majority of the millions of people living with HIV do not know U=U, and many do not have access to the diagnostics, treatment, and care they need to achieve and maintain an undetectable viral load. There are still confusing messages, outdated websites, and uninformed policymakers and healthcare workers who are not comfortable sharing this information, who don't yet know about it, or who don't yet realize the significance of it.
U=U is going to be key if we are ever going to break down the stigma and shaming against people living with HIV. The fear of this is part and parcel with what stops many people from getting tested regularly—fearing that they are living with the virus. The more messaging out there about how manageable and treatable HIV is with proper resources and access to care, the better equipped ASOs and CBOs can be with getting those demographics on treatment and into care.
For me, U=U is personal. It alleviates the personal fear many have when positive that they could be potentially passing on the virus. It alleviates conversations around disclosure, as I have another educational tool that can be used in conversations prior to engaging in sex that ensures the safety of all partners involved. U=U is no longer going to be treated as the exception.
U=U is the new normal.