Why U=U presents a life-changing message about HIV treatment

Studies have proven that those living with HIV who maintain a suppressed viral load cannot transmit it to others

(Alamy)

“Undetectable” is one of the four main elements of the award-winning Do It London HIV campaign. This is the status achieved by someone with diagnosed HIV who takes medication and achieves a suppressed viral load. It is now recognised as one of the key drivers of the reduction in HIV incidence.

The term “undetectable” is used to describe someone who is living with HIV but on successful and effective treatment. Their viral load (the amount of HIV in their body) is so low that – as the name suggests – it can’t​ be detected by standard blood tests. Crucially, as far as HIV transmission is concerned, someone who is undetectable cannot pass on the virus through sex.

This was proven in the landmark PARTNER (Partners Of People On ART – A New Evaluation Of The Risks) study, published in 2016, which monitored condomless sex between more than 1,100 couples across the world who were in “serodiscordant” relationships – where one partner is HIV-positive and the other is HIV-negative. It found no cases of within-couple HIV transmission where the HIV positive partner had an undetectable viral load.

Effective treatment

The 1,166 couples enrolled in the study had condomless sex more than 58,000 times, yet the study found zero transmission of HIV between them. The findings had major implications for the understanding of HIV treatment as another element of prevention, alongside condoms and Pre-Exposure Prophylaxis (PrEP). Not only does it safeguard the health of the positive partner, but it also works effectively as a prevention tool to protect the negative partner. Earlier this year, a second study (PARTNER 2) reported further results, announcing that the risk of HIV transmission from an undetectable partner “is zero”. Researchers said that they were “as confident now that undetectable gay men pose no risk of HIV transmission as we already were for heterosexuals”.

Someone who is diagnosed with HIV usually becomes undetectable after several weeks of beginning HIV medication. Their viral load will begin to drop and once it falls below a certain level, their doctor will confirm that they are undetectable.

Although it may seem like a relatively new innovation, undetectable is not a new term, having been recognised as playing a key part in HIV prevention for more than a decade. However, it was only in 2017 that key public health bodies such as the US Centre for Disease Control and UNAIDS officially confirmed that people with HIV who are undetectable cannot transmit HIV leading to the establishment of a worldwide campaign pronouncing “Undetectable=Untransmittable”, or “U=U”.

Becoming undetectable is an important element of scientifically-proven HIV prevention. It is also a central part of the Do It London campaign, which has reached millions of people in the capital since it began in 2015. Promoting awareness of U=U, alongside regular testing, condom use and PrEP, is what defines combination prevention in the modern age.

The right method for you

Some of these combination methods work together – for instance, undetectable requires regular testing and taking regular medication. In the end, as there are many ways to prevent HIV, it’s important to find the right method for your own HIV status, your relationship and your personal circumstances – a message that is summed up by Do It London’s tagline “do it your way”.

In January, London officially became a “Fast Track” city for HIV when the mayor, alongside borough leaders, signed up to the Fast Track Cities initiative as part of a major push to reduce the rate of HIV infections and eliminate stigma in London – aiming for zero new HIV infections in the capital by 2030.

Paul Steinberg, programme lead at Do It London, believes that more people need to understand what undetectable means, “The implications of this science are huge, especially for fighting the powerful and damaging stigma often associated with HIV,” he says. “The U=U message is changing how people understand sex between HIV positive and HIV negative people, reducing anxiety, fear and painful rejection – and increasing better communication and understanding. Alongside regular testing, PrEP and ongoing condom use, it’s been cited as one of the key reasons for the record falls in HIV diagnosis in London.”

More information about all methods of HIV prevention can be found at doitlondon.org