U=U: The Most Important Equation in HIV Science Today

U=U is probably the most important equation in our understanding of HIV science today. Coined by the Prevention Access Campaign, U=U or Undetectable = Untransmittable symbolizes a breakthrough in HIV treatment and prevention. It has now been scientifically proven that if someone living with HIV maintains an undetectable viral load (with the help of regular checks with their doctor and taking their medications as prescribed) there is effectively no risk of passing on the virus to a sexual partner. This was illustrated by the PARTNER study, where 485 heterosexual and 282 same-sex male couples were followed for three years. The HIV positive partner had to be on medication (ART) and have an undetectable viral load, and the other partner had to be HIV negative. After more than 44,000 unprotected sexual acts, there were zero HIV transmissions.

One cannot simply assume that they have an undetectable viral load because they have been diligent with medication—they have to be told by a clinical professional after completing a viral load test. The term viral load refers to how much HIV is in the blood. An undetectable viral load is achieved when the number of HIV positive cells in the blood are reduced to a number so low the viral load test cannot measure them. All HIV treatment has the goal of helping people achieve and maintain an undetectable viral load.

U=U is big news for those living with HIV. Stigma leads many people to believe that if they are HIV positive, they are unable to have sexual relationships because of the fear of transmission. Even with confirmation from medical professionals that using barrier methods and discussing treatment plans with their partner reduces risk, there may still be some hesitation. For many, U=U removes that hesitation—it removes the crippling fear of passing on the virus.

Hopefully, as U=U becomes better understood by the general public, the stigma around HIV will decrease too. According to experts, most HIV transmissions occur when someone is living with HIV and doesn’t know it. HIV positive people who are connected to care, are on treatment and have an undetectable viral load are much safer sexual partners than people who don’t know their HIV status and haven’t had a recent HIV test.

U=U is starting to gain traction beyond the HIV positive community. By January 2018, the U=U consensus statement had been signed by over 600 organizations from 75 countries, and both the Public Health Agency of Canada and the Centers for Disease Control and Prevention in the United States had released statements supporting the science. The next step for advocates is to ensure that everyone living with HIV has access to equitable health care, so that more people can achieve an undetectable viral load.

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