U=U — What’s that all about?
Department of Health joins national campaign
Have you heard about U=U? Undetectable = Untransmittable?
New science shows that someone with an undectectable HIV viral load cannot transmit the virus to their partner! Undetectable = Untransmittable! The Department of Health is committed to promoting HIV safety and has signed on to the campaign to promote U=U!
Wait, what is a viral load? What does it mean if it’s undetectable?
A viral load is the amount of HIV that can be measured in the blood of a person living with HIV. If the viral load is so low that it can’t be detected on a test, then the person is considered undetectable. Another term that is used is “virally suppressed.” A person with less than 200 copies of HIV per mL of blood is considered to be virally suppressed. People that are virally suppressed, undetectable, cannot transmit the virus sexually to their partners.
What does that mean for people living with HIV?
Although the science is well-known, the message is new. The goal of the U=U campaign is to reduce the amount of stigma felt by someone living with HIV. I acquired HIV years ago and felt “dirty,” mostly because of the way those without HIV discussed people with HIV. People without HIV want a sexual partner who is “clean,” or “ddf” — drug and disease free. So if you’re not clean, then you must be dirty.
In many instances, I was made to feel like a “disease vector.” Back in the ’80s and ’90s, people thought they could get HIV by drinking from the same glass or by using the same restroom or utensils. I think and I hope that those are all distant myths now. By law in most states, a person living with HIV has to notify their partner before having sex. If not, they can face criminal charges even if the partner does not get infected. As a result, hundreds of HIV positive people have been imprisoned for many years for non-disclosure, even in the absence of actual transmission. I need to tell my partners of my status, which is fine. Even though I can’t transmit the virus, I still may be rejected by someone who doesn’t want to “get anything” because of the stigma associated with the virus.
Why do people living with HIV face such stigma?
In our culture, sex and drugs are generally undiscussed subjects. When something happens to a person as a result of sex or drugs, we tend to blame the individual. HIV is transmitted primarily via these two methods, so it really becomes a taboo topic, and the infected person gets blamed.
When someone has a disease, we need to empathize, band together and talk about how we can help them get through it. Stigma makes this much harder.
Many people either don’t disclose their HIV status to anyone, or share it only with a small group of trusted people. We wait quite a long time to come out about it. The shame, blame and stigma are all overwhelming.
When I was first diagnosed back in the mid 1980’s, I hardly told anyone except my doctor. I could not bear the rejection I saw so many others go through. I participated in a clinical trial because I did not want to use my insurance for fear of losing it if my status became known. When the clinical trials ended, I had no choice but to use my insurance. When I changed jobs, the only way I could get health insurance was to do so during the short time when I didn’t have to answer medical questions. Now, with the Affordable Care Act, pre-existing conditions can no longer disqualify someone from getting insurance. That’s at least one step forward to overcome that stigma.
So how do we know that U=U is actually science?
Research. In the PARTNER study, published in the Journal of American Medical Association in 2016, there were no reported HIV transmissions in more than 58,000 condomless sexual acts when the positive person’s viral load was undetectable.
The Opposites Attract study found no transmissions of HIV in nearly 17,000 condomless sexual acts by 358 gay male couples (where one was positive and undetectable and the other negative). These results were presented in the summer of 2017 at the International AIDS Conference in Paris.
The PARTNER 2 study continued the research of the first PARTNER study. More than 77,000 condomless sexual acts were reported among the participants and again there were no reported transmissions of HIV. These results were just made known at the International AIDS Conference in Amsterdam in July 2018.
After researching a lot of sex (over 150,000 sex acts) between HIV positive and HIV negative individuals: there were zero transmissions of HIV. The medical community, including the CDC, has now stated that the risk is negligible to zero.
With the Prevention Access Campaign developing U=U, and the CDC supporting the messaging, I feel some of the negative perception lifted. The stigma is starting to fade. Although I knew it before, now I feel it. I can’t transmit HIV to anyone else. I am not dirty! My hope is that people with an undetectable viral load not being able to sexually transmit HIV — at all — will also become a myth as time goes on.
U=U is a game changer. U=U provides hope, generates empowerment and leads to a greater feeling of self-esteem, which leads to a better quality of life for those living with HIV. On World AIDS Day 2014, Governor Inslee established End AIDS Washington: a set of goals to be accomplished by 2020 that would help end new transmissions of HIV and take better care of those already living with HIV. With less stigma and more treatment, we can get to our goals by 2020.
How great would that be?
Richard Aleshire is program manager for HIV Client Services at the Washington State Department of Health.
