Do you know U=U?
Promoters of the Undetectable = Untransmittable (U=U) message were out, proud and visible this year at the International AIDS Conference, spreading the message that people living with HIV with undetectable viral loads do not transmit HIV to partners.
Numerous conference attendees could be seen sporting U=U t-shirts, and supporters of the campaign spoke at an official conference press conference about treatment as prevention and U=U. More than 300 community partners have signed on to support the campaign: At the conference, the City of Paris, UNAIDS, and Planned Parenthood Federation of America (among others) announced their support.
The science behind U=U, said Anthony Fauci, NIAID director, goes back many years to a time when empiric observations happened outside the realm of clinical trials. Now, in more recent years, we have data from large clinical trials including HPTN 052, PARNTER and Opposites Attract.
“Sometimes clinical studies don’t hold true when you follow them up for years. That has not been the case with treatment as prevention…When you went out into cohorts, like the PARTNER study…there were 53,000 condomless sex acts among discordant couples. And there was not one single linked infection. I think it’s one of the unusual situations in science when the overwhelming accumulated evidence base allows us to be able to confident in what we’re talking about,” said Fauci.
U.S. Global AIDS Coordinator Deborah Birx, MD, also shared support for U=U, saying, “I think what the U=U campaign does is it provides a message to communities that is based on the scientific details, and really provide those details in a real way so that people understand that when you have HIV—which once was a death sentence for many people we are privileged to work alongside—has become an ability to live healthy, productive lives as long as people are adherent to treatment.”
The founder of U=U, Bruce Richman, shared a more personal perspective.
“When I was diagnosed with HIV in 2003, I felt like I was a walking infection. I was terrified about passing HIV on to someone that I love. I didn’t start treatment because taking a pill every day would remind me that I was infectious, every day. After I started treatment in 2012, when my health started to deteriorate, I learned from my doctor that because I was undetectable, I couldn’t transmit HIV. I couldn’t pass it on. I was elated.
“But very soon I became outraged. Because every HIV treatment site, every media outlet, every ASO, every federal health department, every state health department, everywhere, was saying that I was still a risk. And millions of people with HIV were still a risk. It was clear, for many reasons, that the breakthrough science wasn’t, and still isn’t, breaking through to the people it was intended to benefit. It wasn’t accepted or understood outside of well-informed medical and public health communities.
“To clear up the confusion, a group of us living with HIV collaborated with researchers on a consensus statement and advocacy campaign called Undetectable is Untransmittable.”
Richman shared a few more thoughts about the U=U campaign with BETA including the reactions to the campaign, and what he hopes for the message moving forward.
How does it feel to have U=U presented and shared at a press conference at IAS 2017, the premiere international conference on HIV science?
It’s surreal. After five years of seeing how this field hadn’t shared this information with people living with HIV, and only shared it with people like me—people who seemed to be responsible, and withheld it from communities that are already being left out of the healthcare system—I am thrilled to see that the medical establishment is confirming that this is true. So that there’s no longer a doubt. People living with HIV now, all over the world, will have the confidence that if they are on effective treatment, that they cannot transmit HIV sexually.
What has been the reaction to this campaign in the community or this conference?
At this conference, the reception has been heartwarming, overwhelming, validating, exciting, productive. We’ve had many more groups sign on, that didn’t know about the campaign and are excited about it. We have had just in the last 24 hours, DAPP from Zimbabwe, Caribbean Sex Worker Coalition from Guyana, Lean on Me Foundation from Kenya, and then the City of Paris this morning signed on. We’re getting all of this momentum here. People are talking about the campaign, and want to be part of it. The reception has been fantastic.
The fact that IAS did a Facebook Live interview with Pietro Vernazza and me today, it was such an honor—to be with the author of the Swiss Statement. The international community has been so good to us. It’s validating that this campaign is really important now and what we believe and have known for a long time is indeed true. People want to tell the truth, they just need to be encouraged.
Has it been more difficult to shift people out of a fear-based mindset than you anticipated?
Yes. It’s surprising the lengths to which people will go to keep HIV stigmatized. People will seek out data that’s inconsistent with science in order to reinforce their stigmatizing beliefs. This is about unlearning decades of fear of HIV. It has been much harder than I thought. It’s also been much better now.
What’s your hope for the future of U=U?
I hope that we won’t need this campaign anymore. I hope that U=U just becomes common knowledge. I also hope that U=U is successful as an advocacy tool. So that all people living with HIV have an option to get to undetectable.
Still have questions about what it means to be undetectable? Find out more from San Francisco AIDS Foundation, and read more about recent research studying the risk of HIV transmission between serodiscordant couples when the person living with HIV is undetectable.