Doctors Need to Tell More People About U=U

Researchers are demanding that healthcare providers take more of a stance on undetectable equals untrasmittable (U=U) by informing HIV-positive people that they cannot transmit the virus to a sexual partner when their viral load is suppressed (or undetectable). 

“Providers caring for patients with HIV should universally inform their patients about U=U as part of their routine care,” Dr. Sarah Calabrese of George Washington University and Professor Ken Mayer of the Harvard Medical School and Fenway Institute write in The Lancet HIV. “Conveying benefits and risks surrounding any treatment is fundamental to patients’ decision making, and this HIV treatment benefit should be no exception.”

Calabrese’s and Mayer’s testimony points to four studies involving serodiscordant couples (whereby one is poz and the other isn’t), all of which have failed to find a single proven case of sexual transmission of the virus where the HIV-positive partner is taking antiretroviral therapy and has a stable undetectable viral load. 

U=U has been supported by numerous health groups like World Health Organization (WHO) and over 750 organizations worldwide, yet doctors are still adamant about sharing the information in a direct way to folks who are living with HIV.

As reported by NAM AIDS Map, an international survey involving more than 1,000 providers found that only 77 percent of infectious disease specialists and 42 percent of primary care physicians communicate the U=U message when telling folks that their viral load is undetectable. 

Some of the reasons as to why doctors don’t disclose that information included disbelief (i.e. not accepting that U=U), a perception that U=U would undermine personal responsibility and concerns about someone’s behaviour and understanding.

“With evidence supporting undetectable = untransmittable (U=U) now overwhelming, providers should be routinely communicating the message to all of their patients living with HIV,” Calabrese and Mayer argue. 

As the authors note, sharing the U=U message has numerous benefits, including encouragement for people to start and adhere to antiretroviral therapy, and maintain an undetectable viral load; psychosocial boosts, which enable individuals to have intimate sexual relationships without fear, reducing internalized stigma and alleviating anxiety about the possibility of transmission; helping to reduce HIV incidence by encouraging engagement in the HIV treatment cascade; and accelerating reforms in government policy and the law, especially concerning the criminalization of HIV exposure and non-disclosure (which helped Sanjay Johnson in his case). 

Communities most affected by HIV are often misinformed about U=U. Increasing knowledge and understanding of U=U might reduce HIV-related stigma in the broader community, encourage testing, and lessen anxiety about acquiring HIV. As the authors conclude, “The U=U message to be withheld from any person living with HIV is inexcusable, particularly in settings where treatment is accessible."