Undetectable Equals Untransmittable (U=U)
Over the last couple of years, the movement for Undetectable Equals Untransmittable (U=U) has gained traction among hundreds of HIV experts and organizations. Over 500 organizations from 70+ countries have signed a pledge to share and promote the message of U=U. In late 2017, the Centers for Disease Control and Prevention have put forth a defining statement on the U=U movement. According to Doctor Eugene McCray, Director of the Division of HIV/AIDS Prevention at the CDC, “People who take antiretroviral therapy (ART) daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”*
What is antiretroviral therapy? What does it mean to be undetectable?
During antiretroviral therapy (ART), HIV is suppressed and unable to make copies of itself. When someone living with HIV starts ART, their viral load drops. After several months of taking the medication as prescribed, the viral load will drop to an undetectable level (less than 200 copies/ml of blood). With an undetectable viral load, HIV is still present in the body, but not able to be transmitted sexually. Failure to take ART as prescribed can give the virus a chance to rebound and spread once more, so continued treatment is necessary for people to remain undetectable.
U=U + Our Prevention Toolbox = Peace of Mind
Even though HIV cannot be transmitted sexually when it is undetectable, with regular condom use and PrEP (pre-exposure prophylaxis) there will be virtually no risk of transmitting or contracting the virus with a partner who has an undetectable viral load. The other best practice is to continue to utilize our prevention toolbox to keep up to date on how to prevent the spread of HIV.
Transmission Through Other Means
While the CDC has stated there is no risk of sexual transmission with an undetectable viral load, there is still much research to be done for other avenues of transmission. At an undetectable viral load, it may still be possible to transmit HIV through injection drug use or breastfeeding.**
Reaching and maintaining an undetectable viral load is the best thing people living with the disease can do to stay healthy. The U=U campaign is an opportunity to change the narrative surrounding HIV transmission. It serves as a vehicle for helping combat stigma, reduces the fear of transmission, encourages people to stick to their treatment regimen to keep them and their partners healthy, and it brings us closer to helping end the epidemic.