Undetectable=Untransmittable: A Message That Needs Pushing

Several studies, including 3 large ones and some smaller ones, have definitively proven that individuals with HIV who have undetectable levels of the HIV virus cannot transmit it to uninfected individuals. This discovery has huge implications for individuals living with HIV, especially those in serodiscordant relationships who may want to engage in intercourse without condoms or conceive a child. But while viral suppression reduces the transmission risk to zero, not nearly enough individuals are aware of this. And not nearly enough individuals living with HIV have managed to achieve and maintain the viral suppression that would render them noninfectious. A new campaign aims to change that by pushing the Undetectable = Untransmittable (U=U) message.

The Prevention Access Campaign (PAC), which bills itself as a “growing global community of HIV advocates, activists, researchers, and close to 500 Community Partners from 65 countries” that aims to spread the facts about viral suppression and transmissibility, has been working to get out the word to more individuals. “When people are on effective therapy, they are not infectious to others,” Robert M. Grant, MD, MPH, a professor at the University of California San Francisco School of Medicine, chief medical officer at the San Francisco AIDS Foundation, and a founding member of the PAC Founding Task Force told Contagion^®. “We have seen this in multiple studies among heterosexual couples and gay and bisexual men, and from clinical practice. The U=U message is grounded in this truth. In my experience, when we learn about U=U, our focus shifts in helpful ways. We focus on staying on our medications, fostering our relationships, and pursuing our potential. We realize that we are greater than HIV, and so we protect ourselves as treasures of the world.”

This message is key when it comes to encouraging individuals to get tested and adhere to a medication regimen if they are HIV positive. A statement issued by the Centers of Disease Control and Prevention on September 27, 2017, National Gay Men’s HIV/AIDS Awareness Day, asserted that 61% of gay and bisexual men living with diagnosed HIV are virally suppressed (per a recent Morbidity and Mortality Weekly Report). Of course, many individuals with HIV remain undiagnosed. And, for the 39% who are diagnosed but not virally suppressed, barriers to treatment may need to be overcome, including social stigma along with lower income and education levels.

The CDC is taking steps to increase the rates of viral suppression in individuals who are living with HIV. These steps include funding local health departments and community-based organizations (CBOs) that can provide testing and prevention services; promoting the use of pre-exposure prophylaxis (PrEP); and launching prevention and treatment campaigns. “CDC encourages public and private stakeholders to implement interventions that increase retention in HIV care and viral suppression,” the organization wrote in its statement. “In addition, partners such as health departments, CBOs, and others can help address stigma and discrimination—using the resources of the Act Against AIDS campaign, Let’s Stop HIV Together, for example—and extend the reach of their HIV prevention and testing services that focus on gay and bisexual men.”

The 3 major studies that confirmed U=U are the HPTN 052 trial, which studied 1763 serodiscordant couples in 9 countries; the PARTNER study, which examined 1166 serodiscordant couples in 14 countries; and the Opposites Attract study, which looked at 358 homosexual couples in 3 countries. It’s important to note that although established couples were the subjects in these studies, a person does not have to be in a committed relationship to benefit from viral suppression. Myron Cohen, MD, director of the University of North Carolina Institute for Global Health and Infectious Diseases in Chapel Hill, North Carolina, and the principal investigator of the HPTN 052 study told Contagion^®, “Appropriate treatment that leads to viral suppression leads to safer sex regardless of the partner.”

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer- and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.