U=U is short for undetectable equals untransmittable. Basically, it means that HIV does not transmit when a person is on effective medication. U=U is a global campaign driven by people who work around HIV and human rights activists. Reducing stigma is at the core of the campaign. But what do the words undetectable and untransmittable mean in this context?
U=U
U=U means that when a person who has HIV is on effective medication, they cannot transmit HIV. Not even in sex without a condom. The word undetectable refers to the fact that there is too little virus in the blood for the test to find the virus, meaning that the viral load is undetectable in the blood. When the medication is effective it lowers the copies of the virus to their minimum. Virus still exists but the amount of it is too low for transmission. The person living with HIV stays healthy and they can live the way they choose to.
The other word untransmittable refers to the fact that when the person living with HIV is on effective medication and the viral load in the blood is undetectable, they cannot transmit HIV. Not even if they didn’t wear a condom during sex (anal, vaginal or oral). This has been studied among heterosexual and gay couples. Both anal and vaginal intercourse without a condom have been acknowledged in the studies.
U=U has a message for us all
Although the development of the HIV treatment has been groundbreaking during the last two decades, people still do not know enough about HIV and about how the treatment works. People with HIV can live regular and healthy lives when they are on antiretroviral (ARV) treatment. Their life expectancy is the same as the life expectancy of people who do not have HIV. Two recent studies, PARTNER1 (2016) and PARTNER2 (2019), confirmed the essential message of U=U, that HIV does not transmit through sex without a condom when the person living with HIV is on effective ARV-treatment. According to the findings, HIV cannot transmit in anal or vaginal intercourse without a condom when the viral load in the blood is undetectable. The first study included 548 heterosexual and 340 gay serodifferent couples (other one has HIV and the other one doesn’t), where one partner was on effective treatment. The couples did not wear a condom during sex and zero transmissions was recorded during two years’ follow-up. The second study was focused on 782 serodifferent male couples who reported condomless anal intercourse and the other partner was on effective ARV treatment. Zero transmissions between partners was again recorded during a couple of years follow-up.
Unfortunately, research findings have a slow impact on commonly shared knowledge about HIV and old beliefs change slowly. Even institutional practices such as implementations of the law or health care services change way too slowly compared to scientific findings. People who live with HIV are still stigmatized because of HIV. People may also experience stigma because of sexual behavior, sexual orientation, gender or ethnicity, just to mention a few examples. Stigma exists in everyday human interaction and it may appear as prejudice, irrelevant fear, discrimination and isolation. Too often the person living with HIV internalizes the stigma the society around them is carrying and they may suffer from mental problems, self-blame and self-disgust. People may think that only certain groups of people are affected by HIV. Which of course is not true, HIV can affect anyone. This means that a person may become stigmatized simultaneously in many ways, for example HIV, sexual behavior and cultural background.
The fear of becoming stigmatized may prevent people from getting tested for HIV. For the stigma to be dismantled, it is crucial to spread the message of U=U far and wide. It lowers the threshold of getting tested and helps to reach people who have HIV but do not know about it yet. It is essential that the infection is diagnosed as early as possible so that the treatment can be started, and the person stays healthy. The treatment is so effective that people living with HIV can have a regular life with the same life expectancy that people not living with HIV have.
Finland and HIV
HIV is not a common infection in Finland. Every year about 170 people are diagnosed. Around 4000 people live with HIV in Finland and the vast majority are on effective medication. HIV treatment and medication are free in Finland and the quality of care is exceptional. Still the Finnish law treats people living with HIV unequally. People living with HIV are forced to tell their sexual partners about their infection before having sex, even if they are on effective treatment and the viruses are undetectable. The crucial question is, is it fair to punish someone even when they have taken care of themselves and their sexual partners and cannot transmit HIV? Legal practices change way too slowly compared to scientific findings, which sustains the stigma HIV is related with.
Legal practice is only one example about unequal treatment. Our clients at Hivpoint have reported inappropriate treatment in schools, health care services and social relationships. In our counselling services we often encounter the irrational fear of HIV. The fear of HIV lives on ever since the 80’s although the treatment has changed enormously from those days.
HIV is far from a death sentence in Finland. It is a chronic disease that can be compared to diabetes. Unfortunately, it’s not the same for everyone around the world. Last year around 770 000 people died from AIDS and 1,7 million got infected with HIV although the treatment is effective and preventive medications such as PrEP (pre-exposure proxylaxis) and PEP (post-exposure proxylaxis) are available. HIV treatment also protects the baby from infection during pregnancy and delivery.
The biggest challenges in preventing HIV are no longer medical. We need to focus on societal, social and economic change. In order to stop the spread of HIV, make lives easier for people living with HIV and stop people from dying from AIDS, we need to focus on spreading right information and change attitudes. That is exactly what U=U is about.