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Viral Suppression: The Struggle Is Real

July 11, 2016

Richard J. Wolitski, Ph.D.

Richard J. Wolitski, Ph.D. (Credit:

Recently, I've been thinking and talking a lot about the importance of viral suppression. For people living with HIV, getting the virus under control is the most important thing we can do. It's the key to our own survival, reducing deaths, and preventing new infections. Viral suppression reflects not only the quality of medical care, but also how well we are supporting people living with HIV to live long, healthy, and happy lives. Increasing viral suppression is the single most important thing we can do to end the HIV epidemic.

Viral suppression means that the amount of HIV in the blood is less than 200 copies per milliliter. This includes results that are undetectable. Getting to and maintaining that goal isn't always easy. You need to know you have HIV, have a good doctor you trust, get the right medications, and take them every day. Sometimes paying for health care and medications is a very real challenge, and navigating complex healthcare systems and cutting through red tape can be such a hassle that it makes it hard to manage everything.

Sometimes it's other stuff in our lives that gets in the way -- not wanting people to know we have HIV, needing transportation, child care or housing, dealing with issues of mental health, partner violence, or substance use, etc. Regardless of the challenges, the fact remains that getting HIV under control is what we need to do to conquer HIV, stay healthy, and stay alive.

Despite its importance, living with HIV or achieving viral suppression should not define who we are. I was reminded of this at a meeting last month, where a colleague talked about the experiences of young people living with HIV and their concerns about being only seen as a patient or a lab result, and not as a whole person.


Each of us is unique, and we are much more than the virus that has invaded our bodies or our lab results. We have dreams, desires, and fears that have nothing to do with HIV. Achieving (or not achieving) viral suppression is about much more than keeping medical appointments and taking pills. It's about the whole of our lives: our relationships, our current circumstances, and our past experiences. It includes positive aspects, such as the love and support we get from (and give to) our family, friends, and partners. But, for many of us, it also includes dealing with trauma, racism, sexism, homophobia, transphobia, HIV stigma, and other forms of stigma and discrimination. All of these, as a whole, act together to make it easier -- or more difficult -- for us to start and stay in care, take our medications, and do everything else that we need to do be healthy, be happy, and survive.

We have to keep our eye on the goal of achieving viral suppression for as many people as possible, but we have to realize that we cannot achieve that goal in isolation. We have to understand, address, and care about the realities of people's lives in order to support movement along the HIV care continuum. Doing so will require that we consider what needs to be done to improve the health and well being of the whole person. It will also require us to focus not only on patients, but also on what can be improved in healthcare systems, public health, and society. Working together, we can increase the percentage of people living with HIV who are healthy, happy, and virally suppressed. If we do this, we can achieve the vision of the National HIV/AIDS Strategy and beat HIV.

Richard Wolitski, Ph.D., is acting director of the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.

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