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Questions About U=U: What, When, Who, Why

May 4, 2018

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U=U: Undetectable viral load equals untransmittable HIV

Table of Contents

The following questions provide more information about why an undetectable viral load stops HIV transmission (U=U).


What Is U=U?

U=U is an abbreviation for: Undetectable = Untransmittable

It means that someone with an undetectable HIV viral load on HIV treatment (ART) cannot transmit HIV, even without using condoms or PrEP.

U=U is also part of an international campaign to raise awareness about this benefit of ART. Currently, approximately 600 organisations have joined from 75 countries.

www.preventionaccess.org


What Does U=U Involve?

The protection from treatment (ART) depends on:

  • Being on stable ART for several months.
  • Having undetectable viral load for at least three months.
  • Continuing to take meds every day without missing doses.


Related: "U=U": What's It All About?



How Can Someone Not Be Infectious?

The quick answer is because when HIV viral load is undetectable (less than 50 copies/mL) there is too little virus for an infection to occur.

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Even though someone on ART is still HIV positive, there is not enough HIV for transmission to still be a risk.

Most infections need a certain quantity or concentration of virus for transmission to occur. For example, viral load might need to be above 500 copies/mL to be infectious.

HIV is already a very difficult virus to catch and being on ART reduces this risk to zero.


Does It Matter Which Drugs Someone Takes?

No. The types of HIV drugs are not important.

U=U only relates to whether viral load is undetectable.

Any ART that does this is good.


Does U=U Work for Everyone?

Yes. The PARTNER study included both gay and straight couples.

In some straight couples the man was positive and in others the woman was positive.

One third of the couples were gay men.


Does U=U Work for All Types of Sex?

Yes. The PARTNER study collected information about the different sex people had. For example, the numbers of times people had oral, vaginal or anal sex. This study also asked whether the negative partner was active or passive and whether there was ejaculation.

PARTNER reported zero transmission for everything.

This includes the highest HIV risk -- ie when the negative partner was receptive for anal sex.


Does This Mean I Can Stop Using Condoms?

Whether or not you use condoms is a personal choice. Hopefully this is a mutual choice with your partner. Condoms are effective at stopping many STIs and they are an effective contraceptive to stop pregnancy.

But if HIV is the only concern, then in the context of U=U, there is no reason to continue to use condoms.

In the context of U=U, condoms don’t have any further impact on reducing the risk of HIV transmission.

For people who are happy using condoms for other reasons, this will still be an important choice.


My Partner Is HIV Positive and Doesn’t Trust U=U or Stopping Condoms?

Your partner has to come to their own decision about what is right for them.

They might want to use condoms for other reasons, or they might still worry about HIV transmission.

Sometimes it takes time for someone to accept new evidence, especially if they have been using condoms for many years.


My Partner Is HIV Negative and Doesn’t Trust U=U or Stopping Condoms?

Your partner has to come to their own decision about what is right for them.

They might want to use condoms for other reasons, or they might still worry about HIV transmission.

Sometimes it takes time for someone to accept new evidence, especially they have been using condoms for many years.


Is U=U Now Widely Believed?

Most leading HIV scientists and doctors now agree with the U=U statement.

These experts are all convinced by the increasing evidence from many different studies.

Scientists are trained to be cautious people. They need to be convinced by evidence before making factual statements. Although it took a long time for the evidence for U=U to be widely accepted, leading HIV doctors in every country now recognise and support U=U.

For example, Professor Chloe Orkin, chair of the British HIV Association (BHIVA) has been quoted many times:

"There should be no doubt that a person with sustained, undetectable levels of HIV in their blood cannot transmit HIV to their sexual partners".

Similar statements have been made by the International AIDS Society (IAS) and the US CDC.

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'U=U': What's It All About?
U=U: The Backstory
HIV Undetectable = Untransmittable (U=U) Fact Sheet
6 Reasons Why People Skip Their HIV Meds
Word on the Street: Advice on Adhering to HIV Treatment
More on Adherence


This article was provided by HIV i-Base. Visit HIV i-Base's website to find out more about their activities, publications and services.
 

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