In recent years, studies have shown that, when people living with HIV are able to suppress their viral load, their risk of transmitting HIV to their partner becomes negligible.
This groundbreaking research has revolutionized HIV prevention and helped empower people living with HIV. But, advocates say, the knowledge that HIV viral load suppression can eliminate the risk of HIV transmission is not as widespread as it could be.
That's why, as part of its efforts to provide comprehensive HIV prevention tools, the Planned Parenthood Federation of America (PPFA) has signed onto the Prevention Access Campaign's "Undetectable = Untransmittable" consensus statement, following in the footsteps of its New York City affiliate. The national health care provider and advocacy group joins a community of international health experts in confirming what a groundswell of scientific evidence has shown: When a person's viral load is undetectable, the virus is untransmittable.
"For people living with HIV, disclosing one's status can be difficult, especially if people don't know the facts about effective treatment and the negligible risk of transmission," said Raegan McDonald-Mosley, M.D., M.P.H., chief medical officer for Planned Parenthood of America. "U=U means that if you are undetectable and stay on HIV treatment, you are likely to be much healthier than if you were not on treatment, and no longer need to be constrained by fear of transmitting the virus to others."
Over the last few years, health experts around the world have confirmed that people living with HIV who've suppressed their viral load while on antiretroviral therapy (ART) have no risk of transmitting the virus to their partner. The oft-cited 2014 European PARTNER study discovered that no linked transmissions occurred among nearly 900 surveyed mixed-status couples that had vaginal and anal sex without condoms when the HIV-positive partner was undetectable.
A similar PARTNER study published last year yielded the same results. Researchers observed 1166 mixed-status couples and found that, after 58,000 incidences of condomless sex, there were zero HIV transmissions between them.
Yet, some health care providers keep this information from people living with HIV. For example, a 2016 survey conducted by the advocacy group Positive Women's Network-USA (PWN-USA) found that 38% of women surveyed were not told by their doctors that an undetectable viral greatly minimizes the risk of spreading the virus. Anecdotal evidence also shows that people living with HIV are still shamed by their peers and loved ones and are discriminated against because of their status.
The Prevention Access Campaign, a multi-agency health equity initiative, launched the "Undetectable = Untransmittable" campaign in 2016 both to raise global awareness about the breakthrough research and to combat stigma faced by people living with HIV.
"The idea that people living with HIV are dangerous or undesirable has a profound emotional impact on those living with HIV, fuels stigma and discourages testing and treatment," McDonald-Mosley told TheBody.com. "Informing patients, providers and the communities we serve about advances in HIV science can help shift some of this deeply ingrained fear of HIV transmission."
"As HIV prevention and treatment advance and evolve, so must our patient care and education if we are to end the dual epidemics of HIV and HIV stigma," McDonald-Mosley added.
The U=U movement has had tremendous success since it launched. As of September 2017, the "Undetectable = Untransmittable" campaign has 390 partners from 55 countries, and its consensus statement is available in 14 languages.
In addition to PPFA, the National Alliance of State and Territorial AIDS Directors, the International AIDS Society, Human Rights Campaign, the San Francisco AIDS Foundation, and the African and Black Diaspora Global Network on HIV/AIDS have all signed onto the U=U consensus statement.
"The network is increasing rapidly globally," Bruce Richman, cofounder and executive director of the Prevention Access Campaign, told TheBody.com. "Our goal is to support partners by sharing resources and strategies to change this narrative until U=U is widely known and understand by people with HIV and the general population."
Planned Parenthood plans to integrate the U=U campaign into its expanding package of HIV prevention tools. That means sharing medically accurate information on undetectable viral loads, alongside materials on pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), through its hundreds of clinics, on its websites and via its social media accounts.
According to McDonald-Mosley, PPFA rolled out a digital promotion kit to celebrate its sign-on to the U=U consensus statement, including infographics shared on social media. Although PPFA plans to disseminate this information through its clinics, it's unclear as of yet how the organization will integrate U=U information into its policy work.
"Planned Parenthood affiliates are uniquely positioned to deliver holistic, cutting-edge HIV prevention, education and related services to at-risk populations, including black and Latina women, trans persons, young adults of all backgrounds and men who have sex with men," McDonald-Mosley told TheBody.com.
McDonald-Mosley also said that PPFA is also developing a set of interactive U=U training tools for both health center staff and educators. The module, known as a "Medical Minute," will be a clinical question-based post that teaches the fundamentals of undetectable equals untransmittable. While the materials will be uniform in design and dissemination, each Planned Parenthood affiliate will decide how to approach staff training, McDonald-Mosley said.
"Incorporating the message of U=U must go hand-in-hand with a comprehensive prevention effort," McDonald-Mosley told TheBody.com, "especially for those who make not be familiar with the latest advances in antiretroviral treatment."
"Everyone deserves a sex life that is healthy, happy and free from shame and stigma," McDonald-Mosley added.
Richman expressed hope that U=U's partnership with PPFA could be a game-changer for the campaign. By sharing information on undetectable viral loads and transmission risk with its large and diverse network, Planned Parenthood would be able to reach more people, especially women and people of color, "in accurate and quality ways," Richman said. "Because of their extensive reach and muscle, PPFA could be one of our most powerful forces of change in the U.S."
"Planned Parenthood's leadership on this issue is especially important in a time when truth and science about sexual and reproductive health are under attack," Richman continued. "PPFA's partnership sends a message in the U.S. that U=U is uniting with powerful and resilient partners that are committed to truth and choice about our bodies."