Ask DocQ: What Does U=U Mean And Why Is It So Important?


U equals U

Probably the biggest news to dominate the HIV landscape last year was the acceptance by the scientific community and HIV health professionals that U=U – undetectable equals un-transmittable.

The message is that a person with HIV who is on treatment and is undetectable cannot pass on the virus to their sexual partner.

To be undetectable means that the virus cannot be measured in a blood test, and this test result has been known for years as evidence that a person’s HIV therapy is working well. We now know for sure that it also means they are not infectious.

You might say this is old news, but recently I’ve realised that many positive people either don’t know about this, or are skeptical. The message has been somewhat diluted by experts using phrases such as “negligible risk”, which doesn’t inspire complete confidence.

So, I would like to take this opportunity to explain the scientific findings that led to the U=U announcement.

There have been several large studies over the last few years which have been following serodiscordant couples – that’s couples where one person is HIV positive and the partner is HIV negative.

The PARTNER study

The PARTNER study, which was looking at gay and straight couples, reported in 2014 then again in 2016 that there were zero transmissions when the positive partner was undetectable.

The Opposites Attract study looked only at gay and bisexual men, and again reported zero transmissions if the positive partner was undetectable.

That’s more than 40,000 acts of condom-less anal sex, and not a single transmission. Statisticians and scientists are very careful about how they interpret such findings, and they use complicated algorithms to calculate what the actual risk is, and they determined that the risk of transmission was so low as to be measurable.

In the real world, this equates to zero risk.

U=U is now endorsed by the International AIDS Society, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, the British HIV Association and over 600 other organisations.

Why is this message so important? For too long people with HIV have suffered from the stigma associated with having a communicable disease, the stigma of being contagious, and the fear of being potentially risky sexual partners.

Judgemental language has arisen on dating sites, with people using terms like “clean” to describe their HIV negative status.

Many people have felt so stigmatised by their status that they simply don’t date, or agonise over disclosing, and the mental health consequences can be severe – anxiety, depression, even suicidal thoughts.

But now people with HIV who are undetectable on treatment need to know that they are not contagious, they cannot pass on the virus, and they can feel confident that their sexual partners are not at risk.

In summary, U definitely equals U, so share the news!

Dr Fiona Bisshop specialises in LGBT health and is available by appointment at Holdsworth House Medical Brisbane. Call (07) 3894 0794 or visit the Holdsworth House website. Read more by Dr Bisshop on her website here or contact her on Twitter. Send your health question to [email protected] and Dr Bisshop will answer them anonymously in QNews Magazine.

(Photo by Living Positive Victoria)