In 1981, the CDC first reported on a rare lung infection that would eventually be called Acquired Immune Deficiency Syndrome. The subsequent discovery of HIV in 1984 paved the way for effective treatment of HIV through antiretroviral therapy (ART). Additionally, prevention strategies such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are helping prevent people from getting HIV.
The knowledge that a higher viral load indicated higher transmissibility of HIV was apparent to researchers prior to 1996 (Murphy, 2023). While the Swiss Federal AIDS Commission announced in 2008 that a person who is seropositive, but has had an undetectable viral load for at least six months, does not risk transmitting HIV to a seronegative partner.
Today, the majority of research on U=U is conducted in the public health sector, to examine how – and how accurately – knowledge of U=U is disseminated across the world. In a November 2024 Personal View published in The Lancet. HIV, an international team of authors surveyed evidence relating to viral load suppression and the U=U message – which has been translated to different wordings across cultures and languages – with a view towards ending HIV as a public health crisis by 2030 (Okamoto et al., 2024). Among the chief aims of U=U is enabling people with HIV to thrive, and addressing barriers to thriving – namely, stigma, discrimination, and criminalization. There are 80 countries that have HIV-specific criminal laws, and sexual transmission of HIV is prosecuted – even where no actual transmission has taken place (Okamoto et al. 2024).
Making evidence-based education a priority is a key to the success of U=U. Yet awareness of U=U remains critically low among individuals, healthcare providers, and communities. Another challenge to U=U arises in barriers to viral load-testing access. Without access to such testing, individuals are unable to confirm their virus status. When regular adherence to ART is a challenge, this can lead back to stigmatization in individuals who are HIV positive.
Despite U=U having been understood for decades, there remain challenges – systemic, legislative, and cultural – to it being widely accepted and adopted by the public. But it is a key to ending HIV as a public health crisis, so we will likely continue to see evidence being generated on public awareness and implementation of U=U.
References
Murphy, T. (2023). A brief history of U=U. Retrieved Dec 9, 2024, from https://www.poz.com/article/brief-history-uu
Okamoto, E. E., Anam, F. R., Batiste, S., Dukashe, M., Castellanos, E., Poonkasetwattana, M., & Richman, B. (2024). Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk. The Lancet. HIV, 11(11), e783–e790. https://doi.org/10.1016/S2352-3018(24)00241-8
