Changes to CDC HIV manual leave U=U activists and advocates frustrated

Earlier this month Life4me+ reported that the U.S. Centers for Disease Control and Prevention (CDC) had updated their "Guide to the Treatment of Sexually Transmitted Infections". Major changes were made to the HIV transmission section, namely, that a person living with HIV who has an undetectable viral load cannot sexually transmit the virus. This is the key message on which the information campaign U=U (Undetectable = Untransmittable) is based. It would initially appear that justice and common sense have finally triumphed.

But as it turned out, not everything has gone as smoothly as hoped, and now there are questions about the wording used in the new manual. So what has happened?

The CDC has not changed its risk assessment since September 27th 2017 - at which time, such language (when discussing HIV transmission for someone with an undetectable viral load) as "practically risk-free" and "prevents transmission" were used. The CDC approved U=U in a 2019 statement and included U=U (along with the phrase "almost risk-free") in this year's manual.

Therefore, although the CDC has updated the manual, they are continuing to use obsolete language such as “virtually risk-free” and “almost risk-free”. Whilst on the surface the the difference in wording may not seem not huge, from a legal point of view, it is colossal because "almost without risk" and "100% without risk" mean very different things.

Community organisations are working to convince CDC to remove nebulous wording, such as "practically”, and simply use the phrase "risk-free". There's a chance that this could happen next year.

Speaking to Murray Penner, Executive Director of Prevention Access Campaign (PAC), he said on the situation:

"We are grateful for our cooperation with the CDC. After the launch of the U=U campaign in 2016, the CDC responded to a call by U=U supporters to change their HIV transmission risk assessment. In 2017, CDC stated that the risk of sexual transmission, if a person living with HIV has an undetectable viral load, is almost non-existent. And later in 2019, CDC approved the U=U message and informed grantees that the flexibility of messaging using U=U is acceptable. The CDC also says an undetectable viral load is 100% effective to prevent transmission. We look forward to further changes in U=U messaging and appreciate our collaboration with the CDC.”

There is scientific evidence that HIV transmission is impossible from a person living with HIV, who takes antiretroviral therapy and has had an undetectable viral load for at least 6 months. In this case HIV transmission is impossible, in other words, zero risk. Improving public knowledge of U=U reduces HIV-related stigma, encourages people to start taking antiretroviral therapy and follow their treatment regimen. Moreover, knowledge frees people living with HIV from the fear of sexually transmitting the virus. Therefore, it is very important to use clear language so that people are not left with doubt and confusion.