Healthcare providers should talk about “U = U” to all PLWH

Employees of medical organizations should inform all patients with HIV that if the viral load in their body is reduced to an undetectable level, there is no risk of sexually transmitted infection. This was stated by a group of authors in response to the widespread practice in the medical environment of the lack of sufficient information for people about the thesis “U = U” (“undetectable is untransmittable”) - even despite the huge amount of scientific data confirming it's validity.

“Doctors working with patients living with HIV should inform them about the U = U thesis as part of their routine practice,” write Dr. Sarah Calabrese of George Washington University and Professor Ken Mayer of Harvard Medical School and Fenway Institute .

“Communicating the benefits and risks of treatment is fundamental to patient decision-making, and the benefit [of transmitting information about the absence of the likelihood of HIV infection through sexual contact with zero viral load - Ed.] Should not be an exception.”

Four large studies in which several hundred serodiscordant couples took part did not establish a single confirmed case of HIV transmission through sexual contact, when a partner with a “positive” status systematically received antiretroviral therapy and had a stable undetectable viral load.

The evidence supporting the thesis “U = U” turned out to be convincing both in the “man-woman” and “man-man” pairs.

The World Health Organization (WHO) and more than 750 organizations around the world have agreed that people with HIV whose viral load is not stably detected are not a threat to their sexual partners.

However, recent studies show that a significant proportion of healthcare providers do not inform their patients about “U = U”. An international study, which was attended by more than 1000 institutions, showed that only 77% of specialists in infectious diseases and 42% of primary care physicians inform patients about this thesis when people reach an undetectable viral load. The reasons for this are the lack of confidence in this statement, as well as the idea that “U = U” will undermine the personal responsibility of each patient.

“Due to the fact that the evidence supporting“ U = U ”is huge at present, the medical community should regularly report this to all patients living with HIV,” Calabrese and Mayer say.

The authors note that informing patients has many personal and social benefits for health, including:

• encouraging adherence to ART to achieve an undetectable viral load;
• psychosocial benefits that allow people to enter into intimate relationships without fear, thereby reducing internal stigma;
• helping reduce HIV incidence by encouraging participation in the cascade of treatment;
• accelerating health care reforms, in particular those related to the criminalization of HIV status.

The authors emphasize that there is still an extremely high level of ignorance and misinformation about “U = U” in communities.

Enhancing knowledge and understanding of the thesis, they believe, can help reduce stigma for HIV-positive people, as well as stimulate the spread and coverage of diagnostics.

“Hiding data on the U = U thesis from anyone living with HIV is unforgivable, especially in places where treatment is available,” they conclude.