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BHIVA encourages universal promotion of Undetectable=Untransmittable (U=U)

Friday 30 November 2018

In early 2016, the Undetectable=Untransmittable (U=U) consensus statement was launched by the Prevention Access Campaign. To date the campaign has been endorsed by more than 771 organisations from 95 different countries. The statement unambiguously states that a person on fully suppressive HIV treatment cannot transmit HIV.

On 17 July 2017 BHIVA Chair, Professor Chloe Orkin, said: "As the UK's leading voice for HIV health professionals, our backing for U=U is unequivocal. There should be no doubt about the clear and simple message that a person with sustained, undetectable levels of HIV virus in their blood cannot transmit HIV to their sexual partners.

"This fact is a testament to the preventive impact of effective HIV treatment and highlights the need to maximise access to treatment in order to minimise and ultimately eradicate HIV transmission. Spreading the U=U message is also an important way to help reduce the stigma experienced by people living with HIV, whose sexual partners may fear infection unnecessarily."


BHIVA launches new statement on U=U

A BHIVA members' survey on U=U was undertaken in October 2018 which highlighted a need to ensure the U=U message is consistently integrated into clinical care, as recommended in the 2018 BHIVA standards of care for people living with HIV.

Consistent use of ART by people living with HIV to maintain an undetectable viral load is a highly effective strategy to prevent the sexual transmission of HIV. We urge health care professionals to discuss U=U proactively with all people living with HIV at appropriate points during care including, but not limited to:- at diagnosis, when initiating treatment, to encourage adherence, when undetectable, and if planning to conceive.

We recommend consistent and unambiguous terminology when discussing U=U such as "no risk" or "zero risk" of sexual transmission of HIV, avoiding terms like "negligible risk" and "minimal risk."

We encourage clinics to display and provide information on the use of ART to maintain an undetectable viral load as a highly effective strategy to prevent the sexual transmission of HIV. We also advise explaining the scientific evidence behind U=U, emphasising the importance of excellent adherence to ART and highlighting that U=U is dependent on maintaining a sustained undetectable viral load.

Free resources, developed in collaboration with the Kobler clinic at Chelsea and Westminster Hospital NHS Foundation Trust, to help raise the profile of U=U in UK clinics are available from HIV i-Base at http://i-base.info/u-equals-u-resources/


Ends
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Notes for editors
1. The U=U consensus statement issued 12 July 2016 reads:
People living with HIV on Antiretroviral Therapy (ART) with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV. Depending on the drugs employed it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.
https://www.preventionaccess.org/consensus

2. Terminology: 1 October 2018 the Prevention Access website added the following note:
The term "negligible" is not effective in public health messaging to describe the risk of HIV sexual transmission when a person with HIV has an undetectable viral load and is taking ART as prescribed. "Negligible" is often misconstrued as still a risk to take into consideration in sexual and reproductive health decisions. Please see the messaging guide with examples of the words used in public health messaging to convey the risk including "effectively no risk", "cannot transmit" and "do not transmit." It is imperative that language instills confidence rather than promotes unnecessary fear about sexual transmission when a person with HIV has an undetectable viral load and is taking ART as prescribed.

3. Condoms, STIs and pregnancy:
An undetectable HIV viral load only prevents HIV transmission to sexual partners. Condoms also help prevent HIV transmission as well as other STIs and pregnancy. The choice of HIV prevention method may be different depending upon a person’s sexual practices, circumstances and relationships. For instance, if someone is having sex with multiple partners or in a non-monogamous relationship, they might consider using condoms to prevent other STIs.

4. Evidence for U=U:
Research studies to support U=U include PARTNER 1, where couples both straight and gay, had sex more than 58,000 times without condoms. In PARTNER 2, in gay men only, couples had sex more than 77,000 times without condoms. There were no linked HIV transmissions in either study. Other research includes the Rakai, HPTN 052 and Opposites Attract studies. It also includes the Swiss Statement that first published information about the risk of transmission being zero in 2008. This and other evidence is discussed in an online article at www.i-base.info/htb/32308. The evidence for U=U: why negligible risk is zero risk.


Organisations endorsing BHIVA's position on U=U to date include: