In Guatemala, the slogan is “Indetectable = Intransmisible” (I=I); in the Netherlands, it’s “Niet meetbaar = Niet overdraagbaar” (N=N); and in Turkey, “Belirlenemeyen = Bulaştırmayan” (B=B). One of the most striking aspects of yesterday’s pre-conference on “Undetectable = Untransmittable” (U=U), held in advance of the 22nd International AIDS Conference (AIDS 2018) in Amsterdam, was the extent to which the campaign has energised advocates around the world.
“U=U is a fact that every person with HIV around the world should know about,” said Jesús Aguais of AID for AIDS International, an organisation working in six Latin American countries. “People have the right to be informed and it is our responsibility to disseminate this information.”
“I can’t believe this information has been known for ten years and I’ve only heard about in the past six months,” commented Lucy Wanjiku-Njenga of Positive Young Women’s Voices. She said that not many of her peer group in Kenya know what U=U means. Those who do know about it heard about it from a friend or on social media, rather than from a doctor or care provider.
The quotes she presented from other young women testified to the impact the U=U message can have:
“This is a message of hope to those living positively. It is the success that comes along with adherence. The victory after all those days you feel like the drugs were a burden. With this, young women can lead a life without worry of infecting their partners.”
“U=U gives young people who acquired HIV through vertical transmission like me a sense of ‘normalness’. For the first time, I see I am not afraid of infecting someone else because I am virally suppressed! I can finally have a fear-free relationship. I am the safest relationship any guy can have!”
Alex Schneider’s organisation Life4me+ works across Eastern Europe and Central Asia. For him, the Russian language slogan “НЕОПРЕДЕЛЯЕМЫЙ = НЕ ПЕРЕДАЮЩИЙ” (Н=Н) is a new tool for advocacy. It can help raise broader public awareness of HIV, reduce stigma towards people living with HIV, undermine self-stigma, increase HIV testing, motivate early initiation of treatment and improve treatment adherence. So far, 60 organisations, including eleven state organisations, have signed on to the statement in the 14 countries of the region.
Nonetheless, there are very real barriers to treatment in the region, including frequent stock outs of medication. In terms of the 90-90-90 targets, currently 63% of people with HIV are diagnosed, 28% of those diagnosed are on treatment, and 22% of those on treatment are virally suppressed.
In many low- and middle-income countries, viral load monitoring is not routinely available, making it impossible for an individual to be confident that they really are undetectable. U=U provides an additional argument for increasing access to viral load monitoring.
In Vietnam, the Centers for Disease Control and Prevention (CDC) has promoted the slogan “Không phát hiện = Không lây truyền” (K=K). John Blandford of the CDC said that the campaign was conceived as an intervention that would both support changes in HIV care and reduce stigma. The information has been shared via social media, in community meetings and through press coverage.
The community advocacy has helped build support among people with HIV and healthcare practitioners for a switch from CD4 to viral load monitoring. The country’s treatment guidelines are now aligned with K=K, so that a key marker of success is two consecutive viral load test results of less than 200 copies/ml. The proportion of people having their viral load monitored increased from 21% to 73% in a year, with 93% of those on treatment now being virally suppressed.