Undetectable = Untransmittable

U=U is changing the world of HIV. You could also say that U=U is simply changing the world. This revolutionary equation, based on a ton of scientific data (see below), says that when HIV is treated effectively, there is no transmission of HIV.

U=U means “Undetectable = Untransmittable”.

Undetectable means that the viral load, or the amount of HIV virus in the blood, is very low.

Untransmittable means that when the viral load is undetectable, HIV is not transmitted.

U=U is therefore changing the world! After decades of fear and stigma, it’s time to spread the word and celebrate this great advance. It’s with these objectives in mind that the “U=U is changing the world of HIV” campaign was created.

Treatment allows people living with HIV to live long and healthy lives. It also prevents transmission of the virus.

UNAIDS even sees U=U as a concrete stepping stone towards the end of the epidemic.

Indeed, according to the 95-95-95 targets, the epidemic could be eradicated by 2030 if, by 2025, 95% of people living with HIV on treatment have an undetectable viral load.

If this scientific fact is still under-reported in the field of HIV, it is not even known by the general public. Unfortunately, people living with HIV are still discriminated against on many levels because of the fear of HIV that was instilled during the dark years of the AIDS epidemic. Among other things, the results of a 2019 survey on dental care and HIV (in French only) showed:

[…] a lack of information, from either health care staff, support staff or both, about:

HIV and its impact on dental care;

The effectiveness of universal precautions;

The purpose of the health questionnaire.

These gaps fuel differential treatment and, in turn, reluctance to seek care by people living with HIV.

– Non-transmission and transmission contexts

An update on the current realities of HIV is essential, while it is still necessary to recall the contexts of non-transmission and transmission.

HIV is NOT transmitted in everyday situations, such as:

Using the toilet
Sharing glasses and utensils
Physical contact, such as shaking hands, hugging or kissing
Sneezing and spitting
Mosquito bites or other insect bites
Eating, working or playing sports with an HIV-positive person

HIV is transmitted through five bodily fluids only:

Sperm and pre-ejaculatory fluid (pre-cum)
Anal secretions
Vaginal secretions
Blood
Breast / chest milk

HIV is transmitted only when one of these fluids, from an HIV-positive person who doesn’t know their status or is not undergoing efficient treatment, comes into contact with the blood system of an HIV-negative person, through:

A cut on the skin (bleeding, wound)
Ejaculation
Frontal or anal secretions
Breastfeeding or chestfeeding
Sharing equipment for drug injection or inhalation
Mucous membranes: vaginal, anal, around the penis
Using unsterilized or poorly sterilized tattoo or piercing equipment

– The scientific data on U=U

For more than 20 years, scientific studies have reported cases of non-transmission of HIV in serodifferent couples (where one partner is living with HIV) when the viral load is low.

In 2008, following an analysis of the results of various HIV research studies, the Federal Commission for AIDS-related problems in Switzerland sent shockwaves when it published a bulletin for Swiss doctors with the conclusion: “HIV-positive people with no other STIs and on effective antiretroviral treatment do not transmit HIV sexually” (free translation). According to this group of researchers, HIV-positive people had to have an undetectable viral load for 6 months, have very good adherence to treatment and not have any STI.

It would take another ten years of published results from major scientific studies before the rest of the HIV community would loudly affirm U=U.

Studies¹	Research topics	Results
PARTNER 2016 (phase 1) 2018 (phase 2)	Phase 1 : Heterosexual couples and HIV-positive gay men’s couples (with one partner living with HIV) Phase 2 : HIV-positive gay male couples (with one partner living with HIV)	Approximately 36,000 condomless sexual encounters in heterosexual couples Approximately 70,000 sex acts without condoms in gay male couples 0 transmission within couples when viral load was undetectable
Opposites Attract 2017	HIV-positive gay male couples (with one partner living with HIV)	Approximately 12,000 condomless sex acts 0 transmission within couples when viral load was undetectable
HPTN 052 2011	Heterosexual HIV-different couples divided into two groups: 1) HIV treatment initiated at baseline 2) HIV treatment started later (later)	0 transmission within couples when viral load was undetectable In group 1) 1 case of infection within a couple before the viral load became undetectable In group 2) 27 cases of infections in couples before the start of treatment

^1. ^{This table is a summary from the Ontario AIDS Networks’ U=U consensus statement. It has been adapted for use in this paper.}

– U=U is changing the world, literally!

“Undetectable = Untransmittable” was brought to light by a person living with HIV. Bruce Richman had been living with HIV for 10 years when he learned that there was no risk of transmission. Shocked to learn this happy news so late in life, he mobilized community stakeholders and researchers from major studies to develop a consensus statement to share this vital information. The Prevention Access Campaign was born. By 2022, more than 1,000 organizations from over 100 countries had signed the position statement.

Today, U=U is the consensus of various international institutions involved in the response to HIV/AIDS, such as

– U=U is also changing the world in Quebec and Canada

The Quebec Ministry of Health and Social Services published a ministerial position (in French only) in October 2018 on “The effect of treatment of people living with HIV on the risk of sexual transmission of the infection” stating:

There is no evidence of transmission of HIV infection during oral, vaginal or anal sex without a condom

when the person living with HIV is taking antiretroviral therapy as prescribed and

their viral load, as measured by consecutive laboratory tests every four to six months, is maintained at less than 200 copies per milliliter of blood.

In this setting, the risk of transmission is negligible.

(For public health, “negligible” means there is a theoretical potential for transmission, but zero reported cases).

The MSSS position echoes the Public Health Agency of Canada’s statement, released in 2017, which reached the same conclusion:

It has become clear that when a person living with HIV is on antiretroviral therapy, taking their medications as prescribed and has a confirmed suppressed viral load, the risk of transmitting HIV to sexual partners is virtually zero.

– The origins of “U=U is changing the world of HIV”

COCQ-SIDA’s member organizations commissioned the creation of a message to convey this important information. As part of the 24th International AIDS Conference in Montreal in 2022, the Coalition joined forces with the Prevention Access Campaign and Coalition PLUS to share a strong collective message through this campaign.

We are grateful to Tandem Mauricie, BLITSS, le Dispensaire, MIELS-Québec, GAP-VIES, CASM, RÉZO and Portail VIH/sida du Québec for their involvement. We also thank Bruce Richman of Prevention Access Campaign as well as Upperkut, who realized the campaign.

– If you have any questions

Contact the nearest HIV organization

Text SextEd (English) or Sext’Info (French)

Production and distribution of this campaign were made possible by a financial contribution from the Ministère de la Santé et des Services sociaux.

The Public Health Agency of Canada contributed financially to the production and distribution of this campaign.

We thank them very much.