The Third U = UNIVERSAL
Our collective celebration of U=U is undermined if our access to HIV diagnostics, treatment, and healthcare is not universal.
There are numerous economic, social, structural, and legal barriers that intersect in someone's life and may make it difficult or impossible to reach an undetectable viral load.
Various key affected populations living with HIV have unequal access even in the same country or jurisdiction. Access to adequate healthcare and support services is a major concern in many parts of the world, including higher income countries such as the U.S.
Some people living with HIV may choose not to be treated or may not be ready to start treatment. Others may start treatment but have challenges with adherence for a variety of reasons including stigma, mental health issues, substance abuse, unstable housing, hostile environments, difficulty paying for medications, drug resistance, and/or intolerable side effects.
The health and community prevention benefits of effective treatment underscore the need for universal access to HIV diagnostics, treatment and care, for both personal and population health.
Our challenge for the U=U community is to continue to fight for universal access for all people with HIV regardless of what barriers may exist and regardless of where they may live.
What if My Viral Load is Not Undetectable?
People living with HIV are more than just their lab results, and value isn't dictated by viral load. No one living with HIV is a danger.
If you are living with HIV and you have a detectable viral load, there are highly effective HIV prevention options for safer sex including condoms, and in some parts of the world, PrEP for your HIV-negative partners, which can be used individually or in combination. Everyone living with HIV regardless of viral load has the right to full and healthy social, sexual, and reproductive lives.
Treatment is first and foremost a personal choice, and no one should be shamed for not being on treatment or having any level of viral load which may be their choice or due to circumstances that are not in their control.
A viral load of 200 copies/ml or less is still considered untransmittable even though it is technically not undetectable in many parts of the world.
Consult with your medical provider about the options available to you for your health and the health of your partners. For more information, see FAQ 10.
Community Brief: Undetectable = Untransmittable
U=U and the Social Determinants of Health
Getting to undetectable: Population differences in Canada
Views from the front lines: Getting to undetectable
Get involved: More Resources & Support
U=U and Viral Load Testing
U=U and HIV criminalization
Early ART: access and equity of viral load testing for HIV
U=U and the overly-broad criminalization of HIV nondisclosure
Consensus Statement on U=U in Criminal Law Reform
Thank you to Marsha Martin, Mary Ann Torres, Brent Allan, Catherine Hanssens, Solange Baptiste, and Camille Arkell for their excellent input and resources.