U=U is the foundation of being able to end the epidemic and
is redefining what it means to love and live with HIV
around the world.
July 24, 2017: One year after the U=U Consensus Statement was issued, U=U advocates from sixteen countries convened at the International AIDS Society Conference in Paris. The U=U community took center stage and held a press conference with global leaders to endorse the message and call for universal access to treatment and care to save lives and prevent new transmissions.
“U=U is a simple but hugely important campaign based on a solid foundation of scientific evidence. It has already been successful in influencing public opinion, causing more people with HIV (and their friends and families) to comprehend that they can live long, healthy lives, have children, and never have to worry about passing on their infection to others."
The Lancet (November, 2017)
“Undetectable = Untransmittable U=U" campaign aims, and is having success in – changing forever the way organizations and people with HIV talk and think about viral undetectability and infectiousness. Little is more likely to help demolish the stigma against HIV than spreading the U=U news to their partners, family, and community. It offers them and all of us hope."
Gus Cairns, Editor, NAM aidsmap (February, 2017)
“CATIE recently endorsed the Consensus Statement of the Prevention Access Campaign, celebrating the fact that ‘undetectable equals untransmittable.’ This revolutionary statement, pushed forward by a dedicated group of people living with HIV, has prompted CATIE to reflect on our sexual HIV prevention messaging.”
Canadian AIDS Treatment Information Exchange (CATIE) (January, 2017)
“These scientific findings require that we step back and re-assess what we thought we knew for the last 36 years. At United States Conference on AIDS and in discussions we’ve been having for about a year with internal and external stakeholders, it is clear that people living with HIV are leading the way, and they are more than ready for others to follow.”
Richard Wolitski, Ph.D., Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services (September, 2017)
PAC provides technical assistance for communities and activists to integrate U=U in public health communications, clinical, and advocacy work based on best practices learned from the extensive U=U community.
Community Hub & Mobilization
PAC facilitates the sharing of resources among the global U=U community, including social marketing and communications materials, advocacy strategies, and research. In most parts of the world, the U=U information is not yet understood or accepted. This international U=U movement is led primarily by people living with HIV who are changing the narrative about what it means to live with HIV in a fascinating way. For instance, U=U is being integrated into national public health campaigns, healthcare provider training, anti-stigma social marketing campaigns, HIV treatment and diagnostics advocacy, HIV decriminalization work, and HIV testing outreach.
PAC offers training, education, and advocacy tools for organizations and advocates seeking to educate HIV information providers in their communities (e.g., public health departments, AIDS service organizations, health clinics, and religious institutions) as well as provide workshops for people living with HIV and HIV information providers.
Media Monitoring: PAC works to ensure accurate and responsible reporting about the current realities of HIV prevention and stigma by challenging inconsistencies and biases in digital, social, and print media.
Social Media Outreach: Honored with Healthline's 2016 Best Use of Social Media in HIV Advocacy, the U=U campaign and its Community Partners and advocates unite and promote the U=U message widely social media using the hashtag #UequalsU.
Media Outreach: PAC and U=U have received extensive coverage in HIV/AIDS and global media including CBS Evening News, The Washington Post, China Global Television, The Guardian, CNN, BHEKISISA, and the world's leading medical journals, The Lancet and JAMA.
Social Marketing: PAC creates and facilitates the sharing of social marketing campaigns between Community Partners to alleviate the cost and time associated with the creation of materials.
Thank You to Our Founding Sponsor
Why Isn't U=U Widely Known?
Despite the monumental importance of the U=U message, many socio-cultural, political, economic, and systemic barriers have prevented people living with HIV from being accurately and meaningfully informed about their social, sexual, and reproductive health. As a result of these barriers, including many that have existed long before the start of the epidemic, the risk from people with HIV has been exaggerated. That exaggerated risk puts people living with HIV at risk of harm and injustice. Exaggerating the risk wastes valuable opportunities to greatly improve lives and bring us closer to ending the epidemic.
There are many reasons why HIV information providers (e.g., AIDS service organizations, community-based organizations, healthcare providers, HIV communications agencies, public health departments, and HIV/AIDS media outlets) have not been communicating U=U to people living with HIV and the general public.
First and foremost, U=U is radically at odds with the status quo. After decades of deeply ingrained fear of HIV and attachment to the established dogma about how to prevent it, it is difficult to accept that people living with HIV can be no risk to their intimate partners and can conceive children without alternative and costly means of insemination. Shifts in attitudes, beliefs, and behaviors take time, especially when impacted by the unprecedented trauma of the AIDS epidemic.
The longstanding history of paternalism and patriarchy in medicine and public health has stripped agency from people living with HIV, especially marginalized communities, and made it an acceptable practice for healthcare workers and other information providers to serve as gatekeepers of vital health information. When the U=U campaign initially sought endorsements from medical providers and research associations, many agreed with the science but expressed concerns that if they shared U=U with their patients with HIV, then they would stop using condoms and there would be a resulting rise of STIs. They also expressed concerns that patients with HIV would not understand that to stay undetectable and untransmittable required excellent adherence to treatment. Therefore, they felt it was better not to share U=U, or only to share it with patients they deemed "responsible." These paternalistic and unethical arguments were surprisingly widespread.
A main reasons that U=U was considered the "big secret" in HIV is because there were few accessible sources drawing an accurate conclusion about the overall clinical and observational evidence. The first public document concluding that effective treatment rendered a person no longer sexually infectious was the Swiss Statement of 2008, authored by Dr. Pietro Vernazza and published by the Swiss Federal Commission for Sexual Health. The bold and revolutionary statement was ahead of its time, yet widely criticized and denounced by the field. After the Swiss Statement, there was a groundswell of groundbreaking clinical evidence, including HPTN 052, PARTNER, and Opposites Attract. However, even after the final reports of HPTN 052 and PARTNER were published in July 2016, with the exception of a few pioneering NGOs like Terrence Higgins Trust in England, the studies were typically promoted independently and were subject to the politics, biases, and inaccuracies of HIV information providers.
Although there were indeed more sources in print and video that confirmed U=U, they were limited to circulation within the HIV research community. For example, one such source was a position paper from the European AIDS Treatment Group from 2015:
"EATG calls for much better public information to be made available in Europe and globally about the prevention benefits of antiretroviral therapy (ART), and in particular the fact that HIV-positive people with undetectable viral loads are not infectious. Widespread ignorance of this fact helps perpetuate stigma against and criminalisation of people living with HIV and it should be the subject of a funded public awareness campaign, possibly to run in conjunction with a PrEP awareness campaign." European AIDS Treatment Group (EATG) (October, 2015)
Most HIV information providers did not have the authority or experience to draw explicit conclusions from the research. Some HIV information providers used risk reduction assessments such as "greatly reduced risk" or "less likely to transmit." Such phrases are often understood as a reduced risk, but still a risk to be taken into consideration when in fact there was, and is, no risk.
We believe all people living with HIV have a right to accurate and meaningful information about their social, sexual, and reproductive health based on science not stigma. Ending the epidemic requires bold new approaches to dismantle HIV-stigma, improve health outcomes, and prevent transmissions.
Consensus Statement & Coalition Building
In early 2016, PAC collaborated with the leading researchers on HIV sexual transmission from the U.S., Denmark, Switzerland, and Australia and issued the first U=U global Consensus Statement and advocacy video as tools for engaging influential people and institutions to endorse the conclusion. Shortly after the Statement was released in July 2016, the New York City Department of Health and Mental Hygiene and Dr. Demetre Daskalakis, Assistant Commissioner for the Bureau of HIV/AIDS, became the first city health department and public health official to endorse the statement. NASTAD and Housing Works signed on as the first NGO and AIDS service organization, respectively, in the United States.
PAC has since engaged a growing community of over 1,000 Community Partners from 102 countries that have endorsed the U=U message and serve all populations most affected by HIV/AIDS. U=U has been translated into dozens of languages thus far. Partners pledge to share the information in ways that work for their constituencies.
Unprecedented Sexual and Reproductive Health Advocacy
A pivotal part of PAC's work has been leading a coalition of HIV/AIDS and human rights organizations and advocates worldwide to call for updates to local and national health ministries' outdated sexual health messaging, HIV treatment guidelines and policies, and criminalization laws.
Since September of 2016, PAC has worked closely with the U.S. federal health departments to review and align the messaging about viral suppression and transmission risk under the leadership of the Office of HIV/AIDS and Infectious Disease Policy at Health & Human Services. This collaborative process between people living with HIV, scientists, and public health officials has affected a dramatic change in decades of messaging about what it means to live with HIV, greatly improving lives in the U.S. and everywhere the CDC and other U.S. federal health agencies have influence.
The CDC released the first example of the new messaging about the risk of transmission on September 27, 2017, just over a year after the review process began. The phrase "effectively no risk" is now being used across federal health departments and in many parts of the world. In July 2019, the CDC officially authorized the use of PAC's U=U messaging and materials and indicated that viral suppression is 100% effective at preventing sexual transmission.
Prevention Access Campaign and Undetectable = Untransmittable
Prevention Access Campaign is a health equity initiative to end the dual epidemics of HIV and HIV-related stigma by empowering people with and vulnerable to HIV with accurate and meaningful information about their social, sexual, and reproductive health.
Prevention Access Campaign's Undetectable = Untransmittable (U=U) is a growing global community of HIV advocates, activists, researchers, and over 1,000 Community Partners from 102 countries uniting to clarify and disseminate the revolutionary but largely unknown fact that people living with HIV who are on treatment and have an undetectable viral load cannot sexually transmit HIV.
U=U was launched in early 2016 by a group of people living with HIV who created a groundbreaking Consensus Statement with global experts to clear up confusion about the science of U=U. That Statement was the genesis of the U=U movement that is changing the definition of what it means to live with HIV. The movement is sharing the message to dismantle HIV stigma, improve the lives of people living with HIV, and bring us closer to ending the epidemic.
Why is U=U Important?
A groundswell of research confirms that when a person living with HIV is on effective treatment, it will reduce the level of HIV to "undetectable" levels which protects their health and makes them incapable of transmitting HIV to their sexual partners, or what we call "Undetectable = Untransmittable: U=U". As a prevention strategy, this is often referred to as Treatment as Prevention.
The U=U message is an unprecedented opportunity to transform the lives of millions of people with and affected by HIV and to radically transform the field:
Well-being of people with HIV: Transforms the social, sexual, and reproductive lives of people with HIV by freeing them from the shame and fear of sexual transmission to their partners.
HIV stigma: Dismantles the HIV stigma that has been destroying lives and impeding progress in the field since the beginning of the epidemic.
Treatment goals: Reduces the anxiety associated with testing, and encourages people living with HIV to stay on treatment to stay healthy and prevent transmissions to their partners.
Universal access: Offers a critical public health argument in advocacy for universal access to treatment, care, and diagnostics to save lives and prevent new transmissions, bringing us closer to ending the epidemic.
It's a game changer for people living with HIV and for the field that people on effective treatment cannot transmit HIV, but it's still widely unknown. U=U and our partners are changing the narrative.
The U=U movement aims to ensure the groundbreaking U=U research reaches the people and the field it was intended to benefit. Together, we're changing the the narrative about people with HIV and HIV prevention.