Undetectable Equals Untransmittable
Stop the stigma. Get the facts.
What is U=U?
Undetectable equals untransmittable (U=U) is an important addition to the HIV prevention toolkit. U=U means individuals living with HIV who take antiretroviral therapy (ART) as prescribed and achieve and maintain an undetectable viral load have effectively no risk of transmitting HIV to a sexual partner.
One of the goals of ART is to achieve and maintain an undetectable viral load (i.e., when the viral load is so low it is not detectable on standard viral load tests). Depending on the ART regimen you are taking, it may take up to 6 months to achieve an undetectable viral load. You then must remain undetectable for 6 months to be considered untransmittable. The best way to achieve and maintain an undetectable viral load is to take your ART as prescribed.
How often you undergo viral load testing depends on numerous factors. Talk with your HIV healthcare provider to determine a schedule that is best for you. Remember, the only way to know if you achieved and are maintaining an undetectable level is to have regular viral load testing.
Despite taking your ART as directed, you may experience a temporary, small increase in your viral load level, known as a “blip.” This increase from undetectable to a low-level viral load typically returns to undetectable at your next viral load test. Blips do not necessarily mean your ART regimen is no longer working—for instance, it may have occurred due to a brief illness, such as a cold or the flu. However, if your viral load continues to be detectable on 2 consecutive tests, then your HIV healthcare provider may discuss potential causes and may discuss switching your ART regimen. Until your viral load becomes undetectable again, it is advisable to use other forms of prevention.
It is equally important to understand that all individuals living with HIV may not be able to obtain an undetectable viral load. This may be due to not having access to treatment due to transportation or insurance issues, side effects or intolerance to ART, or having other health conditions. Even if you are not able to attain an undetectable level, your HIV healthcare provider may still encourage you to take ART, as there are health benefits associated with a lower viral load.
Why should you remain in care?
Consistent engagement in your care is central to achieving good health outcomes. Staying in care means attending regularly scheduled appointments and taking ART as directed.
Barriers can impede your ability to remain in care. Some barriers may pertain to issues with housing, employment, transportation, insurance, and clinic office hours. Other barriers may be more personal, such as cultural beliefs, concerns about confidentiality, mental health issues, and substance use. If you are encountering barriers to care, contact us to see how we can help.
Science = Fact
Love = Acceptance
U = U
Why is U=U important?
The implications of undetectable equals untransmittable (U=U) are far reaching, as accurate and meaningful information about U=U can break down various barriers surrounding HIV. U=U plays a crucial role in reducing stigma. Dismantling stigma through awareness removes hesitancy in pursuing HIV testing and initiating treatment as well as improving ART adherence. U=U also positively impacts the lives of people living with HIV, as it helps improve quality of life, relationships, self-image, and overall health. Finally, a concerted effort working towards a common goal of understanding U=U offers an opportunity to impact the HIV epidemic.
What doesn’t U=U mean?
Being undetectable does not mean:
- You are cured of HIV. If you discontinue taking ART—even for a few days—your viral load will increase and become detectable.
- You are protected against sexually transmitted infections (STI). For this reason, you should use condoms every time you have sex and undergo routine STI testing. You may also talk with your provider to see if vaccines for human papillomavirus (HPV) or hepatitis are appropriate for you.
- It will prevent pregnancy. There are numerous types of contraception available to prevent pregnancy.
Does U=U apply to non-sexual transmission of HIV?
Advances in HIV treatment provide an innovative approach to reducing mother-to-child HIV transmission. A female living with HIV who maintains an undetectable viral load during pregnancy, labor, and delivery—and the infant takes HIV medication for a few weeks after delivery—has a 1% or less risk of transmitting HIV to her child. However, an undetectable viral load does not eliminate the risk of transmitting HIV through breastfeeding. Since there is a low risk of transmitting HIV through breastfeeding, the CDC recommends females living with HIV avoid breastfeeding.
It is currently unclear if an undetectable viral load prevents HIV transmission through sharing needles or other injection drug equipment. Therefore, it is recommended that you avoid sharing needles and other injection drug equipment and use new equipment each time you inject.