Make ‘U=U’ discussions a standard part of HIV care, researchers urge
International survey finds a high proportion of people living with HIV know about ‘Undetectable = Untransmittable’ – and are more likely to be healthy compared to those who are unaware.
An online survey of around 2,390 people living with HIV and on antiretroviral treatment (ART) found that the majority knew they could not transmit HIV to a sexual partner if they achieved and maintained viral suppression – a concept known as ‘Undetectable equals Untransmittable’ or U=U.
The Positive Perspectives Survey took place between 2019 and 2020 across 25 countries, mainly in Europe, North America, Latin America and the Asia Pacific. There were participants also included from Russia and South Africa, however, the majority of participants lived in Europe and North America.
The survey found that two-thirds of participants had talked about U=U with their healthcare providers. These people were more likely to report a range of good health outcomes compared to those who were unaware of U=U or had learnt about it from other sources.
This suggests that it is beneficial for people living with HIV to have U=U discussions in clinical settings and supports findings from previous studies that people are more likely to believe information if they get it from their healthcare provider rather than from other sources.
But the findings also show that a third of the participants had not been told about U=U by their healthcare provider. The study’s authors say this gap should be closed by making U=U discussions a standard part of HIV care.
Overall, 66.5% of survey participants said they had discussed U=U with their healthcare provider, ranging from 38% in South Korea to 87% in Switzerland. These people were more likely to adhere to treatment, be virally suppressed and have good sexual health when compared to those who were unaware of U=U. They were also more likely to tell sexual partners and others that they are living with HIV.
While learning about U=U from non-healthcare sources was still found to be beneficial, associations with good health outcomes were less strong than among participants who had discussed U=U in healthcare settings.
The groups most likely to discuss U=U in healthcare settings were transgender people (77% had discussed U=U with healthcare providers), people with casual sex partners (75%) and people of black origin (70%).
The proportion of men and women who had discussed U=U with a healthcare provider was fairly similar at 67% and 65%. Men who have sex with men reported high rates of healthcare provider discussions, at 71%. But men who have sex with women had lower rates at 58%.
People living with HIV in Asia were the least likely group to discuss U=U with their healthcare provider, with just half (51%) reporting this.
Participants who said that preventing passing HIV on to a partner had been an important goal when they started ART were more likely to be aware of U=U than those who were less concerned about this (71% compared to 62%).
People who had discussed U=U with their healthcare provider were also more likely to be actively engaged in their HIV care, for instance, by discussing new treatment options. This suggests they had a stronger patient/doctor relationship than other survey participants.
The differences between groups suggest tailored communication could increase awareness of the benefits of U=U among certain populations.
But it is clear that it is beneficial for healthcare providers to discuss U=U with people on HIV treatment. Adding U=U discussions to clinical guidelines would help make these discussions more uniform, and ultimately improve the health and well-being of people living with HIV.