U=u Frequently Asked Questions
In September 2017, the New York State Department of Health became the first state health department in the Unites States to sign on to the Prevention Access Campaigns Undetectable equals Untransmittable Consensus Statement. In doing so, the Health Department endorsed the following statement:
“People living with HIV on ART with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV. Depending on the drugs employed it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.”
The framework of U=U offers a unique opportunity to dismantle HIV stigma and discrimination, and reemphasizes the critical importance of antiretroviral therapy , daily adherence, and continuous engagement in medical care for people living with HIV.
**NOTE: Definitions are available via mouse hover on italicized words below.
If I Am On Hiv Treatment Should My Partner Be On Prep
Couples share the responsibility of preventing HIV. HIV-positive people and their partners should discuss how they can have a healthy, fulfilling and worry-free sex life, including using condoms, HIV treatment, PrEP or emergency PEP .
You and your partner may decide that antiretroviral treatment for the HIV-positive partner provides enough protection against HIV. HIV-negative partners may choose to take PrEP, especially if they have other sexual partners; are unsure of their partner’s viral load or their partner’s ability to keep their viral load undetectable; or feel more secure in their sex lives with the added protection of PrEP.
How Do I Talk To My Partner About Their Risk Of Acquiring Hiv
People living with HIV can involve their partners in their treatment plans. Research shows that adhering to treatment often can improve with support from loving relationships and from the community.
Pre-exposure prophylaxis , in which an HIV-negative person takes antiretroviral medication to prevent infection, can be part of the conversation. Learn more about PrEP.
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What Does Undetectable Mean
The word “undetectable” is the lowest limit of the laboratory tests used to measure HIV viral load. Some viral load tests are very sensitive and can find or detect HIV in a sample of blood when there are only 20 copies of the virus per milliliter . Other viral load tests need up to 200 copies per mL of blood to detect any HIV. In the context of U=U, it does not matter which type of test your doctor uses to measure your viral load. As long as your viral load remains below 200 copies/mL, your risk of sexually transmitting HIV is negligible.
After I Begin Hiv Treatment How Long Does It Take For The Risk Of Sexually Transmitting Hiv To Become Effectively Zero
There is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment.
A persons viral load is considered durably undetectable when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.
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How Is Hiv Transmitted
HIV is transmitted between humans through the exchange of certain types of bodily fluids. Bodily fluids that can transmit HIV include blood, semen, breast milk, and vaginal fluids .
Not all body fluids can transmit HIV. The following cannot transmit HIV:
- Exchanging saliva, like through closed-mouth kissing or sharing drinks/utensils
- Coming in contact with an HIV positive personâs tears, sneezes, or sweat
- Ordinary physical contact, such as hugging, hand shaking, or touching shared objects like cutlery, cups, or toilet seats .
- Air or water
- Pets and insects cannot carry the virus and infect you, because transmission of HIV is only between humans .
While care needs to be taken in some situationsâlike when having sex or when open injuries are presentâthis certainly does not mean that it is unsafe to be around people with HIV. Think of how you interact with the vast majority of peopleâbodily fluids are not exchanged. Harboring discriminatory thoughts only perpetuates a fearful stigma against someone with HIV, which only hurts the person who has it.
HIV is often transmitted through sexual activity and drug use in adults in the United States . Maternal transmissionâfrom mother to childâis how the infection is spread to infants .
Does Hiv Treatment Always Work
About one in six people on their first HIV treatment regimen either never have an undetectable viral load or their treatment stops working in the first year. During the second year on treatment, the chance of your therapy ceasing to work is about one in twenty and this declines further over the next decade to about a one-in-fifty chance of failure in any one year.
So, the longer youve been on a particular HIV therapy, the less likely it is to stop working. Almost everyone who goes on to a second or third regimen reduces their viral load to an undetectable level.
If someones treatment does not result in viral load becoming undetectable, this is usually because they are having problems taking their treatment as prescribed, i.e. they dont take all their pills at the right time, without missing doses. Occasionally missing a dose of medication is unlikely to cause your viral load to become detectable again, but frequently missing doses may lead to a detectable viral load and should be avoided.
If you are having problems sticking with your treatment, talk to your doctor and they may be able to find a drug combination that suits you better.
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The Bottom Line: Bringing Hope To People Living With Hiv
Increasing awareness that having an undetectable viral load means that people living with HIV who remain on medications will not transmit the virus can have a dramatic impact on public and personal views of HIV. We have the tools to end the epidemic, keep people living with HIV healthy and unable to transmit the virus , and keep HIV-negative people negative through PrEP and post-exposure prophylaxis .
The epidemic continues because people are living with HIV without knowing it, because they have never been tested. HIV stigma is the biggest barrier to ending the HIV epidemic, so it is important to break down that stigma wherever possible by providing access to information, community support, and advocacy;;all of which build hope.
U=U has the potential to address all kinds of HIV stigma including institutional stigma occurring in healthcare settings, workplaces, and broadly across society; interpersonal stigma that can be so damaging among family and friends; and internalized stigma , which many people don’t even realize they have.
While researchers must continue to examine the promise and impact of treatment as prevention, the science that is currently available strongly supports U=U. That alone is a reason to make sure that all people living with HIV, or vulnerable to acquiring HIV, have access to this information so that they can make the most informed decisions possible about their own sexual health and lives.
What Will Being Undetectable Mean For Me
Having an undetectable viral load means that your ART is effectively controlling your HIV. This will protect your immune system and help you to stay in good health.
Being undetectable also means that you dont have to worry about passing HIV onto your sexual partners. For many people this is just as important to them, giving them relief from the anxiety of passing HIV on. Some people find that knowing theyre undetectable makes it easier to with others, as it can be reassuring for others to know that your health is protected and you cant pass it on too.
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What If I Am Undetectable And I Use Injection Drugs
If you are undetectable and use injection drugs, your chances of sexually transmitting HIV are negligible. However, even with an undetectable viral load, anyone who injects drugs should always use clean/new equipment and never share works. U=U does not apply at all to HIV transmission with shared works. While stigma as well as inadequate and intermittent health care remain challenges for many people with a history of injection drug use who are living with HIV, it is still important for them to remain engaged in medical care to become virally suppressed.
How Do We Know Treatment As Prevention Works
Large research studies with newer HIV medications have shown that treatment is prevention. These studies monitored thousands of male-female and male-male couples in which one partner has HIV and the other does not over several years. No HIV transmissions were observed when the HIV-positive partner was virally suppressed. This means that if you keep your viral load undetectable, there is effectively no risk of transmitting HIV to someone you have vaginal, anal, or oral sex with. Read about the scientific evidence.
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What Is ‘undetectable Equals Untransmittable’
When a person living with HIV is actively taking HIV drugs and their viral load stays at undetectable levels , that person cannot transmit HIV to a sexual partner who is HIV-negative. HIV community members, advocates, and experts often talk about this groundbreaking news using the simple phrase “Undetectable Equals Untransmittable,” or “U=U.”
Click above to view or download this fact sheet as a PDF slide presentation
Dont Breastfeed Your Baby
- Do not breastfeed your baby, even if you have an undetectable viral load. Having an undetectable viral load reduces the risk of transmitting HIV to the baby through breastfeeding but doesnt eliminate the risk.
- The current recommendation in the United States is that mothers with HIV should not breastfeed their babies.
;You should also have a pelvic examination and get tested for other sexually transmitted diseases during your pregnancy.
If I have an undetectable viral load, do my partner and I need to use anything else to prevent sexual transmission of HIV?
Getting and keeping an undetectable viral load prevents HIV transmission during sex. But there are situations when either partner may want to use additional prevention options.
- Using condoms;can help prevent some other STDs.
- Using condoms or having your partner take PrEP;can provide added peace of mind.
- Also consider using additional prevention options if you
- Are unsure, for any reason, that you have an undetectable viral load;
- Have a high viral load ;
- Have trouble taking HIV medicine regularly;
- Missed some doses since your last viral load test; or
- Have stopped taking HIV medicine or may do so in the future.
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How Well Does The Use Of Hiv Treatment To Maintain An Undetectable Viral Load Prevent The Sexual Transmission Of Hiv
Research conducted in serodiscordant couples shows that consistent and correct use of HIV treatment to maintain an undetectable viral load is a highly effective strategy to prevent sexual HIV transmission for both heterosexual and same-sex male couples. Evidence from this research shows that when people are on successful treatment and engaged in care they do not transmit HIV through sex.
Results from a large two-phase observational study known as PARTNER/PARTNER2 showed that treatment and an undetectable viral load prevents sexual HIV transmission in both heterosexual and same-sex male couples in the absence of other forms of HIV prevention . The first phase of the study included heterosexual and same-sex male couples, and the second phase continued with only same-sex male couples. In this study there were many unprotected sex acts when the HIV-positive partners viral load was undetectable approximately 36,000 among heterosexual couples and 76,000 among same-sex male couples enrolled in the study. By the end of the study, there were no HIV transmissions between couples in the study when the HIV-positive partner was on treatment and had an undetectable viral load. However, 16 new HIV infections were transmitted from a sex partner outside of the relationship.
What If I Am Undetectable And I Want To Breastfeed
At this time, U=U does not apply to HIV transmission during breastfeeding. While the risk of mother-to-child transmission of HIV is significantly reduced with the effective use of ART and an undetectable viral load, neither infant antiretroviral prophylaxis nor fully suppressive maternal ART eliminate the risk of HIV transmission through breastmilk. It is, therefore, recommended that women in the United States who are living with HIV refrain from breastfeeding and feeding their expressed breastmilk to their infants .
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No Guarantee Before The Rest Of Its
It has also cost the doctors, recognizes Dr. Pérez Elías: For those of us who carry 30 Years of instilling in our patients the importance of having sex with a condom, changing the message has not been easy. And the same thing happens to them: they have it burned into their brains. But it is important to admit that I = I, and take your time to transmit it well.
Dr. García Fraile points out: The message, from the biomedical and social point of view, is positive. Allow these people to have a calm, pleasant and fulfilling sex life. Many times they live in fear of what will happen if a condom breaks. We often have the profile of an irresponsible HIV-positive person in our heads, but it is a very minority. Most of the community is very sensitized.
The message of being undetectable only refers to HIV , not to the rest of sexually transmitted infections
This change in the message is experienced, therefore, individually, as a couple and socially. The I = I movement insists that it is an opportunity to transform the lives of people with HIV: transforms their social, sexual and reproductive lives; strikes stigma and strengthens empowerment, and reduces anxiety and encourages continued treatment.
For more information about the studies mentioned, click on the following links : HTPN 052 , from 2011; Partner 1 , from 2016; Opposites Attract, from 2017; and Partner 2 , from 2018.
How Well Does The Use Of Hiv Treatment To Maintain An Undetectable Viral Load Prevent Hiv Transmission To A Baby During Breastfeeding
Without HIV treatment, the risk for HIV transmission through breastfeeding is estimated to be roughly 15%. The rates of HIV transmission through breastfeeding for people who are taking HIV treatment are much lower. A systematic review of HIV transmission in breastfed infants of cisgender women on treatment found that the risk of transmission after birth was 1% after six months of breastfeeding, rising to almost 3% after one year. However, in these studies, the women were on treatment for varying amounts of time and did not continue treatment beyond six months after giving birth. The systematic review did not account for adherence or for viral load, which means that even though the women were taking HIV treatment we do not know how many of them had a detectable viral load at the time of transmission.
There is very limited research on the impact of treatment and an undetectable viral load on HIV transmission during breastfeeding. A study in Tanzania between 2013 and 2016 found two HIV transmissions among 177 infants who were breastfed by cisgender women who started treatment before the infant was born. However, in both cases the women had a detectable viral load. No transmissions occurred in the context of treatment and an undetectable viral load.
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Viral Load At Different Stages
During the first few weeks after someone gets HIV, viral load is usually very high typically several million viral copies per millilitre of blood . There is a considerable risk of passing on HIV at this point. In fact, many people acquire HIV from someone who has only recently acquired it themselves .
After this period of early infection, viral load usually drops. A typical viral load in someone not taking treatment may be 50,000 copies/ml. There is still a considerable risk of passing HIV on.
After starting HIV treatment, viral load usually falls rapidly. Within three to six months, most peoples viral load has become undetectable.
Most clinics in the UK report a viral load as undetectable if it is below 20-50 copies/ml. However, if your viral load remains below 200 copies/ml , there is no risk of passing HIV to your sexual partners. There is no need to worry if your viral load goes slightly above the detection limit of 20-50 copies/ml.
When viral load is detectable, this indicates that HIV is replicating in the body. If the person is taking HIV treatment but their viral load is detectable, the treatment is not working properly. There may still be a risk of HIV transmission to sexual partners.
How Well Does The Use Of Hiv Treatment To Maintain An Undetectable Viral Load Prevent Hiv Transmission Through Injection Drug Use
The limited available research suggests that being on HIV treatment and maintaining an undetectable viral load is effective at helping to prevent HIV transmission among people who inject drugs; however, people who use drugs can get HIV through sex and through sharing drug use equipment. While we know that maintaining an undetectable viral load will prevent HIV transmission through sex, we dont know how much it reduces the chance of passing HIV through shared drug use equipment. The best way to prevent passing HIV through drug use is to use new needles and other equipment every time. People who use drugs need access to enough new equipment to be able to do this consistently and to avoid having to share with others.
The three major studies looking at sexual HIV transmission did not systematically recruit people who inject drugs, they did not ask whether participants were sharing injection equipment and they did not provide any analysis related to participants who reported using drugs.
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