Co-creation of a tailored U=U (undetectable=untransmittable) message to increase HIV testing in men in Western Cape, South Africa


BACKGROUND: Taking daily ART eliminates sufficient virus so that HIV is undetectable via viral load (VL) testing within 24 weeks. HIV-positive individuals with an undetectable VL cannot transmit HIV to sexual partners or through giving birth, this message is commonly referred to as U=U (undetectable equals untransmittable). Since South African men have poorer HIV outcomes than women, we used interactive human centred design co-creation workshops to ask men to create a relatable U=U message aimed at increasing HIV testing and ART uptake in men from high HIV burden communities in Cape Town, South Africa.
METHODS: Two facilitators explained the U=U message to men (n =39) attending the workshop and asked them how to effectively communicate the message. Participants designed messages in the local language, isiXhosa, to assuage fears of testing HIV positive explaining that ART enables people living with HIV to live normal lives and to be 'untransmittable' to their sexual partners.
RESULTS: Participants emphasized three main insights in developing the U=U message:
1) 'Introduce' the benefits of the antiretroviral pill,
2) positively redefine the man for whom the pill is intended, and
3) reframe the benefits of ART to be simple and straightforward for men to understand.
In addition, men discussed fear around testing HIV+ and that this may change their lifestyle in terms of health, girlfriends/wives and partying/alcohol consumption. Men created a message to emphasise
1) 'you cannot spread the virus (HIV) to the other person'
2) and '(the pill) keeps on killing the virus so I can live a normal life for the rest of my life.'
CONCLUSIONS: Men who participated in the workshops co-created a U=U message to flip the HIV cascade to focus on addressing fears related to testing HIV positive and being on ART instead of simply promoting HIV testing. The participants emphasized introducing the positive effects of ART, positively redefining the men for whom the pill is intended, and keeping the message simple, focusing on normalizing having HIV through targeted U=U messages. Programs promoting testing, treatment, and viral suppression may benefit from co-creating tailored messaging with beneficiaries to improve the uptake of HIV services.