Andrew Mujugira

Undetectable=Untransmittable (U=U) is an empowering message which improves optimal sexual and mental health. However, hesitancy of U=U messaging among healthcare providers (HCP) is a barrier to widespread adoption. Addressing provider concerns and improving the understanding of U=U among vulnerable populations is key to increasing adoption of U=U.

U=U has been adopted by 1,050 organizations in 102 countries. U=U improves the wellbeing of people with HIV and dismantles HIV stigma. Bruce Richman presented recently published data from the 25-country 2019 Positive Perspectives Survey (n=2,389). Being informed of U=U by a HCP was significantly associated with higher odds of optimal sexual health, and self-reported HIV disclosure and viral suppression. Data from South Africa suggest that peer-delivered U=U messaging increased HIV testing uptake among men by 89% in a setting where testing coverage is lower among men than women. U=U messaging is empowering for transgender people whose access to HIV services is hindered by multi-level barriers, but few trans people are aware of U=U or the impact it can have on their lives. Research from Kenya found high awareness of U=U among HCP, but lack of conviction to message it. HCP found it easier to provide counselling to HIV discordant couples who came to clinic together and when viral load results were available. However, U=U hesitancy was driven by fear of viral rebound, promiscuity and blame in case of HIV transmission. Use of new media, e.g., scanning a QR code to access Indetectable=Intransmissible (I=I) messaging in Argentina was highlighted.

U=U hesitancy persists among HCP providers despite robust evidence of effectiveness. Engaging HCP, understanding reasons for hesitancy, utilizing U=U champions including young people who can communicate inclusive and positive messaging, and scaling up POC viral load testing are key to increasing adoption of U=U. Remaining gaps include lack of evidence of U=U effectiveness for other modes of HIV exposure (breastfeeding, IDU). Long-acting formulations for treatment and PrEP are a powerful tool for decreasing stigma and inadvertent disclosure, help improve long-term adherence and thus effectiveness of U=U. Better understanding what works and for whom is needed.