The New Language of HIV Prevention

For many years, one of the core principles of HIV prevention has been treatment as prevention (TASP). This means that the virus that causes HIV is not able to be sexually transmitted if the person living with HIV adheres to antiretroviral (ARV) treatment intended to suppress the virus. Undetectable = Untransmittable (U=U) is relatively new language meaning the same thing.

Although ARV treatment can help prolong an HIV-infected individual’s life expectancy by decades, many people don’t adhere to treatment. This means that they might not start treatment or, if they do, they might skip medical appointments or not take their HIV medicines daily and as prescribed.

There are a variety of reasons for a lack of adherence. There could be denial of their condition where they don’t want to admit the diagnosis. There could also be a variety of stressors in their lives that make adhering to their medication difficult not a high priority compared to other, more immediate, needs. People may have housing instability and experience homelessness. They may be uninsured and unable to afford their medication. There could be financial instability regardless of insurance coverage. There could be other factors involving alcoholism, drug use, or depression that prevents them from a regular regiment of medication. Lack of patient education and cultural beliefs can also be contributing factors. As with many health-related issues, underserved populations are disproportionately affected.

Psychology and human behavior are complex and the factors that go into how people act, especially those with a chronic condition, are sometimes difficult to understand. The stigma still associated with HIV can also cause someone to take their medication sporadically, worrying that people they live with or are close to may find out they are living with HIV. A roommate or a family member could discover their medication and question them about their condition. Healthy individuals may also judge someone’s lack of regularity in taking their medication. That judgement can compound the shame and guilt that are so often associated with HIV and complicate a person’s decision to take their medications as directed.

While TASP has been around for years, U=U is a new way of framing the issue in the field of HIV prevention. U=U is a global community working together to improve the quality of life for people living with HIV, dismantle HIV stigma, and bring us closer to ending the HIV epidemic. Some 1,072 organizations in 105 countries have signed on to share the U=U message in ways that engage their communities. There have been dozens of U=U public health campaigns around the world in many languages designed to educate individuals about the updated language of HIV prevention, as well as to inform ways for people living with HIV and their sexual partners to stay healthy.

If you know someone that is living with HIV, you can encourage them to get in treatment, keep their medical appointments, and take medication as prescribed. Discussing someone’s health with them can be a sensitive topic, especially with HIV, so make sure there is no judgment around the conversation. For a person living with HIV, realizing that if you take your medication as prescribed you will not only live a longer, healthier life and cannot transmit the virus to someone else can be a life-changing moment that leads to healthier lives for all of us.