• UequalsU
    UequalsU
    Data coming out of  The Prevention Access Campaign confirms what many professionals and activists have thought for years, people living with HIV and maintain an undetectable viral load cannot transmit the HIV virus to their sexual partners.

A Positive Tomorrow’s Message About UequalsU

We are proud to support and endorse the UequalsU campaign started by the Prevention Access Campaign. People living with HIV who have an undetectable viral load can now rest assured that they will not pass on the virus to their sexual partners. This new information will help to end HIV stigma and discrimination within our communities. This gives us hope, and proof, that we are evolving in the understanding of the virus and helps us to continue to improve upon the way those living with the virus are treated. The key to preventing transmission is for the positive partner to be undectactable for at least 6 months and remains compliant to their HIV treatment.

The largest study supporting the evidence that an undetectable person cannot transmit HIV is the Partner Study (HPTN 052). In the study 1,763 serodiscordant (mixed HIV status) couples were studied to see the likelyhood of the virus passing from an undetectable partner. The study lasted for more than four years and throughout the study there were only 8 instances of transmission. Four of those instances occured before the positive partner reached an undetectable viral load at the beginning of treatment. The remaining infections occurred after the positive partner became detectable again due to non-adherence to treatment and treatment failure.

We urge those in our communities to overcome their fears of those living with the virus and to accept the message of the UequalsU campaign. It is also our wish that those partaking in sexual activities protect themselves and their partners, and seek to remind everyone that even when there is no chance of passing on HIV, there are other STD’s and STI’s aside from HIV. Stay healthy, stay safe, and stay informed in all aspects of your sexual lives.

Consensus Statement

There is now evidence-based confirmation that the risk of HIV transmission from a person living with HIV (PLHIV), who is on Antiretroviral Therapy (ART) and has achieved an undetectable viral load in their blood for at least 6 months is negligible to non-existent. While HIV is not always transmitted even with a detectable viral load, when the partner with HIV has an undetectable viral load this both protects their own health and prevents new HIV infections.[i]  

However, the majority of PLHIV, medical providers and those potentially at risk of acquiring HIV are not aware of the extent to which successful treatment prevents HIV transmission.[ii] Much of the messaging about HIV transmission risk is based on outdated research and is influenced by agency or funding restraints and politics which perpetuate sex-negativity, HIV-related stigma and discrimination.

The consensus statement below, addressing HIV transmission risk from PLHIV who have an undetectable viral load, is endorsed by principal investigators from each of the leading studies that examined this issue. It is important that PLHIV, their intimate partners and their healthcare providers have accurate information about risks of sexual transmission of HIV from those successfully on ART. 

At the same time, it is important to recognize that many PLHIV may not be in a position to reach an undetectable status because of factors limiting treatment access (e.g., inadequate health systems, poverty, racism, denial, stigma, discrimination, and criminalization), pre-existing ART treatment resulting in resistance or ART toxicities. Some may choose not to be treated or may not be ready to start treatment.

Understanding that successful ART prevents transmission can help reduce HIV-related stigma and encourage PLHIV to initiate and adhere to a successful treatment regimen.

The consensus statement has been endorsed by:

  • Dr. Michael Brady – Medical Director of Terrence Higgins Trust and Consultant HIV Physician, London, UK

  • Dr. Myron Cohen – Principal Investigator, HPTN 052; Chief, Division of Infectious Diseases, UNC School of Medicine, North Carolina, USA

  • Dr. Demetre C. Daskalakis, MPH – Assistant Commissioner, Bureau of HIV/AIDS Prevention and Control New York City Department of Health and Mental Hygiene, New York, USA

  • Dr. Andrew Grulich – Principal Investigator, Opposites Attract; Head of HIV Epidemiology and Prevention Program, Kirby Institute, University of New South Wales, Australia

  • Dr. Jens Lundgren – Co-principal Investigator, PARTNER; Professor, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark

  • Dr. Mona Loutfy, MPH – Lead author on Canadian consensus statement on HIV and its transmission in the context of the criminal law; Associate Professor, Division of Infectious Diseases, Women’s College Hospital, University of Toronto, Toronto, ON, Canada

  • Dr. Julio Montaner – Director of the British Columbia Centre for Excellence in HIV/AIDS; Director of IDC and Physician Program Director for HIV/AIDS PHC, Vancouver BC, Canada

  • Dr. Pietro Vernazza – Executive Committee, PARTNER; Author, Swiss Statement 2008, Update 2016; Chief of the Infectious Disease Division, Cantonal Hospital in St. Gallen, Switzerland

The following Community Partners have signed on to the U=U campaign as of May 10, 2017:

End AIDS NY 2020 Community Coalition – 79 New York State-based organizations (USA)

In addition:

A Positive Tomorrow (USA)
ABDGN – African and Black Diaspora Global Network on HIV/AIDS (CAN)
ACCM – AIDS Community Care Montreal (CAN)
ACON (AU)
ACT – AIDS Committee of Toronto (CAN)
ACT UP Dublin (IRL)
ACT UP Minneapolis/St. Paul (USA)
ACAS – Asian Community AIDS Services (CAN)
Afirma’t LGTB (ES)
African American Office of Gay Concerns (USA)
African Services Committee (USA)
AIDES (FR)
AIDS ACTION NOW (CAN)
AIDS Alabama (USA)
AIDS Committee of Durham Region (CAN)
AIDS Committee of Ottawa (CAN)
AIDS Community Care Montreal / SIDA Bénévoles Montréal (CAN)
AIDS United (USA)
AIDS Foundation of Chicago (USA)
AIDS/HIV Forum (IT)
AIDS New Brunswick (CAN)
AIDS Project New Haven (USA)
AIDS Survivor Syndrome – Let’s Kick ASS (USA)
AIDS Survivor Syndrome – Let’s Kick ASS NY (USA)
Albany Damien Center (USA)
Alliance for Living (USA)
APLA Health (USA)
APOYO POSITIVO (ES)
Asociatia Romana Anti-SIDA – ARAS (ROU)
Association of Nurses in AIDS Care (USA)
Australian Federation of AIDS Organizations (AU)
BABES-Network YWCA (USA)
BCN Checkpoint (ES)
Body Positive (NZ)
BeyondPositive (UK)
British Columbia Centre for Excellence in HIV/AIDS (CAN)
Bruce House (CAN)
Canadian AIDS Society (CAN)
Canadian HIV/AIDS Legal Network (CAN)
Canadian Positive People Network – CPPN (CAN)
CARE Center (USA)
Carolinas CARE Partnership (USA)
Cascade AIDS Project (CAN)
CATIE – Canadian AIDS Treatment Information Exchange (CAN)
Center for Health Identity Behavior & Prevention Studies, New York University (USA)
Center for HIV Educational Studies & Training -CHEST (USA)
České Sestry Věčné Radosti – SPI CZ (CZ)
Civil Society for HIV/AIDS in Nigeria (NG)
COGAM Colectivo de Lesbianas, Gays, Transexuales y Bisexuales de Madrid (ES)
Crips Ile-de-France (FR)
CTAC – Canadian Treatment Action Council (CAN)
Czech AIDS Help Society (CZ)
Desiree Alliance (USA)
Desmond Tutu HIV Foundation (ZA)
Equitas Health (USA)
European AIDS Treatment Group (BE)
Fundació Lluita contra la Sida (ES)
George House Trust (UK)
Getting to Zero San Francisco (USA)
GMFA – Gay Men’s Health Charity (UK)
GMHC (USA)
Groupe sida Genève (CH)
Health Initiative for Men – HIM (CAN)
Hello Gorgeous Foundation (NL)
Hispanic Health Network (USA)
HIV & AIDS Legal Clinic Ontario (CAN)
HIV/AIDS Resources and Community Health (CAN)
HIV/AIDS Resource Program – HARP (CAN)
Hiv-Danmark (DK)
HIVE (USA)
HIV Disclosure Project (CAN)
HIV Equal (USA)
HIVForum.info (IT)
HIV Ireland (IRL)
HIV Medicine Association (USA)
HIV Modernization Movement-Indiana (USA)
HIV Scotland (SCT)
HIV Smart (USA)
HIV Vereniging (NL)
Housing Works (USA)
Human Rights Campaign (USA)
Hyacinth AIDS Foundation (USA)
ICASO – International Council of AIDS Service Organizations (CAN)
Imagina MÁS (ES)
Impac+NYC (USA)
[ imstilljosh ] (USA)
INA – Māori, Indigenous & South Pacific HIV/AIDS Foundation (NZ)
International AIDS Society (IAS) (CH)
International Association of Providers of AIDS Care (USA)
International Community of Women Living with HIV (KE)
JACQUES Initiative (USA)
John Snow, Inc. (USA)
Kırmızı Kurdele İstanbul (Red Ribbon Istanbul) (TR)
Latino Commission on AIDS (USA)
LGBT Foundation (UK)
LILA (IT)
Living Positive Victoria (AU)
Mr. Friendly (USA)
MSMGF – the Global Forum on MSM & HIV (USA)
MyFabulousDisease.com (USA)
NAM aidsmap (UK)
NASTAD – National Alliance of State and Territorial AIDS Directors (USA)
National AIDS Trust (UK)
National Association of People Living with HIV Australia (AU)
National Black Justice Coalition (USA)
National Native American AIDS Prevention Center (USA)
NC AIDS Action Network (USA)
New York City Department of Health & Mental Hygiene (USA)
New York Transgender Advocacy Group (USA)
NMAC (USA)
Northern Territory AIDS & Hepatitis Council (AU)
Ohio HIV/STD Hotline (USA)
OHTN – Ontario HIV Treatment Network (CAN)
Peel HIV/AIDS Network (CAN)
Persons with HIV/AIDS Rights Advocacy Association of Taiwan -PRAA (TW)
Please PrEP Me (USA)
Positive Alliance (USA)
Positive Living Society of British Columbia (CAN)
Positive Moving On (NIR)
Positive Voice (GR)
Positive Women’s Network – USA (USA)
Positive Women Victoria (AUS)
Positive Steps Northwest (UK)
PositiveLite.com (CAN)
Positively Mindful (UK)
Positively UK (UK)
POZ I AM RADIO (USA)
PozitiveHope (USA)
PrEP Facts: HIV Prevention & Sex (USA)
Prepster (UK)
Pride for Youth / Long Island Crisis Center (USA)
Prisoners with HIV/AIDS Support Action Network (CAN)
Queensland AIDS Council (AU)
Realize / Réalise (CAN)
REL8 Okanagan (CAN)
RiseUpToHIV (USA)
Rural AIDS Action Network (USA)
San Francisco AIDS Foundation (USA)
Sensoa (BE)
Sidaction (FR)
Snowy Owl AIDS Foundation (CAN)
Southern AIDS Coalition (USA)
Southern HIV/AIDS Strategy Initiative (SASI) (USA)
Stronger Together, Association for Support of People Living with HIV (MK)
Terrence Higgins Trust (UK)
The AIDS Network (CAN)
The HIV League (USA)
The Institute of Many (AU)
The Well Project (USA)
TheBody.com (USA)
Thursday’s Child of Long Island (USA)
Toronto People With AIDS Foundation (CAN)
Trade Sexual Health (UK)
TransLatin@ Coalition (USA)
Vancouver AIDS Society (CAN)
Waverley Care (SCT)
Whitman-Walker Health (USA)
YouthCo (CAN)

[i] Much of the current prevention messaging refers to this as Treatment as Prevention or TasP.  As of the writing of this primer, there have been no confirmed cases of HIV transmission from a person with an undetectable viral load in any studies. The official cut-off point for an undetectable viral load as defined by the WHO ranges from high-income countries to <1,000 copies/ml in low to middle-income countries. For the purposes of this statement, an undetectable viral load is defined as under
[ii] Only a small proportion of people living with HIV in a large US treatment study regarded themselves as non-infectious after up to three years on antiretroviral therapy (ART), and a third of participants regarded their chance of transmitting HIV to a partner as still ‘high’, even though only 10% of participants actually had a detectable viral load.” NAM aidsmap (2016)
[iii] Acknowledgements: In addition to PAC’s Founding Task Force and Bruce Richman (PAC Executive Director), Professor Carrie Foote (Indiana University-Indianapolis) and Edwin Bernard (HIV Justice Network) reviewed and provided valuable input on the Primer.