In the past few years, medical experts have coined the term U = U. It means undetectable equals untransmittable. When a person living with HIV (PLHIV) is taking his antiretroviral treatment (ART), he suppresses the HIV in his body so that it becomes so small, it can’t be detected.
Because the amount of virus in your body is so low, science has determined that you cannot transmit HIV to another person. Experts have even gone as far as to say that a PLHIV who is undetectable and continuously takes his ART, he cannot transmit the virus even if they have unprotected sex.
And I’ve known this for quite a while but I’ve never really said it out loud. Not in the many talks I’ve been asked to give in forums and seminars that I’ve been invited to.
I’ve always been afraid of reckless behaviour. That is what got me in this situation in the first place. Fifteen years ago, when I was younger and less cautious, I had an active sex life and while I had access to condoms, and often enough even kept some at home and with me at all times, I would agree to go condomless with many of my partners because they didn’t want to use it.
I wasn’t being smart. And now I have HIV.
I have been taking ART religiously since 2011 and by 2014, I was undetectable. A few years later, my doctor confirmed the news about U = U and I had known for quite a long while now but it was something I shared only to a few people. Because deep down inside, I didn’t want people to ever get careless or reckless again.
I didn’t want people to leave to chance something as important as their health and safety.
What I’ve discovered only recently, from reading articles from advocates here and abroad is that U = U is an important step towards decreasing the number of HIV infections every year. Undetectable equals untransmittable is a necessary step towards protecting the community and everyone from HIV.
Many members of the PLHIV community are not accessing or taking their ART consistently. According to the HIV registry, as of April 2019, only 37,091 PLHIV are on ART. According to the same statistics, there are 66,303 reported cases of HIV infections.
If my math is correct, that approximates to only 55% of the PLHIV population who are taking ART. That’s 45% who are not on ART and we can assume their viral load is not undetectable. And then there is the estimated number of PLHIV who are not recorded because they haven’t taken the test yet.
And if these PLHIVs are still sexually active, it means they are still able to transmit the virus if they have one reckless, careless encounter.
Undetectable means untransmittable. It means we can reclaim our sexuality and our sex lives without fear of passing on this virus to anyone else. To become undetectable, it means we are accessing our ART and it means we are seeing our doctors routinely and, hopefully, it means we are taking care of ourselves.
I was afraid that if I talked about U = U, it would mean that people in the community would return to their past behaviour thinking everything was going to be okay again. I was thinking short term. I wasn’t thinking about the big picture.
What is the big picture? If everyone who has HIV is on ART and their viral load is undetectable, then no one will ever have to get HIV again. Stop the spread from the source. But at the same time, it means we protect the lives of all the PLHIV out there because undetectable also means that virus is not destroying their immune system.
U = U really equates to life. A meaningful life. A long and healthy existence with an active and safe sex life that’s free of fear. Of course, I’d still prefer that people use condoms because there are other sexually transmitted infections out there than just HIV but it means we don’t have to worry anymore about the one we already know we have.
I’ve been so afraid to talk about U = U for so long now because I can detect some level of guilt for having been sexually active for so long before finding out I was HIV positive. I still haven’t forgiven myself completely for my part in my infection. There’s always just a little bit of guilt and self-hatred that lingers even if your life is okay again, like mine is. That never goes away.
But I’ve let it stop me from talking about U = U, which I’ve finally come to understand how important it is to the community and for everybody.
We need to get every PLHIV on ART and we need to get them to an undetectable viral load. Because that’s how we can stop HIV from spreading.
I was quiet about it before but I’m not. My viral load is undetectable. I’ve been undetectable for over five years now. I cannot transmit HIV to anyone. It is my duty to stay undetectable for as long as I live.
Blood Makes Noise