Multinational Undetectable = Untransmittable (U=U) Call-to-Action

“Throughout the history of the global HIV epidemic, rarely has such a clear opportunity emergedto alter its course. There is a worldwide possibility to fight HIV stigma and improve HIV prevention, care, and treatment outcomes by following the science and disseminating the evidence-based U=U message at scale.”

US and Canadian health officials annouce the MUCA at AIDS 2022

Vietnamese health officials sign on to the MUCA at IAS 2023

At the International AIDS Conference in Montreal in 2022, the Canadian and United States governments issued the Multinational U=U Call-to-Action (MUCA) to call on other nations around the world to support the evidence-based U=U message, and to ensure that U=U is fully integrated into national HIV responses in order to accelerate progress towards ending the global epidemic. The Vietnam government joined the Call-to-Action at the International AIDS Society Conference on HIV Science in Brisbane in 2023.

Read the Public Health Agency of Canada’s press release here, along with their video calling on all countries to recognize U=U and make it a core part of their HIV response.

If you are a governmental official interested in joining the Call-to-Action and implementing a national U=U program, please contact Bruce Richman at bruce@preventionaccess.org.

Multinational Undetectable = Untransmittable (U=U) Call-to-Action

U=U accelerates progress towards national and global goals to end the HIV epidemic

This call-to-action urges all nations to support the evidence-based U=U message and incorporate U=U into national efforts to prevent, diagnose, and treat HIV. Doing so can improve the health of individuals and communities and accelerate progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets1 and related initiatives to achieve epidemic control.

Leading global medical, scientific, and public health institutions accept and promote U=U. UNAIDS, the World Health Organization (WHO), and the U.S. President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) endorse U=U and call for U=U’s inclusion in official guidelines, statements, programming, and communications to ensure broader dissemination of the science and greater impact for those affected by HIV.2

U=U Improves Outcomes for Individuals and Communities

U=U knowledge has been linked to improved HIV prevention, care, and treatment outcomes among diverse populations in high and low resource settings in over 25 countries spanning every region of the world. These benefits span every step of the continuum from HIV diagnosis to viral suppression.

U=U education increases uptake of HIV testing3 and has been linked to improved treatment adherence and viral suppression.4,5 U=U knowledge impacts factors known to influence quality of life and health outcomes, including decreased stigma,6 improved self-image and mental health,7 feeling better about HIV status,8 and comfort with and frequency of sharing HIV status with partners.9

Increasing viral suppression at the community level has been shown to lead to steep, multi-year decreases in new HIV diagnoses among key populations.10 Combination prevention strategies, including prioritizing HIV diagnosis through home-based testing, immediate linkage to care, and support for treatment adherence, can lead to greater reductions in HIV incidence compared to standard of care.11

This accumulating evidence underscores how U=U can be leveraged to reach the 95-95-95 goals and support national efforts to end HIV as a public health crisis. Greater support of U=U is a win-win; improving the health of people living with HIV improves the public health of communities.

Strategies for U=U Integration

The following strategies presented for consideration are informed by the evidence base, emerging and promising practices, and lessons learned from national U=U rollouts. These strategies are intended to be applicable in diverse settings when developed with the meaningful and ongoing involvement of people living with HIV, key populations, and other affected stakeholders from all sectors and in collaboration with multiple levels of government.

  • Develop national strategies for sustainable and effective countrywide U=U programs that are informed by the communities and individuals most impacted;
  • Integrate U=U science into HIV guidelines and official communications;
  • Implement policies to address inequities, decrease barriers, and increase access to treatment, care, and diagnostics;
  • Include U=U as a mandatory component of existing HIV prevention, care, and treatment research, services, policies, and programs;
  • Use U=U in health education and promotion efforts to generate demand and increase utilization of testing, prevention, care, and related services;
  • Conduct U=U awareness campaigns for key populations and the general public to decrease stigma;
  • Improve access to and uptake of HIV treatment and viral load testing to ensure equitable access to the benefits of U=U, particularly those in low-resource settings;
  • Recognize U=U as a primary HIV prevention method and/or adopt combination prevention strategies that prioritize prompt diagnosis, linkage to care, and treatment adherence support for people living with HIV; and
  • Train, support, and require the HIV prevention and care workforce, including clinicians, peers, and other support professionals to deliver accurate and concise U=U messages during service delivery.

Conclusion

Throughout the history of the global HIV epidemic, rarely has such a clear opportunity emerged to alter its course. There is a worldwide possibility to fight HIV stigma and improve HIV prevention, care, and treatment outcomes by following the science and disseminating the evidence-based U=U message at scale. Doing so will propel nations, and the entire world, one step closer to finally ending the epidemic. As global leaders unite to amplify U=U, let all nations follow the science to achieve 95-95-95 goals and worldwide elimination of HIV.

 

  1. UNAIDS. New global pledge to end all inequalities faced by communities and people affected by HIV towards ending AIDS. Published June 8, 2021. Accessed December 10, 2023. https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2021/june/20210608 _hlm-opens
  2. UNAIDS, World Health Organization (WHO) South-East Asia Regional Office. Joint Statement Ministry of Public Health of Thailand, World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS). Published online February 21, 2020. https://www.who.int/docs/default- source/searo/hiv-hepatitis/joint-moph-unaids-who-uu.pdf?sfvrsn=8378cd0_2
  3. WHO. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Published July 16, 2021. Accessed December 10, 2023. www.who.int/publications/i/item/9789240031593
  4. PEPFAR. PEPFAR 2022 Country and Regional Operational Plan (COP/ROP) Guidance for all PEPFAR-Supported Countries. Published 2022. Accessed December 10, 2023. https://www.state.gov/wp- content/uploads/2022/02/COP22-Guidance-Final_508-Compliant-3.pdf
  5. Smith P, et al. Undetectable = Untransmittable (U = U) Messaging Increases Uptake of HIV Testing Among Men: Results from a Pilot Cluster Randomized Trial. AIDS Behav. 2021;25(10):3128-3136. doi:10.1007/s10461-021-03284-y
  6. Okoli C, et al. Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries. Sex Transm Infect. 2021;97(1):18-26. doi:10.1136/sextrans-2020-054551
  7. Kalichman SC, et al. Mobile Health Intervention to Reduce HIV Transmission: A Randomized Trial of Behaviorally Enhanced HIV Treatment as Prevention (B-TasP). JAIDS Journal of Acquired Immune Deficiency Syndromes. 2018;78(1):34. doi:10.1097/QAI.0000000000001637
  8. Rivera AV, et al.. Prevalence of U = U Awareness and Its Association with Anticipated HIV Stigma Among Low– Income Heterosexually Active Black and Latino Adults in New York City, 2019. AIDS Patient Care STDS. 2021;35(9):370-376. doi:10.1089/apc.2021.0070
  9. Rendina HJ, et al. Treatment Is More Than Prevention: Perceived Personal and Social Benefits of Undetectable = Untransmittable Messaging Among Sexual Minority Men Living with HIV. AIDS Patient Care STDS. 2020;34(10):444-451. doi:10.1089/apc.2020.0137
  10. Samuel K. HIV incidence fell by three-quarters in Australian gay men, with strong association with treatment as prevention. aidsmap.com. Published March 10, 2020. Accessed December 10, 2023. https://www.aidsmap.com/news/mar-2020/hiv-incidence-fell-three-quarters-australian-gay-men-strong- association-treatment
  11. Pebody R. African studies show that lowering viral load in the community reduces HIV incidence, but is not enough to eliminate HIV. aidsmap.com. Published March 10, 2020. Accessed December 10, 2023. https://www.aidsmap.com/news/mar-2020/african-studies-show-lowering-viral-load-community-reduces- hiv-incidence-not-enough

 

Contact: Info@preventionaccess.org July 28, 2022