As many of us are now aware, U=U (Undetectable Equals Untransmittable), means that people living with HIV (PLHIV) can feel confident that, if they have a sustained undetectable viral load for at least six months, they will not pass on HIV to their sexual partners. Treatment as Prevention®, pioneered by the BC-CfE in 2006, formed the scientific foundation for a highly influential international movement and has increased quality of life for many, especially when coupled with universal access to treatment (the case now in BC).
A decade later, in 2016, the U=U movement was born out of a Consensus Statement endorsed by leading research doctors around the world, as well as hundreds of service and public health organizations. Last month, Dr. Francis Collins, head of the National Institutes of Health in the US, blogged about how “Treatment is Prevention”.
PAN joined in June 2017, alongside others in BC. Significantly Canada became the first country to endorse the statement in December 2018. If you haven’t already, please consider adding your agency to the 829 organizations from 97 countries (as of today).
YouthCO has already started a provincial campaign, where they are fully aware that treatment is first and foremost for personal health, that there are unjust barriers to accessing treatment, that not all people living with HIV will achieve an undetectable viral load, and there is no place for stigmatizing anyone living with HIV at any viral load. In fact, compared to other age groups in British Columbia, youth living with HIV have the lowest rates of undetectable viral loads. Helpfully, they highlight that whether or not a PLHIV has an undetectable viral load, there are a number of options to avoid transmitting HIV.
In 2019, Positive Living BC is looking to launch their U=U campaign with other agencies in the PHSA’s Collective Impact Network to promote awareness and confidence in the core message, facilitating informed treatment decisions for PLHIV, curbing new infections and challenging HIV-related stigma by dispelling myths about virus transmission.
Sharing the U=U message provides an unprecedented opportunity to improve the lives of PLHIV and to dismantle HIV stigma. It has far-reaching public health implications for engagement across each stage of the treatment cascade and for expanded access to treatment and care.
Beyond the science, it aims to decrease the stigma that too often accompanies living, dating and loving with HIV, and can deter individuals from accessing HIV testing and treatment. Add to this stigma barriers such as inadequate health insurance coverage, poverty, racism and criminalization, and care can seem out of reach to some. These factors can impact prevention – allowing HIV to persist, unchecked and untreated.
As the U=U movement advances, there are laws and policies that need to catch up. Currently, it can be a crime in Canada – categorized as aggravated sexual assault – not to disclose one’s sexual status with consenting sexual partners, even if there is zero chance of transmission due to undetectable levels of virus. But in July 2018, at the International AIDS Conference, twenty scientists from regions across the world developed the Expert Consensus Statement to address the use of HIV science by the criminal justice system, and accompanying editorial, both applauded by advocates around the world. So, on World AIDS Day 2018, the Canadian Federal Government released directives regarding prosecutions of HIV non-disclosure cases, with details in the Canada Gazette (p11-13).
However, in BC, the Prosecutorial Guidelines (March 2018) on alleged HIV non-disclosure do not refer to the robust scientific evidence available which led PAN and other allies to express their concern to BC’s Attorney General. PAN secured a meeting but it has been postponed whilst his office reviews the new federal directives, and the Canadian HIV/AIDS Legal Network’s comprehensive briefing paper that details the ways in which new directives here in BC can even improve upon the federal directives, to ensure an end to the overly broad and unjust use of the criminal law in relation to HIV non-disclosure, exposure and transmission in this province.
So the U=U campaign continues to impact the world, with (their) message of love that: Roses are red, Violets are blue, Share the good news #UequalsU.
Questions? Feedback? Get in touch!
Simon Goff, Executive Assistant and Collective Impact Coordinator, [email protected]