Understanding that Undetectable Equals Untransmittable
Posted on 17 Dec 2018

At the start of December, along with many others, I marked World Aids Day. It is of course a moment where, globally, people pause and come together, to reflect on those living with HIV and remember those who are no longer with us, having succumbed to this terrible virus.

It’s estimated that around 37 million people across the world are currently living with HIV, and for years, this global pandemic looked unstoppable as it cut down swathes of healthy men, women and children.
HIV has been in the consciousness for as long as I’ve been alive, the first related diagnosis being made in 1980, only a year prior to my birth. Subsequent decades of scientific research have now determined that the HIV virus, or its earliest strain, was first passed from chimpanzees to humans as far back as 1929 in the Democratic Republic of Congo, most likely a result of man’s hunting, butchering and eating of these simian cousins. Cross-contamination of blood over a sustained period of time was sufficient for the Simian Immunodeficiency Virus (SIV) to make its devastating leap, and later mutate, into what would become the first strain of HIV (Human Immunodeficiency Virus) in humans; HIV-1. The virus therefore has been around for nearly 90 years, but the fatalities prior to the 1980s went unreported, simply because they were small in number. The deaths were attributed to unknown causes or other determined illnesses.


The arrival of HIV in the western world came earlier than most imagine. In 2003, analysis of HIV types found in the United States, compared to known mutation rates, suggest that the virus may first have arrived in America in 1968. Yet it was from 1980 onwards that gay men in New York, San Francisco and elsewhere first presented themselves to hospitals with rare forms of diseases such as Kaposi’s Sarcoma (a rare cancer) and a lung infection called PCP, brought on as their immune systems began to collapse as a result of the impact of the HIV virus. The rest of the timeline becomes something of a well told, if tragically lived, history.


It wasn’t until 1987 that the first treatments began to arrive, but these had limited success and many side-effects. Ten years later came HAART, reducing death rates by 47%. By 2010 there were 20 different treatment options, and with the advancement in ART (Anti Retroviral Therapy), huge leaps have been taken in recent years in terms of controlling, and then surprising, the virus. In 2019, HIV can now be suppressed to such an extent that someone who has the virus can reduce their viral load so significantly that they become ‘undetectable’. Once undetectable, the HIV virus cannot be transmitted to someone who doesn’t have it, even during bareback sex. In a nutshell, U=U (Undetectable Equals Untransmittable) states that people living with HIV who are on antiretroviral therapy and have been undetectable (less than 40 copies in a millilitre of blood) for at least six months cannot infect others through sexual transmission.
Let’s just pause a second and be really clear about what this means. If you, as a HIV-negative person, have unprotected, condomless sex with your latest crush, who is undetectable, they cannot pass on the virus to you. This is a game-changer!


Medical trials have been conducted for some time to determine whether in fact this statement really lives up to its claim. Among the most notable trials was the Partner study. The study looked at 888 serodiscordant couples - that is, where one partner is HIV-positive and the other negative. Thirty-eight percent of them were gay male couples, the rest were heterosexual. The trial was conducted in 75 clinics in 14 European countries and tracked 58,213 condomless sex acts, both anal and vaginal. Again, like in previous trials, the HIV-positive sexual partner was on antiretroviral therapy for at least six months - and the study showed zero linked transmissions.   

This has to be the biggest and most rewarding achievement to date for all those who have been tirelessly working in HIV prevention. Endorsed by more than 350 bodies from 34 countries, HIV organisations who joined the U=U campaign have heralded this milestone. We should all now be singing this message from the rooftops - yet I can guarantee that few among the community in the Midlands have really heard about or believe it, instead feeling it’s just another one of those headline-grabbing statements behind which there’s nothing of substance. Well, it’s not - the evidence is there for all to read!


As a HIV-negative gay man, I’ve always been amazed and deeply horrified by the stigma and prejudice surrounding HIV that exists in our community, especially when aimed at those who carry the virus. As a child of the 1980s and ’90s, I vividly remember the ads, the news and the hysterical media stories that encouraged HIV shaming and stigma. Those stories seeped into global society’s very core, as prejudice and hatred were fuelled and justified by fear. But this surely cannot be justified anymore. To find it every day in my own community has always been heart-breaking. Can we not now set aside that entrenched fear and begin to see HIV for what it means and is today; and more importantly, recognise that we all have a role to play in overcoming it?

Understanding that Undetectable Equals Untransmittable is the duty of us all. Only with knowledge do we have the strength to build a brighter, more loving future for everyone in our community; masc, femme, gay, bi, trans, HIV-positive, negative, undetectable, and much else besides. We all truly deserve and have the right to be loved for simply being who we are.


Feature by Stephen Spinks


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