US: A Breakthrough Strategy for Ending the HIV Epidemic

At the height of the AIDS epidemic, one of the defining characteristics of the crisis was the belief that condomless sex basically guaranteed transmission of HIV. Public health authorities offered condoms and abstinence as the only prevention options, but even in the darkest days of the crisis, they were not enough to stop new infections from climbing. Experiencing sexuality included feelings of fear, shame, and stigma.

Today, that fear is changing. New York City has achieved historic success in driving down the rates of HIV: New diagnoses have dropped by 64 percent since HIV case reporting began nearly two decades ago, from 5,900 to 2,157 per year. And newly acquired infections, a measure of recent HIV transmission, are on an even faster downward trajectory in the city.

The progress in New York City, most recently, is often traced to interventions like pre-exposure prophylaxis (PrEP), a safe and effective daily pill that greatly reduces the risk of HIV infection, and public health officials’ efforts to diagnose people with HIV earlier and link them to care.

But the consistent and steady decline in HIV is also related to the power of an increasingly better known, life-saving HIV treatment that has the wonderful side effect of preventing sexual transmission. This prevention method is also called “U=U,” or Undetectable Equals Untransmittable. U=U is a simple way to disseminate a scientific fact: People living with HIV on effective treatment do not sexually transmit HIV. This Pride Month, U=U is the subject of the New York City Health Department’s new sexual health marketing campaign.

The city’s health department, where we work, became the first U.S. government agency to officially join the U=U movement three years ago. Today, more than 860 community partners from nearly 100 countries have signed on, and the Centers for Disease Control and Prevention has endorsed the science behind U=U.

When we talk about U=U, data, not dogma, should drive the conversation. Last month, a landmark study was published in the Lancet that followed nearly 800 eligible male couples where one partner was living with HIV and the other was not. In over 76,000 reports of condomless sex, not one person with HIV who was taking antiretrovirals—or medications to treat HIV—and had an undetectable viral load passed HIV to their sexual partner. The researchers concluded, “evidence for gay men, as for heterosexual couples … indicate that the risk of HIV transmission when HIV viral load is suppressed is effectively zero for both anal and vaginal sex.” Read more via Rewire