U=U Messaging in the Community

Content From: Harold J. Phillips, MRP, Director, White House Office of National AIDS Policy•Published: July 27, 2023•5 min read

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Last year at the 24th International AIDS Conference Exit Disclaimer, I was proud to join federal colleagues to reaffirm Exit Disclaimer the U.S. government’s commitment to undetectable = untransmittable (U=U) messaging as a powerful messaging tool to support individual and community-level health. U=U is also a critical component of educating the public about HIV and combating HIV stigma and discrimination.

Over the past year, my federal colleagues and I have traveled to several communities, held listening sessions, and presented at countless conferences. I have been so moved to hear how advocates, healthcare providers, and community-based organizations are incorporating U=U into their service delivery models. The efforts below are a handful of examples that show how stakeholders across the country are incorporating U=U into their work.

Community Efforts

South Carolina Department of Health and Environmental Control adopted U=U as part of its Ending the HIV Epidemic in the U.S. (EHE) initiative plan and quickly moved to incorporate programming to combat HIV stigma. The health department partnered with a nonprofit, an HIV ministry, and two local designers to create large U=U art displays placed in front of the State House for World AIDS Day. The (U=U) + PrEP + Condoms=EHE (ending the HIV epidemic) also involved a QR code linking to education messages and resources, a video featuring U=U messaging, and a Gubernatorial Proclamation emphasizing U=U.
Maricopa County, Arizona created the Positively You Exit Disclaimer educational campaign focused on getting the word out about services available through the Ryan White Part A program. The campaign also has an interactive social media component and videos featuring people with HIV highlighting the importance of treatment as prevention and U=U in their lives.
The Southwest Center Exit Disclaimer in Phoenix, Arizona, incorporated U=U messaging into its community engagement and outreach efforts working to eliminate HIV-related stigma.
Los Angeles County Division of HIV and STD Programs has created a U=U Action Kit including provider and patient resources. The kit is structured around the core principle of Share Truth Not Stigma so that all staff and clients understand the U=U message. The kit includes a provider resource guide (PDF, 161KB) highlighting scientific literature about U=U, a summary of U=U key messages (PDF, 162KB), and a document that suggests preferred language (PDF, 207KB) when talking about HIV prevention and treatment.
Tarrant County, Texas has created the website, Beat HIV Exit Disclaimer which highlights U=U messaging for people seeking information about HIV.
The Fundación Latinoamericana De Acción Social Exit Disclaimer (FLAS) & Ventanillas de Salud, located in Houston, Texas, work to educate Latinos about HIV prevention, care, and treatment resources in the community and provide information about U=U.
The Louisiana Department of Public Health has increased the amount of provider trainings on HIV and cultural humility and included topics such as U=U and de-stigmatizing substance use.
New Orleans, Louisiana created the Bounce to Zero Exit Disclaimer social media campaign featuring local bounce music culture and influencers such as Big Freedia Exit Disclaimer, highlighting messages around U=U, PrEP, PEP, and available services.

Federal Efforts

Federal agencies are also incorporating U=U messaging into their critical work to end the HIV epidemic.

Last year, the Centers for Disease Control and Prevention’s (CDC) Division of HIV Prevention (DHP) updated the language it uses to describe treatment as prevention and references U=U as part of that messaging. CDC’s changes are now standard language throughout agencies of the federal government, stating that “Based on the evidence, people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load (or stay virally suppressed), won’t transmit HIV to their HIV-negative sexual partners.” This clear language about there being no risk of HIV transmission when someone with HIV has an undetectable viral load (U=U) is a critical component of our EHE efforts to keep people with HIV healthy, prevent new transmissions, and combat HIV stigma and discrimination.
The Department of Health and Human Services’ Office of Infectious Disease and HIV/AIDS Policy launched a national viral suppression campaign, “I am a Work of ART” and “Celebro Mi Salud,” featuring people with lived experience. The campaign encourages people with HIV who are not in care, or who have fallen out of care, to seek care, stay in care, and achieve viral suppression through antiretroviral therapy (ART). Learn more by visiting gov/ART and the “Celebro Mi Salud” campaign page.
In April 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment published a nearly $21 million notice of funding opportunity to increase HIV services in existing programs that provide substance use disorder treatment to racial and ethnic minority individuals. Included in the allowable activities is incorporating U=U messages into communication strategies for grant recipients. Learn more about the funding opportunity here.

Updates

I was heartened to see that at IAS 2023, the 12th International AIDS Society Conference on HIV Science Exit Disclaimer, the World Health Organization released Exit Disclaimer new guidance on HIV viral suppression, recognizing the role of viral suppression in improving individual health and decreasing HIV transmission. The new guidance was accompanied by a Lancet literature review Exit Disclaimer looking at 244 studies describing the powerful evidence for U=U messaging and the opportunities to destigmatize HIV and promote viral suppression.

Science has shown that people with HIV who are on ART and have an undetectable viral load, known as viral suppression, will stay healthy and will not transmit HIV to their sexual partners, also known as undetectable = untransmittable, or U=U. Innovative efforts to disseminate the U=U message have helped to correct misconceptions about HIV and AIDS, while engaging members of key populations in testing and treatment services. We are all encouraged to help spread the message of U=U to help end the HIV epidemic.