Ask the NP: U equals U fights HIV stigma; do you know what it means?

U Equals U

Photo: Harford County Health Department

This column is an on-going health series from Dr. James Simmons. He will offer useful news and tools that will help empower LGBTQ+ readers to make informed choices about their health.

A friend of mine mentioned at a recent party that he did not fully understand the concept of U=U, or undetectable equals untransmittable. 

After a long drawn out “guuurl,” he proceeded to get the explanation he didn’t know he needed, but was ultimately glad he got. 

And, it only took about 47 seconds. 

This friend is a very well-educated (academically and otherwise) 40-something, HIV negative gay man. I wish I could say this lack of awareness about U=U was an isolated experience. No shame to my friend, but it happens more frequently than it should.

Fully understanding the science behind U=U might be one of the biggest keys to finally removing the unnecessary and damaging stigma aimed at people living with HIV.

Whether you like hearing this or not, stigma perpetuated by willful ignorance among HIV negative persons still plays an enormous role in the lives of people living with HIV.

Understanding the science of U=U also allows us to simultaneously remove HIV-related stigma and actually live up to all the big talk about ending the HIV epidemic. 

Sometimes that talk feels like pie-in-the-sky platitudes, but we indeed have the tools and resources to do our part on an individual level.*

Helping end the HIV stigma and HIV epidemic doesn’t have to feel like a dream if everyone took 47 seconds to understand how. 

Ready, start your timer.

BTW – If you fully understand U=U, keep reading.

If you don’t fully understand U=U, keep reading.

OK, NOW you can start your timer.

This is not a science column, so I won’t get into the nitty-gritty, but here’s the bottom line.

If you are living with HIV and are taking HIV medications as prescribed, and you achieve and keep an undetectable viral load, you cannot transmit HIV to anyone through sex. 

12.8 seconds. We’re doing good.

For those who do want a little nitty-gritty, here you go. 

Across three landmark studies, more than 130,000 instances of bareback-penetrative sex were analyzed between HIV positive and HIV negative partners. The HIV positive partners had undetectable viral loads in each study, and not one instance of HIV transmission occurred.

28.7 seconds. Plenty of time.

While that much sex might sound fun, it’s nearly statistically impossible. You would need to have bareback-anal sex 5.9 times per day, everyday, starting at age 18 until you die at age 78 (the average U.S. life expectancy).

42.07 seconds. Uh oh, getting close.

If you combine this fact with sexually active HIV negative people taking HIV prophylaxis, or PrEP, as prescribed — which is 95 to 99% effective at preventing the transmission of HIV through sex — then you reach a statistically significant level of transmission being zero.

Zero percent chance of transmitting HIV through sex. 

That was 57.8 seconds. I owe you 11 seconds. Humor me.

As we all try to stick to our lofty new year’s resolutions, align our chakras, and set our intentions for 2023, I urge one of those intentions to include actively advocating for U=U education and truly working to end HIV stigma.

*Ending the HIV epidemic globally must also address the intersecting inequities, racism, and massive healthcare gaps present in most countries. Until this is addressed with a coordinated, strategic effort, HIV will continue to be a global epidemic despite the science to make it otherwise. Have no fear, we will address these points in future columns.

Disclaimer: This information is not advice and should not be treated as such. You must not rely on the information from this post or any posts on this site as an alternative to medical advice from your qualified health care provider. If you think you have a medical or psychiatric condition, seek help immediately. You should never delay seeking medical advice, disregard medical advice, or discontinue treatment because of information found on this site/page. You release any and all liability prior to any interaction with this post and by engaging with this post in any way (including viewing, reading, liking, commenting, sharing, saving, or any other interaction).

About the author

Dr. James Simmons

Dr. James Simmons is a board certified acute care nurse practitioner and clinical ambassador for the CDC’s “Let’s Stop HIV Together” campaign. He also taught Naomi Campbell how to walk in heels and is the world’s foremost Whitney Houston lip-sync champion.

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