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U=U brings an Aids-free world into sight

The Eastern Cape is the first South African province to officially launch an Undetectable equals Untransmittable programme of action. U=U refers to the fact that HIV+ people who are on effective HIV treatment and virally suppressed, cannot transmit HIV to their HIV negative sexual partners.

In September, the Eastern Cape Aids Council and the provincial Department of Health, along with civil society and other partners, threw their weight behind this breakthrough development that, in the words of Dr Anthony Fauci, Director of the US National Institute of Health, promises to be the “the foundation of being able to end the [HIV/AIDS] epidemic”.

The launch received pledges of support from the great and the good in politics ad public health, including the Eastern Cape Premier, the chief executive of the South African National Aids Council (Sanac) and the  South African Country Director for UNAids.

Evidence supporting U=U is now overwhelming yet its uptake does not match its scientific promise.

Mandisa Dukashe,
a pioneer of the U=U movement

Four landmark studies (HPTN 052, Partner, Partner 2 and Opposite Attract Study) have shown that treatment prevents sexual transmission of HIV. Across all four studies, there were no linked HIV transmissions observed between mixed-HIV-status partners when the partner with HIV was virally suppressed (defined in these studies as having a plasma HIV RNA viral load less than either 200 copies/mL).

The evidence is causing a cultural shift in HIV prevention, expanding the meaning of safer-sex beyond the use of condoms and provides renewed hope that ending the epidemic is within sight.

The Dukashe Family: Mom (HIV+), Dad HIV- have two HIV negative children, thanks to U=U.

The findings of the four studies reinforce consensus by WHO and much of the Aids community worldwide, that U=U is a foundation to ending the epidemic by 2030, the Eastern Cape Aids Council said in a press release. “The promotion, knowledge and uptake of U=U would alleviate stigma, reduce HIV transmission and bring us closer to epidemic control.”

Approximately 1,000 organisations from 102 countries have shared the U=U message to-date and the campaign has been translated into more than 25 languages, including K=K in Vietnamese, N=N in Dutch, B=B in Turkish, and I=I in Spanish, Italian, and Portuguese.

Vietnam officially endorsed U=U via national guidelines and is the first Pepfar country to achieve viral suppression in over 95% of people on antiretroviral treatment.

Zambia had a 83% viral suppression in 2018-2019. They endorsed U=U in 2019 and the report shared by CDC Zambia country director stated that Zambia viral suppression is now at 92%.

The Eastern Cape Aids Council, said that together with the Department of Health, development partners and civil society, they had embarked on a U=U campaign, “with the focus on promoting adherence to treatment and viral suppression among HIV positive people as a strategy to prevent transmission of HIV to sexual partners and children (PMTCT)”.

The overall goal and the objectives of the Eastern Cape’s U=U campaign is to reduce HIV transmission by promoting treatment adherence and decrease loss to follow up, increase viral load uptake and viral suppression, and improve data management.

In the words of Dr Anthony Fauci: “If we accomplish U=U, if you think for a moment, what does that mean? That means we don’t have anybody transmitting HIV infection. That’s what I mean when I say the concept of U=U is the foundation of being able to end the epidemic.”

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