Ending AIDS as a public health threat: the imperative for clear messaging on U=U, viral suppression, and zero risk

Abstract

To end AIDS as a public health threat by 2030, we must leverage both the impactful message of U=U (undetectable equals untransmittable) and viral suppression to improve the wellbeing of individuals living with HIV, increase engagement with HIV services, and reduce barriers such as stigma, discrimination, and criminalisation. This message requires clear and unambiguous evidence-based narratives that emphasise the message that there is zero risk of sexual transmission when an undetectable viral load is maintained and negligible risk when viral suppression (as defined by 200-1000 copies per mL) is maintained. Dissemination of this information to individuals living with or affected by HIV, health-care workers, communities, the general public, and policy makers will increase awareness and credibility of this message and challenge deep-seated misperceptions. Furthermore, understanding the impact of this evidence underscores the necessity to urgently prioritise universal access to quality care, including viral load testing; leverage community leadership to address structural barriers; and monitor for ongoing success. Responsible and equitable messaging, which includes attention to women and marginalised groups, should be used to realise benefits for personal wellbeing and work towards an AIDS-free future.