Health care providers have an ethical obligation to provide correct information on U=U, the message that someone on consistent antiretroviral therapy who has a sustained undetectable viral load cannot transmit HIV to their sexual partner, Sarah K. Calabrese, Kenneth H. Mayer, and Julia L. Marcus wrote in a viewpoint for The Lancet HIV.
Some providers withhold U=U information in an effort to prevent people living with HIV (PLWH) from engaging in sexual activities that they perceive to be risky, such as having multiple partners or engaging in condomless intercourse, the authors note. Others lack the necessary level of knowledge on U=U themselves, or are uncomfortable talking with their patients about sexual practices. They may also be worried about other possible consequences of not using condoms—such as pregnancy or STIs—or mistakenly believe that condoms are still necessary to mitigate the (nonexistent) residual risk of HIV transmission by virally suppressed PLWH.
However, knowing about U=U reduces anxiety for sexually active people independent of serostatus, thereby enhancing sexual pleasure, the viewpoint co-authors write, adding that U=U also offers an incentive for PLWH to adhere to their antiretroviral regimen and keep their viral load undetectable. Withholding information on U=U means not fully disclosing the risks and benefits of HIV treatment, which violates medical ethics guidelines, they argue.
The authors recommend that health leaders publicly endorse U=U; that standards around U=U messaging be developed and communicated to providers; and that U=U be incorporated into medical school curricula and continuing education activities, as well as prioritized at conferences and in journals. Disseminating accurate information on HIV transmission should also become the purview of different types of health care workers, including nurses and pharmacists, they urge. They note that additional funding will be needed to develop educational content and social marketing campaigns directed at the health care workforce.
In the end, U=U is all about allowing patients to decide for themselves on matters of importance to their health: “Patients should be educated about the risks and benefits of all preventive options and empowered to make informed decisions,” the viewpoint authors conclude.