FAQ: Frequently Asked Questions

The term "viral load" refers to the amount of virus in the blood stream of a person living with HIV. The higher the viral load, the greater the chance that the virus will be transmitted.

Antiretroviral treatment (treatment received by a person living with HIV) can reduce the viral load to such low levels (usually below 50 copies of the virus / ml), so that HIV transmission cannot take place through sexual intercourse, even without the use of a condom or other prophylaxis (eg PrEP: Pre Exposure Prophylaxis) while, at the same time, achieving a non-detectable viral load has positive effects on health. Antiretroviral treatment does not completely eliminate the virus from the blood stream, nor does it cure HIV. Medication adherence, however, is critical to keeping the virus at undetectable levels.

No. A person living with HIV, receiving treatment and having an undetectable viral load cannot transmit the virus through sexual intercourse.

The HIV virus must be sufficiently concentrated to be transmitted. The non-detectable load is too small to be transmitted through HIV.

The proof for U=U is based on the scientific results of multi annual research such as "HPTN 052", "PARTNER, PARTNER 2, Opposites Attract," and Swiss Statement.

In ΗΡΤΝ 052, ZERO transmissions of HIV were recorded among 1,763 discordant couples (one HIV-negative partner and the other HIV-positive), where the HIV-positive partner was on antiretroviral treatment and had a non-detectable viral load.

PARTNER recorded 58,000 unprotected intercourses between couples where the HIV-positive partner was on antiretroviral treatment and with a non-detectable viral load. ZERO transmissions of the virus to their negative partners were noted.

ΡΑRTNER 2, which was the follow-up to the PARTNER study, studied exclusively Men Who Have Sex with Men and recorded ZERO transmissions of the virus to 77,000 unprotected sex partners from positive antiretroviral partners with a non-detectable viral load to HIV-negative sex partners.

The Opposites Attract study found ZERO transmissions of the virus from 17,000 unprotected intercourses between couples in which one partner was HIV-negative and the other partner positive in antiretroviral treatment and with a non-detectable viral load.

Finally, it is worth noting that since the start of combination therapy no case of transmission of the virus by a person with a non-detectable viral load has been recorded.

In reality, the answer is YES. Theoretically the risk for transmission is a very small fraction close to 0 (zero). But there is no point in focusing on theoretical risks, simply because it is impossible to prove zero risk in science. Statistical analysis shows that this number will grow to near zero, with researchers around the world agreeing that "An HIV-infected person achieving Non-Detectable Viral Load, CANNOT Transmit HIV through sexual intercourse ”.

It is a widespread error which refers to the findings of the HPTN 052 study. The reason why the risk reduction was 96% (based on the provisional results of the study) and the risk reduction of 93% (based on the final results of the study) was due to the fact that there were HIV transmissions before the antiretroviral treatment suppressed the virus and, therefore, it didn't function properly for a very small number of participants. If only the transmission-related effects after the first six months of ART were taken into account, when HIV-positive partners had a non-detectable viral load, then the risk reduction would be 100% at ZERO transmission risk.

Almost all people who start ART reach a Non-Detectable Viral Load within 6 (six) months. Due to various endurance problems, about one in six people will need some extra time to find the appropriate treatment. Adherence to treatment and regular monitoring of viral load are REQUIREMENTS to maintain a Non-detectable viral load.

Access to adequate health care, treatment and viral load testing are serious obstacles in many parts of the world. Some people who have access to treatment may choose not to receive treatment or are not ready to start an antiretroviral therapy. Others who do start treatment, face challenges for adhering to it for a reasons such as, stigma, mental health challenges, substance abuse, unstable housing, difficulty paying for medication, a hostile environment, drug resistance or drug side effects. Furthermore, some people with low but detectable viral loads cannot transmit HIV. For example, a person whose virus is suppressed (below 200 copies / ml) and is still detectable (above 50 copies / ml) cannot transmit the virus. For people living with HIV and for whom the virus is not 'undetectable', there are extremely effective options to protect and prevent transmission such as, the use of condoms and lubricants or PrEP, which can be used alone or in combination to prevent HIV. All people living with HIV, regardless of their viral load, have a right to a full and healthy social, sexual and reproductive life.

If you are living with HIV, regular viral load testing is usually recommended 2-4 times a year, especially for people who have a steady Non-Detectable Viral Load. If you use your Non-Detectable Viral Load status as a prevention method for HIV transmission, then it is suggested to discuss this with your doctor and seek their advise regarding more frequent testing.

No. A non-detectable viral load means that there are very few copies of the virus in the blood. Even with an undetectable viral load, an HIV-positive person is still HIV-positive. That is why it is important for people living with HIV to continue to receiving treatment.

No. Undetectable viral load does NOT mean that there is no virus in the blood. It means that there are very few copies of the virus. An antibody test for HIV will "react", indicating that it has detected antibodies to HIV. A viral load test will find and measure copies of the virus in the blood. That is, if you test with a non-detectable viral load, it is very likely that the test will "react" and NOT give a negative result.

The existence of an STI (Sexually Transmitted Infections) does NOT affect the transmission of HIV, especially when the HIV-positive partner has a non-detectable viral load.

However, having an STI in the presence of Detectable Viral Load, may increase the chance of HIV transmission.

If you live with HIV, have an undetectable viral load and keep it undetectable by regularly taking your antiretroviral treatment, then you are likely to be much healthier than by not being treated. So, you need not worry that you may spread the virus to your sexual partners. Of course, if you want to stop using condoms, it is very important that you discuss this with your partner to make sure you are both comfortable with this decision.

Discussing about living with the virus and having an undetectable viral load can help reduce anxiety about HIV transmission. All this information is probably new to most people who do not live with HIV and it may take some time for someone to understand and trust what you are saying.

It is important to remember that with an Untraceable Viral Load you are protecting your sex partners from HIV but, that does not protect you or them from other STIs (Sexually Transmitted Infections) or any unwanted pregnancies.

Missing your meds once will not change U=U because viral load will still be undetectable but good adherence is essential for viral suppression. This is very important for avoiding drug resistance as well. You would probably need to miss HIV meds for several days before viral load becomes detectable again. If for any reason, you do miss ART for days, it is important to check your viral load is still undetectable before relying again on U=U. U=U depends on not regularly missing your HIV meds.

The use of PrEP and condoms are not necessary to prevent HIV transmission if the HIV-positive partner has a non-detectable viral load. A Non-detectable viral load, PrEP and condoms, are all HIV prevention methods that can be used alone or in combination. Knowledge of these methods and how each one works should be taken into account in order for everyone to choose the method(s) that suits them. A person can use one or more prevention methods, individually or in combination, depending on what they want. Condoms are currently the ONLY method that can prevent the transmission of HIV and other STIs (Sexually Transmitted Infections), as well as an unwanted pregnancy.

Having a non-detectable viral load for at least 6 months and regularly and consistently taking your antiretroviral treatment as directed by your doctors, will prevent HIV transmission. This means your sex partner is in no danger from contracting HIV.

But, it is advisable to consider the advantages and disadvantages of informing your sexual partner about your HIV status. Although the risk of HIV transmission is ZERO with a non-detectable viral load, a sexual partner can be displeased if he or she learns about your HIV status after having had sex with you. It is also extremely important to know that in some countries there are laws that obligate people living with HIV to inform their sexual partners about their HIV status, even when there is no risk of transmission.

Yes. Learn more about combination prevention here.

Quite simply, it means that if your sexual partner is living with HIV and maintains an undetectable viral load, you do not need to worry that the virus can be transmitted. Of course, if you want to stop using condoms, it is very important to talk to your partner and make sure you are comfortable with that decision. It is also very important to remember that with if your partner has a Non-Detectable Viral Load, you are only protected from HIV transmission, and that the Non-Detectable Viral Load of HIV neither protects you, nor your partner from other STIs (Sexually Transmitted Infections) or from an unwanted pregnancy.

You can't just look at another person and know if he or she is living with HIV. The same goes for whether hey have or have not a Detectable Viral Load. If you choose to trust your partner, that is a completely personal decision, most likely based on your sexual practices and the circumstances of your relationship. People who are involved in consensual sex, each have their share of responsibility for their sexual health. In some cases the use of PrEP is an excellent option.

Knowing that a Non-detectable viral load impedes the transmission of the virus can be very useful to individuals who wish to conceive and do not want to use an alternative method of insemination. A Non-detectable viral load dramatically reduces vertical transmission of the virus, during pregnancy and / or lactation.

More information about HIV in reproductive health (pregnancy and lactation) can be found at: www.HIVEonline.org και TheWellProject.org.

The scientific community has confirmed that Antiretroviral therapy which drives viral load in the blood to Non-detectable levels simultaneously reduces the HIV load to Non-detectable levels in both sperm as well as vaginal and anal fluids. Occasionally, people with an undetectable viral load in the blood may have HIV or RNA of the HIV virus in semen, vaginal or rectal fluids, but it has not been shown to increase the likelihood of transmission of the virus. The DNA and RNA of the virus are parts of the virus and in order to transmit, the entire virus needs to be present. In addition, studies have shown that the DNA or RNA of the virus is mainly found when a person initiates his or her antiretroviral therapy, and usually after a year (or more), it is increasingly spotted, up to no.

U=U does not apply to HIV transmission through syringe sharing.

There is still insufficient evidence and research to draw conclusions.

There are many reasons why some HIV information providers (such as health care providers, the media, etc.) have not yet communicated the U=U message to people living with HIV as well as the general population.

Changes in attitudes, perceptions and prejudices take time. For several decades, organised groups, activists and health care providers have tried desperately to end HIV transmission. The use of condoms has always been the safest way to do this, while campaigns for the use of condoms were mainly based on fear of transmitting the virus. For many, the fact that the Undetectable Viral Load acts as a barrier to HIV transmission is a difficult message to accept.

Also, although U=U is a purely scientific fact, there is still the issue of other STIs (Sexually Transmitted Infections), as well as an unwanted pregnancy. Condom use can prevent the transmission of other STIs and Treatment as Prevention is limited to HIV only.

More importantly, people living with HIV, as well as those who are at an increased risk of transmitting the virus, are often people who, because of their sexuality, are already confronted with stigma and prejudice.