“Undetectable = Untransmittable” (U=U) is a campaign that has caused a few controversies, not to mention the medicolegal implications. This campaign confirms that the sexual transmission of HIV can be stopped once the infected partner is virologically suppressed. How true is this and how relevant is it? In this presentation, I discussed the concept of U=U as one of the measures to reduce the incidence of HIV and help people live a more fulfilling life while also living with the disease.

1. U = U
UNDETECTABLE = UNTRANSMITTABLE
PRESENTED BY
THE DEPARTMENT OF FAMILY MEDICINE
DORA NGINZA HOSPITAL

2. WHAT IS U=U?
• “Undetectable = Untransmittable” (U=U) is a campaign that
confirms that the sexual transmission of HIV can be stopped
once the infected partner is virologically suppressed
• People living with HIV on ART [antiretroviral therapy] with an
undetectable viral load in their blood have a negligible risk of
sexual transmission of HIV. HIV viral suppression should be
monitored to assure both personal health and public health
benefits

3. WHAT IS U=U?
• This concept known as Undetectable = Untransmittable
(U=U) is one of the advancements in HIV medicine
• People cannot pass HIV through sex when they have
undetectable levels of HIV.
• This prevention method has been estimated to be 100%
effective as long as the person living with HIV takes their
medication as prescribed and stays virologically undetectable.

4. CAN U=U BE TRUSTED?
• The U=U assertion is a product of several studies done and
scientific evidence gathered from heterosexual and homosexual
couples where one of them is HIV positive and the other is HIV
negative.
• In all of these studies, it was found that there was not a single
HIV transmission from an HIV-positive partner who had an
undetectable viral load.

5. SOME OF THE STUDIES & EVIDENCE
SUPPORTING U=U CAMPAIGN

6. U=U (CONT)
• U=U relies on the premise that if an HIV-positive individual
on ART is virologically suppressed, at this stage, HIV cannot
be passed on sexually.
• It further confirms that when a person is virologically
suppressed, condoms are also not required to prevent HIV
transmission.

7. U=U SPECIAL CONSIDERATIONS
• It should however be noted that U=U applies to HIV
transmission through sex only.
• It does not prevent other sexually transmitted infections
• It also does not apply to other ways of HIV transmission,
including breastfeeding and IV needle sharing.

8. U=U SPECIAL CONSIDERATIONS
• Once the viral load is undetectable, it does not automatically
stay undetectable forever.
• Viral load can fluctuate and small “blips” can occur, although this
is rare, and may infect the previously negative partner.
• Even when an individual is adherent to ART, other health and
non-health issues may lead to unsuppressed viral load, including
ABCDE.
• Regular viral load monitoring is therefore recommended.

9. ABCDE FOR UNSUPPRESSED VIRAL LOAD
Source: 2023 ART clinical guidelines for the management of HIV in adults, pregnancy and breastfeeding, adolescents, children, infants and neonates. Republic of South Africa National

10. ABCDE FOR UNSUPPRESSED VIRAL LOAD
Source: 2023 ART clinical guidelines for the management of HIV in adults, pregnancy and breastfeeding, adolescents, children, infants and neonates. Republic of South Africa National

11. FOR THE HIV-NEGATIVE PEOPLE
• U=U is one of the strategies to protective negative individuals
from contracting the disease.
• It helps to keep their sexual relationships intact once their
partner is adherent to treatment and are virologically
suppressed.
• It is however advisable for these high-risk individuals to be on
prep particularly if the HIV status or the viral load of their
partner(s) cannot be reliably ascertained.

12. REFERENCES
2023 ART clinical guidelines for the management of HIV in adults, pregnancy and
breastfeeding, adolescents, children, infants and neonates. Republic of South Africa
National Department of Health; 2023 [cited 2023 Nov 27]. Available from:
https://knowledgehub.health.gov.za
Acknowledge Dr Dele for her input in the slides preparations.

13. QUESTIONS & COMMENTS