The science is the message
It’s been a decade since How we see the world, how we figure out and respond to the challenges we face in the world or to the struggles we wrestle with within ourselves. We are each our own creation. I think that’s especially true for people living with HIV and in the LGBTQ+ community.
Launched by Bruce Richman and the Prevention Access Campaign (PAC) in 2016, U=U has become one of the most consequential and successful HIV public health campaigns, writes Tim Murphy in his report that starts on page 10. The campaign helped prompt changes to HIV treatment guidelines and was used to repeal or modernize outdated state laws that criminalized people living with HIV if they did not disclose their status. And U=U has done much to address stigma—including internalized HIV stigma.
“It was very empowering,” says Todd Fuqua, an Indiana activist living with HIV, in Tim’s story.
A 2021 study conducted in sub-Saharan Africa found that men who heard about and understood U=U were more likely to get tested for HIV. Another study reported that people with HIV who had conversations with their care provider about U=U had better rates of adherence to treatment and becoming undetectable. They were also more likely to inform their partners of their status.
But not everyone is sold on the message. In a 2024 online survey of mostly gay men in the U.S., 95% were aware of U=U, but only 41% believed it. Of the 457 participants, 106 were living with HIV; 351 were negative or had uncertain status. Two-thirds of the men with HIV believed in the science, compared to one-third of the men with negative or uncertain status. Among the skeptics, brief informational messaging about U=U did little to change their opinions. The study noted, “Interventions are needed to correct commonly held, outdated misconceptions about HIV transmission risk.”
And U=U has not reached everyone equally, says PAC interim executive director Monique Carry, PhD: “Awareness remains uneven across regions, communities and healthcare settings. Provider resistance is still a real barrier. Outdated beliefs, fear of liability or discomfort with sexuality prevent providers from fully embracing or communicating U=U, despite the science being clear. In other settings, health systems have been slow to integrate U=U into training, counseling and public-facing materials, leaving clients to learn about U=U elsewhere or not at all.”
She adds that structural barriers like racism, criminalization, poverty, gender inequities and political hostility toward public health are all factors.
While the message of U=U is as simple as a bumper sticker—or a meme—it is settled science, but the details are nuanced.
There’s a difference between being undetectable and suppressed. Both terms describe how much virus is in a person’s blood. Undetectable means that the amount of virus in a person’s blood is below a test’s ability to measure—generally, less than 20 copies per milliliter (mL). But moreover, a person has to have remained undetectable for at least six months by having stayed adherent to their HIV treatment, whether that’s oral medication or a long-acting injectable, to be considered untransmittable.
If your virus is suppressed—a viral load of less than 200 copies/mL—that’s still low enough to be undetectable.
Elsewhere in the issue, in separate essays, two people born with HIV write about how the science of U=U changed their lives. Brandon Cox Sanford (aka standup comedian Andy Feds) recalls how he met his wife, Jasmine; they were married last December (HERE). As a child, Kim Canady planned her own funeral, not wanting to be a burden on her family. Years later, she’s married and the mother of a high school football player—both husband and son are HIV-negative (HERE).
Managing your health as you age can be complicated enough without HIV. Tim Murphy offers a cheat sheet that can help (HERE). Addressing the complicated relationship between HIV and sexualized drug use requires a syndemic approach, writes David Fawcett, PhD (HERE).
Our coverage of CROI 2026, written by Larry Buhl, highlights key presentations at one of the largest HIV medical conferences of the year. Bridgette Picou attended the conference and writes in her column about how the pre-CROI Cure Research Community Workshop provides common ground for researchers and community.
The HIV community—those of us living with HIV, advocates, care providers and researchers—is stronger when we work together to find solutions.
You are not alone.