Undetectable=Untransmittable=Universal Access (U=U=U): transforming a foundational, community-led HIV/AIDS health informational advocacy campaign into a global HIV/AIDS health equity strategy and policy priority

Abstract

Background Undetectable=Untransmittable (U=U) first emerged in 2016 as a health information campaign to promote rigorous scientific evidence that people living with HIV (PLHIV) on effective treatment who have reached an undetectable or suppressed viral load cannot pass on the virus sexually. Within 7 years, U=U underwent transformation from a global community-led, grassroots movement into a global HIV/AIDS health equity strategy and policy priority. Methods For this narrative review, a targeted literature search on ‘history’ + ‘Undetectable=Untransmittable’ and/or ‘U=U’ on Google and Google Scholar, in addition to a search of online documents on the Prevention Access Campaign (PAC) website, was conducted. The article utilises an interdisciplinary policy studies approach that recognises the roles of multi-stakeholder, especially that of the community and civil society, to effect policy change. Results The narrative review first provides a synopsis of the scientific origination of U=U. The second section highlights the progress and leadership on U=U led by the PAC and civil society partners and efforts of the PLHIV and ally communities in advocating for the broad recognition and dissemination of the evidence, which has proven to be a game-changer within the HIV/AIDS response. The third section spotlights the recent developments of U=U within the local, national, and multilateral spheres. Conclusion The article ends with recommendations for community and HIV/AIDS multi-stakeholders on how they can further integrate, implement, and strategically utilise U=U as an essential and complementary HIV/AIDS pillar to the current Global AIDS Strategy 2021–2026 to end inequalities to end AIDS by 2030.

Global evidence, impact and implementation of U=U

“…Hui's review delves into the movement's origins, tracing its beginnings and shedding light on its development over time. 2 Additionally, it offers insights and suggestions on effectively incorporating the U=U message into existing policies and frameworks related to HIV/AIDS on a global scale.…”

2023 Undetectable = Untransmittable global policy roundtable report: a multistakeholder perspective on Undetectable = Untransmittable research and policy priorities

“…8 Although the potential benefits of U=U are immense, persistent structural barriers and lack of universal access to antiretroviral medications and viral load diagnostics in lower resource settings remain areas of concern to people living with and affected by HIV. 9 From its inception in 2016, U=U has been a grassroots, community-led movement, and is endorsed by over 1050 organisations in 105 countries worldwide. 9 The U=U movement underpins international efforts to reach community-level UVL and virtually eliminate new HIV transmissions, and end AIDS as a public health concern, by 2030.…”

“…9 From its inception in 2016, U=U has been a grassroots, community-led movement, and is endorsed by over 1050 organisations in 105 countries worldwide. 9 The U=U movement underpins international efforts to reach community-level UVL and virtually eliminate new HIV transmissions, and end AIDS as a public health concern, by 2030. 10 Key priorities for improving community-centred, evidence-informed U=U policy and research were the focus of a half-day global roundtable held in 2023 alongside the 12th International AIDS Society Conference on HIV Science in Brisbane, Australia.…”