This article has been updated to include a call-to-action statement from APCOM and Prevention Access Campaign.
HIV advocates and researchers in Thailand have encountered “extreme backlash” against the U=U message, which promotes the fact that people with HIV who adhere to treatment and maintain an undetectable viral load cannot transmit HIV via sex, even when condoms aren’t used.
The International AIDS Society (IAS) issued a call to action—signed by HIV leaders in Malaysia, Japan, Australia, Thailand and India—asking the community to stand up for science and support U=U in Thailand.
The IAS statement reads in part:
The scientific validation of the HIV treatment as prevention strategy, commonly known as U=U, has overwhelmingly been welcomed by leading researchers and global health agencies, including the [National Institutes of Health and the Centers for Disease Control and Prevention in the United States as well as the United Nations HIV program UNAIDS]. Beyond the science of preventing HIV transmission, U=U also impacts behavioral, sexual and social norms and challenges many laws that criminalize HIV exposure. Crucially, it can help reduce the pervasive stigma that many people living with HIV face as they embrace the paradigm of U=U in their daily lives and practices.
However, despite the unequivocal scientific evidence, those who have spoken publicly in support of U=U in Thailand have recently received an extreme backlash for ensuring this science is put into practice. Only by expanding truths and challenging long-held myths about HIV prevention—on the basis of established science—will inroads be made to end this epidemic.
The truth of U=U is calling on all of us to augment our approach toward HIV prevention. While it is not a silver bullet, it is recognizing that communities and frontline health care workers need to engage in a more nuanced conversation about HIV that more readily fits into the realities of peoples’ lives. To avoid misinformation, medical associations and establishments must uniformly and openly recognize U=U. The pre- and in-service training of a range of health care practitioners must ensure that the principles of U=U are understood across a range of diverse settings. Including an evidence-based U=U message within all client interactions will ensure that everyday prevention and the choices people make are grounded in science.
What can you do to spread the U=U word in Thailand? IAS’s statement includes sample tweets, in English and Thai, that you can post with a simple click. They read:
It is scientifically proven that people living with #HIV who maintain an undetectable viral load by taking antiretroviral therapy cannot sexually transmit the virus to others. Undetectable = Untransmittable (U=U) http://ow.ly/aElQ30qinGv #UequalsU
ข้อเท็จจริงทางวิทยาศาสตร์ได้พิสูจน์แล้วว่า คนอยู่ร่วมกับเชื้อเอชไอวี แล้วกินยาต้านไวรัสอย่างต่อเนื่อง จนกดปริมาณไวรัสให้ต่ำมากได้ถึงระดับที่ไม่สามารถตรวจหาไวรัสในเลือดพบ จะไม่สามารถถ่ายทอดเชื้อเอชไอวีให้ใครได้เลยทางเพศสัมพันธ์ http://ow.ly/aElQ30qinGv #UequalsU
APCOM and Prevention Access Campaign (PAC) issued a joint statement supporting U=U in Thailand. ACOM is a coalition of members from community-based organizations, nonprofits, U.N. organizations and governmental groups across Asia and the Pacific that focuses on HIV issues and topics related to the health and wellbeing of men who have sex with men. PAC is the HIV advocacy group that launched the U=U campaign. The joint statement includes a list of call-to-action items from a task force of the Thai Red Cross AIDS Research Center. The list urges that:
- Doctors need to be formally educated on U=U and how to apply it in clinical practice;
- In Thailand, medical authorities such as The Ministry of Public Health, Thai AIDS Society, and Thai Medical Council, as well as Thai People Living with HIV Network, must publicly endorse U=U;
- International HIV communities, researchers, clinicians, people living with HIV, and policy makers should seriously strategize dissemination of this evidence-based U=U message to educate wider global communities; and
- In Thailand and worldwide, the existence of condomless sex must be seen and accepted regardless of HIV status. Other preventive methods must be accessible to people who choose to practice condomless sex with no judgement.
The resistance to the U=U message in Thailand may be surprising. After all, the country has been home to important HIV research, including the RV144 vaccine trial. What’s more, the country has successfully lowered its HIV rates in recent years.
In 2018, Thailand recorded 6,400 new HIV diagnoses, marking a 59% drop from 2010. What’s more, of the 480,000 people estimated to be living with HIV in Thailand, about 75% have access to treatment, according to the United Nations Programme on HIV/AIDS (UNAIDS). For further details and articles, visit UNAIDS’s Focus on Thailand.
The U=U movement was launched in 2016 by the Prevention Access Campaign to fight stigma and inform the world about the fact of U=U. To learn more, see our March 2019 cover story (pictured above), “Understanding Undetectable Equals Untransmittable,” along with the related feature “Viral Load Does Not Equal Value: Ensuring Health Equity for All People Living With HIV.” And for more recent data, check out “How Well Do U=U and PrEP Work? The CDC Updates Its Answers.”
To read a collection of U=U stories from across the globe, visit the U=U POZ Blog.