Being on ARVs can lead to (HIV) risk-free sex. Why do so few know?

Science tells us that HIV positive people on uninterrupted ARV treatment can get to a point where they cannot transmit the virus, as long as they remain on treatment. U=U, meaning ‘undetectable equals untransmittable’ is a groundbreaking campaign that promises HIV+ people that once viral suppression is reached, the virus cannot be transmitted to their sexual partner. Although evidence supporting U=U is now overwhelming, a study released in May 2021 (1) suggests that knowledge of this fact is poor, both globally, and in South Africa.

The implications of this lack of knowledge are serious, especially considering that the world failed to reach global HIV targets (to find 90% of people living with HIV, place 90% of them on antiretrovirals and ensure 90% of them became virally suppressed) by December 2020, that there are estimated to be 8,2 million people living with HIV (PLHIV) in South Africa (2) and that the number of people starting on ARVs dropped by 35% between the first quarter of 2019/20 and 2020/21 (13) .

As Harry Hausler, CEO of TB HIV Care, states, “In summary, South Africa has a large population of people living with HIV and the number of them starting on ARVs is dropping, despite the fact that ARVs are not only life-saving, they are simultaneously an excellent way of preventing new infections too.”

In response, TB HIV Care is working with partners, such as the Eastern Cape AIDS Council to launch campaigns to raise awareness of U=U and the fact that if you are on effective treatment and virally suppressed, you can’t transmit HIV. Some of the interventions being rolled out include digital incentive campaigns to encourage PLHIV to stay on treatment, community dialogues, and a comprehensive communications strategy which involves PLHIV telling their stories live on social media platforms.

1. Bor, J., Fischer, C., Modi, M. et al. Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and
“Undetectable = Untransmittable”: A Systematic Review. AIDS Behav 25, 4209–4224 (2021).
2. StatsSA. 2021. Mid year population estimate.
3. SANAC. 2021. World AIDS Day Concept Note.