Adopting U = U to end stigma and discrimination

Ford, Olivia G; Rufurwadzo, Tinashe G; Richman, Bruce W.; Green, Ian; Alesi, Jacquelyne

doi:10.1002/jia2.25891

Cited by 18 publications

(12 citation statements)

References 13 publications

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“…Communicating U=U was associated with improved overall sexual and mental health, medication adherence, and viral load suppression [ 109 ]. Moreover, it is a huge step in de-stigmatization, particularly among people who face multiple intersecting stigma [ 108 , 110 ].…”

Section: Hiv Treatment and Care Deliverymentioning

confidence: 99%

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

Gangcuangco

Eustaquio²

2023

TropicalMed

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In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15–17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine–tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

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Section: Hiv Treatment and Care Deliverymentioning

confidence: 99%

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

Gangcuangco

Eustaquio²

2023

TropicalMed

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“…HTS providers can provide critical support by retesting individuals who are struggling to accept their diagnosis and start ART. In parallel, clients should receive counseling on the benefits of ART for their own health and on the critical value of viral suppression in protecting their sexual partners: increasing knowledge of U = U (undetectable is equal to untransmittable) can reduce self-stigma and anxiety [57]. HTS providers should also accept and enable retesting as a means to facilitate re-engagement in treatment services.…”

Section: Importance To the Future Of Hiv Testingmentioning

confidence: 99%

The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

Grimsrud¹,

Wilkinson

Ehrenkranz

et al. 2023

PLoS Med

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“…11,12 Awareness of the U=U message, combined with engagement in regular viral load monitoring, can alleviate anxiety and fear of onward transmission, which can have a positive effect on sexual pleasure, reduce self-stigma and improve wellbeing. 13 Yet, although there is an emerging recognition of the opportunities of the U=U message to influence stigma, [14][15][16][17][18] we have not yet invested in explaining and supporting the development of viral load literacy across a wide-range of populations and age groups. How U=U is represented, if at all, in provider-client conversations has been shown to be heavily influenced by providers' stigmatising attitudes towards some groups.…”

Section: The Transformative Effect Of U=u: What It Can Domentioning

confidence: 99%

Let’s talk about U=U: seizing a valuable opportunity to better support adolescents living with HIV

Bernays,

Lariat,

Ameyan

et al. 2023

Sex. Health

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The clinical knowledge that people living with HIV who maintain an undetectable viral load and therefore cannot transmit HIV sexually, known as Undetectable equals Untransmittable (U=U), has reached a critical mass of adults, but it is relatively silenced within adolescent HIV care and support. We argue that understanding the full range of opportunities enabled by viral suppression, including the elimination of transmission risk, could transform adolescents’ understanding of living with HIV, incentivise optimal treatment engagement and support and sustain their positive mental health. However, the reluctance to discuss U=U with adolescents means that we are not providing them with adequate access to the information and tools that would help them to succeed. We need to recognise, value, and invest in the mediating role of building viral load literacy, illustrated by conveying U=U in ways that are meaningful for adolescents, to accelerate viral suppression. Rather than protect, rationing access to information on U=U only increases their vulnerability and risk to poor HIV and mental health outcomes.

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Adopting U = U to end stigma and discrimination

Cited by 18 publications

References 13 publications

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

Let’s talk about U=U: seizing a valuable opportunity to better support adolescents living with HIV

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