In 2016, a group of people living with HIV collaborated with HIV researchers to launch Prevention Access Campaign’s Undetectable = Untransmittable (U=U) campaign.
The U=U campaign launched with the following goals: (1) create an international science-based consensus confirming that when treatment reduces HIV to undetectable levels it can’t be sexually transmitted (U=U); (2) disseminate the groundbreaking science with a global network of partners that could adapt and localize the message; and (3) leverage the U=U science in policy advocacy to ensure universal access to the information, treatment and care for U=U to be a reality for all people living with HIV.
Once a grassroots campaign, U=U is now a global health and human rights movement of over 1,000 organizations and health ministries in more than 100 countries. U=U has been accepted by the global medical and scientific community as a life-changing, stigma-busting, and transmission-stopping fact. By working collaboratively across sectors and leveraging the expertise of scientists, activists, and public health officials, the U=U campaign has been able to effect a seismic shift in the understanding and perception of HIV. The success of U=U is a testament to the power of evidence-based advocacy, partnerships, and the unwavering commitment of the HIV community. This achievement is particularly noteworthy given the significant resistance that initially surrounded the U=U concept. It was a hard-fought battle, but one that was necessary to challenge the status quo and change decades of stigmatizing outdated communications, laws, policies and practices.
The U=U movement builds upon the rich history of HIV activism, research, and developments in treatment and prevention dating back to the early days of the epidemic. Below is a timeline of some of the key moments in the history of the U=U movement. We wish we could honor all the extraordinary people and organizations that made this movement what it is today. A full list of U=U Community Partners can be found here.
The evolution of U=U
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1981
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1987
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1996
Highly effective HIV treatment is developed
(Highly Active Antiretroviral Retroviral Treatment/ HAART) means HIV becomes a chronic illness and is no longer a death sentence.
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2006
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2008
Dr. Pietro Vernazza and the Swiss National AIDS Commission are the first to confirm that people living with HIV on effective treatment cannot sexually transmit HIV
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2011
HPTN-052 clinical trial reports that early treatment dramatically reduced the risk of HIV transmission in heterosexual couples with different HIV status.
The study was so effective that it was stopped early so all participants could use ART.
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2014
PARTNER 1 study reports no HIV transmission after sero different couples had sex without condoms more than 44,000 times
“When asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said:“Our best estimate is it’s zero.”
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2016
Gus Cairns and Bruce Richman brainstorm “U=U”
At the 2016 Conference on Retroviruses and Opportunistic Infections (CROI), Gus Cairns (global HIV activist-journalist & member of the Prevention Access Campaign’s Founding Task Force) and Bruce Richman (Prevention Access Campaign’s Founding Executive Director) discussed strategies to build a consensus that an undetectable viral load was uninfectious. Gus called this “the big secret” in the HIV field. While it was being discussed as “Undetectable = Uninfectious,” Gus suggested the catchy slogan “U=U,” which, over time, and with additional community input, became “Undetectable = Untransmittable” or “U=U.”
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2016
U=U is launched in early 2016 by a group of people living with HIV and global experts to build a consensus about the science of transmission risk and to promote it as “U=U”
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2016
Terrence Higgins Trust issues the world’s first U=U statement from an NGO and medical director
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2016
PARTNER 1 final results are published, reporting zero HIV transmissions after more than 58,000 condomless sex acts
Image credit: Terrence Higgins Trust
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2016
HPTN-052 final results are published which confirm that no participants with an undetectable viral load transmitted HIV to their HIV-negative sexual partner during the study
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2016
New York City Department of Health becomes the world’s first city and health department to endorse U=U
Dr. Demetre Daskalakis leads NYC Department of Health and Mental Hygiene in historic world-first
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2016
NASTAD and YouthCo become the first nonprofits in the US and Canada to sign on and issue U=U statements
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2016
Dr. Carl Dieffenbach and the National Institute of Allergy and Infectious Diseases (NIAID) produce videos to confirm U=U and ZERO risk of transmission
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2017
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2017
Activists protest at the the International AIDS Society conference in Paris demanding that U=U be communicated worldwide
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2017
At the International AIDS Society conference, leaders from UNAIDS, PEPFAR, and Dr. Anthony S. Fauci confirm U=U
One year after the U=U Consensus Statement was issued, U=U advocates from sixteen countries convened at the International AIDS Society Conference in Paris where the mayor of Paris signed the city on to U=U and leaders from UNAIDS, PEPFAR, and Dr. Anthony S. Fauci confirm U=U at a press conference.
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2017
The Opposites Attract study shows zero HIV transmissions among gay male couples of different HIV status
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2017
Dr. Anthony S. Fauci, director of the National Insitute of Allergy and Infectious Diseases (NIAID), declares “the science really does verify and validate U=U” at the United States Conference on AIDS
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2017
CDC confirms U=U: People living with HIV who are virally suppressed have “effectively no risk” of transmitting HIV
See more of of the CDC’s language and sources at U=U Flagship Endorsem*nts.
The CDC Follows the Data: Effectively NO RISK -
2017
The Washington Post writes “[U=U is] the campaign credited with beginning to change the public perception about HIV transmissibility”
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2018
Dr. Maureen Goodenow, Director of the National Institutes of Health Office of AIDS Research (OAR) writes U=U is a “game changer”
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2018
Dr. Alison Rodger announces “The risk is zero” with the results of the PARTNER 2 study at the International AIDS Conference in Amsterdam
The PARTNER studies’ lead author Dr. Alison Rodger sends a message to clinicians who hesitate to share U=U with their patients, stating “it’s very clear the risk is zero,” and “the time for excuses is over.” Dr. Rodger incorporates PAC and U=U into all PARTNER 2 official communications including the published journal article and press releases.
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2018
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2019
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2019
Brazilian government becomes first in Latin America to include U=U in updated HIV guidelines
The guidelines state (translated into English): “The rationale for using the concept is supported by scientific evidence that antiretroviral therapy (ART) and undetectable viral load do not transmit the virus sexually. The term Undetectable = Untransmissible (U = U) is already used by scientists and reference institutions on HIV worldwide.”
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2019
The CDC endorses the use of “Undetectable = Untransmittable” and Prevention Access Campaign materials
“We urge you to share this groundbreaking science with your communities. You can use CDC-developed materials, as well as materials developed by community groups such as Prevention Action Campaign, the organization responsible for the U=U campaign (undetectable=untransmittable).” See more of the CDC’s language and sources at U=U Flagship Endorsem*nts.
CDC Letter Approving Usage of U=U Communications -
2019
CDC confirms viral suppression is 100% effective for preventing sexual transmission of HIV
See more of the CDC’s language and sources at U=U Flagship Endorsem*nts.
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2019
Dr. Anthony S. Fauci calls U=U the “foundation of being able to end the epidemic” and says transmission when someone has an undetectable viral load is “impossible”
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2019
U=U is awarded Special Recognition by U.S. Congress at the U.S. Conference on AIDS
The U.S. Congress Recently Recognized “U=U.” Here’s How It Happened. -
2019
The official United States HIV treatment guidelines are updated to include U=U
“All persons with HIV should be informed that maintaining a plasma HIV RNA (viral load) of <200 copies/mL, including any measurable value below this threshold value, with antiretroviral therapy (ART) prevents sexual transmission of HIV to their partners. Patients may recognize this concept as Undetectable = Untransmittable or U=U.”
U.S. Government Updates HIV Treatment Guidelines to Include U=U -
2020
Groundbreaking research shows that people living with HIV report significantly better health outcomes when their healthcare providers inform them about U=U
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2020
Love Without Borders in Beijing holds China’s first U=U & PrEP Advocates Conference
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2021
U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) includes U=U education as a minimum requirement of all 50 PEPFAR countries
“The idea that someone living with HIV, who is both on treatment and virally undetectable, cannot transmit the virus to a sexual partner is revolutionary.” “Information on the benefits of ART should be provided to PLHIV and U=U should be emphasized when counseling people for HIV testing.” See more of PEPFAR’s language and sources at U=U Flagship Endorsem*nts.
PEPFAR 2021 Country and Regional Operational Plan (COP/ROP) Guidance for all PEPFAR Countries: U=U Made as Minimum Requirement -
2021
Advocates in Russia hold first U=U (H=H) conference
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2021
The United Nations endorses U=U and encourages member states to leverage U=U as a stigma intervention tool
Undetectable = Untransmittable Endorsed by United Nations -
2021
The World Health Organization (WHO) includes U=U in official guidelines on on HIV prevention, testing, treatment, service delivery and monitoring
“ARV drugs play a key role in HIV prevention. People taking ART who achieved viral suppression (<200 copies/ml) do not transmit HIV to sexual partners.” “With U=U, HIV treatment has transformed the HIV prevention landscape.” See more of WHO’s language and sources at U=U Flagship Endorsem*nts.
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2021
