Intended for healthcare professionals

Feature Essay

U=U is a blessing: but only for patients with access to HIV treatment: an essay by Tamás Bereczky

BMJ 2019; 366 doi: (Published 17 September 2019) Cite this as: BMJ 2019;366:l5554
  1. Tamás Bereczky, communications and course director
  1. European Patients’ Academy for Therapeutic Innovation, Berlin, Germany
  1. tamas{at}

Fear of transmission is a major barrier to accepting people with HIV, writes Tamás Bereczky, but the U=U campaign message—that an undetectable viral load makes HIV untransmittable—is cold comfort for people lacking diagnostics and antiretroviral drugs

The U=U campaign (undetectable means untransmittable, see box) seeks to publicise the science that shows that people with an undetectable viral load cannot transmit HIV.1 But my limited enthusiasm for this good news often earns me the scorn of fellow HIV activists.

“Don’t be such a sour apple,” they say. “Don’t you understand the importance of U=U for stigma reduction?”

I know, sadly, that the message is often still missing from the information that healthcare providers and counsellors give patients.23 Worse, U=U is meaningless for the many people with HIV worldwide who don’t have access to diagnostics and drugs—as the campaign acknowledges with a “third U” that represents universal access.

Fear of transmission

I’ve had HIV for 16 years, and I come from Hungary where stigma and discrimination are rampant.4 I understand, particularly acutely, how fear of transmission prevents acceptance of people with HIV—and why it is so important to eliminate this barrier.

In 2008, the Swiss National AIDS Commission gave a statement that said that people who are taking effective antiretroviral treatment cannot transmit HIV through sexual contact.5 When I heard this, my initial scepticism ultimately gave way to genuine relief: I didn’t pose any risk to my partners.

Communities of people with HIV worldwide have translated the U=U abbreviation and message for their own languages and settings.

The consensus statement

The U=U consensus statement has been signed by an impressive group of organisations, researchers, and politicians.

It says, “People living with HIV on antiretroviral therapy with an undetectable viral load in their blood have a negligible risk of sexual …

View Full Text

Log in

Log in through your institution


* For online subscription