The U=U (Undetectable = Untransmittable) movement has played a pivotal role in reducing HIV-related stigma and promoting accurate information about transmission. In “How U=U is Spearheading the Fight Against HIV Stigma, Bruce Richman mobilized the U=U campaign upon discovering that an undetectable viral load means HIV cannot be transmitted. Richman called for action with this new understanding as he was “elated,” but also “outraged because people weren’t being told” (Brunette Foundation, 2022). Richman’s frustration stemmed from the failure of healthcare systems to provide information that he believed was viscerally and truly life changing, which could help agents with HIV live more openly and without necessary fear.
However, while U=U has been widely celebrated, Johnson (2020) brings up relevant concerns about the unintended consequences of language surrounding the campaign. Johnson argues that while the movement is scientifically based, it risks being conflated for viral suppression being the ultimate goal of HIV care. They caution that “U=U is great as science and as a tool in the toolkit of care–not the entire toolbox” Johnson, 2020). This perspective emphasizes the broader social determinants of health that impact a person's ability to achieve and maintain undetectability while also treating contracting HIV rather than preventing infection in the first place.
Moreover, the creation of hierarchies within the HIV community that stems from emphasis on undetectability as an ideal status has led to further stigma against individuals who are unable to achieve it. While there is colloquial language for this, Johnson (2020) states the “U=U movement has in a sense emboldened the idea that negative status (or as close to it as possible) is perfection.” This raises an important ethical question of whether U=U inadvertently reinforces a binary of HIV statuses? HOw can public health messaging ensure that it empowers all people with HIV rather than excluding some?
Furthermore, policies or semantics tied to U=U raise concerns about protection disparities, Johnson (2020) warns “a person is only as undetectable as their last labs,” pointing out the privilege of relying on viral suppression as a safeguard. If undetectability becomes a condition for protection from stigma or even legal/health systems, what happens to those who experience lapses in care due to systemic barriers?