Destigmatizing HIV & advocating strict adherence to ART
As Nagaland celebrates its 61st Statehood on December 1, the day is also marked as World AIDS Day under the theme ‘Let Communities Lead.’ As Nagaland, along with the rest of India, under the United Nations Program on HIV and AIDS (UNAIDS), aims to end the HIV/AIDS epidemic by 2030, Nagaland’s adult HIV positivity rate stands at 1.61%, the second highest in the country.
Meanwhile, as per Sankalak 2022 report, 87.46% of HIV transmission occurs through sexual route in Nagaland.
However, the emergence of Undetectable = Untransmittable (U=U) has sparked a new era in HIV discourse. The World Health Organization (WHO) has lent full support to the U=U concept, recognizing that individuals with undetectable viral loads no longer pose a risk of sexually transmitting the virus and can be achieved through strict adherence to Antiretroviral therapy (ART). ART is the treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs.
In July 2023 during the International AIDS Society Conference on HIV Science in Brisbane, Australia, WHO further reaffirmed this concept while releasing its policy brief emphasizing the role of HIV viral suppression in improving individual health and reducing transmission.
Within the brief, the authors conclude that “People living with HIV who have an undetectable viral load should be told that, along with achieving better health, there is zero risk of transmitting HIV through sex as long as they continue to take their antiretroviral therapy as prescribed.”
WHO’s guidance, citing the Lancet’s article on ‘The Risk of Sexual Transmission of HIV in Individuals with Low-Level HIV Viraemia: a Systematic Review,’ emphasizes that the risk of sexual transmission is nearly nonexistent with viral loads below 1000 copies per mL. These findings seek to destigmatize HIV and encourage adherence to ART.
The National Institute of Allergy and Infectious Diseases asserts that scientific evidence firmly establishes that individuals with HIV, maintaining an undetectable viral load through daily ART, cannot sexually transmit the virus. Hence, HIV treatment stands as a powerful tool in the prevention of the virus. According to both WHO and the Lancet, there is zero possibility of HIV transmission when a person living with HIV maintains a viral load less than 200 copies per mL.
HIV is now recognized as a chronic disease, manageable through medication. However, stigma remains a formidable barrier, impeding those at risk from accessing preventive services and timely care. The Lancet article highlights that “evidence showing almost zero risk of sexual transmission when HIV viral loads are less than 1,000 copies per mL provides a powerful opportunity to [destigmatize] people who are living with HIV and promote adherence to ART through dissemination of this positive public health message.”
The progress in HIV treatment, allowing infected individuals to lead healthy lives with virtually no risk of transmission through effective ART, is a significant success. Despite evidence growing since the 2000s, according to Lancet, the public perception change has been slow.
It is crucial to note that the empowering U=U movement traces its roots back to the Swiss Consensus Statement of January 2008. According to this statement, a person living with HIV can be considered ‘non contagious’ to a seronegative sexual partner if they receive ART with excellent adherence, maintain a consistently undetectable blood viral load (<40 copies per mL), and have no sexually transmitted infections (STIs).