IAPAC Endorses WHO U=U Policy Brief

Clarity of Guidance Critical to Equitable HIV Responses

BRISBANE, AUSTRALIA (July 23, 2023) – The International Association of Providers of AIDS Care (IAPAC) was among the first medical institutions to endorse Undetectable Equals Untransmittable (U=U) as an evidence-based message that de-stigmatizes an HIV diagnosis, creates demand for HIV testing and treatment, and promotes adherence to antiretroviral therapy (ART) to achieve an undetectable viral load level. Consistent with studies regarding the benefit of HIV treatment to prevent sexual transmission of HIV, IAPAC has delivered global medical education to specialized and primary care clinicians as well as community education about U=U to support its implementation in clinical and community settings.

IAPAC President/CEO Dr. José M. Zuniga believes today’s release of the World Health Organization (WHO) policy brief, “The Role of HIV Viral Suppression in Improving Individual Health and Reducing Transmission,” should serve as definitive guidance to allay any concerns regarding the degree of HIV transmission risk associated with the U=U message. The updated treatment algorithm presented during a WHO symposium at the International AIDS Society (IAS) 2023 conference includes three defined terms and their corresponding risk levels for transmission of HIV to sexual partners:

• Undetectable – Not detected by WHO-validated test/sample type used; ZERO RISK
• Suppressed – Detected but ≤1,000 copies/mL; almost zero risk or negligible risk
• Unsuppressed – Viral load of >1,000 copies/mL; increased vulnerability of transmitting HIV

“IAPAC endorses the WHO policy brief and its updated articulation of viral load thresholds with associated levels of transmission risk,” said Dr. Zuniga, who also serves as President/CEO of the Fast-Track Cities Institute. “The policy brief should increase clinician confidence in communicating that people living with HIV who are on ART and achieve an undetectable viral load cannot sexually transmit HIV. The risk is zero. This is a message that clinicians should convey accurately, clearly, and consistently to all people living with HIV who achieve an undetectable viral load level.”

He added that “achieving an undetectable viral load level, and the preventive benefit that it confers, should be a celebratory message that clinicians gladly deliver to people living with HIV. Positive messaging is critical if we are to facilitate long-term adherence to ART and the positive HIV and other health outcomes that come with successful HIV clinical and psychosocial management that created an enabling environment to achieve U=U.”

The WHO policy brief also clarifies that all WHO-prequalified viral load tests and sample types, including point-of-care and dried blood spot, can accurately determine whether a person living with HIV who is on ART is unsuppressed, suppressed, or undetectable. In that regard, Dr. Zuniga issued a call to action for increased efforts to scale-up access to WHO-prequalified viral load tests within the context of achieving health equity for people living with HIV.

In line with its partnership frameworks with WHO and the Prevention Access Campaign (PAC), plans to scale up its global medical and communication education efforts to action the policy brief’s guidance. According to Dr. Zuniga, “We aim to advocate the wide-scale implementation of the WHO policy brief’s recommendations so that the game-changing promise of U=U can be more widely felt across the global HIV response.”

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