Using U=U to Take Ownership of Our Lives and Our Futures

Overview

Introduction

This tool is a collection of three, short graphic stories focused on different scenarios where U=U (undetectable equals untransmittable)  can apply to the lives of young people living with or affected by HIV.

Young people from across Africa were leaders in the conceptualization, design, writing, and validation of this tool. The goal of the story collection is to provide a practical resource for young people and providers working with young people to talk about U=U in a way that makes sense and applies to regular situations that happen in young people’s lives.

Why we created this tool:

U=U is a concept that has been shared most frequently through different messages over social media and different campaigns to empower people to keep taking their medication in gaining power and control over their lives to not transmit the virus once reaching the undetectable level.

Before we started to create this tool, we looked at the types of resources on U=U for young people globally and across the African continent. We found no resources that applied U=U to real life scenarios of young people and explained it in a way that would make sense to young people.

U=U can be a complex topic to talk about and understand. A few concepts are critical to understand that accompany U=U, including viral load, viral load suppression, and adherence.

What is U=U?

U=U stands for Undetectable = Untransmittable for sexual relations. Being Undetectable is when someone who is living with HIV — and on antiretroviral therapy (ART) — and has a viral load that is so low that it is barely detected (a very small amount or none detected) during the viral load test. Once the amount of virus is under a certain level, the virus is Untransmittable. This means it
CANNOT be passed sexually to another person.

Undetectable: The levels for viral detection are often as low as 20 or 50 copies per milliliter (mL) in a viral load sample. Having a viral load under 200 copies per mL for at least six months is undetectable for sexual transmission. For prevention of mother to child transmission, the level for preventing transmission is lower at less than 50 copies/mL.

Untransmittable: Not spreading or transmitting the virus to a sexual partner

The Stories

Martha and Ibrahim: Story of a young woman finding out she is pregnant and sharing with her partner

This is a story about Martha and Ibrahim. When Martha was 16-years-old, she contracted HIV. She later met Ibrahim during her tertiary education and told him about her status. Martha explained to Ibrahim how she manages her diagnosis and how her viral load has become undetectable. Martha’s viral load has remained so low that it has gone undetected for the last few years. Martha recently found out that she is expecting a baby, and, while she is excited to tell Ibrahim all about it, she is also very nervous. She speaks to her friend, Shahida, who she met at the health care facility and who has a one-year-old daughter, Mercy. Martha shares her experience of living undetectable but also her concerns for her baby and her growing family. Later, she tells Ibrahim the news, and they speak about their situation.

Read the Story

Libra and Obi: Story of disclosure in a relatively new couple between a young woman and young man

This is a story about Obi and Lira. They met a month ago at a party where they spent the entire evening dancing the night away. They have been meeting and talking regularly since that time and started dating. Recently, Lira also disclosed to Obi that she tested positive for HIV when she was born because her mother had been living with HIV. She’s always been on treatment and knows that by staying on treatment the amount of virus in her blood remains so low, it is undetected. This was also confirmed at her recent doctor’s appointment. Lira asks Obi to come along with her to meet a peer supporter at the community center so she and Obi can find out more information together. They start by telling the peer supporter about their situation (what they are experiencing, what they feel, what their concerns and fears are related to U=U). 

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Tambo and Junior: Story of disclosure and prevention in a relationship between two young men

This is a story about Tambo and Junior. Tambo has been living with HIV for the last two years and only recently informed Junior (his partner for the last six months) about his diagnosis. Tambo has been on treatment since he was informed that he is living with HIV. They have had sex multiple times, and, since his viral load is undetectable, he is not concerned about transmitting HIV to Junior. Tambo explained to Junior how his undetectable viral load means that the virus is untransmittable. Junior is apprehensive about continuing the relationship, but Tambo convinces him to go along with him and see a friend of theirs, Blessing, who is living with HIV and has experienced the same situation with his partner who is HIV-negative.

Read the Story