U=U: A guide for service providers


The third U=Universal: Viral load does not equal value (V≠V)

There are legitimate concerns that the U=U message places inordinate focus on the issue of undetectability and does not address the fact that some people in Canada living with HIV do not have equitable access to ART and to quality, rights-based healthcare. Our collective celebration of U=U is undermined if access to testing, treatment, care, and support — and viral suppression — is not universal.

Approaches to our work with people who live with or face systemic risk factors for HIV should be intersectional. We need to think critically about the ways colonialism, race, class, gender, gender identity, sexual orientation, immigration status, incarceration history, and other factors may affect access to healthcare and experiences of stigma — regardless of moral or institutional judgment on behaviours. These factors must be considered when we discuss the impact of U=U on the individuals and communities with whom we work.

As service providers working with people who live with or face systemic risk factors for HIV, our work must always be about ensuring that everyone has equitable access to healthcare and supportive services. Access to HIV treatment and its desired outcome — an undetectable viral load — is a right, and lack of access to treatment is a violation of that right.

We must avoid creating two classes of people with HIV, those who have an undetectable viral load and those who do not. People living with HIV are more than their laboratory results, and their value is not dictated by their viral load.

Treatment is, first and foremost, a personal choice, and no one should be shamed for not being on treatment or for having any level of viral load, which may be their choice or due to circumstances not in their control.1

People living with HIV with a detectable viral load2 are not a danger to others. There are highly effective HIV prevention options for  safer sex available to them, including condoms, and pre-exposure prophylaxis (PrEP) for their HIV-negative partners, which can be used individually or in combination. Everyone living with HIV, regardless of viral load, has the right to full and healthy social, sexual, and reproductive lives.

U=U is a new tool for advocacy because its undoubted benefits make a compelling argument for ensuring access to testing, treatment, care, and support — and therefore, ultimately, viral suppression — for all, regardless of what barriers may exist.

  1. Some people living with HIV in Canada may choose not to be treated or may not be ready to start treatment. Others may start treatment but have challenges with adherence for a variety of reasons, such as stigma, mental health issues, drug use issues, unstable housing, hostile environments, difficulty paying for medications, drug resistance, and/or intolerable side effects
  2. More than 200 copies/ml of blood.