U=U: A guide for service providers


U=U and women* living with HIV

The prevention of sexual transmission of HIV afforded by U=U covers women*1 as it does everyone else. If women* and/or their sexual partners have an undetectable viral load, then sexual intimacy can be enjoyed without fear of transmission.

However, because the current application of U=U is focused on the risk of sexual transmission, as service providers we need to consider the other ways that HIV is transmitted and that uniquely affect the lives of women*, many of which are linked to their sexual and reproductive health and rights.

Research evidence indicates that women* who are on ART before pregnancy and maintain an undetectable viral load throughout their pregnancy have healthy, HIV-negative babies.2

Another topic that we need to include in any conversation about the use of ART for the prevention of HIV transmission for women* is breastfeeding/chestfeeding.3 There is mounting evidence that the rate of transmission of HIV through breastfeeding/chestfeeding for women* who are on ART is extremely low. Despite this, Canadian guidelines continue to recommend the use of formula instead of breastfeeding because of the small risk. However, there are complex realities surrounding women’s choices on infant feeding.

Women* with HIV may ask their healthcare or service providers to support them in their decision to breastfeed/ chestfeed their babies. Additionally, some women* with HIV who breastfeed/chestfeed may do so without telling their healthcare or service providers for fear of stigma, criminalization, and/or negative interactions with public health authorities and child protection services. It is therefore important that healthcare and service providers engage in conversations with women* to create a treatment plan that reduces risk and includes medical monitoring and consistent support based on the principles of informed consent and equitable access to the full range of information currently available.

  1. This guide acknowledges the diversity of women living with HIV in Canada, which includes people who can get pregnant but who may not identify as women. This guide refers to “women with an asterisk” to reflect this diversity.
  2. Arkell C. HIV treatment and an undetectable viral load to prevent HIV transmission. Toronto: CATIE; 2019. Available from: https://www.catie.ca/en/fact-sheets/transmission/hiv-viral-load-hiv-treatment-and-sexual-hiv-transmission [accessed June 20, 2019].
  3. Chestfeeding is a term often used by transgender people who nurse their babies.