World AIDS Day: Clients can handle the truth


Thousands of HIV organizations around the world are adding a new message to their World AIDS Day campaigns this year, and it is turning decades of HIV prevention messaging on its head. We can now say conclusively that a person living with HIV who takes treatment and maintains an undetectable viral load does not transmit the virus to their sexual partners.

The evidence was solidified last year with the final results of PARTNER and HPTN 052, two large studies confirming zero cases of HIV transmission within serodiscordant couples where the HIV-positive partner was undetectable. “Undetectable equals untransmittable”, or U=U, is a grassroots movement led by people living with HIV and their allies, urging us all to communicate these results clearly and directly.

When CATIE endorsed the U=U consensus statement this year, many lauded us for helping to spread the message across Canada. But we also faced resistance from those who felt the message was dangerous.

We heard concerns about sharing this news with clients. Will people living with HIV and their partners abandon condoms? Will we see an upsurge in other sexually transmitted infections like gonorrhea? Will people no longer take the risk of HIV transmission seriously?

These arguments are not new to us. CATIE was founded in 1990 to share information about emerging treatments for people living with HIV, at a time when this information was unavailable, inaccessible or closely guarded by professionals who believed that their clients could not be trusted with it.

This paternalism has re-emerged time and time again over the course of the HIV epidemic. When pre-exposure prophylaxis (PrEP) was proven as a highly effective HIV prevention strategy, some argued that offering any HIV prevention option other than condoms would encourage people to take greater risks, exposing them to drug-resistant HIV and other sexually transmitted infections. We even received complaints for simply providing information about the effectiveness of PrEP.

Similarly, there has been strong opposition to the approval of home-based HIV testing kits in Canada, a tool that is readily available in the United States and is proven to increase the uptake and frequency of HIV testing among key populations. Even some service providers have argued that their clients should not have direct access to HIV testing without a counsellor mediating the process.

We have confronted these paternalistic attitudes in the past, and we should continue to resist them today. Whether we are talking about U=U, PrEP or HIV self-testing, we must provide all the information and options to our clients, and trust them to make the best decisions for their own health.