Undetectable = Untransmittable (U=U) is a message grounded in clear scientific evidence that individuals living with HIV who consistently adhere to treatment and maintain an undetectable viral load have zero risk of transmitting HIV through sex to their partners. Since its launch in 2016, the U=U campaign has helped challenge stigma, reshaped how service providers and health professionals talk about treatment, and empowered people living with HIV to make informed choices about their health. CATIE spoke with two experts living with HIV about their perspectives on U=U, how trust and awareness in the message have evolved over the past decade, and what still needs to be done to strengthen this messaging.
- Breklyn Bertozzi is the executive director of the Canadian AIDS Society.
- Randy Davis is an HIV advocate and educator; founder of InclusHIV Consulting; associate trainer, U=U University (Prevention Access Campaign); and national ambassador, CANFAR.
See more in this article: U=U: A decade of progress, challenges, and the work still to be done.
Breklyn Bertozzi, executive director, Canadian AIDS Society
What has the U=U message meant to you as a person living with HIV?
As a woman living with HIV, the U=U (Undetectable = Untransmittable) message has meant a great deal to me. It symbolizes a significant shift not only in medical understanding but also in social perception. Knowing that if my viral load is undetectable, I can’t transmit the virus to my partner or my child has relieved so much anxiety and stigma surrounding my status. It has empowered me to live my life more fully and has allowed me to continue with my reproductive goals and celebrate my sexuality, more openly. This message has also helped in reducing the stigma that people living with HIV often face, making conversations about health more open and informed.
What, if anything, has changed in the last 10 years since the U=U campaign started? What has not changed?
In the last 10 years since the U=U campaign started, I’ve noticed several changes. Advances in treatment have made it easier to achieve and maintain an undetectable status, and the message has helped in educating both the public and healthcare providers. U=U has created a greater sense of community and understanding, reducing misconceptions and fear.
However, some elements remain unchanged — in particular, the stigma and discrimination individuals still face because of the lingering impacts of fear and misinformation surrounding HIV. There’s still reluctance to discuss HIV openly, which perpetuates the cycle of stigma.
What needs to happen to further increase awareness of and trust in the U=U message?
To further increase awareness of and trust in the U=U message, several approaches could be beneficial. First, continuous education and outreach programs, particularly in schools, can normalize conversations about HIV and sexual health. Storytelling and testimonies from people living with HIV humanize the experience and undermine the myths and stereotypes surrounding the virus.
Moreover, the healthcare system needs to reinforce trust by ensuring access to treatment and creating supportive environments for people living with HIV. Policies should focus on equitable access to healthcare and medications globally, breaking down barriers that prevent people from achieving an undetectable status.
Finally, media and influencers have a role to play — they can help amplify the U=U message, communicating it to broader audiences through channels that have a wide reach and are trusted. Celebrities and public figures who advocate for the message can have a significant impact in reducing stigma and increasing understanding.
Randy Davis, HIV advocate and educator; founder of InclusHIV Consulting; associate trainer, U=U University (Prevention Access Campaign); national ambassador, CANFAR
What has the U=U message meant to you as a person living with HIV?
U=U completely changed how I saw myself and my future. When I was diagnosed in 2015, a full year before U=U was launched by the Prevention Access Campaign, my healthcare team reassured me that with treatment I would live a long and healthy life, but no one explicitly told me that it would be impossible for me to pass on the virus to my sex partners if I maintained an undetectable viral load. That omission shaped how I viewed myself for a long time. When I later learned about U=U, it reframed everything. It shifted my sense of self from one rooted in shame to one grounded in empowerment and connection. U=U is not only a scientific fact, but also a human right and a message of dignity that restores agency to people living with HIV.
What, if anything, has changed in the last 10 years since the U=U campaign started? What has not changed?
There has been real progress in awareness and institutional adoption, but communication and implementation remain uneven. Too many healthcare providers still avoid or fail to share the message with their patients. While U=U has become integrated into public health policy in many places, stigma and misinformation continue to show up in exam rooms, in media reporting, and even within the HIV sector.
What has changed is that people living with HIV are leading the conversation, collaborating across organizations, and developing evidence-based tools that build knowledge and trust. Despite this, public health campaigns and sexual health resources often fail to reflect diverse lived experiences, leaving people uncertain about whether U=U applies to them.
What has not changed are the structural barriers that prevent U=U from reaching everyone who should benefit from it. These include inconsistent education and training standards across provinces and territories, which means some healthcare providers are well- informed about U=U while others still rely on outdated information. There are also gaps in access to HIV care, including treatment and regular viral load testing, which are necessary to achieve an undetectable viral load and know that it remains undetectable. This unequal access is more likely in certain communities, for example, in rural and northern regions, and among Indigenous, Black, racialized, and 2SLGBTQ+ communities, reflecting broader systemic discrimination in healthcare.
The ongoing criminalization of HIV non-disclosure in Canada continues to undermine trust in healthcare providers and public health systems by reinforcing stigma and fear, contradicting the U=U message that people with an undetectable viral load do not transmit HIV to their sex partners. Until barriers to U=U are addressed through coordinated national education, equitable access to prevention, testing, treatment and care services, and policy reform grounded in human rights, the promise of U=U will remain unevenly realized.
What needs to happen to further increase awareness of and trust in the U=U message?
We need to continue closing the gap between science, practice, and lived experience. U=U education must become a core competency for anyone working in sexual health, primary care and public health. That means integrating it into both formal and continuing education in medical and nursing curricula, public health training, and ongoing professional development for clinicians, frontline workers, and policy-makers.
It also means creating accessible, community-led learning opportunities that reflect the realities of the people most affected by HIV. Through my work with U=U University and InclusHIV Consulting, I have seen how evidence-based training can bridge those worlds. I have delivered this type of training to healthcare providers in my community, helping them strengthen their confidence in communicating U=U accurately and compassionately with their clients and patients. These sessions often include discussions on stigma, language, and the importance of trust building in care relationships. When health professionals and community partners learn together, they all strengthen their understanding of the science, with the added benefit that the health professionals gain insight into the lived experience of people living with HIV.
By centring collaboration, equity, and consistent messaging, we can make U=U part of every interaction, from medical education to public health practice to community engagement. Trust grows when people hear the same message, delivered clearly and compassionately, and backed by lived experience.