One of the biggest barriers to #UequalsU has been clear messaging. No more excuses! The World Health Organization (WHO) says U=U = ZERO risk. It’s time to #SayZero!
The following is a transcript of the conversation between Karl and Lara Vojnov.
DR. LARA
The majority of people living with HIV are not transmitting HIV sexually to their partners. KARL
Welcome to a very special edition of +TALK on +LIFE. Breaking news over the weekend from the World Health Organization, breaking exciting news and joining me to tell me all about it is Dr. Lara Vojnov. She’s the diagnostics advisor for Global HIV, Hepatitis, and STI program at World Health Organization. That is one very long business card that you need to get all of that. Good to see you, doc.
DR. LARA
Thank you. Appreciate you having me on.
KARL
This is exciting stuff. Tell us, you’re the author of this report, what is the World Health Organization saying about undetectable now?
DR. LARA
So we have a couple of key messages. I think the biggest one that you’ve heard over this week and over the conference is that we, and based on evidence that came out a couple of days ago from the Lancet, is that people living with HIV who have an undetectable viral load have zero risk of transmitting HIV to their sexual partners. I think another key piece is not just for those who are undetectable, but who have a suppressed viral load. So that means they have some viral load it’s detected, but it’s less than 1,000 copies per mL. And we now state that people living with HIV who have a suppressed viral load have almost zero risk or negligible risk of transmitting HIV to their sexual partners.
KARL
Now, so just to be clear, because I think a lot of us, in the activism space anyway, those of us living with HIV, we have been saying zero risk for the last few years, but this is a big step because I noticed that in a lot of official language that we often see, whether it’s put out by CDC or other organizations, we might see effectively zero risk or almost zero risk when it comes to identifying undetectable. So this is a big shift because you guys are removing that effectively or that almost in reference to undetectable. That’s a game changer, isn’t it?
DR. LARA
I think so, and that’s what we’ve heard from the community. We even in our own documents and our guidelines and of course some of our guidelines can be quite long have said there’s no evidence, but that doesn’t seem to translate particularly well across the entire HIV programmatic spectrum. And so I think what we’re trying to do with this policy brief is make sure that it could be understood by anyone within the response, from the general public ideally, people living with HIV, and policymakers, researchers, et cetera, so no one can misinterpret ideally this message anymore.
KARL
Why did the report come about now? What prompted you to put this together for this time?
DR. LARA
We started to hear from countries, from partners and stakeholders that the current treatment monitoring algorithm, while most of them were being taken up, it wasn’t allowing for expanded access to viral load testing. Not all people living with HIV even in developed settings are getting viral load tested. And part of this issue is this focus and prioritization of only using plasma-based technologies and samples in order to provide viral load testing. And so with this, we wanted to really highlight that there are a lot of other options out there to be able to provide viral load testing like dried blood spots, point of care technologies, that can still do what you want programmatically identifying whether you have an undetectable viral load as well as for the individual health. And so with all of that together and really understanding the potential impact of this kind of message for the community, we felt that now was really the necessary time to put this out.
KARL
Yeah, because often, and I’ve had this in my own experience, I will go in for my regular checkups or anything and we might do a CD4 checkup, where are we at with the viral load? Oh look, we don’t need to run that this time. It’s a very expensive test and all of that. This helps kind of mitigate that worry about cost especially for point of care providers, right?
DR. LARA
I think so, the costs are really coming down and although countries are really trying to scale up viral load, now it provides the opportunity for people living with HIV to come up and say, “I want this test. I want this test to be able to tell my family, to tell my friends this positive news and to be able to live a normal healthy life,” both for their own health as well as their own sexual life.
KARL
Well, and we know ultimately that becomes a win-win for everybody, not just for the person living with HIV, but the partner and really society on a whole when we’re not burdened with extra financial costs. We talk about this report as also moving the needle and helping us towards health equity. How so?
DR. LARA
I think for us it’s one of the things we really reflected on was the ongoing challenges that people living with HIV face around stigma, discrimination, and criminalization. I worked very closely with one of my colleagues Andy Seale on this work and one thing we continually spoke about was the consistent criminalization of people living with HIV and we wanted to try to switch the discussion a little bit and make it clear that the majority of people living with HIV are not transmitting HIV sexually to their partners. And I think that was one of the key additional figures that we included here as an effort to help decriminalization of people living with HIV and to help the general public understand that again, the majority, anywhere from 68 to 75% people living with HIV have an undetectable viral load or a suppressed viral load and again have no risk or zero risk of sexually transmitting HIV to their partners.
KARL
And your report also really does show that very clear and concise messaging such as using language like zero risk encourages people, supports people, once people have clear messaging like that, they are more willing to go and get tested and talk about prevention as treatment and things like that too, right?
DR. LARA
Exactly, and I think there are probably a lot of people out there who don’t have access to viral load and don’t know that they have an undetectable viral load and have zero risk of transmission. And so imagine the doubts and the concerns that they continue to have when ideally they’d go now and say, “I want this test, I want to know where I’m at so I can live a very different life.” KARL
Yeah, and I mentioned PrEP there for a second. How do the findings of a report like this help support getting things like PrEP, prevention treatment, out so that everyone has access, not just gay white men in America?
DR. LARA
Yeah, ideally this is something that policymakers, governments, et cetera, really think about particularly being empowered to know that the people who are transmitting HIV are those who are undiagnosed or those who are diagnosed but not yet on treatment. And so now, of course, PrEP continues to be important and should be an important pillar of our response, but we also now need to focus on making sure we identify all people living with HIV and putting them onto optimal treatment to then prevent ongoing transmissions.
KARL
Well, Dr. Lara Vojnov of the World Health Organization, thanks for making the time. Thanks for getting up early there in Australia and for this report. It really is a game changer and we are happy and proud to say zero. Thank you so much for your time.
DR. LARA
And thank you, I appreciate it.
KARL
That’s gonna do it for this special edition of +TALK. If you want more information, check out the website pluslifemedia.com. Remember, you can follow us across social media platforms. We are @PLUSLIFEMEDIA. Until next time, remember, say zero. We’ll see you soon. Bye-bye.