Canada’s Bruce House: U=U Is Fundamental to What We Do

U=U, or Undetectable=Untransmittable, is a science-backed consensus statement detailing how individuals living with HIV/AIDS who get to an undetectable viral load and are able to maintain that by adhering to their antiretroviral treatment can’t sexually transmit the virus to their partners. In Canada, this level is below 40 or 50 copies/mL.

Patrick Morley, office and communications coordinator for Bruce House in Ottawa, Ontario, Canada, which has been serving individuals living with HIV and AIDS for 34-plus years, speaks about how the organization continues to express the importance of U=U.

Transcript

How do you live the message of U=U and educate others about it?

I was very proud when Bruce House signed the U=U consensus statement. I’m even more proud that so many agencies have now and the Public Health Agency of Canada recognizes the statement as valid. But I’ll have to admit that when we first signed it, as a nonprofit sector, you advocate and then you get what you advocated for and there’s that “Now what?” moment. I was a little bit unsure how we were going to proceed, because we don’t have an education mandate, so “Okay, I have to put this message out in context.”

And also very early on, I became aware of what’s been called the third view, which is “unequal.” Not everyone living with HIV can achieve an undetectable viral load. Some people just get a low viral load, but it’s detectable. And, what is required to be on HIV treatment? Well, you have to take a pill every day. That was my lightbulb moment, because that’s our reason to exist at Bruce House: What is keeping you from being in treatment? Is it because you don’t have a home, you don’t have food, you have other concerns?

So as we’ve moved forward, we’ve seen how U=U is so fundamental to what we do. So if we talk about HIV stigma, let’s say we’re speaking to a group of health care providers or social service providers, there is no doubt, here is a statement endorsed by leading health authorities, backed by research. You are not at risk from your clients and patients.

It’s a comprehensive evidence-based argument, so when we talk about things like treatment as prevention, here is proof that somebody under treatment can likely not transmit HIV as long as they get an undetectable viral load. It’s a good argument to support things that may be controversial, like PrEP [preexposure prophylaxis]. Again, you’re not only preventing transmission, but you are also preventing that person from further transmitting if they are infected.

And it’s so affirming for people living with HIV, that connection. One of the first stories about U=U I heard was at a group presentation, somebody in the audience left crying. So one of the facilitators do what you’re supposed to do [and] go to the hallway and say, “Are you okay?” And the person apparently was crying out of joy and relief. For years they had lived with fear and guilt, feeling that every time they had sex with their partner, they could transmit HIV. And they just communicated that it was that sense of relief. That sense of, “I no longer have to worry, ‘Did the condom break? Did we do something we shouldn’t have?'” It was that sense of relief, it was affirming.

To wrap up, for us, U=U is one of the foundations we build our work on, in the same way we build out work on culturally appropriate services, on indigenous reconciliation, on understanding people’s challenges, on nonjudging. This is a cornerstone of our work now, and I’m very proud of that.