U = U? Finally, some maths we can understand!
In an autobiography published last year, Jonathan Van Ness (Queer Eye) opened up about being an out-and-proud member of “the beautiful HIV-positive community”.
Having fainted in a salon, aged 25, while colouring a client’s hair, he subsequently developed flu-like symptoms before testing positive for HIV at a Planned Parenthood. Since then, he has gone on to live a life many of us can only imagine – worldwide fame as the Queer Eye grooming expert, a global comedy tour, a New York Times bestselling book and figure skating dates with Michelle Kwan.
Despite this, as he revealed in an interview on the Today Show, people still think, “well he has HIV, is he okay? Is he sick? How’s he feeling?” This is because, as a community, many of us are unaware of just how far HIV medication has come. Not the terrifying death sentence of the 1980s and ’90s, medical advances have meant that those who test HIV-positive can go on to live normal lives, or even extraordinary lives in the case of JVN. Beyond this, medical advances also mean that HIV-positive people will not pass the virus on to others if medication is taken correctly. To understand this, we need a quick biology lesson.
HIV is a virus that, once in our system, attaches itself to a type of white blood cell that forms part of our immune system. Once attached, the virus takes control over the cell’s machinery, to force that cell to make many more copies of the virus. These copies then sit inside the cell until it can’t hold any more. At this point, like a balloon, the cell bursts open and dies, releasing all those virus copies into the blood so that they can then attack more white blood cells. This is the life cycle of HIV.
If left untreated, the virus eventually kills most of our white blood cells, essentially decimating our immune system. This is AIDS. Furthermore, the more copies of the virus in the blood, the more likely it is that the virus will be passed on to others.
Medication works at all levels of infection to prevent the virus attaching to our white blood cells and prevent those cells from then producing more copies of the virus. Crucially, this lowers the amount of virus present in the blood – the viral load. In this way, medication helps to protect white blood cells, to therefore protect the immune system. This is why JVN can double axel (ice-skating term) his way through 2020.
Today, HIV medication is so effective that, if taken properly, the viral load can be lowered to such an extent that there is simply too little virus in the blood for HIV tests to detect it. This is what we mean by “undetectable”. Crucially, if the viral load is low enough to be undetectable, there is also too little virus present for it to be passed on to others. This is what we mean by “untransmittable”.
This complex biology creates some rather simple maths: U = U (Undetectable = Untransmittable). People living with HIV who maintain an undetectable viral load and stay on treatment do not transmit HIV through condom-less sex.
This equation is backed up by science. A 2016 study on gay couples where one person was positive (but had an undetectable viral load) found that there were zero partner-transmissions, despite these couples collectively having condom-less sex over 22,000 times. Another study, published last year, followed 1,000 similar gay couples through eight years of condom-less sex and again found no cases of HIV transmission within the couples.
Now, this isn’t necessarily a hall pass for us to throw out our condoms; it goes without saying that other STIs can easily be passed on, as can HIV if medication isn’t taken correctly.
Instead, U = U means that thousands of gay couples across the world are free to love who they love, without the fear of infecting them. It is thus a simple and powerful equation that means HIV-positive people are able to not just survive, but thrive, like JVN.