The perceived impact of U=U on HIV status-sharing in MSM
Research type
Research Study
Full title
The perceived impact of Undetectable = Untransmittable on HIV status-sharing beliefs and behaviour in men who have sex with men (MSM)
IRAS ID
354924
Contact name
Claire Gilchrist
Contact email
Sponsor organisation
Royal Holloway University of London
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
The Prevention Access Campaign (PAC) (2016) was launched to promote evidence that people living with HIV (PLHIV) who attain an undetectable viral load through treatment, cannot transmit HIV sexually. The term for this is ‘undetectable = untransmittable’ or ‘U=U’ (PAC, 2016). The U=U campaign also aimed to reduce HIV stigma, as despite medical advancements, PLHIV still experience this (Calabrese et al., 2024; Flint et al., 2023).
HIV stigma has been associated with poor physical health management and mental health difficulties (Earnshaw et al., 2013). Sharing one's HIV status can be difficult. Anticipated risks such as rejection and judgement from others is considered to contribute to this (Bird & Voisin, 2011). However, HIV status-sharing may support improvement in psychological wellbeing (Bondarchuck et al., 2024). Status-sharing may also improve physical health management, such as treatment adherence (Mengesha et al., 2023).
The aim of this study is to explore how knowledge of and beliefs about U=U may impact beliefs and behaviours about HIV status-sharing: for example, does status-sharing increase or decrease with U=U knowledge? The focus is on men who have sex with men (MSM), as this group are disproportionately affected by HIV in the UK (Health Security Agency (HSA, 2023).
Lay summary of study results: Six key themes emerged. First, many participants were migrants to the UK, and their cultural and family backgrounds significantly shaped how safe they felt sharing their HIV status. Second, those who already knew about HIV treatment and U=U before their diagnosis were better able to adjust emotionally to the diagnosis. Third, U=U reduced fears about passing HIV on to others and allowed participants to re-engage with their sexual lives. Fourth, U=U changed how participants thought about their moral responsibility to tell others, particularly reducing the perceived obligation to share in casual sexual encounters, while status-sharing in meaningful relationships still felt important. Fifth, status-sharing remained emotionally and socially risky, with participants carefully assessing the safety of relationships before choosing to share. Finally, the study identified what can be described as the U=U Paradox. While U=U freed participants from the fear of transmitting HIV, it also made it easier to avoid sharing their status altogether. Whilst this protects individuals from experiences of discrimination, it also reduced opportunities for others to learn about HIV, challenge their own misconceptions, and contribute to reducing HIV stigma.Conclusion: U=U is a powerful message for many PLWH. It improves sexual confidence, reduces anxiety, and supports psychological wellbeing. However, knowing the facts about HIV is not enough on its own to overcome the deep-rooted HIV stigma that continues to shape PLWH’s lives. Healthcare professionals, public health campaigns, and wider society all have a role to play in reducing HIV stigma. This responsibility should not fall on PLWH alone. HIV services should ensure conversations about status-sharing are part of routine care, and U=U communication should go beyond the biomedical facts to address the emotional and relational dimensions of life with HIV.
REC name
London - Bloomsbury Research Ethics Committee
REC reference
25/LO/0399
Date of REC Opinion
15 Jul 2025
REC opinion
Further Information Favourable Opinion