U=U and Treatment as Prevention (TasP)

As well as being good for your health, ART also prevents transmission.

Your HIV doctor should talk about this – sometimes called Treatment as Prevention (TasP).

Having an undetectable viral load  on ART protects your partners, even if you don’t use condoms.

Since 2016, the global U=U community campaign has focussed on Undetectable = Untransmittable.

Your HIV doctor should talk about this. It is sometimes called Treatment as Prevention (TasP).

  • The PARTNER study and the Opposites Attract study both reported zero transmissions from the positive partner with an undetectable viral load. In PARTNER, this was after 58,000 times that couples had vaginal or anal sex without condoms.
  • In PARTNER 1 there were no linked infections after 58,000 times that couples had vaginal or anal sex without condoms. PARTNER 2 had no transmissions after gay couple had sex more than 77,000 times.

This means condoms are only important if you want to protect against pregnancy and some STIs. 

This evidence should reduce the worry and anxiety for couples where one partner is positive and the other is negative, even if they still chose to use condoms.

It should also help reduce fear and stigma about HIV.

ART as prevention

UK guidelines recommend that every HIV doctor should talk about how ART reduces the risk of transmission.

Taking ART will benefit your own health and reduce the risk of sexually transmitting HIV.

Public health and personal choice

U=U has changed the approach to HIV and ART. 

But your decision to use ART should always be your personal choice.

If you do not want to take ART for your own health, you should not be under pressure to take ART for TasP.

  • Most HIV positive people never put their partners at risk.
  • Most new infections are likely to come from people who are not yet diagnosed. This is related to people being most infectious in early infection, or having a high viral load in later infection.
  • Many HIV positive people find that the greater awareness of U=U has improved their life. It is good to no longer have to worry about whether your partners are at risk.
  • ART makes it easier to have relationships without the fear of HIV.

We are both HIV positive and not using condoms is a special part of our relationship. We are both on treatment and have no resistance.

We don’t usually have other partners, but agree to use condoms if this happens, so that we would reduce the risk of STIs…

— Steve, Manchester.

I am positive and so is my partner.

I am happier to continue using condoms.

This is because I feel better to be in control of this part of my life.

At least I don’t have to worry about my health if he decides to have other partners… 

— Paula, London.

Last updated: 1 October 2019.