Learning objectives

By the end of this section you'll be able to:

  • Know how and when to bring discussions about U=U into your consultations.
  • Explain U=U in terms that are clear for your patients.
  • Explain to patients how to talk about U=U to their sexual partners.
  • Know how to talk to people living with HIV about the risks of other sexually transmitted infections in the context of U=U.
  • Explain to patients how to talk about U=U in the context of having children.

What this page covers

  • When to discuss U=U.
  • Who to discuss U=U with and the importance of repeating the message and providing other sources of information.
  • The language to use and the language to avoid.
  • How to talk to patients about talking to their sexual partners about U=U.
  • How to talk to patients about the risks of other sexually transmitted infections in the context of U=U.
  • How to talk about U=U in the context of having children.

How to talk about U=U during a consultation

From the survey we conducted in November/December 2019 of the 309 people living with HIV, only 104 (34%) had heard about U=U from a healthcare professional.

Of those 104 respondents who were told about U=U by a healthcare professional:

  • 61 (59%) were told about the research behind U=U.
  • 62 (60%) stated they were given more information to take away with them.
  • 41 (39%) had a discussion about how to talk to their sexual partners about U=U.

You should cover all of these topics in a consultation with an HIV-positive patient.

Clinical consultation

This video shows a consultation between Professor Chloe Orkin and a young HIV-positive gay man who has been diagnosed for about five years. It demonstrates how to discuss U=U with your patients.

The consultation covers a broad range of topics, including STIs, how to talk to sexual partners and adherence, all of which are useful for discussions with people living with HIV in any clinical setting.

You can find downloadable case studies of other scenarios in our training resources section.

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Why every healthcare professional should always reinforce U=U

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Why it’s a moral imperative to say zero risk and communicate the message

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Language to use when discussing U=U in a consultation

You should always:

  • Say there is zero risk of sexual transmission of HIV.
  • Use language such as:
    • 'You will not transmit.'
    • 'You can’t pass it on.'
    • 'There is no risk of transmission.'

You should never say:

  • There is a negligible risk.
  • The risk is next to zero.
  • Transmission is virtually impossible.
  • The risk is really low.

These statements are factually incorrect and sows seeds of doubt in people’s minds, which impacts on their confidence in the U=U message.

For further information about the importance of language, how incorrect language perpetuates stigma and discrimination for people living with HIV and the correct language to use, please see the People First Charter.

Discussing U=U with people who want to have children

The aim of antiretroviral therapy is to ensure that people can lead a normal life, and that includes having children.

The risk of an HIV-positive individual who has an undetectable viral load passing HIV on to their partner during conception is zero.

The risk of a mother who has an undetectable viral load passing HIV on to their unborn baby is practically zero (0.1%) if they continue to take their medication during pregnancy and are closely monitored.

U=U does not apply to breastfeeding and, in the UK, the advice is to not breastfeed as there are safe alternatives such as formula feed and clean water to mix it with. But, if someone chooses to breastfeed, they should be supported to do so and there is guidance in place to ensure this can be done safely.

Further information on breastfeeding and leaflets for people living with HIV:

Key messages from videos

What an HIV consultation should include:

  1. Background history.
  2. Any other medical problems or issues.
  3. HIV treatment and other medication.
  4. Latest blood test results.
  5. Adherence.
  6. Social history.
  7. Sexual history.
  8. Discuss U=U, including:
    • Adherence.
    • Sexually transmitted infections.
    • PEP.
    • PrEP.
    • Talking to sexual partners.
    • Having children.

Must do's when talking about U=U

  • Always say the risk of sexual transmission is zero – any other language that leaves room for doubt is confusing and unhelpful for your patients.
  • Discuss U=U at every consultation and document what was said. Remember that many people find the message hard to accept so it needs to be reinforced and repeated.
  • Offer to meet partners and/or relatives to explain U=U to them as they may not believe it from your patient and may prefer to hear it from a healthcare professional.
  • If people want to have children, explain that there is no risk of HIV transmission during conception when the HIV-positive individual has an undetectable viral load. Explain that this doesn’t apply to breastfeeding and that appropriate antenatal care and HIV treatment will prevent vertical transmission.
  • Address any concerns about criminalisation and reassure them that, as there is a zero risk of HIV transmission with effective treatment and an undetectable viral load, there should be no concern about criminalisation in the UK because a transmission of HIV or an exposure to HIV will not occur.

Find more information on HIV criminalisation in the difficult questions section.

Find more ways to provide support and information to your patients in our patient resources section.

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Links to more resources

Pregnancy, birth and breastfeeding

Where to refer patients who want more information and support around Can't Pass It On/U=U:

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