Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda
Abstract Background HIV serodifferent couples where one partner is living with HIV and the other is not, remain a key population for HIV prevention. Maintaining an undetectable viral load eliminates the risk of sexual HIV transmission, this principle is often summarised as undetectable = untransmitt...
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2025-08-01
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| Online Access: | https://doi.org/10.1186/s12889-025-24120-1 |
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| author | Elizabeth Senkoro Timothy Muwonge Leila Samson Vicent Kasiita Alisaati Nalumansi Brenda Kamusiime Gertrude Mollel Maja Weisser Andrew Mujugira |
| author_facet | Elizabeth Senkoro Timothy Muwonge Leila Samson Vicent Kasiita Alisaati Nalumansi Brenda Kamusiime Gertrude Mollel Maja Weisser Andrew Mujugira |
| author_sort | Elizabeth Senkoro |
| collection | DOAJ |
| description | Abstract Background HIV serodifferent couples where one partner is living with HIV and the other is not, remain a key population for HIV prevention. Maintaining an undetectable viral load eliminates the risk of sexual HIV transmission, this principle is often summarised as undetectable = untransmittable (U = U). However, the extent to which this principle is understood and utilised by serodifferent couples remains unclear. This study aimed to explore both partners’ perceptions, experiences and adoption of U = U within their relationships. Methods We conducted an exploratory qualitative study using in-depth interviews with 20 serodifferent couples (40 participants) between July and August 2023 in Ifakara, Tanzania and Kasangati, Uganda. Each partner was interviewed separately. Interviews explored: (1) Awareness of U = U, (2) Lived experiences related to U = U, and (3) Social perceptions of U = U and HIV serodifference. The interviews were audio-recorded, transcribed, and analysed using thematic analysis with Atlas.ti for coding. Results All participants were in a heterosexual serodifferent relationship and had mutually disclosed their status. The average age was 25 years, and couples had been partnered for approximately 3.5 years. All 40 participants (100%) had basic knowledge of U = U or treatment as prevention. The qualitative analysis identified four key themes that were broadly consistent in both settings: (1) Knowledge of U = U facilitated adoption, with initial doubts giving way to trust over time as partners remained HIV-negative; (2) Disclosure triggered emotional responses, which were alleviated through counselling, with U = U influencing relationship confidence and fertility decisions; (3) Use of additional prevention (PrEP, condoms) reinforced trust in U = U, addressing residual concerns about adherence and fidelity; (4) Persistent stigma and limited community awareness constrained U = U’s potential impact. Themes were largely consistent across Uganda and Tanzania, though Ugandan participants more frequently reported detailed provider counselling and PrEP use. Conclusion This study highlights how understanding experiences of U = U among HIV serodifferent couples in Tanzania and Uganda are shaped by personal, relational, and contextual factors. Our findings suggest that U = U communication strategies should be strengthened through context-specific counselling, improved access to viral load testing, and community education. Further research is needed to explore how U = U is perceived and adopted in more diverse settings. |
| format | Article |
| id | doaj-art-e193fb45c7b34e97ac4aef20821d0508 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Public Health |
| spelling | doaj-art-e193fb45c7b34e97ac4aef20821d05082025-08-24T11:55:37ZengBMCBMC Public Health1471-24582025-08-012511910.1186/s12889-025-24120-1Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and UgandaElizabeth Senkoro0Timothy Muwonge1Leila Samson2Vicent Kasiita3Alisaati Nalumansi4Brenda Kamusiime5Gertrude Mollel6Maja Weisser7Andrew Mujugira8Ifakara Health Institute, Chronic Disease Clinic of IfakaraInfectious Diseases Institute, College of Health Sciences, Makerere UniversityIfakara Health Institute, Chronic Disease Clinic of IfakaraInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityInfectious Diseases Institute, College of Health Sciences, Makerere UniversityIfakara Health Institute, Chronic Disease Clinic of IfakaraIfakara Health Institute, Chronic Disease Clinic of IfakaraInfectious Diseases Institute, College of Health Sciences, Makerere UniversityAbstract Background HIV serodifferent couples where one partner is living with HIV and the other is not, remain a key population for HIV prevention. Maintaining an undetectable viral load eliminates the risk of sexual HIV transmission, this principle is often summarised as undetectable = untransmittable (U = U). However, the extent to which this principle is understood and utilised by serodifferent couples remains unclear. This study aimed to explore both partners’ perceptions, experiences and adoption of U = U within their relationships. Methods We conducted an exploratory qualitative study using in-depth interviews with 20 serodifferent couples (40 participants) between July and August 2023 in Ifakara, Tanzania and Kasangati, Uganda. Each partner was interviewed separately. Interviews explored: (1) Awareness of U = U, (2) Lived experiences related to U = U, and (3) Social perceptions of U = U and HIV serodifference. The interviews were audio-recorded, transcribed, and analysed using thematic analysis with Atlas.ti for coding. Results All participants were in a heterosexual serodifferent relationship and had mutually disclosed their status. The average age was 25 years, and couples had been partnered for approximately 3.5 years. All 40 participants (100%) had basic knowledge of U = U or treatment as prevention. The qualitative analysis identified four key themes that were broadly consistent in both settings: (1) Knowledge of U = U facilitated adoption, with initial doubts giving way to trust over time as partners remained HIV-negative; (2) Disclosure triggered emotional responses, which were alleviated through counselling, with U = U influencing relationship confidence and fertility decisions; (3) Use of additional prevention (PrEP, condoms) reinforced trust in U = U, addressing residual concerns about adherence and fidelity; (4) Persistent stigma and limited community awareness constrained U = U’s potential impact. Themes were largely consistent across Uganda and Tanzania, though Ugandan participants more frequently reported detailed provider counselling and PrEP use. Conclusion This study highlights how understanding experiences of U = U among HIV serodifferent couples in Tanzania and Uganda are shaped by personal, relational, and contextual factors. Our findings suggest that U = U communication strategies should be strengthened through context-specific counselling, improved access to viral load testing, and community education. Further research is needed to explore how U = U is perceived and adopted in more diverse settings.https://doi.org/10.1186/s12889-025-24120-1HIVSerodifferent couplesU = UQualitativeSub-Saharan africa |
| spellingShingle | Elizabeth Senkoro Timothy Muwonge Leila Samson Vicent Kasiita Alisaati Nalumansi Brenda Kamusiime Gertrude Mollel Maja Weisser Andrew Mujugira Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda BMC Public Health HIV Serodifferent couples U = U Qualitative Sub-Saharan africa |
| title | Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda |
| title_full | Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda |
| title_fullStr | Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda |
| title_full_unstemmed | Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda |
| title_short | Experiences of undetectable = untransmittable among couples with different HIV serostatus: a qualitative study in Tanzania and Uganda |
| title_sort | experiences of undetectable untransmittable among couples with different hiv serostatus a qualitative study in tanzania and uganda |
| topic | HIV Serodifferent couples U = U Qualitative Sub-Saharan africa |
| url | https://doi.org/10.1186/s12889-025-24120-1 |
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