Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey
Background Launched in the United States (US) in 2016, the ‘undetectable equals untransmittable’ (U = U) message has revolutionized human immunodeficiency virus (HIV) management by affirming that individuals on antiretroviral therapy (ART) with undetectable viral loads (VL) cannot sexually transmit...
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SAGE Publishing
2025-08-01
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| Series: | Journal of the International Association of Providers of AIDS Care |
| Online Access: | https://doi.org/10.1177/23259582251370236 |
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| author | Bekana K Tadese PhD, MPH M Janelle Cambron-Mellott PhD Jean Marie Arduino ScD, MS Bridget L Balkaran MS Shakiba Eslamimehr PhD José M Zuniga PhD, MPH |
| author_facet | Bekana K Tadese PhD, MPH M Janelle Cambron-Mellott PhD Jean Marie Arduino ScD, MS Bridget L Balkaran MS Shakiba Eslamimehr PhD José M Zuniga PhD, MPH |
| author_sort | Bekana K Tadese PhD, MPH |
| collection | DOAJ |
| description | Background Launched in the United States (US) in 2016, the ‘undetectable equals untransmittable’ (U = U) message has revolutionized human immunodeficiency virus (HIV) management by affirming that individuals on antiretroviral therapy (ART) with undetectable viral loads (VL) cannot sexually transmit the virus. This study aimed to assess the knowledge and understanding of U = U and factors associated with the lack of understanding among people living with HIV (PLHIV) in the US. Methods A cross-sectional, online survey was fielded from February to June 2022 in the US to PLHIV aged ≥18 years who were currently taking ART. Data on sociodemographic variables, HIV-related and general health characteristics were collected. The study assessed the knowledge and understanding of U = U and sources of U = U information. Multivariable analyses were used to identify the factors associated with the lack of U = U understanding among PLHIV. Results A total of 781 PLHIV completed the study and were included in the analysis. Most participants were <50 years old (67.0%), cisgender males (56.2%), and majority having at least some college education (80.5%). More than half (54.5%) of the participants did not know the meaning of the U = U. Sources of learning about the meaning of ‘undetectable’ included a healthcare provider (HCP) alone (50.4%), the U = U campaign alone (7.6%), both an HCP and the U = U campaign (14.7%), and sources other than HCPs or the U = U campaign (32.2%); 3.1% of participants reported having never heard the term before. About 12.0% of the participants were unaware of their VL status. After adjusting for covariates, PLHIV who lacked an understanding of U = U were more likely to have a college degree or higher education (OR: 0.6, 95% CI: 0.41-0.86, P = 0.006), recent HIV diagnosis (6 months to <12 months) (OR: 2.06, 95% CI: 1.14-3.77, P = 0.018), suboptimal ART adherence (OR: 2.74, 95% CI: 1.88-4.01, P < 0.001), and lack HCP communication about the importance of an undetectable VL compared to those who understood U = U. Conclusion The study highlights substantial gaps in understanding U = U among PLHIV and in HCP-patient communication. These findings underscore the need for targeted education for both PLHIV and HCPs, emphasizing the clinical implications and benefits of U = U in relation to HIV prevention. |
| format | Article |
| id | doaj-art-e4ed95c4b2f04887a691337fd14344a5 |
| institution | Kabale University |
| issn | 2325-9582 |
| language | English |
| publishDate | 2025-08-01 |
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| series | Journal of the International Association of Providers of AIDS Care |
| spelling | doaj-art-e4ed95c4b2f04887a691337fd14344a52025-08-20T11:03:58ZengSAGE PublishingJournal of the International Association of Providers of AIDS Care2325-95822025-08-012410.1177/23259582251370236Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional SurveyBekana K Tadese PhD, MPH0M Janelle Cambron-Mellott PhD1Jean Marie Arduino ScD, MS2Bridget L Balkaran MS3Shakiba Eslamimehr PhD4José M Zuniga PhD, MPH5 Outcome Research, , Rahway, NJ, USA Real-World Evidence, Oracle Life Sciences, Austin, TX, USA Outcome Research, , Rahway, NJ, USA Real-World Evidence, Oracle Life Sciences, Austin, TX, USA Real-World Evidence, Oracle Life Sciences, Austin, TX, USA , Washington, DC, USABackground Launched in the United States (US) in 2016, the ‘undetectable equals untransmittable’ (U = U) message has revolutionized human immunodeficiency virus (HIV) management by affirming that individuals on antiretroviral therapy (ART) with undetectable viral loads (VL) cannot sexually transmit the virus. This study aimed to assess the knowledge and understanding of U = U and factors associated with the lack of understanding among people living with HIV (PLHIV) in the US. Methods A cross-sectional, online survey was fielded from February to June 2022 in the US to PLHIV aged ≥18 years who were currently taking ART. Data on sociodemographic variables, HIV-related and general health characteristics were collected. The study assessed the knowledge and understanding of U = U and sources of U = U information. Multivariable analyses were used to identify the factors associated with the lack of U = U understanding among PLHIV. Results A total of 781 PLHIV completed the study and were included in the analysis. Most participants were <50 years old (67.0%), cisgender males (56.2%), and majority having at least some college education (80.5%). More than half (54.5%) of the participants did not know the meaning of the U = U. Sources of learning about the meaning of ‘undetectable’ included a healthcare provider (HCP) alone (50.4%), the U = U campaign alone (7.6%), both an HCP and the U = U campaign (14.7%), and sources other than HCPs or the U = U campaign (32.2%); 3.1% of participants reported having never heard the term before. About 12.0% of the participants were unaware of their VL status. After adjusting for covariates, PLHIV who lacked an understanding of U = U were more likely to have a college degree or higher education (OR: 0.6, 95% CI: 0.41-0.86, P = 0.006), recent HIV diagnosis (6 months to <12 months) (OR: 2.06, 95% CI: 1.14-3.77, P = 0.018), suboptimal ART adherence (OR: 2.74, 95% CI: 1.88-4.01, P < 0.001), and lack HCP communication about the importance of an undetectable VL compared to those who understood U = U. Conclusion The study highlights substantial gaps in understanding U = U among PLHIV and in HCP-patient communication. These findings underscore the need for targeted education for both PLHIV and HCPs, emphasizing the clinical implications and benefits of U = U in relation to HIV prevention.https://doi.org/10.1177/23259582251370236 |
| spellingShingle | Bekana K Tadese PhD, MPH M Janelle Cambron-Mellott PhD Jean Marie Arduino ScD, MS Bridget L Balkaran MS Shakiba Eslamimehr PhD José M Zuniga PhD, MPH Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey Journal of the International Association of Providers of AIDS Care |
| title | Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey |
| title_full | Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey |
| title_fullStr | Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey |
| title_full_unstemmed | Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey |
| title_short | Lack of Knowledge and Understanding of Undetectable Equals Untransmittable (U = U) Among People Living with HIV in the United States: Results from a Cross-Sectional Survey |
| title_sort | lack of knowledge and understanding of undetectable equals untransmittable u u among people living with hiv in the united states results from a cross sectional survey |
| url | https://doi.org/10.1177/23259582251370236 |
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