Abstract:
In the last decade, reliable scientific evidence has emerged to support the concept
that undetectable viral loads prevent human immunodeficiency virus (HIV). Undetectable equals
untransmissible (U = U) is a simple message that everyone can understand. The success of this concept
depends on strict adherence to antiretroviral therapy (ART) and the attainment of suppressed viral
loads (VLs). To achieve U = U in sub-Saharan Africa (SSA), poor adherence to ART, persistent low-level
viremia, and the emergence of drug-resistant mutants are challenges that cannot be overlooked.
Short of a cure for HIV, U = U can substantially reduce the burden and change the landscape of HIV
epidemiology on the continent. From a public health perspective, the U = U concept will reduce
stigmatization in persons living with HIV (PLWHIV) in SSA and strengthen public opinion to accept
that HIV infection is not a death sentence. This will also promote ART adherence because PLWHIV
will aim to achieve U = U within the shortest possible time. This article highlights challenges and
barriers to achieving U = U and suggests how to promote the concept to make it beneficial and
applicable in SSA. This concept, if expertly packaged by policy-makers, clinicians, health service
providers, and HIV control programs, will help to stem the tide of the epidemic in SSA.
