Science has proven that a person with sustained, undetectable levels of HIV in their blood cannot transmit HIV to their sexual partners (undetectable = untransmittable or U=U). The National Coalition of STD Directors (NCSD) celebrates this fact and we stand committed to raise awareness of U=U.

It is on us, the public health community, to empower people to make choices that promote sexual health across a lifetime. To do so, STD prevention and U=U must go hand in hand within a broader sexual health framework, one that emphasizes sex-positive approaches to informed decision making.  This will require a paradigm shift in how we operate in the STD and HIV fields. We must think outside of our silos and embrace allies in primary care, mental and behavioral health, women’s health, reproductive health, LGBTQ health, and beyond.

To meet the full promise of U=U, the intertwined HIV and STD epidemics must be addressed.  STDs are one of the underlying causes of new HIV infections. Research shows that 10 percent of new HIV infections are caused by gonorrhea and chlamydia alone and it is estimated that the risk of transmission from syphilis is even greater.^1,2 Progress has been made in reducing new HIV infections due to sustained advocacy and investment, and groundbreaking advancements such as Treatment as Prevention (TasP). Unfortunately, these advancements have not been mirrored in the STD field, and cases have ballooned to all-time highs for the fourth year in a row.³

The same forces that drive HIV also drive other STDs, fueled by health disparities and stigma. U=U provides an unprecedented opportunity to fight stigma and to engage and sustain people in HIV and STD care. This engagement must include continued promotion of condoms as a proven STD prevention tool, but also the frank acknowledgment that condoms are not for everyone. We must also recognize that biomedical advancements such as PrEP and TasP will remain inaccessible to some due to structural and financial barriers and personal choices. The full suite of prevention strategies—including condom use, promotion of risk reduction and safer sex practices,  STD testing and treatment, comprehensive sex education, and access to biomedical prevention tools—remain essential in the fight against both STDs and HIV.

The public health infrastructure that supports U=U must also rise to the STD challenge. NCSD calls on the community, the administration, and public health leaders at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and other Department of Health and Human Services offices and agencies, to take urgent action. This action should include advancing programs, awareness campaigns, and science around STD tracking, diagnostics, and therapy.  We also implore Congress to support funding for the Ending the HIV Epidemic initiative, STD prevention at CDC, and STD research at NIH.

We cannot be shortsighted. The HIV epidemic taught us that we must be proactive and prepare for what new sexually transmitted infection may be around the corner. Embracing U=U, HIV prevention, and STD prevention as interdependent and fundamental parts of broader sexual health will provide the best opportunity to realize the goal of an HIV-free world.

NCSD is proud to support this generational advancement and is committed to advancing sexual health through promotion of U=U and STD prevention.

References

1. Jones J, Weiss k, Mermin, Dietz P, et al. Proportion of incident HIV cases among men who have sex with men attributable to gonorrhea and chlamydia: A modeling analysis. Sex Transm Dis. 2019; 46(6):357-363.
2. Peterman T, Newmann D, Maddox L, Schmidt K, Shiver S. High Risk for HIV Following Syphilis Diagnosis Among Men in Florida, 2000–2011. Public Health Reports. 129(2): 164–169. 2014 Mar-Apr.
3. CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. New CDC analysis shows steep and sustained increases in STDs in recent years. https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html. Accessed August 2, 2019.