A cross-sectional analysis of U=U as a potential educative Intervention to mitigate HIV stigma among youth living with HIV in South Africa

Introduction: the HIV educative campaign Undetectable Equals Untransmissible (U=U) is a potential gamechanger to address HIV stigma. We investigated what percentage of South African adolescents were aware of U=U, and the associations with perceived HIV stigma and past-year HIV testing. Methods: we used a cross-sectional design. Data were from the 2017/2018 South African National HIV prevalence, incidence, behaviour and communication survey. HIV status was measured using both laboratory confirmation and self-reports. Among adolescents aged 15-18 years, we calculated the percentage who believed that "the risk of HIV transmission through sex can be reduced by an HIV-positive partner consistently taking drugs that treat HIV." Data were weighted to yield nationally representative estimates. Results: overall, 49.8% of all adolescents aged 15-18 years (and 49.2% of this HIV seropositive) believed that the risk of HIV transmission through sex can be reduced by an HIV-positive partner consistently taking drugs that treat HIV. After adjusting for HIV status, geographic location, race, sex, and orphanhood status, those with belief in U=U were less likely to endorse stigmatizing statements that teachers with HIV should not teach (IRR=0.63, 95%CI, 0.47-0.84), pupils with HIV should not attend class (IRR=0.62, 95%CI, 0.45-0.84), or that children with HIV in general should be in segregated schools (IRR=0.55, 95%CI, 0.41-0.74). Among those reporting not living with HIV, U=U belief was associated with increased likelihood of past-year HIV testing (IRR=1.19, 95%CI, 1.01-1.41). Conclusion: U=U belief was associated with reduced stigma perceptions and increased HIV testing. Adoption of U=U into clinical practice guidelines in South Africa may benefit public health.