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December 2018 December 1 was World AIDS Day. Unless you or someone you know is living with HIV, you probably don’t think about AIDS much. It isn’t in the news like it once was and it rarely comes up in casual conversation. However, without proper treatment the virus remains a potent health threat. The great news is that when patients achieve and maintain an undetectable viral load by using daily antiretroviral therapy (ART), their symptoms—and the likelihood of transmission—drop to practically zero. SCIENCE REINFORCES THE U=U MOVEMENT For more than 20 years, researchers have seen a relationship between a patient’s viral load (the amount of HIV genetic material in the blood) and the likelihood of HIV transmission: the higher the load, the higher the risk of transmission. However, until the mid-90s and the advent of triple-drug ART, health professionals couldn’t reduce the viral load enough to keep HIV from spreading. Now they can. Recent research by the National Institutes of Health reinforces what health professionals were seeing: people with suppressed HIV do not infect their sexual partners or pass HIV to their babies in utero. The journal Science named the National Institutes of Health’s HPTN 052 clinical trial as the 2011 breakthrough of the year. The HPTN 052 trial involved 1,763 heterosexual couples in Botswana, Brazil, India, Kenya, Malawi, South Africa, Thailand, the United States, and Zimbabwe, and it showed clear evidence that when viral loads were suppressed, especially when ART was started in relatively healthy patients, "antiretroviral medications can not only treat but also prevent the transmission of HIV infection among heterosexual individuals," said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), sponsor of the clinical trial. Two additional studies, PARTNER and Opposites Attract, showed similar results for male-male couples. HIV health professionals are using this Undetectable = Untransmittable (U=U) message to encourage patients living with HIV to consistently maintain ART treatment. When patients feel healthy, they are sometimes less motivated to maintain the expensive and inconvenient daily ART regimen, but knowing it can suppress the viral load to the point of becoming undetectable—and therefore untransmittable—helps some patients stay consistent. Stopping treatment allows the viral load to increase, becoming detectable and therefore dangerous to partners and, in the case of pregnant women, fetuses. To learn more about how an undetectable viral load prevents HIV transmission, see NIAID’s fact sheet 10 Things to Know About HIV Suppression. GET TESTED Every person who is sexually active should be tested for HIV at least once in their lifetime. Those with risk factors like multiple sex partners, injection drug use, or men who have sex with men should get tested more frequently. Those at high risk should consider pre-exposure prophylaxis (PrEP), a daily antiviral pill that can greatly reduce the risk of infection. When the virus is identified early, people with HIV can now live long, healthy and productive lives. The Mendocino Community Health Clinic provides primary medical care to People Living with HIV/AIDS funded in part through a grant from the federal Ryan White Care Program. If you are in need of primary HIV medical care, please call the Ryan White Nurse Case Manager at 707-472-4627 for more information and to schedule an appointment.   Stephan Ouellette is a licensed clinical social worker and the Ryan White Program Manager at MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people residing in Lake and Mendocino Counties.