HIV and young people
Understanding the HIV epidemic
How to talk about U=U with young people
Abbo, a 21-year-old sex worker, has been on HIV treatment for three months. She has heard about U=U and asks the nurse about it during a monitoring appointment.
How NOT to speak to a young person about U=U
Dembe, the nurse, calls another nurse into the cubicle who comes in and leaves the curtain open. “Are we allowed to tell prostitutes about U=U?’ Dembe asks the second nurse, who shakes her head. Dembe turns back to Abbo and says: “U=U is only something we can talk to respectable, married people about.” Abbo says she has the right to hear about information if it can help her health. Dembe checks Abbo’s file and tells her she needs to be “stable on treatment”. He adds: “Your lifestyle might make it hard to adhere to treatment in the long-term. While you are continuing with this behaviour you should use condoms or you will be guilty of spreading HIV.”
Dembe offers to pray for Abbo to “find a better path”. He gives Abbo some condoms. He tells her to come back once she “starts living morally” and he will be pleased to discuss U=U with her then.
How to speak to a young person about U=U
Dembe, the nurse, closes the cubicle curtain and asks Abbo what she knows about U=U. Abbo says she has heard that if she keeps taking HIV treatment she will not be able to pass HIV on. Dembe tells her it is good to hear her asking about this. Then he explains that U=U stands for “undectable equals untransmissible”. He explains that being undectable means that HIV has fallen to such a low level in the blood that it does not show up in blood tests. He tells her that if this happens, Abbo will not be able to pass HIV on through sex and it will also help her stay healthy. Dembe tells Abbo that the only way to become undectable and to stay undectable is to take HIV treatment every day and to come for regular viral load monitoring. He asks Abbo if she knows what viral load monitoring is. She shakes her head so he explains.
When he has finished, Dembe asks her if she has any questions. He says he will book her in for a viral load test. Dembe also suggests that Abbo gets tested for STIs. He explains she should still use condoms and lubricant as she is at higher risk of STIs. He asks if she is on any form of birth control, and Abbo says she is on the pill. Dembe advises Abbo that there are other contraceptive choices in addition to the pill and she can come and discuss this if useful at any point. Dembe also tells her that, if she decides she wants to get pregnant in the future, if she is undetectable she will not pass HIV on to her baby.
