Friday, March 23, 2018

Undetectable Equals Untransmittable: The Battle Against HIV

By Ulysses Konstantin Largado and Jhemarie Arca

Much has been said about what one can do to prevent getting infected with HIV. In recent years, as we’ve seen an alarming spike in reported cases in the Philippines, most campaigns are aimed at educating Filipinos on how to lower their risks.

This approach remains to be the focus, and for good reason. As of the December 2017 HARP data, over 48% of reported HIV cases since 1984 are under Antiretroviral Therapy (ART) - the science of suppressing the virus to levels that are essentially low, it can no longer be detected (“undetectable”) during tests, which also means it can no longer be transmitted. Note that HIV can only be transmitted through 3 modes: blood and blood products, mother-to-child, and unprotected penetrative sex. The effectiveness of ART in lowering the viral load benefits not only the PLHIV undergoing treatment, but also other people who are at risk of HIV infection through sexual contact and mother to child transmission. It is the basis of the Undetectable Equals Untransmittable (U=U) campaign, a significant shift in approach on how we deal with HIV. As crucial as it is to drive prevention, it is only half of the battle. As any battle would require, the soldier aka the person fighting for one’s own welfare, should be mindful of the discipline, adherence, and an overall improvement of lifestyle.


Timely Treatment and Testing

LoveYourself’s care principle, the Triangle of Self-Care (TSC), emphasizes the importance of Timely Testing to know your status, and Timely Treatment for those found to have been reactive for HIV.

So we can fully understand U=U, let’s refer to the risk checklist known as ESSE - Exit, Sufficiency, Survival, and Entry. Sufficiency refers to higher levels of viral load found in blood, semen, vaginal fluid, and breast milk. When any of these bodily fluids exit the body and enters another, HIV is transmitted.

Baselining and succeeding routine tests determine a PLHIV’s viral load. When it can no longer be detected, it simply means the content is no longer sufficient for HIV to be successfully transmitted.

Several studies on U=U yield the same output, backing up its efficacy and reliability. Numerous case studies and researches, such as the 2016 PARTNER Study, support the stance that U=U, best seen in serodiscordant couples where one is infected with HIV while the other isn’t, and remains negative. Understanding the concept of U=U leads to a goal-oriented approach in taking and adhering to treatment. This sets PLHIVs to a realistic and attainable objective.

In a statement released through the Prevention Access Campaign, “People living with HIV on ART with an undetectable viral load in their blood have a negligible risk of sexual transmission of HIV. Depending on the drugs employed it may take as long as six months for the viral load to become undetectable. Continued and reliable HIV suppression requires selection of appropriate agents and excellent adherence to treatment. HIV viral suppression should be monitored to assure both personal health and public health benefits.” In its statement, the term “negligible” refers to one that is insignificant, something so small or unimportant as to be not worth considering.

LoveYourself’s Role

LoveYourself continues to partner with its clients in attaining U=U. To date, 99% of our clients on ART have been virally suppressed, and 80% have undetectable viral levels. This demonstrates how timely treatment actually works, and this is what we aim to reinforce.

LoveYourself Anglo community clinic located in Shaw Blvd., Mandaluyong is a DOH accredited primary care facility for HIV in the region, where PLHIVs get initial medical assessment and obtain ART. LoveYourself Anglo provides its clients with education, testing, treatment services, and life coaching services.

“We focus on client needs in terms of psychological and biomedical support. We are open to the client choices regarding time management (ARV medication) and treatment schedule (refill schedule) as long as it benefits both parties.” ~ Kahel Jay Sta. Maria, Lead Life Coach, HIV and TB Program Co-Manager.

The two clinics in Pasay expand LoveYourself’s reach: LoveYourself Uni along Taft Ave. offers testing accessible even to those residing outside the Metro. The newly-renovated Victoria by LoveYourself broadens its services by not only providing HIV testing and counseling, but offers hormone replacement therapy consultations as well. Find out more about our services and facilities here.


Winning the Battle

The key in winning any battle, in life or in actual battlefield, is the knowledge in knowing what you’re getting into. By being mindful about the information around us, one will know how to strategize and equip themselves with the right weapons to reach the goal. Thus, with early detection and treatment one can prevent the further transmission of HIV by attaining an undetectable status.

Photos by: Jhemarie Arca and John Danvic Rosadi┼ło