Belief in the ‘Undetectable equals Untransmissible’(U=U) statement and associations with stigma, mental health and sexual satisfaction in people living with HIV (PWH) in the UK

OBJECTIVES: The 'Undetectable equals Untransmissible' (U=U) statement is based on robust evidence. Spreading this message aims to reduce HIV stigma, increase antiretroviral therapy (ART) adherence, and improve quality of life for people with HIV (PWH). Among PWH in the UK, we assessed the proportion believing U=U and its associations with HIV-related self-stigma, mental health, and sexual satisfaction. DESIGN: Positive Voices 2022 is the largest UK national survey of PWH (April 2022-March 2023). Participants self-completed a questionnaire on socio-demographic, HIV-related, health, and lifestyle factors. METHODS: We assessed associations of demographic, socioeconomic, and HIV-related factors with belief in U=U, and associations of belief in U=U with self-stigma, depression symptoms, anxiety symptoms, and sexual satisfaction (the latter among participants who had sex in the past 3 months) using logistic regression, unadjusted and adjusted for demographic group, age, and time on ART. RESULTS: Four thousand five hundred and fifty-three people on ART were included: 2671 (59%) gay or bisexual MSM (GBMSM), 1104 (24%) women, 646 (14%) heterosexual men; 1100 (24%) participants of Black ethnicity; median (IQR) age 52 years (44-60). 4192 (92%) had heard of U=U; fewer (2906, 64%) believed it. Lack of belief in U=U was more common among older participants, heterosexuals, those with less education, those with financial hardship, and those without knowledge of their last viral load level. Lack of belief in U=U was associated with HIV-related self-stigma [adjusted odds ratio (aOR) 1.88, 95% confidence interval (CI) 1.63-2.18], depression symptoms (aOR 1.33, 95% CI 1.13-1.56) anxiety symptoms (aOR 1.48, 95% CI 1.23-1.77), and less sexual satisfaction (physical pleasure: aOR 0.62, 95% CI 0.51-0.75; emotional satisfaction: aOR 0.72, 95% CI 0.60-0.87). With the exception of depression symptoms, these associations remained after additional adjustment for financial hardship. Patterns of association were similar among GBMSM compared to all other demographic groups combined. CONCLUSION: Despite high awareness of U=U among PWH in UK, belief remains inadequate, especially in disadvantaged groups. Promoting this message could help combat HIV-related stigma and improve mental health.