HIV/AIDS: Stop the Fear Advocacy, Adopt the U=U Approach

For over 30 years, our HIV message in Ghana and across Africa has been built on fear. Fear of death, fear of shame, fear of pictures of sick people on billboards. This has worked to create awareness, but it has failed to encourage more testing.

Today, the people most at risk are the ones most afraid to walk into a testing centre. Not because they don't know about HIV, but because they know exactly what will happen after a positive result in their community: stigma, rejection and whispers that they are promiscuous and that they are finished.

Fear advocacy tells people: "If you get HIV, your life is over.” So they choose not to know, and when they don't know, they don't treat, and when they don't treat, they spread the virus.

It is time to change the message to U=U in order to minimise the fear surrounding HIV and encourage more testing.

What is U=U?
U=U means Undetectable = Untransmittable.
This is not a slogan, rather it is science confirmed by the World's biggest health bodies namely, The Centres for Disease Control and prevention (CDC) USA, World Health Organisation (WHO) and The National Institutes of Health (NIH) USA.

The science is this: When a person living with HIV takes their antiretroviral treatment (ART) every day as prescribed, the amount of virus in their blood becomes so low that a lab test cannot detect it. This is called an undetectable viral load.

When a person is undetectable and stays on treatment for at least 6 months, they cannot transmit HIV to their sexual partner, not low risk, Zero risk.

Undetectable = Untransmittable.
Why Fear Has Failed
1. Fear creates hiding. In Ghana, many still believe HIV is a death sentence or a punishment for immorality. So people avoid the test to avoid the label.

2. Fear kills treatment adherence. If you think you are already condemned, why take medicine every day?

3. Fear targets the wrong generation. Young people today did not see the 90s AIDS crisis. Graphic images don't scare them; they just make them scroll past.

We have billboards showing skeletons, but testing rates among young men and young women in Ghana remain low. The fear approach has reached its limit.

Why U=U Will Bring People Forward For Testing

U=U changes HIV from a death sentence to a health condition with a solution.

Imagine two messages at the testing centre:
Fear Message: "Come test, or you will die and infect everyone."

U=U Message: "Come test. If you are negative, we help you stay negative. If you are positive, you can start treatment, live a normal healthy life, have a family, and you will not transmit it to the person you love."

Which one would make your daughter, son, sister, brother, friend walk through the door?

U=U does three powerful things:
1. It removes shame and replaces it with hope. A positive result is no longer the end. It is the beginning of treatment and protection for your partner.

2. It encourages treatment. People want to be undetectable when they know undetectable means they cannot harm the people they love. Studies show U=U messaging improves adherence to ART.

3. It fights stigma at its root. The stigma comes from the idea that people with HIV are infectious and dangerous. U=U proves that a person on treatment is not a risk to anyone.

The Way Forward for Ghana Health Service and Ghana AIDS Commission are as followed;

1. Train all counsellors to lead with U=U, before testing, after testing, during treatment.

2. Replace some fear billboards with hope billboards: "On treatment and undetectable? You can't transmit HIV, know your status."

3. Use people living with HIV who are undetectable as champions. Let young people see them living, working, marrying, and having HIV-negative children.

4. Make testing about love, not death. "Test for the person you love. U=U protects you both."

We will not end AIDS in Ghana by scaring people more, we have scared them enough.

We should tell them the truth that science has given us: Testing saves your life, treatment protects your love, and undetectable means you cannot transmit. Fear kept people away, U=U will bring them in.