Leading Canadian HIV experts are calling for urgent action among healthcare providers and health organizations after a recent national report exposed a troubling lack of public awareness around a powerful HIV stigma reduction message.

Only 1 in 5 Canadians say they have heard of the message “U = U or Undetectable = Untransmittable,” according to a recent Ipsos survey conducted in partnership with the Canadian Positive People Network (CPPN) and funded by REACH Nexus at St. Michael’s Hospital (Unity Health Toronto), Gilead Sciences, and the Public Health Agency of Canada.

Multiple well-controlled studies and clinical trials have shown that people living with HIV who take antiretroviral therapy (ART) and maintain an undetectable viral load cannot transmit the virus sexually.

Launched in 2016 by the Prevention Access Campaign, a global non-profit organization dedicated to ending the HIV epidemic, U=U is a movement aimed at raising awareness, eliminating stigma, and improving the lives of people living with HIV.

"That only about 20% of Canadians are aware of U=U is both surprising and deeply concerning," said Dr. Gordon Arbess, Clinical Director of the HIV/AIDS Program with the St. Michael’s Academic Family Health Team. “This isn’t just a public health message — it’s a transformative truth that can improve lives, relationships, and health outcomes.”

The Science Behind the Message

Research over the past two decades has consistently shown that ART lowers viral load, and when it’s fully suppressed, sexual transmission doesn’t occur.

The landmark HPTN 052 trial, conducted across nine countries, followed more than 1,600 heterosexual couples and found transmission occurred only when the partner with HIV was not yet virally suppressed. Other major studies like PARTNER, Opposites Attract, and PARTNER2 confirmed these results—including for male-male couples—further establishing Undetectable = Untransmittable (U=U).

Yet despite the science, misconceptions linger. Among those Canadians who had heard of U=U, fewer than half were familiar with the studies and data supporting it.

This disconnect, experts warn, allows stigma, fear, and misinformation to persist.

“The biggest barrier to U=U isn’t science — it’s outdated thinking,” said Dr. Sean B. Rourke, director of REACH Nexus at Map Centre for Urban Health Solutions.

“Too many healthcare providers still lack the knowledge or confidence to talk about what U=U truly means. Until we fix that, we’re leaving people behind with fear instead of facts.”

Dr. Rourke said the science around U=U is “undeniable.”

“What holds us back isn’t science — it’s stigma, outdated systems, and a lack of will. U=U isn’t just sound public health policy — it’s a message rooted in dignity, respect, and basic human reality.”

A Missed Opportunity to End the HIV Epidemic

HIV rates have been rising in Canada over the past five years, punctuated by a sharp 35.2% increase in 2023 compared to the previous year.

The estimated average lifetime cost of a new HIV diagnosis in Canada is now $1.44 million per person, totaling $2.1 billion for all incident cases in 2021—an 11% increase from a decade ago—placing a heavier burden on Canada’s strained public health care system.

The CPPN report underscores the missed opportunities that come with low awareness: the chance to reduce new HIV transmissions, improve the quality of life for people living with HIV, and dismantle harmful stigma that continues to isolate communities.

A key finding, was that once U=U was explained, it resonated widely with the public.

Two-thirds of respondents (66%) believe that increasing awareness of the U=U message can help change public opinion and reduce HIV stigma—especially among those already familiar with it.

“Knowing patients cannot transmit HIV removes a significant psychological burden,” said Dr. Arbess.

“It helps remove the risk perception that has often isolated people with HIV from having romantic or sexual relationships. U=U has allowed people living with HIV to live full, healthy lives without being seen as a risk.”

Healthcare providers and public health organizations, he said, must be on the front lines of this educational push. Doctors, researchers, clinicians, policy makers and frontline organizations all play a critical role in promoting the U=U message that Undetectable = Untransmittable—both as trusted messengers and as leaders in HIV care and treatment.

“They can reduce stigma by continually communicating the science of U = U,” said. Dr. Arbess. “This is also a powerful incentive for people to get tested, start treatment early and remain in care-helping people stay healthy while protecting their partners.”

Public Attitudes Lag Behind the Science

While one in three Canadians say learning about U=U makes them more comfortable interacting with or dating someone living with HIV, the majority remain unsure or unconvinced. Roughly 34% say the message wouldn’t change how they feel, while 11% say it would make them less comfortable and 17% remain uncertain.

These statistics speak to the need for a comprehensive, consistent national awareness campaign.

REACH Nexus is committed to advancing U=U efforts across Canada and is currently working to implement U=U University, a global health initiative created by the Prevention Access Campaign, to expand U=U awareness and reduce HIV stigma.

REACH is also planning to host a Canadian Train-the-Trainer event to build community capacity to share accurate U=U information.

“Doctors, researchers and health care providers need to take the lead and train other clinicians, public health workers and other staff about the evidence behind U = U,” said Dr. Arbess. “It is imperative that healthcare professionals advocate for policies that integrate U = U messaging into HIV prevention campaigns, sexual health education and national treatment guidelines.”