HIV Does Not Define Us

U=U CAMPAIGN TACKLES STIGMA IN MOZAMBIQUE 

By Nina Hasen, Director of HIV/TB, PSI and Micaela Rodrigues, Marketing Director, PSI Mozambique 

Somos Iguais. (We are the same.) 

These simple words are packed with meaning when one of us is living with HIV and the other is not. For decades, an HIV diagnosis has been the great divider, putting those infected with the virus on one side and those uninfected on the other. All over the world, societies have assumed that people living with HIV were forever marked and different, in large part because they could pass this deadly virus on to others. HIV has been stigmatized, even criminalized, for this reason. Now it is time to change that—and PSI, through the Meeting Targets and Maintaining Epidemic Control, or “EpiC” Project, is tackling this challenge in Mozambique with a new kind of communications campaign. 

We learned 10 years ago that we have a solution to this problem.  

HIV treatment, called anti-retroviral therapy or ART, can prevent transmission of the virus from infected to uninfected people. It works like this: when a person has HIV, the virus multiplies inside their body. It is these copies of the virus that get passed on through sexual intercourse, breastfeeding or needle-sharing. When a person living with HIV takes ART every day, the amount of virus in their body is eventually reduced to a level so low, they cannot pass it on. We call this state of viral suppression “undetectable,” since tests to measure the virus in blood cannot detect it. A person who is undetectable is not cured – HIV can hide out in the body. But this person cannot get sick from the HIV and cannot pass it on. From this reality came the slogan “undetectable = untransmissible” or “U=U.” 

U=U campaigns have had a galvanizing effect in the U.S. and in Europe. As people living with HIV came to understand that they couldn’t pass on the virus, they felt liberated from the stigma and shame associated with HIV. This in turn, increased motivation to get tested for HIV, to start treatment if the test is positive, and to stay on treatment permanently.  

But the news that treatment prevents transmission has not been as widely shared in Africa. The tests required to demonstrate that a patient on ART is virally suppressed have only become available in recent years. And some healthcare providers are scared to tell their patients about U=U. They may not fully trust that a person living with the virus cannot transmit it or believe that patients will take their medication every day. So, people living with the virus don’t get the information and lose their motivation to stay on ART; and the cycle continues.  

In Mozambique, EpiC is trying something different. With support from PEPFAR and USAID, we are fielding a new kind of U=U campaign, one that is thoughtfully adapted for the context. The message of the Somos Iguais campaign is that ART makes us equal. It makes me as a person with HIV just like you, a person who is not living with HIV. Images from the campaign show ordinary people enjoying life’s joys and frustrations and openly taking treatment medication. Testimonials from people on ART are running on national television.  

The message is one of hope grounded in science: “Because of these drugs, I can live a long and healthy life, I can fall in love, have a family and support them. I can do what you can do because we are the same.”  

As the campaign runs, EpiC will collaborate with other PEPFAR partners to help nurses and other providers to tell the U=U story more clearly to their patients. EpiC is also finding champions in the Ministry of Health and across civil society to spread the word. And we’re refining our message as we go, by getting regular feedback from people living with HIV and their communities.   

The campaign is still in its early days, and it remains to be seen whether we can change long-held beliefs with this message. However, it is clearly resonating with the target audience. 

The below messages from the campaign’s Facebook page are evidence of the potential this could have in the future: 

“The ‘We are the same’ campaign moved me and makes me want to spread these messages to others. To let people know we are the same.”  

–Somos Iguais Facebook follower, private message. 

“This spot made it possible for me to explain to my 16 and 8-year olds what it means to be HIV positive. Congratulations on the initiative…Those who live with PLHIV know how important these messages are.” 

–Somos Iguais Facebook follower, private message. 

“Thank you very much. You are building our motivation to stay on treatment…I would like to become an activist some day. I am HIV positive as well. I discovered this in 2019, and since then I have been on treatment,”  

–Somos Iguais Facebook follower, private message. 

We also take heart from the tremendous impact U=U has had elsewhere. A 2020 study published in the British Medical Journal stipulated that those reporting U=U discussions with their healthcare providers were more likely to take their medication correctly, and more likely to be virally suppressed. More reported “optimal sexual health” and that they “always shared” their HIV status with their partners. (Okoli C, Van de Velde N, Richman B, et al Undetectable equals untransmittable (U = U): awareness and associations with health outcomes among people living with HIV in 25 countries Sexually Transmitted Infections 2021;97:18-26.) 

We look forward to gathering more insights from the U=U campaign’s impact in Mozambique, and we will iterate to be increasingly effective in reaching our target audiences. Together with our partners in the Ministry of Health, PEPFAR, and across the country, we will continue to find a way to tell this story and set people living with HIV free from the specter of stigma. Why? Because we know for sure that somos iguais. 

Banner image courtesy of Flickr/Deidre Schoo, International Center for AIDS Care and Treatment Programs, Columbia University School of Public Health.

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