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By Maegan McCane Violence against women and girls (VAWG) is an issue that continues to be perpetuated and reproduced worldwide. The United Nations (UN) defines VAWG as: '…as any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women and girls, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. Violence against women and girls encompasses, but is not limited to, physical, sexual and psychological violence occurring in the family or within the general community, and perpetrated or condoned by the State.' In the UK, VAWG’s definition covers crimes such as domestic abuse including homicide, sexual assault, stalking, sexual exploitation, child abuse, female genital mutilation (FGM), forced marriage, and harassment in work and public life. In the UK, there are about 2.3 million victims, aged 16 to 74, of domestic abuse each year (Elkin, 2022). Two-thirds of these are women. Women and girls from Black and minority ethnic communities (BME) experience higher levels of VAWG. (Siddiqui, 2018). Black Caribbean and Black African women and girls experience higher instances of domestic homicide and abuse-driven suicide, and they are more subject to culturally specific VAWG practices, such as FGM or forced marriage. Generally, experiencing VAWG comes with a host of health problems. The World Health Organization (2021) describes VAWG as taking the form of physical, mental, behavioral, and/or sexual and reproductive violence. Physical Sexual and reproductive • acute or immediate physical injuries, such as bruises, abrasions, lacerations, punctures, burns and bites, as well as fractures and broken bones or teeth • more serious injuries, which can lead to disabilities, including injuries to the head, • unintended/unwanted pregnancy • abortion/unsafe abortion • sexually transmitted infections, including HIV • pregnancy complications/miscarriage • vaginal bleeding or infections eyes, ears, chest and abdomen • gastrointestinal conditions, long-term health problems and poor health status, including chronic pain syndromes • death, including femicide and AIDS related death • chronic pelvic infection • urinary tract infections • fistula (a tear between the vagina and bladder, rectum, or both) • painful sexual intercourse • sexual dysfunction Mental Behavioral • depression • sleeping and eating disorders • stress and anxiety disorders (e.g. post- traumatic stress disorder) • self-harm and suicide attempts • poor self-esteem • harmful alcohol and substance use • multiple sexual partners • choosing abusive partners later in life • lower rates of contraceptive and condom use As we see, VAWG has significant and long-lasting impacts on one’s physical health. A woman or girl could be exposed to injury or other physical harm, unwanted pregnancy or pregnancy complications, sexually transmitted infections, or even death. VAWG is extremely detrimental for one’s mental health. Those experiencing any type of VAWG will often have mental health issues such as depression or anxiety and can be at higher risk for suicide. People experiencing sexual violence or sexual exploitation violence can deal with sexual dysfunction or have anxiety around sex and intimacy. These women and girls are at increased risk for urinary tract infections, incontinence, constant pain, pain during and difficulty having sex, repeated infections, which can lead to infertility bleeding, cysts, and abscesses, and problems during pregnancy, labor, and childbirth, which can be life threatening for mother and baby (National Health Service, 2022). How Can We Help Women and Girls Experiencing VAWG? Addressing VAWG requires an effort from multiple parts of society. First, we need to understand the impact VAWG has on the health and well-being of women and girls. We also need more empathetic and caring health workers who understand what is needed for a truly survivor-centred response. Many minority ethnic women and girls express the wish for services that are catered towards them. Creating those services and integrating them into existing health services will do nothing. Finally, from a logistics standpoint, addressing VAWG means having a set protocol in place, referral networks that actually work, and documentation, monitoring, and evaluation of existing services to see how they can be improved on. Not only will improving VAWG services help change the lives of those affected, it will be nothing but a net benefit to society as a whole. Economically, VAWG costs states millions of pounds a year, primarily in policing and social services; one in ten calls to the police are about domestic violence. The social impact of VAWG cannot possibly be measured economically, but instead can be measured in suffering, loss, pain, and trauma. Improving VAWG services can help to stop traumatic instances before they begin or further escalate. Targeted domestic violence policy, therefore, should be a top priority for the government. In 2021, the UK passed legislation that directly addresses and allocates more resources to VAWG. The Domestic Abuse Act of 2021 is a landmark piece of legislation and is a good first step, but as a society, we need to go further in our policy decisions that address VAWG.

PRESS RELEASE Thursday 30 November 2023 World AIDS Day: “We can end inequalities by letting communities lead” says UNAIDS executive director Exemplifying the UNAIDS World AIDS Day theme of ‘Let Communities Lead’, National AIDS Trust and One Voice Network are proud to have hosted UNAIDS’ Executive Director Winnie Byanyima, to learn more about a pioneering partnership centering Black communities in HIV care. The Unheard Voices project is a collaboration between National AIDS Trust and One Voice Network, an independent collective of Black-led community organisations, seeking to improve the health and wellbeing of Black communities in the UK who are affected by HIV. The project aims to end structural inequalities by ensuring Black communities living with or at risk of HIV can hold decision-makers to account, influence actions, and become part of the decision-making process. According to figures from UKHSA, despite making up a smaller number of the overall London population, Black Africans represented 26% of all newly diagnosed London residents in 2021. Black Africans were more likely to be diagnosed late than the white population (57% and 32% respectively). “It is through enabling communities like those I met today that we will end HIV transmissions and end AIDS as a public health threat. You light the way,” said Winnie Byanyima, Executive Director of UNAIDS. “As a black woman, I have experienced how difficult it is to make our voices heard. Your determination inspires me. Racism, sexism and homophobia are bad for our health. It is vital to let communities lead to address systemic inequalities in all aspects of life. That is how we will make sure that everyone’s right to health and social services is realised.” By involving Black communities in decisions about their HIV care and commissioning, Unheard Voices aims to influence a health and support system which offers equitable standards of care, to reduce the disproportionate impact of HIV or HIV related stigma and discrimination. Reverend Jide Macaulay, One Voice Network chairperson and Founder and CEO of House Of Rainbow, said: “The United Kingdom has made significant strides in combatting HIV and achieving UNAIDS goals; however, it is evident that the quality of life for Black African communities is currently at a critical low. Urgent actions are needed to allocate resources and provide support to address this issue.” Oluwakemi Agunbiade, Policy and Campaigns Officer at National AIDS Trust, said: “When community voices are included throughout the journey of HIV service design, decision-makers benefit from a new perspective on how Black people impacted by HIV can be best supported. Without involving with Black communities, health care systems are missing out on vital information to understand how best to meet their HIV related needs. “Whilst our upcoming report on community involvement in London HIV commissioning does highlight that many commissioners are engaging with community leaders, much more needs to be done. We strongly encourage a shift towards coproduction where community members are stakeholders with a say in their own healthcare. To further guide decision-makers, the Unheard Voices Report will also include best practice on how to overcome the barriers to effective genuine community involvement when designing HIV services. “We’re so delighted to be able to let Winnie Byanyima know about the work of Unheard Voices and share UNAIDS vision of collaborative, community focussed interventions to improve the lives of people living with and affected by HIV.” Ahead of World AIDS Day, Winnie joined representatives from National AIDS Trust and the twelve London based organisations who make up the One Voice Network, to gain a greater understanding of the grassroots work being done to support Black people living with HIV. During the event, Winnie and attendees from within the HIV community were treated to a performance from the Joyful Noise choir. The choir, organised by One Voice Network organisation NAZ, are an inclusive, peer support group made up entirely of people living with HIV. The choir serves as a community for HIV-positive individuals, as well as an inspiring tool to help end the stigma associated with HIV. UNAIDS is the specialised agency within the United Nations that works towards ending the AIDS epidemic as a public health threat by 2030. For World AIDS Day 2023, UNAIDS are highlighting and uplifting the communities who are at the frontline of progress in the HIV response with their theme ‘Let Communities Lead’. To coincide with World AIDS Day, UNAIDS have further highlighted the impact that community based organisations have had on the response to HIV in their Let Communities Lead report30. Published this week, the report reveals how communities working to end AIDS are too often unrecognised, under-resourced and in some places even under attack. Further information about the Unheard Voices project can be found on the One Voice Network website. For more information on World AIDS Day visit National AIDS Trust’s dedicated website. Ends For more details please contact Joe Parry on joe.parry@nat.org.uk, 020 7814 6738 Notes to editors About National AIDS Trust We’re the UK’s HIV rights charity. We work to stop HIV from standing in the way of health, dignity and equality, and to end new HIV transmissions. Our expertise, research and advocacy secure lasting change to the lives of people living with and at risk of HIV. www.nat.org.uk

A recent study suggests that intimate partner violence (IPV) increases the risk of HIV beyond what is expected for women living in sub-Saharan Africa who have male partners living with HIV. Women aged 15-24 had a 3% increase in risk when they had a partner living with HIV who perpetrated IPV, compared to women whose partner just had HIV. Men who perpetrate IPV were also shown to have higher rates of HIV. In Sub-Saharan Africa, one in three women between 15-49 report IPV at some point in their lifetime. Thus, the importance of tackling IPV to decrease HIV must not be underestimated. The study conducted by Salome Kuchukhidze of McGill University and colleagues which pooled data from several sub-Saharan countries was published in PLOS Global Public Health. Increased alcohol use, acceptance of IPV and stereotypes of male dominance contributed to violence against women. Perpetrators of IPV were more likely to engage in behaviours associated with an increase in HIV risk, which may be part of the reason why they had higher HIV rates. The researchers analysed data from 27 different countries between 2000 and 2020. The data was all taken from nationally representative household surveys which were all anonymised. There were 111,659 heterosexual couples that were reported to be married or co-habiting, aged over 15 years old. Of these couples, 79,325 had data on HIV available. IPV was detected by the female partner reporting sexual or physical violence within the last year in the survey, and the perpetrator was assumed to be her current partner. A separate analysis to assess if IPV increased the risk of HIV included only women aged 15-24 years old, to decrease the chance of pre-existing HIV before their current partner. Women aged 15-24 also have the highest risk of IPV and greatest incidence of HIV, making it the best group to estimate the additional risk of HIV in the context of IPV. Overall, 21% women reported IPV. Unsurprisingly, women who were younger, poorly educated, less likely to have a say in household decisions and less wealthy were more likely to report IPV. Women earning more than their partner were more likely to experience IPV, which may be due to the challenge this poses to gender stereotypes, leaving the male partner feeling threatened. These women may be more likely to refuse sex and negotiate condom use which would reduce their HIV risk but may increase their IPV risk. After adjustments for other factors, men who perpetrated IPV were 9% more likely to be living with HIV than those that didn’t. These men were slightly more likely to report paying for sex and having multiple partners in the previous year, which may contribute to the increased rates of HIV. Men who had more accepting attitudes towards IPV and who drank more alcohol were also more likely to be perpetrators. The researchers suggested that underlying attitudes around dominance over women could be driving higher rates of HIV in perpetrators of IPV due to these attitudes, leading to behaviours that increase the risk of HIV. When looking at women aged 15-24, the risk of HIV was 26.6% higher when their partner was living with HIV and 0.4% higher if they reported IPV. Combining these values, one might expect that the risk of HIV would be 27% greater for women who had a partner living with HIV and experienced IPV. However, women who reported IPV and had a partner with HIV were found to have a 30.1% increased risk of HIV, showing a joint effect of IPV with HIV which increased the risk of HIV by a further 3.1%. This may be explained by the finding that men living with HIV who perpetrated IPV were less likely to be on ART and virally suppressed compared to men who didn’t perpetrate IPV, although the sample size was too small to be conclusive on this point. However, other studies have shown higher rates of unsuppressed viral loads for men living with HIV who commit IPV compared to men who do not commit IPV. Other factors that the researchers suggest could increase the risk of HIV for those experiencing IPV were the effects of IPV on mental health and sexual behaviours which could increase risk factors for HIV acquisition like substance misuse, transactional sex and coerced anal sex. Important limitations to this study are that the timings of IPV perpetration and HIV acquisition are not available, making it impossible to be sure about whether IPV or HIV came first. It is also important to note that IPV and sexual behaviours may have been underreported due to their sensitive nature. However, neither of these limitations diminish the importance of trying to tackle IPV when trying to decrease HIV transmission. Given that this study was conducted over 27 different countries, the cultural and structural practices underlying the high rate of IPV are varied and complex. Efforts to decrease violence against women and girls must be tailored and specific. Further research to assess the causality of the increase in HIV amongst women subjected to IPV must be undertaken, which will inform efforts to reduce both IPV and HIV. “The impacts of violence and HIV are profound and have long-lasting effects on the well-being of millions of women and girls globally,” the researchers note. “Actions to eliminate violence and end AIDS must be accelerated.” References Kuchukhidze S et al. Characteristics of male perpetrators of intimate partner violence and implications for women’s HIV status: A pooled analysis of cohabiting couples from 27 countries in Africa (2000–2020). PLOS Global Public Health 3: e0002146, 2023 (open access). https://doi.org/10.1371/journal.pgph.0002146 Source: https://www.aidsmap.com/news/nov-2023/intimate-partner-violence-increases-womans-risk-acquiring-hiv

Africa Advocacy Foundation OUR WORK At Africa Advocacy Foundation, we empower individuals to take control of their health and wellbeing through accurate information, advice, and guidance. We provide safe, judgment-free, and inclusive platforms for community members to discuss and engage in activities that promote healthy lifestyle choices. ABOUT US AAF UPDATE NATIONAL HIV TESTING WEEK ​ Order your free self test kit for HIV We can stop HIV - It Starts With Me CLOSED INNOVATION AAF is striving for new and creative ways to reduce health inequalities and to promote health and wellbeing for our communities. We are passionate about new healthcare technologies, the latest biomedical interventions, health services re-design, and empowering communities to be active partners in health. PROGRAMMES COMMUNITY HUB Our physical and emotional health is linked to the strength of our community. The Africa Advocacy Foundation represents a community that, like any other, is stronger, together. The more we communicate, the more we share our wisdom, thoughts and ideas- the stronger our community gets. GO TO HUB Chat Chat What is Monkeypox? Monkeypox can cause a range of signs and symptoms. While some people have less severe symptoms, others may develop more serious illness and need care in a health facility. Those typically at higher risk include people who are pregnant, children and persons that are immunocompromised. Chat Chat What is Monkeypox? Play Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Video of PrEP for Black Communities PrEP is now freely available across England from sexual health clinics. For more information about PrEP visit: www.africadvocacy.org Video of PrEP for Black Communities Video of PrEP for Black Communities Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Now Playing 06:41 Play Video Video of PrEP for Black Communities. Are you PrEPared to have a healthy sex life? Now Playing 01:35 Play Video Video of PrEP for Black Communities (Short Version) Now Playing 02:07 Play Video Prep and Prejudice, Pre-exposure prophylaxis (PrEP) Interviews about PrEP for Black Communities Ouma Obanda interviewed with Dr Vanessa Apea and Dr Emily Mabonga about PrEP. Upcoming Events Contact Us Online Want to know more about how to access healthcare in England? Contact Us Online Free online sessions to find out more about - Your rights to healthcare - How to access different health services - Your rights at work - Sexual health and contraception Join sessions on either Saturdays or Thursdays starting 24 February. RSVP 0 Tolerance day towards Female Genital Mutilation In acknowledgement of 0 Tolerance day towards FGM, one of our amazing service users has shared their experience with the harmful cultural practice. FGM stands for Female Genitalia Mutilation, and is to this day practiced around the world on young women and girls. It carries short and long term consequences that significantly affect physiological and psychological well-being. AAF aims to help eradicate this practice and offer support and resources to those that have been affected. AAF is open to referrals via email Vawg@africadvocacy.org . If you have been affected by this video, or know someone who has, please do not hesitate to reach out via dms or email for support or answers to your questions. Together we stand to keep our sisters, mothers, aunts, daughters, nieces and friends safe. Chat Chat

VOLUNTEER WITH US Want to use your time and skills in a rewarding way? Then join our AAF team as a volunteer! Volunteering can be a lot of fun and is a great way to meet new people and make friends. It could also help you learn new skills and gain valuable work experience. We currently have a number of volunteering opportunities that might interest you. Interested volunteers are invited to submit their application form and CV along with a cover letter to info@africaadvocacy.org . You can also contact us by phone, email or visiting us at AAF. NO VOLUNTEER VACANCIES CURRENTLY " By volunteering, I am able to stay connected with issues like VAWG that I am passionate about, gain new skills and take pride in supporting AAF's work. " Anne Flaherty | AAF Volunteer FUNDRAISE WITH US You can raise funds or donate to AAF activities. Whether you organize a one-off fundraising event or donate monthly, we guarantee that your donation you make to AAF goes directly to supporting our service users in greatest need. Thank you for your support. CONTACT US Work with us WORK WITH US ​ Vacanc i es: ​ Qualified Specialis t IDV A x 2 ​ We are looking for 2 dynamic, highly motivated and innovative and qualified Independent Domestic Violence Advisors (IDVAs) to join our Hidden Voices Project team working towards addressing the current gaps in the provision of specialist domestic abuse and FGM services for black minority women and girls who are undocumented, asylum seekers, refugees, victims of trafficking and those with no recourse to public funds. ​ ​ Job Adv ert ​ Job Description ​ Application Form ​ . Closing date: Monday 4th March 2024 ​ ​ This post is funded by: The National Lottery Community Fund ​ ​ APPLY

U=U is an abbreviation for: Undetectable = Untransmittable It means that someone with an undetectable HIV viral load on HIV treatment (ART) cannot transmit HIV, even without using condoms or PrEP.

Did you know that having an undetectable viral load when you are taking HIV treatment (ART) also stops HIV transmission? For at least 20 years we have known that ART reduces HIV transmission. But for the last few years, leading scientists agree that the risk is not just reduced – it is stopped completely. ART is not only good for your health but it protects your partners. This means that you don’t need to use condoms if you were only using them to stop HIV. The protection from ART depends on: Taking ART every day. Having undetectable viral load for at least three months (some guidelines say six months). Continuing to take meds without missing doses. The evidence for U=U comes from studies with both gay and straight couples, and for all types of sex. See links below for details.

What is U=U? U=U is an abbreviation for: Undetectable = Untransmittable It means that someone with an undetectable HIV viral load on HIV treatment (ART) cannot transmit HIV, even without using condoms or PrEP. U=U is also part of an international campaign to raise awareness about this benefit of ART. Currently, more than 720 organisations have joined from over 90 countries. What does U=U involve? This protection using treatment (ART) depends on: Being on stable ART for several months. Having an undetectable viral load for several months – guidelines say six months. Continuing to take your meds every day. How can someone not be infectious? The short answer is because when HIV viral load is undetectable, there is too little virus for an infection to occur. Even though someone on ART is still HIV positive, HIV transmission is no longer a risk. Most infections need a certain quantity or concentration of virus for transmission. For example, viral load might need to be above 500 or 1000 or 1500 copies/mL to be infectious. The actual upper limit is not known, but being undetectable is too low. HIV is already quite a difficult virus to catch and being on ART reduces this risk to zero. Does U=U work for everyone? Yes. The PARTNER study included both gay and straight couples. In some straight couples the man was positive and in others the woman was positive. In PARTNER 1, about one-third of the 900 couples were gay men. PARTNER 2 included 1000 gay couples. In PARTNER 1, couples had sex more than 58,000 times without condoms. In PARTNER 2 this figure was 77,000 times. There were no linked HIV transmissions in either study. Does this work with all HIV drugs? Yes. The exact combination is not important. U=U only needs viral load to be undetectable. All ART that does this will mean U=U. Does U=U work for all types of sex? Yes. The PARTNER study collected information about the different sex people had. For example, the numbers of times people had oral, vaginal or anal sex. It also asked whether the negative partner was active or passive. It included whether there was ejaculation. PARTNER reported zero transmissions for everything. This included sex with the highest HIV risk – ie being the receptive partner for anal sex. Does this mean I can stop using condoms? Whether you use condoms is a personal choice. Or hopefully it is a mutual choice with your partner. Condoms are good at stopping many STIs and they are an effective contraceptive to stop pregnancy. But if HIV is the only concern, then in the context of U=U, there is no reason to continue to use condoms. For people who are happy using condoms for other reasons, this will still be an important choice. My partner is HIV positive and still wants to use condoms? Your partner has to come to their own decision about what is right for them. They might want to use condoms for other reasons. Or they might still worry about HIV transmission. Sometimes it takes time for someone to accept new evidence. Especially if they have been using condoms for many years. My partner is HIV negative and still wants to use condoms? Your partner has to come to their own decision about what is right for them. They might want to use condoms for other reasons. Or they might still worry about HIV transmission. Sometimes it takes time for someone to accept new evidence. Especially if they have been using condoms for many years. Is U=U now widely believed? Yes, most leading HIV scientists and doctors now agree with the U=U statement. These experts are all convinced by the increasing evidence from many different studies. Scientists are trained to be cautious. They need to be convinced by the evidence before they making factual statements. Although it took a long time for the evidence for U=U to be accepted, the world’s leading HIV doctors and organisations now strongly support U=U. For example, Professor Chloe Orkin, chair of the British HIV Association (BHIVA) said: “There should be no doubt that a person with sustained, undetectable levels of HIV in their blood cannot transmit HIV to their sexual partners”. Similar statements have been made by the International AIDS Society (IAS) and the US Center for Disease Control (CDC). Do STIs affect the zero risk? U=U still works if, without realising it, one or both partners has an STI. The PARTNER study included couples where STI rates were reported, usually in the context on an open relationship. Although routine check-ups for STIs are important, with treatment if needed, there were still no HIV transmissions. It is only when ART is not used that the risk of HIV transmission becomes higher if either partner has an STI. Will my doctor and health workers know about this? Hopefully, yes. U=U has been headline news for at least two years. U=U is also included in HIV treatment guidelines. However, just as leading experts took time to accept the evidence, some doctors are slow to discuss U=U with all their patients. For many years, condoms were the main way to protect against HIV. This is no longer the case. New studies prove that both U=U and PrEP are more effective than just relying on condoms. U=U is included in the BHIVA Standards for HIV Care (2018). If your doctor doesn’t tell you about U=U, then ask them why. How long does viral load need to be undetectable? Guidelines recommend having an undetectable viral load for six months before relying on 100% protection from U=U. However, this is a cautious approach, and is why guidelines refer to being on “stable ART”. Guidelines refer to taking up to three months for viral load to become undetectable. This depends on your choice of meds. If viral load was very high when you started ART, it can sometimes take longer to become undetectable. But using an integrase inhibitor in the combination can often get an undetectable viral load within one month. Although guidelines recommend waiting for an undetectable viral load to be confirmed by a second test, many doctors think this is being too cautious. Many doctors think that a single undetectable viral load test is fine. What if I forget to take my meds one day? Missing your meds once or occasionally will not change U=U. This is because viral load will still be undetectable. Good adherence is important, but you would probably need to miss HIV meds for 2-3 days before viral load becomes detectable. If you do miss ART for several days, it is important to check your viral load is still undetectable before relying again on U=U. This is importance for avoiding drug resistance as well. Good adherence is essential for U=U. U=U depends on not regularly missing your HIV meds. What about viral load blips? Sometimes viral load results can “blip” above 50 and go back to undetectable without changing treatment. Any result less than 200 copies/mL will not affect U=U. In the PARTNER studies, undetectable viral load was defined as being less than 200 copies/mL. Is there a risk viral load can rebound to higher levels? In the context of good adherence, viral load doesn’t rebound. Once viral load has been undetectable for over six months, then so long as you take your meds, they will continue to work. Good adherence is essential. A drug interaction that reduces your HIV drugs might have a risk of viral load rebound. This just means checking with your pharmacist or doctor that and new meds or supplement (including over-the-counter) don’t interact with your ART. Less than 5% of people on stable ART have viral load each year and these cases of rebound are nearly always linked to lower adherence. The chance gets lower with every year you are on ART. How do we know undetectable viral load is so effective? Researchers have known for over 20 years that ART reduces the risk of transmission. It is only in the last few years however, that it became clear that transmission is stopped completely. In 2007, some doctors were already so convinced that they published a document called the Swiss Statement. Since then several studies have provided more evidence. The most important of these were the two PARTNER studies. Each study enrolled aoround 900 serodifferent couples (where one partner was HV positive and the other HIV negative). The positive partner needed to be on ART with an undetectable viral load and the couple needed to be having sex without condoms. In PARTNER 1, about one-third of the couples were gay men and in PARTNER 2 all the couples were gay men. PARTNER 1 reported zero linked HIV transmissions after more than 58,000 times the couples had sex without condoms. In PARTNER 2 this figure was 77,000 times. In the few cases where the negative partner did become HIV positive, this was always from outside the relationship. The study was able to prove this by comparing the structure of the different viruses. What is the difference between “zero” and “very low”? In the case of U=U, the difference between zero risk and a very small risk is a technical detail that is not important in practice. Technically, even if the true risk is zero, it is not possible to prove something will not happen. Instead, the scientific approach is to define a possible risk, however small. For example, one in a million etc. This is easy to do with low risk activities, but with zero risk activities, there is nothing to measure. In these cases a very small theoretical risk is effectively zero. This is why scientists are happy to say the risk for U=U is now zero. The risk is not “greatly reduced”, it is not “negligible”. The risk is zero. In more than ten years since the Swiss Statement was published in 2007, there have been no proved case reports of HIV transmission with undetectable viral load. Even if in the future, a case is reported, the absolute risk would be so low for this to still be effectively zero. Does U=U apply to other ways that HIV is transmitted? Having an undetectable viral load on ART also reduces the risk of other ways that HIV is transmitted. However, it doesn’t reduce other risks to zero. For example, a baby can still become HIV positive from breastfeeding, even if the mother has an undetectable viral load. The risk of transmitting HIV from sharing drug injecting equipment is higher than sexual transmission. There isn’t evidence to support this risk being zero. What is the evidence to support U=U? The evidence for U=U (Undetectable = Untransmittable): why negligible risk is zero risk. This covers many different types of studies from the last 20 years. Individual results from key studies and the Swiss Statement are included below. ZERO: no linked HIV transmissions in PARTNER study after couples had sex 58,000 times without condoms (2016) Gay men with undetectable viral load do not transmit HIV: Opposites Attract study supports U=U (2017) Treatment is prevention: ARV treatment in HPTN-052 reduces transmission by at least 96%: single transmission in treatment arm occurred prior to viral suppression (2011) HPTN 052: no HIV transmissions on effective ART – long-term follow-up (2015) The Swiss Statement (2007) Source : https://i-base.info/u-equals-u-qa/