I’m particularly concerned about certain people for whom daily medication is a personal safety issue. When people living with HIV are in hostile environments, experiencing homelessness, struggling with mental health, or engaging in survival or commercial sex work, it may be difficult or even dangerous to keep medication available for their daily use. When someone is experiencing homelessness, adherence to daily medication can be impossible. People living with HIV worldwide are often targets of discriminatory laws and practices, and face employment loss, criminal prosecution, violence, banishment from their homes and other unacceptable consequences when their status is disclosed by choice or circumstances out of their control. When faced with these dangers, a pill bottle, no matter how life-saving, can become a weapon against them.
To truly see change, approaches to treatment must become more sensitive to the individual needs of people living with HIV and the social, structural, and economic barriers to treatment to achieve viral suppression. No two people living with HIV are the same, so the more choice and control we can offer individuals, and the stronger we are in advocating for the health and human rights of all people living with HIV, the more we can remove critical barriers to reaching and maintaining U=U.
Innovative treatment options can offer transformative solutions, but they are just one part of a bigger picture. The role of healthcare providers is also paramount. We know that people living with HIV want to be more involved in their treatment, as demonstrated by the PP2 study which indicates that good quality communication between people living with HIV and their healthcare providers has a positive impact on health outcomes. And we know that when healthcare providers talk with their patients with HIV about U=U, their patients report significantly improved health outcomes. When healthcare providers display curiosity and interest in people’s fears and worries, they encourage open, intimate, and honest conversations and improve the chances of making the right treatment choices and achieving positive health outcomes for everyone.
If our goal is to improve the quality of life for people living with HIV and to end HIV transmission, we must advocate for access to innovative medicines that help overcome challenges to making U=U a reality for all people living with HIV. U=U should be a priority for economies and governments who have so much to gain from prioritising the health of people living with HIV. To achieve our goals, we must be forensic and honest in our assessment of the barriers to treatment. We must be committed to ensuring that people living with HIV have the knowledge and access to medicines needed to make their own treatment choices for the way they want to live. Lastly, we must strive for every individual to have the treatment and care to experience U=U and an optimised quality of life.