Ahead of AIDS 2026 and as part of the Rethink. Rebuild. Rise. campaign, VirusOFF continues its series on what HIV prevention looks like in Central and Eastern Europe and Central Asia today — not only as a set of medical tools, but as a matter of access, trust, confidentiality, human rights and community support.
This time, we focus on U=U — undetectable = untransmittable.
It is one of the most important scientific and deeply human messages in the modern HIV response. It means that a person living with HIV who is on effective antiretroviral treatment and has an undetectable viral load does not transmit HIV sexually.
UNAIDS explicitly described U=U as a message that can help address stigma and discrimination: when a person living with HIV is on effective treatment, the level of virus in their blood falls to undetectable levels and the likelihood of sexual transmission of HIV is zero.
But U=U is not simply a powerful formula. It is a prevention message that works only when a person has real access to treatment, a stable supply of medicines, regular viral load monitoring, and a system built on trust, confidentiality and support.
This is where the most important conversation for our region begins.
For a long time, public communication around HIV prevention was framed through fear: “avoid”, “beware”, “check others”, “be careful”. Often, this did not create more safety. It created more stigma — especially towards people living with HIV.
U=U changes the very logic of this conversation.
It is not about a person being “dangerous”. It is about the power of treatment. It is not about blame, but about access. It is not about control over someone else’s body, but about a person’s right to know their status, receive treatment, be supported and live without fear.
This is why U=U is a prevention message. Antiretroviral therapy not only protects the health of a person living with HIV. When treatment is effective and the viral load is undetectable, it also prevents sexual transmission of HIV. In May 2025, UNAIDS and WHO again emphasized in their material on the consequences of treatment interruption that a person living with HIV who is taking antiretroviral therapy and has an undetectable viral load does not transmit HIV sexually.
But it is important not to take one sentence out of context. U=U does not work “on its own”. It works through a system: testing, treatment, laboratory monitoring, trust, treatment adherence support, protection from stigma and continuity of services.
In other words: prevention = tools + access.
In Central and Eastern Europe and Central Asia, U=U needs to be heard loudly precisely because the region still faces unequal access to testing, treatment and prevention.
According to the UNAIDS 2025 regional profile, around 2.1 million people were living with HIV in Eastern Europe and Central Asia in 2024, there were approximately 130,000 new HIV cases, and only 51% of people living with HIV were receiving treatment. Data on viral suppression remain even more concerning: 43% of people living with HIV had a suppressed viral load according to 2023 data, while 2024 data were still pending.
This means that for many people, U=U is still not an everyday reality — not because the science “does not work”, but because the system does not always reach the person.
A person may not know their HIV status. They may receive a diagnosis late. They may be afraid to enter care. They may have had a negative experience with a doctor. They may interrupt treatment because of war, migration, lack of documents, job loss, depression, violence, criminalization, fear of status disclosure or a shortage of medicines.
That is why, in Central and Eastern Europe and Central Asia, U=U cannot be presented as a matter of “simple individual responsibility”. It should not sound like: “just take your treatment”. For many people, “just” does not exist.
The right message should sound different: every person has the right to treatment, support, confidentiality, clear information and services without judgement. This is when U=U becomes real prevention.
HIV-related stigma is often rooted in outdated ideas: that a person living with HIV is somehow “dangerous”; that their sexuality should be controlled; that they must constantly prove something; that their status matters more than their life, relationships, work, parenthood, desires, plans and dignity.
U=U breaks this logic.
It says that a person living with HIV who has an undetectable viral load is not a threat to their sexual partner. They can have relationships, a sex life, a family, a future and the right to peace of mind. Their life should not be defined by other people’s fears or outdated myths.
UNAIDS emphasized that U=U can change not only knowledge about HIV, but also the way people living with HIV feel about themselves: it restores hope, a sense of normal life and the ability to speak about health without shame.
For prevention, this is essential. People are more likely to test, seek services and remain in treatment when they are not afraid of being humiliated, judged or “punished” because of their status. Stigma, by contrast, pushes people away from systems. And when a person fears the system, prevention does not work.
U=U is proof of the power of treatment. But for it to work beyond research and global campaigns, very practical things are needed.
1. A person needs to know their status
Without testing, there is no starting point. If a person does not know their HIV status, they cannot access treatment, achieve an undetectable viral load or benefit from U=U for their own health and for prevention.
This is why testing must be confidential, accessible, free of charge or affordable, welcoming to different communities and safe for people who fear status disclosure.
2. Treatment needs to start quickly and continue without interruption
U=U is not possible without antiretroviral therapy. It is critical that a person does not wait for months, get lost between offices or depend on whether they have the “right” documents, address, insurance or permanent registration.
Treatment interruption can put a person’s health and the prevention effect of therapy at risk. UNAIDS and WHO emphasized in 2025 that when treatment is interrupted, the benefits of treatment as prevention may be reduced or put at risk.
3. Viral load monitoring needs to be accessible
U=U depends not only on taking treatment, but also on whether a person has achieved and maintains an undetectable viral load. This means laboratory monitoring must be accessible, understandable and regular.
A person needs to know what viral load is, when it should be checked, what the result means and what to do if the result is not as expected.
4. Support is needed, not control
Treatment adherence is not built through moral judgement. It is built when a person has stable access to medicines, trust in their doctor, support from a peer counsellor, mental health support, a safe space for questions and the possibility to say “I am struggling” without fear of punishment or shame.
5. Confidentiality must be real
If a person fears that their status may become known to family, an employer, a partner, the police, migration services or the community, they may avoid testing, treatment and viral load monitoring.
That is why confidentiality is not an “extra benefit” of a service. It is a condition for prevention.
A tool by itself does not equal access.
Antiretroviral therapy may exist in a country — but a person may not reach treatment because of fear or documents. Testing may be free of charge — but a person may fear a breach of confidentiality. Viral load can be measured — but the laboratory may be far away or appointments may be unavailable. U=U may be included in guidelines — but a doctor may never mention it to a patient.
Prevention works only when the tool reaches the person.
This is especially important for Central and Eastern Europe and Central Asia, because the region still faces structural barriers. The UNAIDS 2025 regional profile notes that criminalization, aggressive law enforcement, stigma and discrimination prevent people — especially communities most affected by HIV — from seeking HIV-related and other health services.
This is the point where U=U becomes a political, social and human rights message. If we want U=U to work, it is not enough to tell people “treatment = prevention”. We need to create conditions in which treatment is genuinely accessible, safe and uninterrupted.
What needs to change
First, U=U must become a standard part of counselling. A person living with HIV should not hear this message by chance from the internet, but from a doctor, peer counsellor or service that supports them after testing.
Second, systems must guarantee continuity of treatment. War, migration, changes in documents, job loss or relocation must not mean treatment interruption.
Third, investment in community-led services is needed. These services often explain U=U in plain language, help people overcome fear, accompany them into care, support treatment adherence and build trust where formal systems have lost it.
Fourth, stigma-free language is essential. Not “dangerous people”, not “carriers”, not “sources of infection”, but people living with HIV who have the right to treatment, sexual health, relationships, family, work, dignity and a future.
