Humanise and demedicalise Undetectable=Untransmittable in Thailand

Thailand National AIDS Committee endorsed Undetectable=Untransmittable (U=U) as a science which needs an urgent translation into actions to address pervasive stigma faced by people living with HIV (PLHIV). We aimed at humanising and demedicalising U=U by exploring a 'people-centered value' of U=U and translate them into efficient U=U communications.

During August-September 2022, in-depth interviews were conducted with 43 PLHIV and 17 partners from various background in five regions of Thailand. Focus group discussions were made with 28 healthcare providers (HCPs) and 11 PLHIV peers. Thematic analysis was used for data analysis.

Among PLHIV, how U=U frees them up to 'live a full life' was valued highest. A great relief from sin, immorality, and irresponsibility was mentioned by all. U=U communications allowed PLHIV and their partners to love/be loved and enjoy intimacy and sex with pleasure again. HCPs and PLHIV peers almost always refer U=U value to 'physical health'. Common concerns were around increasing sexually transmitted infections with condomless sex. The people-centered U=U values, together with dismantling of power imbalance within healthcare system and sexual health skills empowerment among providers, were used to develop a humanised and demedicalised National U=U Training Curriculum. The Curriculum was highlighted in country's planned activities to address multi-level/multi-setting stigma and discrimination.

U=U can be successfully humanised and demedicalised in designing efficient communications. At an individual level, U=U can address one's intersectional stigmatizing attitudes. At a policy level, national endorsement can initiate and sustain tangible actions and interest around U=U across country's leaderships.