Beyond Awareness: Perceived Psychological Impact of the Undetectable = Untransmittable (U=U) Message and Mental Health Among People Living with HIV in Turkey

This study examined associations between awareness of the Undetectable = Untransmittable (U=U) message, U=U-related perceptions, mental health symptoms, and expectations regarding sexual protection among people living with HIV (PLWH).

This cross-sectional study was conducted in Istanbul, Turkey, between 2023 and 2024 and included 210 PLWH aged 18-65 years. Participants completed the Hospital Anxiety and Depression Scale (HADS) along with self-report measures assessing U=U awareness and perceptions. Descriptive analyses and multivariable linear regression models were used.

Overall, 73.8% of participants reported being aware of the U=U message. U=U awareness was associated with relationship status, HIV status disclosure, and stronger beliefs regarding the psychological benefits of U=U dissemination but was not associated with expectations of discontinuing condom use. In unadjusted analyses, participants who were aware of U=U reported lower anxiety and depressive symptoms. However, in multivariable analyses, U=U awareness was no longer independently associated with mental health outcomes once U=U-related perceptions were included. In contrast, greater perceived psychological impact of U=U dissemination was independently associated with lower levels of both anxiety and depressive symptoms.

These findings suggest that perceived psychological impact of the U=U message was more consistently associated with anxiety and depressive symptoms than U=U awareness after adjustment for relevant sociodemographic and relational factors. The potential value of integrating U=U into psychosocial counseling frameworks, rather than presenting it solely as biomedical information, warrants further examination in longitudinal and intervention studies. Given the cross-sectional design, the direction of these associations cannot be determined.