Undetectable Is Untransmittable – Bruce Richman Speaks On HIV, Stigma & U=U

 Bruce Richman: I’m Bruce Richman. I’m The Executive Director of Prevention Access Campaign’s Undetectable Equals Un-transmittable.

Dr George: Okay, and you are also (and may I quote?) the number one most amazing HIV positive person of 2018, I believe. According to the website that I saw today.

Bruce Richman: Plus Magazine. Yes, and I accept that on behalf of the thousands and thousands of people that are working on the campaign.

Dr George: Listening to you tonight I can understand how that accolade would actually have come about. Because you’re passionate and you have a fantastic message, which is U = U. For people who are not aware of that, could you tell us what that is?

Bruce Richman: U = U means undetectable is un-transmittable. That’s a phrase that was created by activists, scientists, and AIDS service organisations to describe the scientific fact that many people still don’t know, that if someone who is HIV positive is on treatment and undetectable, they cannot transmit HIV through sex. There is no risk of transmission.

Dr George: It was last year that was really the key point with IAS 2017 where the announcement was made. What had to happen to allow that to occur?

Bruce Richman: Well, first off, this is radical information for most people. You’re a doctor who is well educated, and knew about this because of your connections to the medical and scientific community, but most people outside of these circles had no idea and the science wasn’t getting out to the public. There was this gap between science and the public, and that’s where public health communications comes in. What we had to do was bring the scientists together and create a consensus statement that U = U is true, so we had this statement that was like the holy grail for us, really. We took that statement and we went around to different influencers around the world and had them sign on as well. So the more people that signed on, the more comfortable people would feel about signing on, and eventually we had a critical mass of the best minds in science saying, “This is indeed true.” And it started to get out more to the public. People started creating social marketing campaigns and really ensuring that this finally gets to the people and field it was intended to benefit.

Dr George: Absolutely. What has the impact been with your message, U = U? If you were approaching a friend who was not yet on treatment, how would you approach that?

Bruce Richman: I mean, I think it’s a very basic, simple message. To folks in the medical field, who’s not an everyday person, there’s a personal health benefit and there’s a public health benefit. But to a friend of mine who I was trying to show the benefits of treatment for them and for their partners, I would say, “This will keep you healthy, and it will keep your partners healthy. You’ll stay healthy, you’ll live longer, and you don’t have to worry about transmitting HIV through sex. You can have the kind of sex that you want without fear. You can use condoms, you don’t need to use condoms, your partners can use PrEP, or maybe not use PrEP. You’ll stay healthy and you’ll have this new sexual freedom that you never thought was possible being HIV positive.

Dr George: So you talk about, in a number of interviews, that there was a light bulb moment. Was it 2009, where you said that was when you discovered U = U?

Bruce Richman: Yeah. My doctor told me in 2009 that I couldn’t transmit HIV.

Dr George: And what was that change that you talk about?

Bruce Richman: For me, when I learned that I couldn’t transmit HIV in 2009 because I was undetectable, it changed everything for me. It opened up possibilities for love, for sex without fear, for conceiving children. Things that I thought that I would never have without fear, without risk, without a barrier between me and someone that I loved. But I also wasn’t so sure because nothing was saying that was true except my own doctor, and I trusted him. But when I looked at all the health information sites, and social marketing campaigns, everything said, “Undetectable, there’s still a risk. Always use condoms.” But then I ended up learning that he was correct, and that’s where this campaign started to snowball.

Dr George: Okay. I do a lot of online advocacy, and I’m in the middle of the road where I have people coming in going, “Oh, my god. I can’t believe I just had sex with a Poz guy, and he didn’t disclose.” How do you approach that person who’s so stuck in fear? How do we move them forward, even if it’s just a little bit, to understand that there is science that’s really working?

Bruce Richman: I think it really depends on the situation. If they met somebody and it’s in a backroom, and the person said that they’re undetectable after they fucked and they don’t know the person very well, then sure they should go on PrEP. I don’t think that’s someone that they probably know well enough to trust whether they’re undetectable, or taking their medications or not. But, if they know someone, and they’re in a relationship, and they’re freaking out about this, someone they know potentially, they’re in a relationship with, I would walk them through the rest of the world, the biggest names in science and research are agreeing that this is real and that, if your partner, or person you’re dating or have sex with is adhering to their meds there isn’t any problem. If you don’t trust them, and you don’t know them that well, it’s possible that they aren’t adhering to their meds, and so maybe consider PrEP. But when people are so entrenched in their deeply held, stigmatising beliefs about people with HIV, it’s hard to get them to be rational. You know, there’s this emotional side that doesn’t always catch up with the rational side.

Like you’re saying, the sciences could be there but that person’s emotional being, and what we’ve learned for so many years is hard to unlearn.

Dr George: Yep. Where to from here? Where do you see this in 10, 15 years?

Bruce Richman: Well, I think undetectable is un-transmittable as a concept is going to be integrated into all forms of public health communications, and clinical work, and policy work so this will have a major impact on the field. Certainly I think we’ll see more people going on treatment and staying on treatment, staying in care. We’re going to see policy changes where policy makers are going to decide to allocate resources to get people virally suppressed, to get them the option to be virally suppressed, the services they need to stay virally suppressed in order to end the epidemic. Not to save our lives, that’s not always the number one reason why people will shift policy. We’re going to see policy changes, we’re going to see major reduction in stigma. I think that’s going to take a long time, the reduction of HIV stigma. Because, while the internalised stigma may be reduced more rapidly, the community stigma is still really strong, and there are folks who are just so invested in keeping people with HIV a risk that they look for any reason to stigmatise you and keep us in a corner.

But I’m mostly focused on the internalised stigma and the shame that people with HIV feel, and the way that it impacts our lives, our social lives, our sexual lives, our reproductive lives. I know that’s going to be greatly reduced because of this campaign and lives will be improved.

Dr George: Absolutely. Thank you very much for coming all the way to Australia to share your message. May it propagate forward. I really look forward to seeing how this whole campaign goes, and to bit by bit, piece by piece, doctor by doctor, person by person sharing the message forward.

Bruce Richman: Thank you. Thanks for having me.

Dr George: Thank you very much.

Bruce Richman: I’m Bruce Richman. I’m The Executive Director of Prevention Access Campaign’s Undetectable Equals Un-transmittable.

Dr George: Okay, and you are also (and may I quote?) the number one most amazing HIV positive person of 2018, I believe. According to the website that I saw today.

Bruce Richman: Plus Magazine. Yes, and I accept that on behalf of the thousands and thousands of people that are working on the campaign.

Dr George: Listening to you tonight I can understand how that accolade would actually have come about. Because you’re passionate and you have a fantastic message, which is U = U. For people who are not aware of that, could you tell us what that is?

Bruce Richman: U = U means undetectable is un-transmittable. That’s a phrase that was created by activists, scientists, and AIDS service organisations to describe the scientific fact that many people still don’t know, that if someone who is HIV positive is on treatment and undetectable, they cannot transmit HIV through sex. There is no risk of transmission.

Dr George: It was last year that was really the key point with IAS 2017 where the announcement was made. What had to happen to allow that to occur?

Bruce Richman: Well, first off, this is radical information for most people. You’re a doctor who is well educated, and knew about this because of your connections to the medical and scientific community, but most people outside of these circles had no idea and the science wasn’t getting out to the public. There was this gap between science and the public, and that’s where public health communications comes in. What we had to do was bring the scientists together and create a consensus statement that U = U is true, so we had this statement that was like the holy grail for us, really. We took that statement and we went around to different influencers around the world and had them sign on as well. So the more people that signed on, the more comfortable people would feel about signing on, and eventually we had a critical mass of the best minds in science saying, “This is indeed true.” And it started to get out more to the public. People started creating social marketing campaigns and really ensuring that this finally gets to the people and field it was intended to benefit.

Dr George: Absolutely. What has the impact been with your message, U = U? If you were approaching a friend who was not yet on treatment, how would you approach that?

Bruce Richman: I mean, I think it’s a very basic, simple message. To folks in the medical field, who’s not an everyday person, there’s a personal health benefit and there’s a public health benefit. But to a friend of mine who I was trying to show the benefits of treatment for them and for their partners, I would say, “This will keep you healthy, and it will keep your partners healthy. You’ll stay healthy, you’ll live longer, and you don’t have to worry about transmitting HIV through sex. You can have the kind of sex that you want without fear. You can use condoms, you don’t need to use condoms, your partners can use PrEP, or maybe not use PrEP. You’ll stay healthy and you’ll have this new sexual freedom that you never thought was possible being HIV positive.

Dr George: So you talk about, in a number of interviews, that there was a light bulb moment. Was it 2009, where you said that was when you discovered U = U?

Bruce Richman: Yeah. My doctor told me in 2009 that I couldn’t transmit HIV.

Dr George: And what was that change that you talk about?

Bruce Richman: For me, when I learned that I couldn’t transmit HIV in 2009 because I was undetectable, it changed everything for me. It opened up possibilities for love, for sex without fear, for conceiving children. Things that I thought that I would never have without fear, without risk, without a barrier between me and someone that I loved. But I also wasn’t so sure because nothing was saying that was true except my own doctor, and I trusted him. But when I looked at all the health information sites, and social marketing campaigns, everything said, “Undetectable, there’s still a risk. Always use condoms.” But then I ended up learning that he was correct, and that’s where this campaign started to snowball.

Dr George: Okay. I do a lot of online advocacy, and I’m in the middle of the road where I have people coming in going, “Oh, my god. I can’t believe I just had sex with a Poz guy, and he didn’t disclose.” How do you approach that person who’s so stuck in fear? How do we move them forward, even if it’s just a little bit, to understand that there is science that’s really working?

Bruce Richman: I think it really depends on the situation. If they met somebody and it’s in a backroom, and the person said that they’re undetectable after they fucked and they don’t know the person very well, then sure they should go on PrEP. I don’t think that’s someone that they probably know well enough to trust whether they’re undetectable, or taking their medications or not. But, if they know someone, and they’re in a relationship, and they’re freaking out about this, someone they know potentially, they’re in a relationship with, I would walk them through the rest of the world, the biggest names in science and research are agreeing that this is real and that, if your partner, or person you’re dating or have sex with is adhering to their meds there isn’t any problem. If you don’t trust them, and you don’t know them that well, it’s possible that they aren’t adhering to their meds, and so maybe consider PrEP. But when people are so entrenched in their deeply held, stigmatising beliefs about people with HIV, it’s hard to get them to be rational. You know, there’s this emotional side that doesn’t always catch up with the rational side.

Like you’re saying, the sciences could be there but that person’s emotional being, and what we’ve learned for so many years is hard to unlearn.

Dr George: Yep. Where to from here? Where do you see this in 10, 15 years?

Bruce Richman: Well, I think undetectable is un-transmittable as a concept is going to be integrated into all forms of public health communications, and clinical work, and policy work so this will have a major impact on the field. Certainly I think we’ll see more people going on treatment and staying on treatment, staying in care. We’re going to see policy changes where policy makers are going to decide to allocate resources to get people virally suppressed, to get them the option to be virally suppressed, the services they need to stay virally suppressed in order to end the epidemic. Not to save our lives, that’s not always the number one reason why people will shift policy. We’re going to see policy changes, we’re going to see major reduction in stigma. I think that’s going to take a long time, the reduction of HIV stigma. Because, while the internalised stigma may be reduced more rapidly, the community stigma is still really strong, and there are folks who are just so invested in keeping people with HIV a risk that they look for any reason to stigmatise you and keep us in a corner.

But I’m mostly focused on the internalised stigma and the shame that people with HIV feel, and the way that it impacts our lives, our social lives, our sexual lives, our reproductive lives. I know that’s going to be greatly reduced because of this campaign and lives will be improved.

Dr George: Absolutely. Thank you very much for coming all the way to Australia to share your message. May it propagate forward. I really look forward to seeing how this whole campaign goes, and to bit by bit, piece by piece, doctor by doctor, person by person sharing the message forward.

Bruce Richman: Thank you. Thanks for having me.

Dr George: Thank you very much.