"The First Thing I Must do is Become Undetectable": Examining U=U Awareness and the HIV Care Continuum Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV in Lima, Peru.

Abstract

ObjectivesAwareness of "Undetectable = Untransmittable" (U=U) may strengthen HIV care engagement, yet its influence remains underexamined, particularly in Latin America. Among gay and bisexual men living with HIV in Lima, Peru, we examined (1) sociostructural correlates of U=U awareness; (2) U=U educational experiences and trust; (3) associations between U=U awareness and self-reported ART use; and (4) associations between U=U awareness and viral load.MethodsWe conducted a sequential explanatory mixed-methods study including a survey (N=310) and individual interviews (N=30).ResultsMost participants (86%) were aware of U=U. Awareness was less common among those diagnosed more recently, those without income in the past month, and non-binary participants. Participants aware of U=U were more likely to report linkage to care, current ART use, and viral suppression. Qualitative findings highlighted U=U as a motivator for ART adherence and viral suppression.ConclusionsTogether, these findings underscore the importance of integrating clear, consistent U=U counseling into HIV services in Peru and globally.