Awareness, acceptance, and impact of undetectable equals untransmittable (U = U) among people living with HIV across Canada.

Undetectable equals Untransmittable (U = U) is a pivotal tool for HIV prevention, stigma reduction, and improving quality of life for people living with HIV. This study examined awareness, acceptance, and impact of U = U among people living with HIV across Canada, and explored differences across sociodemographic characteristics. From 2018-2024, 1,083 participants were recruited in-person and online using snowball sampling. Peer researchers conducted interviews, initially in person and later mostly online due to COVID-19. Demographic data and U = U outcomes were collected and analyzed using multivariate logistic regression. Overall, 72% of participants had heard of U = U, 67% strongly accepted it, and 51% had discussed it with a healthcare provider. Awareness and acceptance were lower among heterosexual and bisexual participants. Cis-women and participants who were unemployed were less likely to report positive impacts from U = U. Black-identifying participants were more likely to report benefits, while Indigenous participants were more likely to believe U = U could reduce stigma and shift public opinion. Older participants were less likely to discuss U = U with a healthcare provider. Findings highlight U = U's potential to reduce stigma, but gaps remain in awareness, acceptance, and provider communication. Tailored strategies are needed to engage diverse communities and support healthcare providers in confidently sharing the zero-risk message.