U=U’s Impact on Youth with Dr. Allison Agwu of Johns Hopkins

Dr. Allison Agwu is an Associate Professor of Adult and Pediatric Infectious Diseases at Johns Hopkins University School of Medicine, and Co-director of the Johns Hopkins Center for AIDS Research (CFAR) Adolescent and Youth Scientific Working Group.

Dr. Agwu’s clinical and research interest is in HIV/AIDS, with a special focus on the health disparities and optimal treatment strategies for adolescent and young adults. She sees patients both in the pediatric and adult HIV clinics and has been integral to the transition of pediatric HIV infected patients to adult care, leading the Accessing Care Early (ACE) Youth/Young Adult Transition Clinic.

We asked Dr. Agwu to discuss how the U=U message is changing the lives of youth and giving them hope for the future.

How have you watched the U=U message evolve over the last few years?

We have been talking about viral suppression for years because it gives you the optimal chance to live long and prosper. It really began with taking care of moms—trying to suppress the virus so as to not transmit it to babies.

Then, about two years ago, we started hearing the message reframed as U=U. It’s a way to say all that complex stuff in a quick, easy-to-understand message. And it takes that big “S” off the chest—that scarlet letter. When I put a U on my chest, I’m not so bad.

More providers are understanding, too. There is more talk around viral loads, rah-rah around the viral loads. We’ve been saying this message for years, but the term “viral load” can be confusing. But now we say “undetectable,” and providers get that.

How has U=U changed your patients’ lives?

I take care of a lot of young people, many of them are stigmatized and marginalized in so many areas before you even get to the HIV part of their life. A lot of patients are black and brown. They’re MSM or LGBTQ. They feel marginalized already. And having that virus compounds that and impacts their decision-making. They think, “I can’t do anything. I can’t succeed. I’m just going to accept this terrible relationship, for example, because who else will want me?”

U=U gives us a positive way to reach these patients and change their mindsets. It shows patients how resilient they are, to have done this amazing thing [in achieving viral suppression]. It reframes the conversation in terms of “Let’s focus on what you do well. You took the virus and took control of it.” It’s wonderful to see how it empowers people. Sometimes that smile you get is amazing. They realize they don’t have to accept just anyone or anything. They did this one thing, and now they can work on all the other stuff in their lives too. It’s such a big empowering message.

My favorite part of my job is interacting with my patients. I walk into my clinic space, and it’s literally like hanging out with friends. “What’s happening in your life? What’s going on with school?” With all the medicines and U=U, HIV becomes such a small part of that conversation. It’s about developing people to the best of their potential and getting HIV under control is part of that.

How important is it for U=U to become a community message, not just for those living with HIV?

People think HIV is a someone-other-than-myself disease. HIV can and does impact all of us. The U=U message is that this will make us all healthier as a community. It’s a community benefit.

My big hope is that the empowerment and self-esteem-building and stigma reduction gets permeated throughout the community, and that we come together in a way to support people with HIV and get them there.

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