For Black people living with HIV, U=U doesn’t guarantee protection from stigma, criminalization or systemic harm
nFIRST PERSONn COMMENTARY
U=U changed what we know about HIV. It did not change how Black people are treated by systems built on fear, stigma and outdated law.
Two realities
Black people living with HIV are being asked to live in two realities at the same time. Science says they are safe. The law still treats them as a threat.
Take your medication. Stay in care. Become undetectable. Tell the truth. And still, that truth can be used against you. That is what HIV criminalization looks like in practice, and it does not impact everyone the same way. It lands on Black people.
“You see it in who gets reported and who gets believed. For Black people, HIV is still treated like fear, not fact.”
There is an assumption that once science changed, everything else would follow. That understanding would replace stigma. That policy would catch up. That people would respond differently. But that has not happened. Science evolved. The systems did not.
The science is clear. When someone is undetectable, they cannot transmit HIV through sex. U=U is not up for debate. It changed what is possible.
But the law did not move with it.
There are still laws in place that reflect a time when HIV was not understood the way it is now. They do not account for viral suppression, access to care or what it means to live with HIV today. As a result, someone can be doing everything they are supposed to do and still be treated like they are dangerous.
That gap between what we know and how systems respond is where harm happens.
Because disclosure stops being about honesty and starts becoming exposure. It becomes something that can be used against you.
Ciarra with husband Dwayne Brown, in front of Philadelphia City Hall. (photo by Chocky, Tswago Photography)
Living in the gap
For Ciarra Covin, that gap is not theoretical. It is something she navigates in her everyday life as a Black woman living with HIV.
“I’ve always been upfront,” she says. “From the beginning, I made sure I was honest about my diagnosis. For me, it wasn’t just about disclosure. It was about building trust.”
That trust did not happen automatically. It required her to take on the role of educator inside her own relationship and family. She had to translate what HIV actually means in real time, pushing back against assumptions people carry.
“I see myself as a bridge,” she explains. “I take what I learn and bring it back to my partner and my family so they understand what this really means, not what people assume it means.”
That work is constant. It is part of what it takes to create safety in spaces where systems have failed to do so. And even then, there are limits to what personal responsibility can cover.
Learning about U=U shifted how she understood herself and her life. It allowed Ciarra to move HIV out of the center of her identity in a way that had not been possible before.
“It took HIV out of the center of my life every day,” she says. “Being undetectable means I’m not sick in the way people think. My immune system is working. I can live my life.”
That shift matters. It changes what feels possible.
But it does not change everything.
“U=U is not the be-all and end-all for Black people living with HIV. It does not erase the societal harm, and it does not remove the bull’s-eye placed on Black bodies living with HIV.”
"As a Black woman, I don't feel like U=U protects me. It's more like that is for everyone else,” she says. “My life is still going to go on whether my viral load is detectable or not. I am still going to be looked at weird if I'm in a space others don't feel I belong. It is still going to be their word against mine."
That does not live in theory. It shows up in real decisions. What to say. When to say it. How to say it. Whether it will be received with understanding or turned into something else. Whether truth will build connection or create risk.
The science is clear. The lived experience is not aligned with it. U=U eliminates transmission risk. But it does not change how people are perceived, how laws are applied or who is most likely to be targeted.
“The laws are still based on archaic mindsets,” she says. “Everything falls on the person living with HIV. But nobody is asking anyone else what they are doing to protect themselves.”
When the law ignores the science
That imbalance shapes how responsibility is assigned and how risk is defined. It also shapes how punishment is delivered.
In Texas, that reality has played out in ways that are hard to ignore. In 2008, Willie Campbell, a Black man, was sentenced to 35 years in prison after being accused of spitting on a police officer, with HIV treated as a deadly weapon. Spitting does not transmit HIV, yet the legal system moved forward as if it did.
Campbell was experiencing homelessness at the time, and his sentence was increased through prior conviction enhancements, layering punishment beyond the situation itself. Because of the "deadly weapon" enhancement, Texas law mandated that Campbell serve at least 50% of his sentence (17.5 years) before he could even be considered for parole. Cases like this show how systems interpret HIV through stigma instead of science.
Mental health and context are often ignored, with prosecution used as the default response instead of care.
This is not a public health approach. It is a criminal legal approach.
And it does not stop in the courtroom.
In Texas, the case of Cicely Bolden shows how these narratives shape what happens next. She disclosed to her partner that she was HIV positive. She did what people are told to do. And she was killed.
After her death, her HIV status became part of how her story was framed, creating barriers for her family when they tried to access support. That is what it looks like when stigma shapes how harm is understood and whose lives are valued.
Beyond U=U
Even in healthcare, these gaps continue to show up.
“They only focus on whether you’re undetectable,” Ciarra says. “Nobody is talking about your whole health, your sexuality, your pleasure or your partner.
“I’ve been in appointments where nobody even asked about my partner or prevention beyond me.”
U=U is specific. It addresses HIV transmission. It does not prevent other sexually transmitted infections, and it does not replace the need for broader sexual health conversations.
Those conversations are often missing.
As attention has centered on viral suppression, other sexual health concerns have not been addressed with the same clarity or urgency. People are left navigating their health with incomplete information while systems focus on a single outcome.
That is not a failure of science. It is a failure of systems.
What must change
At the center of all of this is how HIV is still understood.
“No matter what, I feel like I would be judged anyway,” Ciarra says. “That does not go away just because I am undetectable.”
Science has changed. The experience has not caught up. And until laws, systems and narratives shift together, that gap will remain.
Organizations like the Center for HIV Law and Policy, The Sero Project and The Well Project are working to change that. But policy change alone is not enough. Understanding has to change too.
Right now, two realities still exist.
Science says people are safe.
The law still treats them as a threat.
And until those realities align, the harm will continue.
Michelle Anderson, MA, is a nationally recognized HIV advocate with over two decades of experience working at the intersection of public health, reproductive justice and the criminal legal system. She has contributed to national advocacy efforts, including the implementation of the National HIV/AIDS Strategy, and has worked to challenge HIV criminalization, expand healthcare access and center the voices of Black women and communities most impacted.
She is also the former 2011 Ms. Plus America, using her platform to redefine representation and amplify advocacy beyond traditional spaces. Her work is rooted in advancing justice, shifting narratives and ensuring that lived experience informs policy and that systems change.