The status neutral framework provides care for the whole person by offering a “one-door” approach. People living with HIV and people seeking HIV prevention services can access treatment, prevention, and other critical services in the same place. Normalizing HIV treatment and prevention helps destigmatize both. In a status neutral approach to care, a provider continually assesses and reassesses a person’s clinical and social needs. The goal is to optimize a person’s health through continuous engagement in treatment and prevention services without creating or deepening the divide between people living with HIV and people who could benefit from prevention methods.
Status neutral HIV service delivery is:
- Healthcare that encompasses HIV testing, treatment, and prevention services
- HIV treatment and prevention that is offered alongside other local medical healthcare services frequently used by the community. For example: sexual health, gender affirming and other LGBTQIA+ focused care, healthcare for people who use substances, and general primary care.
- Service delivery that recognizes and includes broader social services that support the path to optimal HIV and other health outcomes, such as housing, food, transportation, employment assistance, harm reduction services, and mental and substance use disorder services -- regardless of the HIV status of the people seeking care.
- Culturally affirming, stigma-free HIV treatment and prevention delivered by supportive and accepting providers who have been trained to recognize and address implicit racial/ethnic, sexual orientation, and other biases, and provided in settings that consider and prioritize a positive experience for the person seeking services.
Status neutral services begins with an HIV test. In a status natural approach, an HIV test spurs action regardless of the result by recognizing the opportunity created by a negative or positive result for an individual to achieve better health.
- If a person receives a negative HIV test result: The provider engages the person in HIV prevention and offers powerful tools that prevent HIV, such as pre-exposure prophylaxis (PrEP). The prevention pathway emphasizes a consistent re-evaluation of the engaged person to match prevention and social support strategies to the individual’s needs. Being engaged in such preventative services also means expedited connection to HIV care in the event of a new positive HIV test result. Condoms, syringe services, and other harm reduction strategies are also an important part of this prevention pathway, especially for people who are not ready or eligible for PrEP.
- If a person receives a positive HIV test result: The provider offers a prescription for effective treatment to help the patient achieve viral suppression and maintain an undetectable viral load as well as other clinical and support services to help support general health and achieve a high quality of life. Studies have shown that people with an undetectable viral load do not transmit HIV to their sexual partners, this is often referred to as Undetectable = Untransmittable (U=U).
Undetectable = Untransmittable (U=U)
When taken as prescribed, HIV medications can decrease the amount of HIV present in a person’s blood (HIV viral load) to be too low to be measured through modern testing. When unmeasurable, this is called undetectable. Being undetectable prevents HIV disease from progressing and protects the health of any potential partners.
People cannot transmit HIV when they have undetectable levels of HIV. This prevention method is estimated to be 100% effective as long as the person living with HIV takes their medication as prescribed and maintains an undetectable viral load level. This concept is known as U=U.
The HIV/STD Program supports and encourages HIV efforts conducted through the Status Neutral Care Model, including PrEP, PEP, and U=U.
